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Flashcards in LYMPH Deck (35)
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1
Q

Most Common Causes of LE edema

A
  1. chronic venous insufficiency
  2. CHF
  3. idiopathic edema
  4. pulmonary HTN
2
Q

some causes of LE Edema

A
  1. chronic venous insufficiency
  2. CHF
  3. idiopathic edema
  4. pulmonary HTN
    medication, renal disease, liver disease, premenstrual edema, pregnabcy/preeclampsia, obesity, lymphedema, beriberi, mat thumer syndrome, lipidema, myxedema, malignancy, high sodium diet, compartment syndrome, baker’s cyst, acute swelling
3
Q

What causes lymphedema

A
  1. Plasma/blood
  2. Interstitial fluid
  3. lymphatic fluid
  4. lymph capillaries
  5. lymph nodes
  6. blood stream
4
Q

what does lymph fluid do?

A

lymph fluid washes all the cells in the body: clears out waste products, transports foreign cells (bacteria) to lymph nodes, and provides nutrition to interstitial tissues and cels

5
Q

explain in lay man terms lymphatic system

A

Body drain system, nodes are plumbers, vessels are pipelines

after filtration: lymph fluid leave the body in urine

lymphedema: occur after a disruption to the lymphatic system cause stagnant lymph fluid in the skin

6
Q

mechanical insufficiency in lymphedema

A

mechanical insufficiency: problem with transportation of lymph fluid

lymph fluid has high protein concentration-only lymphatic system can absorb high protein lymph fluid -cannot leave in osmosis

7
Q

vicious cycle of lymphedema

A
proteins are hydrophilic sponges, when there is a mechanical insufficiency of the lymphatic system lymph fluid remains in the interstitial  (area between cells) 
proteins stay there 
1. more H2O absorbed
2 grow bigger
3.  inflammation
4. fibrotic tissue build
5. visible swelling.
8
Q

Factors: Edema with a lymphatic origin

A
  1. lymph node resection (taken out)
  2. tumor block of lymph vessels (obstructs the vessels)
  3. severed lymph vessels
  4. burns (lymph close to skin)
  5. filariasis
  6. trauma
9
Q

right UE lymphedema

A

axillary lymph nodes resected from right armpit

10
Q

LE lymphedema

A

post surgery (TKR, THR, pelvic surgery, irradiation)

11
Q

Staging Lymphedema

A

4 stages, incurable at stage 2 (irreversible)
Stage 0: lifetime risk to develop lymphedema
Stage 1: reversible lymphedema
Stage 2: IRREVERSIBLE lymphedema
Stage 3/4: elephantiasis lymphedema

12
Q

where are lymph nodes most?

A

head and neck

also in abdomen, popliteal, cubital fossa and anywhere with fatty adipose tissues

13
Q

where do you want to bring the lymph after a surgery?

A

to areas of functional lymph nodes

R side compromise: bring it down ipsilateral and across contralateral

14
Q

Lymphedema Stage 0

A

at lifetime risk of developing lymphedema but no clinical signs or sx
[had a surgery by the lymph nodes but no lymphedema as of now]

15
Q

Lymphedema Stage 1

A

reversible stage of lymphedema
pitting edema occurs
–if tx quickly can bring them to 0 (but will always have at least 0)

16
Q

Lymphedema Stage 2

A

IRREVERSIBLE stage of lymphedema

non pitting edema occurs

17
Q

Lymphedema Stage 3/4

A
elephantiasis lymphedema (swell to massive proportions)
skin fibrosis, hardening, and deformation
18
Q

Primary Lymphedema

A
congenital due to:
1. aplasia = no lymphatics
2. hypoplasia = less lymphatics
3.  hyperplasia = more lymphatics
mostly females, develop by teens
19
Q

how many lymph nodes in the body?

A

500-700

20
Q

Secondary Lymphedema

A

injury or trauma (broken limbs/deep laceration), radiation therapy, lymph node resection, surgery, cancer, or tumor blockage

21
Q

what can cause elephantiasis?

A

parasites living in the lymph nodes cause filariasis resulting in elephantiasis

22
Q

Elephantiasis

A

occurs in case of filariasis (parasites) or podoconiosis (irritants from soil) [mainly seen in 3rd world countries]

  • -in the US can get if have chronic untreated lymphedema
  • -chronic untreated lymphedema can cause lymphangiosarcoma
23
Q

lipa-aedema

A

in LE in women
pear shaped body
ankles not effected
something wrong with adipose tissue

24
Q

treating lymphedema: BAD APPROACHES

A
  1. dont do surgery
  2. lipedema: liposuction can damage and remove lymph nodes and they dont regenerate
  3. lymphatic grafting: take from area of healthy lymphatics to replenish non healthy lymphatics-bad
  4. diuretics: removal of water load but does not remove the proteins so have a vicious cycle (only take for HTN or CHF, not for lymphedema)
25
Q

possible to treat lymphedema:

A
  1. low level laser tx: need outpatient tx can decrease skin fibrosis but need more research
  2. compression pumps: only flexitouch machines which mimics manual lymphatic drainage, otherwise dont do it
26
Q

Effective Interventions for Lymphedema: CDT/MLD

Pros
Cons

A
complete de-congestive therapy
PROS:
1. not invasive
2. performed in conjunction with skin care and exercise
3. highly effective/evidence research
CONS
1. need a specialist 
2. need intensive therapy-compliance (1-2hr)
27
Q

Effective Interventions for Lymphedema: CDT/MLD

Stages

A

Phase 1: the intensive Phase: reduce swelling with manual lymphatic drainage and daily compression bandaging. also do skin care and Ther-ex, and pt education.
Phase 2: Maintenance Phase (given compression garments to maintain–short stretch bandage for high working pressure and low resting pressure)

28
Q

how does manual lymphatic drainage work?

A

uses gentle hands on technique to stretch and stimulate lymphangioactivity–redirect lymph flow from area of compromised lymphatics to healthy lymphatics

  1. open channels of healthy lymphatics
  2. diaphragmatic breathing–helps relax pt and stimulate thoracic duct
  3. establish new lymph flow and drainage areas
  4. massage affected limb: proximal to distal
29
Q

is MLD/CDT a permanent cure?

A
  1. highly effective to reduce edema
  2. maintain decongested sized limb
  3. non invasive
  4. relaxing for patients
  5. does not disrupt lymphatic system
  6. NOT a permanent cure
    BUT it does reduce hospital visits to treat cellulitis/infections/skin ulcerations
    -also they need to maintain skin care with acidic lotion/hygiene, do ther-ex, ADL training
30
Q

Compression garments–what pressure?

A

start at 20-30mmHg

31
Q

Theory Behind Compression

Necessary components of compression bandages are:

A
  1. tubular bandage lining
  2. digit bandages
  3. polyester, cotton, or foam under-cast padding
  4. multiple layers of short-stretch bandages with 50% overlap and 50% stretch to over the whole limb
32
Q

long term phase

A
  1. nightly self bandaging versus bandaging alternatives
  2. daily wear of well fitting compression garments
  3. daily maintenance of skin hygiene and compliance with lymphedema precautions and safety factors
  4. renew compression garments every 6-12 months
  5. annual “tune-ups” with therapist
  6. daily self-MLD
33
Q

short stretch bandages

A
  1. short stretch: limited flexible (40-60%)
  2. relies on layers and not increasing tension 3. tension low when pt at rest and when muscles move they get to be higher pressure to create an internal pump to circulate fluid
  3. also prevent refill of the fluid into the tissues
  4. reduce fibrosis
    - -need in phase I and sometimes phase 2
    * long stretch stretches 140%
34
Q

why do diaphragmatic breathing?

A

diaphragmatic breathing–helps relax pt and stimulate thoracic duct

35
Q

Do we want to use an ace bandage to wrap?

A

ace wraps have high resting pressure and we dont want that because it has a turnicate effect