Lymphatic

Question 1

Flow of lymph

Answer 1

Capillaries > collecting vessels > nodes > trunks > ducts > subclavian veins.

Mnemonic: CV? Not To Day.

Question 2

Lymphatic Duct drains from…

Answer 2

RUE
R face

Question 3

Thoracic Duct drains from…

Answer 3

LUE
BLE
L face

Question 4

Lymphatic Load definition

Answer 4

amount of fluid that must be transported

Question 5

Lymphatic Capacity definition

Answer 5

max amount of fluid the lymphatic system can transport

Question 6

What happens to lymphatic Load & Capacity with lymphedema?

Answer 6

Load increases.
Capacity decreases.

Question 7

Lymph node removal causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease

Answer 7

d) capacity decrease

Question 8

Venous insufficiency causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease

Answer 8

a) load increase

Question 9

Primary Lymphedema: definition & examples

Answer 9

Caused by a disorder of the lymphatic system.
Milroy’s Disease (age 0-2)
Meige Disease (age 10-20)
Lymphedema Tarda (age 35+)

Question 10

Secondary Lymphedema: definition & examples

Answer 10

Results from an injury to the lymphatic system.
Lymph node removal.
Infections, tumors, trauma.
Venous insufficiency.
Fibrosis.
Filariasis (mosquito infection).

Question 11

List the types of edema from least to most severe

Answer 11

1. Pitting
2. Brawny
3. Weeping

Question 12

Pitting Edema definition

Answer 12

Takes several seconds to rebound.
Little to no fibrotic changes.

Question 13

Brawny Edema definition

Answer 13

Hard to palpation.
No pit forms w/ pressure.
Progressive fibrotic changes.

Question 14

Weeping Edema definition

Answer 14

Typically affects LE only.
Cuts & sores form.
Fluid leaks out.

Question 15

Stemmer’s Sign

Answer 15

Pinch & lift on the dorsum of fingers/toes.
(+) if skin cannot be pinched/lifted.
(+) indicates Stage 2 or 3 Lymphedema.

Question 16

Is Stemmer’s Sign reversible? (i.e., once it’s positive, can it later be negative?)

Answer 16

NO

Question 17

Stage 0 Lymphedema

Answer 17

No edema, skin normal.
Stemmer’s (-).
Occasional reports of limb heaviness.

Question 18

Stage 1 Lymphedema

Answer 18

Pitting edema.
Stemmer’s (-).
Edema increases w/ standing or activity.
Edema decreases w/ elevation.

Question 19

Stage 2 Lymphedema

Answer 19

Hard edema (progresses to Brawny).
Stemmer’s (+) but may be (-) in early Stage 2.
Edema does NOT decrease w/ elevation.
Fibrosclerotic (hard) tissue.

Question 20

Stage 3 Lymphedema

Answer 20

Severe Brawny edema.
Possible Weeping edema.
Stemmer’s (+).
Skin changes, frequent infections.

Question 21

How is pitting edema graded?

Answer 21

Depth of pitting & time to rebound.

Question 22

Grade 1+ Pitting Edema

Answer 22

Depth: <1/4in

Question 23

Grade 2+ Pitting Edema

Answer 23

Depth: 1/4 to 1/2in
Time to rebound: 15s

Question 24

Grade 3+ Pitting Edema

Answer 24

Depth: 1/2 to 1in
Time to rebound: 15-30s

Question 25

Grade 4+ Pitting Edema

Answer 25

Depth: >1in Time to rebound: >30s

Question 26

What is Lipedema? How is it different from Lymphedema?

Answer 26

Lipedema: bilateral & symmetrical, affects proximal LEs (buttocks, thighs). Feet less often affected. Stemmer's (-) bc feet intact. Lymphedema: usually unilateral; can be bilateral, but will still be asymmetrical.

Question 27

Methods of measuring edema

Answer 27

Girth: circumferences at landmarks 10cm apart along limb. Volumetric: place limb in water tank. Bioelectric Impedance: higher resistance = more fluid present. Lymphoscintigraphy: tests for lymphatic insufficiency.

Question 28

Best way to measure PROXIMAL edema?

Answer 28

Girth

Question 29

Best way to measure DISTAL edema?

Answer 29

Volumetric

Question 30

Best way to measure PRE-POST SURGERY edema?

Answer 30

Bioelectric Impedance

Question 31

Palpating nodes: what's NORMAL?

Answer 31

Soft Non-tender Non-palpable <1cm

Question 32

Palpating nodes: what's ABNORMAL?

Answer 32

Hard Tender Immobile/fixed Persistent enlargement

Question 33

Complete Decongestive Therapy - Phase 1

Answer 33

Intensive Phase: Manual Lymph Drainage (MLD). Compression bandaging. Skin & nail care. Exercise.

Question 34

Complete Decongestive Therapy - Phase 2

Answer 34

Maintenance Phase: Self-MLD. Compression garments. Multiple layer bandaging at night. Skin & nail care. Exercise.

Question 35

Manual Lymph Drainage

Answer 35

Work proximal to distal areas. Stroking goes distal to proximal (towards specific nodes).

Question 36

What type of compression bandage should be used? Why?

Answer 36

Low-Stretch (AKA Short-Stretch). Has high working pressure & low resting pressure. High Working Pressure: provides resistance to force mm to work harder, pushes fluid into vascular system. Low Resting Pressure: not much resistance at rest, so OK to wear at night.

Question 37

How should compression bandages be applied?

Answer 37

More pressure distally

Question 38

How to take blood pressure with lymphedema?

Answer 38

NEVER on affected extremity

Question 39

Exercise considerations

Answer 39

Proximal to distal: start w/ trunk, core, neck. Then progress to shoulder > elbow > wrist/hand. Breathing exercises BEFORE proximal exercises (if breathing exercises included). Lower intensity if wearing compression. Aquatic/swimming good bc provides compression.