Lymphatic Anatomy/Physiology

Question 1

Components of Lymphatic System

Answer 1

• lymph vessels
• lymph nodes
• thymus gland
• lymphocytes
• tonsils
• spleen
• Peyer’s patches

Question 2

Lymph Vessels

Answer 2

• capillaries
• pre-collectors
• collectors
• trunks

Question 3

Right Drainage Area

Answer 3

• RUQ

- (drainage from right UE, right side of head, right upper trunk)

Question 4

Left drainage area

Answer 4

-Everything but RUQ

drainage from LE, lower trunk, Left trunk, left UE, left side of head

Question 5

70% of lymphatic system is______

Answer 5

-superficial

Question 6

Cistema Chyli

Answer 6

-collects emulsified fats

Question 7

True/False: the lymphatic system is symmetrical

Answer 7

-false

Question 8

Lymphangion

Answer 8

-functional unit of muscle tissue around lymphatic valves to push fluid in correct direction

Question 9

Lymph system relies on_____

Answer 9

-voluntary skeletal muscle contractions to move fluid

Question 10

Lymph system circulates _____ l/day

Answer 10

2-2.5 liters/day

Question 11

Chyle

Answer 11

-lymph plus emulsified fats

Question 12

Lymph Vessels Function

Answer 12

• return protein to cardiovascular system
• remove excess fluid from interstitium
• transport chyle (intestinal lymph vessels)
• transport capacity>lymph load

Question 13

Insufficiency

Answer 13

• Dynamic (high volume)
• Mechanical (low volume_
• Combined

Question 14

Dynamic Insufficiency

Answer 14

• High volume

- lymph load exceeds transport capacity

Question 15

Mechanical Insufficiency

Answer 15

• Low volume (normal load)
• decreased transport capacity due to injury/impairment
• more common

Question 16

Forms of LE edema

Answer 16

• venous insufficiency
• Congestive heart failure
• lymphedema

Question 17

Lymphedema

Answer 17

• transport capacity<lymph load
• abnormal accumulation of protein-rich fluid in interstitium
• cases inflammation and reactive fibrosis of affected tissue

Question 18

Skin Characteristics of Lymphadema

Answer 18

• hyperkeratosis
• lichenification
• Peau d’orange texture
• ulcerations unusual
• elasticity/hydration of skin maintained longer than in venous disease

Question 19

hyperkeratosis

Answer 19

-excess of keratin deposits

Question 20

Peau d’orange texture

Answer 20

-skin textured like orange (little dimples, surrounding hair follicles)

Question 21

Lymphadema does NOT cause_____

Answer 21

Ulcers, pain

Question 22

Lymphedema Causes

Answer 22

• Primary

- Secondary

Question 23

Primary Lymphadema Causes

Answer 23

• congenital/heredity

- born with it

Question 24

Secondary Lymphadema Causes

Answer 24

• surgery
• radiation
• trauma
• filariasis
• CVI
• infection
• tumor growth
• artificial (self induced)

Question 25

Lymphadema Staging

Answer 25

- latency - stage 1: reversible - stage 2: spontaneously irreversible - stage 3: lymphostatic edemas

Question 26

Latency Stage

Answer 26

- transport capacity reduced - no visible palpable - subjective complaints possible

Question 27

Stage 1

Answer 27

- reversible - accumulation of protein-rich fluid - pitting edema - reduces with elevation - no fibrosis

Question 28

Stage 2

Answer 28

- Spontaneously Irreversible - proteins stimulate fibroblast formation - pitting becomes progressively worse - connective/scar tissue formation

Question 29

Stage 3

Answer 29

- lymphostatic edema - hardening of dermal tissues - pitting absent - fibrosis/sclerosis - skin changes - elephantiasis--filariasiss

Question 30

Edema not detected clinically until______

Answer 30

-interstitial volume reaches 30% above normal

Question 31

LVF

Answer 31

- location - volume - fibrosis

Question 32

Primary Differential Diagnosis

Answer 32

- vascular anomaly | - tumor

Question 33

Secondary Differential diagnosis

Answer 33

- DVT, venous insufficiency - infection - cardiopulmonary failure - hepato-renal failure - systemic disease (amyloidosis) - lipedema

Question 34

Causes of local edema

Answer 34

- lymphedema - lipedema - acute DVT or thrombophlebitis - chronic venous insufficiency - congenital vascular malformations - arteriovenous fistula - trauma - infection, cellulitis - ruptured synovial cyst (baker's cyst) - hematoma - dependency

Question 35

Diagnostic Lab Tests

Answer 35

- CBC - Electrolytes - Albumin - SPE (serum protein electrophoresis)

Question 36

Low Albumin

Answer 36

-too much fluid leaves vessels to insterstitium

Question 37

Diagnostic Imaging

Answer 37

- US - MRI - Venous studies - CT - Microlymphography - x-rays - lymphoscintigraphy

Question 38

Gold Standard diagnostic Imaging

Answer 38

-Direct Lymphography

Question 39

Diagnosis

Answer 39

- med history - physical exam - measurements - venous evaluation - laboratory

Question 40

Pneumatic Compression Pump

Answer 40

- NOT indicated - and pressure will collapse superficial lymphatic drainage - also fluid won't be able to get past the blockage

Question 41

Treatment

Answer 41

- surgery - pharmocologic - CDP-complex decongestive therapy

Question 42

Phases of Complex Decongestive Therapy

Answer 42

- I: intensive daily treatments | - II: supportive

Question 43

Comprehensive Management

Answer 43

- CDT/CDP - nutritional counseling - education - psychosocial intervention

Question 44

Manual Lymph Drainage

Answer 44

- increase lymph vessel contractions - increases reabsorption of fluid - direct superficial flow - improve lymph transport capacity

Question 45

Bandaging

Answer 45

- reduce ultrafiltration rate - improve muscle pump efficiency - provide support for tissues/joints - prevent re-accum of evacuated fluid - facilitate softening of fibrotic tissue