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COMP EXAM PREP > Lymphatic System > Flashcards

Lymphatic System Flashcards

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1
Q

Lymph:

A

The portion of interstitial fluid that enters the lymphatic vessels

Composed of: water, proteins, lipids, immune cells, and waste

Returns to the bloodstream via the venous system (usually at the subclavian vein)

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2
Q

Major Lymphatic Organs:

A

nodes
tonsils
thymus
spleen
thoracic duct
bone marrow

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3
Q

lymph nodes =

A

Filter lymph, trap pathogens, immune response

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4
Q

tonsils =

A

Protect entrance of digestive/respiratory tracts

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5
Q

thymus =

A

T-cell maturation (more active in children)

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6
Q

spleen =

A

Filters blood, removes old RBCs, immune surveillance

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7
Q

thoracic duct =

A

Main lymphatic vessel → drains into left subclavian vein

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8
Q

bone marrow =

A

Produces lymphocytes and other blood cells

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9
Q

Major Lymph Node Clusters

A

Submaxillary = face/jaw
cervical = neck
axillary = armpits
inguinal = groin

mesenteric, iliac = abdomen

popliteal = behind knee
cubital = elbow
supraclavicular = collarbone
parasternal = chest

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10
Q

Swollen lymph nodes =

A

sign of infection, inflammation, or cancer

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11
Q

Right lymphatic duct drains ___

A

right upper quadrant only

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12
Q

Thoracic duct drains ___

A

the rest (entire left side and lower body)

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13
Q

Thymus Gland =

A

Upper chest, behind the sternum, anterior to the heart

Part of the lymphatic and endocrine systems

Primary site of T-lymphocyte (T-cell) maturation

Plays a critical role in adaptive immunity

Largest and most active in childhood

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14
Q

The thymus is not involved in direct lymph filtration (unlike lymph nodes), but it’s essential for:

A

T-cell development early in life

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15
Q

Flow of Lymph

CVNTD

A
  1. fluid is transported from lymphatic CAPILLARIES
  2. lymphatic collecting VESSELS
  3. along the length of these vessels, lymph NODES occur to filter the lymph
  4. lymphatic TRUNKS
  5. lymphatic collecting DUCTS
  6. subclavian veins
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16
Q

Right Lymphatic Duct:

A

drains: Right upper quadrant only: right arm, right chest, right head/neck

empties into: Right subclavian vein

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17
Q

Thoracic Duct:

A

drains: Everything else: both legs, abdomen, left arm, left chest, left head/neck

empties into: Left subclavian vein

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18
Q

The ___ duct is the larger and dominant drainage vessel.

A

thoracic

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19
Q

Damage to ___ = more severe lymphedema risk.

A

thoracic duct

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20
Q

Lymphatic Load:

A

The volume of interstitial fluid (including proteins, water, waste, immune cells) that the lymphatic system must transport

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21
Q

Transport Capacity:

A

The maximum amount of lymphatic fluid the system can move efficiently

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22
Q

Lymphedema cause:

A

Occurs when LL > TC → fluid backs up in interstitial space, causing swelling

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23
Q

Normally, TC > LL →

A

lymphatic system clears what the body produces

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24
Q

Venous Insufficiency

A

↑ Lymphatic Load (too much fluid moves into interstitial space)

Lymphatic system may compensate, but chronic overwork can lead to failure over time
→ High-volumeinsufficiency

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25
Lymph Node Removal or Damage (e.g. mastectomy, radiation)
↓ Transport Capacity due to structural damage Lymphatic system cannot handle even normal load → Low-volume insufficiency → True lymphedema
26
Lymphedema =
chronic, progressive condition caused by an accumulation of protein-rich lymph fluid in the interstitial space leading to swelling, most commonly in the limbs
27
Primary Lymphedema
Cause: Congenital or hereditary malformation of the lymphatic system (↓ transport capacity) Usually unilateral
28
Primary Lymphedema Subtypes:
Milroy disease = Congenital (birth) = 0-2 years Meige disease = Lymphedema praecox (puberty) = 10-25 years Lymphedema tarda = After age 35
29
Secondary Lymphedema
Cause: Damage to a previously normal lymphatic system More common than primary Usually unilateral but can be bilateral
30
Secondary Lymphedema Common Causes:
Lymph node dissection (e.g., mastectomy) Radiation therapy Cancer or tumor compressing lymphatics Infection (e.g., filariasis — #1 cause worldwide) Chronic venous insufficiency Trauma or surgery Fibrosis from repeated inflammation/infection
31
Lymphedema severity
based on tissue characteristics pitting brawny weeping
32
Pitting Edema
indentation of the skin that persists for several seconds after the pressure is removed significant but short duration edema with little or no fibrotic changes in skin or subcutaneous tissue
33
Brawny Edema
Tissue feels hard or firm on palpation more severe form of interstitial swelling progressive, fibrotic changes in subcutaneous tissue
34
Weeping Edema
Most severe long duration fluid leaks from cuts or sores wound healing is significantly impaired almost exclusively in LE
35
severity =
Pitting = soft & early Brawny = firm & fibrotic Weeping = severe, skin breakdown, infection risk
36
Stage ___ lymphedema are associated with these more fibrotic and chronic changes.
2 and 3
37
Stemmer Sign
A clinical test used to help diagnose lymphedema Evaluates the presence of fibrotic skin thickening, especially in the toes or fingers Attempt to pinch and lift the skin at the base of the second toe or finger (dorsal surface) Compare bilaterally to the unaffected limb
38
Positive Stemmer Sign =
Skin cannot be pinched/lifted (or is very difficult) → indicative of fibrosis Suggests Stage II or III lymphedema not seen in lipedema, early venous insufficiency, or generalized edema
39
Negative Stemmer Sign =
Skin can be pinched → more likely normal or Stage I
40
Lymphedema Staging System
lymph0-3dema
41
stage 0
= latency No clinical edema, occasional reports of heaviness * Stemmer sign negative * Tissue and skin appears normal
42
stage I
= Reversible Stage Edema present (soft and pitting) * Edema increases with standing and activity but reduces on elevation * Stemmer sign negative
43
Stage II
= Spontaneous Irreversible Hard swelling present; progresses to non-pitting ”brawny” edema * Stemmer sign positive (although still may be negative at early stage II) * Tissue appears fibrosclerotic; proliferation of adipose tissue
44
Stage III
= Lymphostatic Elephantiasis Edema present; severe ”brawny” nonpitting edema * Stemmer sign positive * Skin changes (papillomas, deep skinfold, warty protrusions, hyperkeratosis, mycotic infections, etc.) * Repeated bacterial and viral infections are common
45
Grading of Pitting Edema
1+ - 4+
46
1+
Mild barely perceptible indentation <1/4-inch pitting
47
2+
Moderate easily identified depression return to normal within 15 seconds 1/4-to-1/2-inch pitting
48
3+
Severe depression takes 15 to 30 seconds to rebound 1/2-to-1-inch pitting
49
4+
Very Severe depression lasts for >30 seconds or more >1 inch pitting
50
Lipedema =
bilateral condition affecting the lower extremities affects the proximal areas, such as the buttocks and thighs, but not distal areas, such as the feet affects skin’s elasticity, the skin sensitive to pressure and touch, which makes it bruise easily and painful
51
Lymphedema vs Lipedema distribution:
Lymphedema: Unilateral or bilateral with one leg affected more severely (asymmetric) Lipedema: Bilateral lower extremities (rarely upper extremities) symmetric involvement
52
Lymphedema vs Lipedema cellulitis:
Lymphedema: Common Lipedema: Rare
53
Lymphedema vs Lipedema pain on pressure:
Lymphedema: Absent Lipedema: Present
54
Lymphedema vs Lipedema distal edema in foot:
Lymphedema: Present Lipedema: Absent
55
Lymphedema vs Lipedema stemmer sign:
Lymphedema: Present (positive) Lipedema: Absent (negative)
56
Girth Measurements =
Circumferential measurements of the involved limb in comparison to uninvolved limb Identify specific landmarks at which measurements are taken so measurements during subsequent examination are reliable Limb circumference at that landmark and at 10 cm intervals
57
Volumetric Measurements =
Immerse the limb in a tank of water to a predetermined anatomical landmark and measure the volume of water displaced
58
Bioimpedance Measurements =
Use of a low-level alternating electrical current to measure the resistance to the flow through the extracellular fluid in the upper extremity The higher the resistance to flow, the more extracellular fluid present Measurements must be taken prior to surgery, and re-measurements should be taken at set intervals throughout the treatment
59
Summary for Diagnosis Proximal:
Girth Measurement
60
Summary for Diagnosis Distal (UE/LE):
Volumetric
61
Summary for Diagnosis Pre-Post Surgery:
Bioelectric Impedance
62
Summary for Diagnosis Lymphatic Insufficiency:
Lymphoscintigraphy
63
Lymphoscintigraphy (lymphangioscintigraphy):
Measured during rest and exercise, identifies lymphatic insufficiency
64
Doppler US:
To D/D from venous insufficiency
65
Normal palpation:
Soft, non-tender, non-palpable
66
Abnormal palpation:
* Tender * Hard * Immobile If abnormal, physician referral is indicated
67
Tender: Indicative of ___
inflammation or infection
68
Fixed, hard and non- tender: Indicative of ___
malignancy
69
____ is a concern
Persistent enlargement
70
Radical mastectomy causes what type of lymphedema?
secondary
71
What tool is used to assess lymphedema pre/post surgery?
bioelectric impedance
72
What stage of lymphedema has Stemmer sign positive and initial signs of fibrosis?
stage 2 - spontaneous irreversible
73
What condition has symmetrical lower extremity edema with no pedal edema?
lipidema
74
Main goal of treatment is to:
minimize the lymphedema as much as possible or return the lymphedema to a latency stage
75
Interstitial pressure is increased by external forces:
manual lymphatic drainage or compression therapy
76
Dynamic pressure changes within the body:
diaphragmatic breathing or muscle contractions
77
____ can be even more effective in the movement of fluid
A muscle contraction combined with external forces from a bandage or compression garment
78
Complete Decongestive Therapy
1. Manual Lymphatic Drainage 2. Compression therapy 3. Exercises 4. Skin and nail care
79
Manual Lymphatic Drainage:
Proximal areas (trunk, groin, buttocks or axilla) cleared first; distal areas done later Proximal to distal. Clear the traffic jam! MLD is performed using semi-circular movements and stroking Direction of the stroking is Distal to Proximal and towards specific lymph nodes
80
3. Exercises
Active ROM, stretching, low intensity resistance exercises - performed wearing compression garment or bandages * walking, ROM, biking, swimming * Proximal-to-Distal direction (breathing, cervical, trunk, arms)
81
4. Skin and nail care
Prevention of skin breakdown, infection and delayed wound healing * BP? never take on affected limb * Temperature? neutral - not too hot or too cold
82
Compression therapy:
type of compression used depends on the phase of treatment Phase I (Active reduction phase) use only lowstretch bandages Has low resting pressure and high work pressure From Distal-to-Proximal direction Used during day and night High stretch sports bandage (ACE wraps) NOT recommended
83
Phase I: Intensive phase
*Manual lymphatic drainage (MLD) *Multiple layer compression bandaging *Skin and nail care *Exercise
84
Phase Il: Maintenance phase
* Self-MLD by the patient * Compression therapy ○ Compression garment during the day ○ Multiple layer bandaging in the evening/night * Skin and nail care * Exercise
85
Technique & Direction MLD Stroking Exercise
MLD: proximal to distal Stroking: distal to proximal Exercise: proximal to distal
86
True or False: Swimming is not recommended for patients with lymphedema
false
87
True or False: Patients should perform self MLD in Phase 2 as needed
true
88
True or False: Compression garments are wrapped with more pressure proximally
false

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