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PHTH 546 > Lymphatic System and Lymphedema > Flashcards

Lymphatic System and Lymphedema Flashcards

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1
Q

lymphatic system function

A

helps the immune system defense and transports excess fluids

drainage and sanitation sytem due to the one way system of transporting lymph fluid

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2
Q

fluid make-up

A

protein
water
fatty acids
WBCs
bacteria or viruses

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3
Q

location of major lymph nodes

A

mesenteric
iliac
inguinal
popliteal
supraclavicular
substernal
axillary
cervical
cubital
submaxillary

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4
Q

amount of nodes in the body

A

600-700

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5
Q

amount of fluid being moved

A

20L of fluid circulated/day total
~ 3 L per day

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6
Q

connection of the lymphatic system

A

connects to the venous system at the venous angle

formed by the juction of the internal jugular vein and subclavian vein

results in the thoracic duct and right lymphatic duct

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7
Q

hereditary/congenital malformations

A

hypoplasia - vessels are smaller in size or amount

hyperplasia - vessels are bigger in size or amount

aplasia - no development (dorsum of foot is common)

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8
Q

3 forms of primary

A

Milroy’s
Meige disease
lymphedema tarda

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9
Q

Milroy’s disease

A

congenital hereditary lymphedema

b/l LEs at birth or infancy

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10
Q

Meige disease

A

lymphedema praecox

lymphatic build up in LE
- most common primary
- almost exclusively girls and young women

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11
Q

lymphedema tarda

A

develops after age 35

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12
Q

secondary lymphedema

A

happens after trauma to a normal lymphatic system

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13
Q

secondary lymphedema risk factors

A

overweight, radiation therapy, infection, trauma, surgery, tumors, chronic venous insufficiency

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14
Q

secondary lymphedema causes

A
  • breast cancer treatments is the most common in US due to radiation, sentinel node biopsy
  • filiariasis
  • tumors
  • malignancy or obstructive lesion
  • UE DVT
  • Scar tissue
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15
Q

filariasis

A

parasite infection of the lymph systems
- most common worldwide

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16
Q

Stage 0

pre-stage
latency

A

no clinical edema - tissue looks “normal”
lympth transport capacity already reduced
(-) Stemmer sign

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17
Q

Stage 1

Reversible stage

A

soft, pitting edema present - tissue looks “normal”
edema increases with long standing or activities
edema reversible with elevation
(-) stemmer sign

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18
Q

stage 2

irreversible stage

spotaneously

A

progresses to nonpitting brawny edema
edema does NOT reverse with elevation
(+) stemmer sign
tissue is fibrous; proliferation of adipose tissue
increased frequency of skin infections, skin changes observed

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19
Q

stage 3

lymphatic
elephantiasis

A

severe brawny edema - non-pitting edema
does NOT reverse with elevation
(+) stemmer sign
permanent integumentary system changes:
- deep skinfolds
- change in color
- change in texture
- papillomas
- hyperkeratosis
- myotic infection

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20
Q

clinical presentation review

A

unilateral swelling
pitting edema –> brawny edema –> fibrotic edema
heaviness, achy
paresthesia
decreased ROM
pain
trophic changes of skin and nail
hyperkeratosis and lymphangiectasis
reoccuring infections in the involved limp
sx can increase certain times

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21
Q

hyperkeratosis

A

skin thickening

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22
Q

lymphangiectasis

A

dilated superficial lymph vessels

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23
Q

conditions when symptoms increase

A

warm weather
menstruation
limb left in a dependent position

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24
Q

s/s that affects the intestines

Study These Flashcards
A

abdominal bloating
diarrhea
intolerance to fatty foods

25
gold standard imaging
lymphoscintigraphy - minimally invasive w/ dye and nuclear imaging - measure both superficial and deep
26
direct lymphography
invasive and rarely used because of contrast being used perform repeated radiographs may need to do prior pelvic surgery or more complicated conditions
27
indirect lymphography
MRI and CT - MRI for tumors, seeing lympth trunks, nodes or soft tissue near obstruction + gold standard
28
pitting edema | types of edema
indentation with pressure even after pressure is removed can return to original shape - can be reversed
29
brawny edema | types of edema
hard/firm palpation fibrotic changes happening in the subcutaneous
30
weeping edema | types of edema
almost always in LEs fluid is leaking or oozes from open wounds delayed wound healing most severe form of lymphedema
31
edema | differential dx
- increase water in the inteerstitial space - improves with elevation - symmetrical apperance except for posttrauma - localized or systematic - dynamic insufficiency of system - pitting is always there
32
lymphedema | differential dx
- increased water and protein in the interstitial space - intially - improved with elevation --> chronic: no improvement with elevation - asymm appearance - localized - mechanical insufficiency - pitting only in stages 1-2
33
palpate lymph nodes
easiest to palpate * axilla * head * neck * trochlear * inguinal regions **abnormal** = tender or hard/immobile & instant report to MD
34
goal of lymphedema managemeent
**minimize stage progression** - to do that, fluid needs to be removed from the system to retain or restore tissue integrity - interstial pressure changes when external pressure or force is increased
35
steps of complete decongestive therapy | CDT
1. manual lymph drainage 2. compression therapy 3. exercise 4. education
36
manual lymph drainage | CDT
slow, light repetitive stroking circular motions across the top layer of the skin clear proximal region --> distal portion (avoid clogging) pt can be taught these manual techniques
37
compression therapy | CDT
low-stretch, low-resistance bandage applied to the limb worn all day and night needs to be applied by skilled clinician can educate pt or caregiver **key component in MLD success**
38
phase 1 of CDT
MLD compression exercise in bandages meticulous skin care
39
phase 2 of CDT
compression (garment at day/bandages at night) exercise with compression meticulous skin care MLD
40
manual lymph drainage
moving very lightly across the skin to improve drainage "on-off" : on = pressure direction of desired drain / off = no pressure but hands in contact of skin proximal --> distal - **clear upper levels to move fluids in a proximal direction** goal = fluid transport and reabsorption into system to move fluid out deeper pressure = fibrotic tissue
41
intervention contraindications
any modality that produces **vasodilation** to the involved area
42
avoiding what for interventions
temp changers: ice, heat, hot packs, saunas, contrast baths paraffin no e-stim because of potential skin irritation
43
ultrasound | intervention
ONLY using paramaters that mimize heating effects - **3 MHz 50% pulse @ 0.1-0.3 x 5-8 min** pulsed US can soften fibrotic tissues
44
low-level laser therapy | intervention
can be effective to soften hard tissues without increasing tissue temp
45
traditional massage | interventions
**contradicated** because of mechanical insufficiency in the system - doesn't let for proper fluid return and increases a load to system
46
pneumatic compression | intervention
contraindicated - more damange to the system SPECIFIC for the lymph system = it's ok
47
lymphedema pumps purpose
* reducing pain and edema * mimic the lymph system * promote lymph flow by moving fluid in the proper direction * stimulate circulation to promote wound healing * deliver continous flow
48
Class 1 | garment compression classification
**20-30 mmHg** Indications: - mild lymphedema - UE > LE - pt with fragile skin or elderly
49
Class 2 | garment compression classification
30-40 mmHg Indications: - commonly usef for stage 2 UE lymphedema - min compression for LE lymphedema
50
Class 3 | garment compression classification
40-50 mmHg Indications: - rarely used for UE - for stage 2 LE - for patients with LE involved with high-intensity, repetitive activities
51
Class 4 | garment compression classification
50-60 mmHg Indications: - rarely used - only for LE - only custom-made
52
therapeutic exercise and education
* effect on lymph system = increases fluid uptake * benefits = support or improve lymph function and overall mobility * participate in CV-enhancing low impact activities with external compression * exercises with compression * low-exertion * slow and rhythmic * diaphragmatic breathing
53
skin care
**prevention!!** lymph fluid collected in soft tissue is breeding ground for germs daily inspection foot and nail care monitor for s/s of infection
54
daily skin care routine
- bathe with hypoallergenic soap - skin moisturize - daily inspection - protect skin with insect repellent, sunblock, protective clothing - inspect affected areas or wounds - specialist for trimmig thickening or ingrown toenails - always wear shoes - beware fo constricting clothing items
55
skin care precautions
- reduce risk for skin tears/openings = increases infection risk - avoid extreme temps - avoid over exertion activities/repetitive shear forces on skin
56
contraindication for management
acute DVT (in the past 6mos) acute infection untreated CHF untreated cancer kidney dysfunction arterial insufficiency neuropathy
57
lipedema
gradual and progressive symmetrical accumulation of fat in subcutaneous tissues - usually butt and LE - Diff dx for lymphedema
58
characteristics of lipedema
gender: almost always women common if family hx rare cellulitis pain with pressure easy bruising no distal edema in the foot (-) stemmer sign

PHTH 546 (4 decks)

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