Lymphatics

Question 1

First lymph vessel is known as ____ and is the smallest. IT is near blood capillaries and is responsible for….

Answer 1

initial lymph vessel
collecting fluid from interstitium that is not picked up by venous system.

Question 2

Lymphatic system transports _____ _____.
It is responsible for ___-___% of interstitial fluid while venous system does the other percentage.

Answer 2

extracellular proteins
10-20%

Question 3

Initial lymph vessels transport towards larger lymph vessels known as

Answer 3

lymph collectors

Question 4

Lymph collectors transport to even larger lymph vessels known as

Answer 4

lymphatic trunks

Question 5

The two main lymphatic trunks are

Answer 5

R lymphatic duct and thoracic duct

Question 6

R lymphatic duct drains

Answer 6

R arm and R side of head

Question 7

Thoracic duct drains

Answer 7

remainder of body

Question 8

Lymphatic trunks empty lymph directly into

Answer 8

venous system via subclavian veins

Question 9

Lymphatic system is under control of

Answer 9

autonomic nervous system

Question 10

Other components of lymphatic system include

Answer 10

thymus
bone marrow
spleen
tonsils
Peyer patches in the small intestine

Question 11

Lymphedema is

Answer 11

chronic and incurable

Question 12

Primary lymphedema

Answer 12

occurs due to abnormal development of lymphatic system

Question 13

Secondary lymphedema

Answer 13

occurs as a result of some other disease or injury that causes damage to lymphatics

Question 14

Three types of lymph insufficiencies

Answer 14

dynamic
mechanical
combined

Question 15

Dynamic insufficiency

Answer 15

most common
occurs when there is excess lymph circulating that exceeds the transport capacity
pitting edema
Examples: venous insufficiency, CHF, pregnancy

Question 16

Mechanical insufficiency

Answer 16

occurs when transport capacity is reduced due to damage to the lymph system
results in more protein rich lymphedema
non-pitting

Question 17

Combined insufficiency

Answer 17

both increase in lymph fluid and decrease in transport capacity

Question 18

Individuals at greater risk for lymphedema

Answer 18

lymph node removal
extensive chest surgeries
radiation therapy
obesity

Question 19

Those at greater risk should

Answer 19

avoid injury to skin
avoid constriction of extremity
diet and exercise to maintain healthy weight
when exercising, observe any changes in limb
avoid extreme hot and cold
wear compressions during strenuous activity and when standing or sitting for long periods of time

Question 20

Procedure for limb circumference measuring

Answer 20

7 circumferences recommended for upper and lower extremities to see if fluid has been removed and not just redistributed

Question 21

A difference of ___-___cm between 4 comparative circumferences on bilateral UE is evidence of lymphedema.

Answer 21

2-3

Question 22

Mild lymphedema is classified as

Answer 22

<3 cm between affected and unaffected limbs

Question 23

Moderate lymphedema is classified as

Answer 23

3-5 cm

Question 24

Sever lymphedema is classified as

Answer 24

> 5 cm

Question 25

Staging of Lymphedema: 0

Answer 25

latent or preclinical stage no visible edema transport capacity is affected

Question 26

Staging of Lymphedema: 1

Answer 26

reversible pitting edema present and increases with activity or heat but diminishes with elevation and rest.

Question 27

Staging of Lymphedema: 2

Answer 27

spontaneously irreversible non-pitting edema and does not change with elevation or rest skin begins to show fibrotic changes stemmers sign is positive

Question 28

Staging of Lymphedema: 3

Answer 28

elephantiasis stage extensive non-pitting edema significant fibrotic changes papillomas skinfolds kyperkeratosis infection is common

Question 29

Treat lymphedema with

Answer 29

complete decongestive therapy

Question 30

CDT two phases:

Answer 30

Phase I is acute treatment in outpatient 4-6 weeks Phase II is self-management Can return to phase I when significant changes are noted.

Question 31

CDT consists of

Answer 31

manual lymphatic drainage compression therapy exercise skin care

Question 32

Compression therapy is in phase ___. ___-____bandages are used because they have a ____ resting pressure. Phase II consists a ___ of compression during the day and night. Bandages and garment should have ____ pressure distally.

Answer 32

I short stretch low combination higher

Question 33

Basic guidelines for exercise should start with

Answer 33

trunk exercises followed by extremity working from proximal to distal end with trunk again and deep breathing wear compression during exercise

Question 34

Soaps and moisturizers in lymphedema

Answer 34

low or neutral pH

Question 35

Contraindications to CDT

Answer 35

acute infection cardiac edema diabetes HTN malignancy renal insufficiency DVT

Question 36

Filariasis

Answer 36

parasitic infection most often seen in tropical climates most common causes of secondary lymphedema

Question 37

hyperkertosis

Answer 37

thickening of outermost layer of skin observed in stage 3 lymphedema

Question 38

Lymphadenitis

Answer 38

inflammation and infection of lymph nodes

Question 39

Lymphadenomegaly

Answer 39

enlargement of lymph nodes secondary to cancer, infection, allergic reactions

Question 40

Lymphadenopathy

Answer 40

affects size, number or consistency of lymph nodes

Question 41

Lymphangitis

Answer 41

infection and inflammation of lymphatic sys

Question 42

Milroy's disease

Answer 42

inherited type of primary lymphedema that typically presents in infancy. BLE

Question 43

Papilloma

Answer 43

benign wart in stage 3

Question 44

Spleen

Answer 44

upper left quadrant responsible for filtration of RBCs as well as production of antibodies to fight infection

Question 45

Stemmers sign

Answer 45

positive if dorsal base of second toe/finger cant be easily lifted away from bone which indicates thickening of skin due to fibrotic changes

Question 46

Thymus

Answer 46

posterior to sternum and anterior to heart that produces T cells and T lymphocytes to help combat infection