Lymphedema

Question 1

function of lymphatic system

Answer 1

drainage and sanitation system
one way transport of lymph fluid
role in homeostasis to assist peripheral vascular system

Question 2

anatomy of the lymphatic system - small to large

Answer 2

lymph capillary
pre collectors
collector
lymph nodes
lymphatic trunks
lymphatic duct and thoracic duct

Question 3

how much fluid is circulated through the lymphatic system daily

Answer 3

lymphatic system moves 1-2 L per day

Question 4

superficial vs deep drainage: how much % does each drain from tissues?

Answer 4

99% of drainage comes from superficial system in skin
1-2% of drainage comes from deep system from muscles, tendons, organs

Question 5

thoracic duct drains what part of the body?

Answer 5

L side of body
everything but R head, shoulder, UE
empties into aorta

Question 6

R lymphatic duct drains what part of the body?

Answer 6

R head, shoulder, UE
drains into internal jugular

Question 7

where do the lymphatic and venous system connect?

Answer 7

venous angle which is formed by internal jugular and subclavian

Question 8

primary lymphedema

Answer 8

congenital/hereditary malformation of lymphatic system

Question 9

hypoplasia

Answer 9

congenital primary lymphedema
vessels are smaller in size or lower in numbers in an area

Question 10

hyperplasia

Answer 10

congenital primary lymphedema
system vessels are larger in size or valves are incompetent

Question 11

aplasia

Answer 11

congenital primary lymphedema
no development or absence of lymph vessels in a region
like the dorsum of the foot

Question 12

milroy’s lymphedema

Answer 12

BL LEs affected after birth

Question 13

lymphedema praecox - meige disease

Answer 13

girls and young women
common primary
legs affected
develops around puberty

Question 14

lymphedema tarda

Answer 14

develops after age 35 in LE

Question 15

secondary lymphedema

Answer 15

occurs after trauma/systemic disease causing damage to the lymphatic system cause insufficiency

Question 16

risk factors for lymphedema

Answer 16

overweight
radiation therapy
trauma
surgery
infection
benign/malignant tumor
chronic venous insufficiency

Question 17

causes of secondary lymphedema

Answer 17

breast cancer treatment - radiation and biopsy
filariasis - parasite infection
tumor - malignancy or obstruction
UE DVT
scar tissue

Question 18

stages of lymphedema

Answer 18

0: normal appearance, reduced lymph transport capacity, negative stemmer
1: reversible: soft pitting edema with normal tissue, reversible with elevation
2: irreversible: nonpitting brawny edema, infection, skin changes, positive stemmer
3: elephantiasis: tissue changes with positive stemmer, tissue changes

Question 19

clinical presentation of lymphedema: s/s

Answer 19

swelling - UL
pitting edema –> brawny edema –> fibrotic
heaviness
paresthesia
decreased ROM
pain
trophic changes
hyperkeratosis
skin infections
changes in symptoms with weather, menstruation, dependent position
primary lymphedema can include abd bloating, diarrhea, fatty food intolerance

Question 20

diagnostic imaging for lymphedema

Answer 20

lymphoscintigraphy - radioactive dye to visualize lymphatic system
direct lymphography - invasive, radiographs
MRI/CT for diagnostics and tumors

Question 21

pitting edema

Answer 21

indentation with pressure lasting after pressure is removed
reversible

Question 22

brawny edema

Answer 22

tissue is firm on palpation with fibrotic subcutaneous changes

Question 23

weeping edema

Answer 23

in LE fluid leaks from open wounds
delayed wound healing
most severe lymphedema

Question 24

edema vs lymphedema

Answer 24

lymphedema comes with increased protein in interstitial space
chronic LD doesn’t improve w elevation
LD is always localized and due to mechanical insufficiency of lymphatic system
LD can progress to nonpitting brawny edema

Question 25

abnormal lymph node palpation

Answer 25

firm, tender, immobile and palpable at all

Question 26

lymphedema management techniques

Answer 26

1. manual lymphatic drainage CDT 2. compression therapy 3. exercise 4. education

Question 27

phases of complete decongestive therapy

Answer 27

phase I: mild compression, exercise in bandages and complete skin care phase II: compression w garment during day and bandage at night, exercise w compression, skin care, manual lymphatic drainage

Question 28

manual lymphatic drainage

Answer 28

lightly move across skin to improve or restore drainage on/off pressure, on pressure in desired direction of drainage clear upper levels first to move fluids in a proximal direction assist fluid transport and reabsorption

Question 29

classes of compression

Answer 29

1: 20-30 mmHg mild LD 2: 30-40 mmHg stage II LD 3: 40-50 mmHg stage II LE LD 4: 50-60 mmHg custom garment

Question 30

types of exercise for LD

Answer 30

low exertion slow/rhythmic diaphragmatic breathing gentle ROM aerobic exercise gentle stretching

Question 31

LD skin care

Answer 31

prevention #1 hypoallergenic soap moisturize skin inspection protect skin (sunscreen etc) toenail management shoes for protection avoid constricting clothing

Question 32

contraindications to LD management

Answer 32

acute DVT last 6 months acute infection untreated CHF untreated cancer kidney dysfunction arterial insufficiency neuropathy

Question 33

lipedema

Answer 33

gradual and progressive symmetrical accumulation of fat in subcutaneous tissue most commonly in LE

Question 34

stemmer sign

Answer 34

skin on the dorsum of the roes cannot be pinched

Question 35

a pt with soft pitting edema without fibrosis and swelling that reduces with elevation, what stage?

Answer 35

stage I

Question 36

purpose of the lymphatic system to tp collect and transport fluid from the:

Answer 36

interstitial spaces to the venous system

Question 37

s/s of chronic venous insufficiency include:

Answer 37

venous distension in affected limb dependent peripheral edema brown pigment

Question 38

main cause of lymphedema in US

Answer 38

breast cancer and treatment

Question 39

main cause of LD worldwide

Answer 39

filariasis

Question 40

reliable method of detecting stage I LD includes:

Answer 40

observation subjective history circumferential measurement not effective at early detection of stage 0

Question 41

risk factors for patients in the US developing LD

Answer 41

BMI >30 axillary lymph node biopsy with mastectomy or7+ lymph nodes radiation of treatment area previous infection of treatment area previous episode of LD

Question 42

short stretch bandages are best for:

Answer 42

adding compression while moving

Question 43

long stretch bandages are best for:

Answer 43

adding compression at rest

Question 44

modalities and treatments that are contraindicated

Answer 44

anything causing vasodilation NO ice, heat, sauna, contrast bath, parafin, electrical of any kind due to skin concerns only use ultrasound on settings to minimize heat like 20% no traditional massage bc it doesn't allow proper fluid return, increases load on system pneumatic compression generally contraindicated

Question 45

modalities that are ok for LD

Answer 45

low level laser: soften tissue without temp increase pneumatic compression IF segmental compression pulsed US 3 MHz 50% pulse .1-.3 for 5-8 min to soften fibrotic tissue without heating

Question 46

where in a garment should the highest level of compression be?

Answer 46

most distal portion

Question 47

circular vs flat knit garments

Answer 47

flat knit give better compression but are more expensive

Question 48

differentiate lipedema from lymphedema

Answer 48

lipedema: family hx, BL, pain with pressure, easy bruising, no stemmer, no distal edema to feet lymphedema: no family hx, UL, cellulitis, distal edema into foot, + stemmer's sign