Lymphedema Flashcards Preview

822: Integumentary > Lymphedema > Flashcards

Flashcards in Lymphedema Deck (112):
1

What are the 2 main functions of the lymphatic system?

- Regulate fluid balance
- Assist with infection control

2

How many liters of fluids are removed from the interstitial space per day?

18 L

3

Of the 18 liters removed, __-__% via the veins and __-__% via the superficial and deep lymphatic vessels. How many liters via the lympathics?

80-90

10-20 (2-4L)

4

What occurs when the lymphatics cannot remove the remaining interstitial fluid?

Lymphedema

5

__-__% of women with breast cancer will develop lymphedema

23-45

6

__% of women with ovarian cancer will develop lymphedema

21

7

__% of patients with endometrial cancer will develop lymphedema

28

8

Up to __% of men with prostate cancer will develop lymphedema

70

9

What are the chief complaints of lymphedema?

- limb heaviness
- paresthesias
- achiness
- skin tightness
- poor-fitting clothes
- altered cosmesis
- decreased ADLs
- reduced ROM

10

The lymphatic system is composed of 2 interconnecting drainage systems, what are they?

superficial and deep lymphatics

11

Describe the function and arrangement of the superficial lymphatics

Drains the skin and subcutaneous tissue

Roughly parallels the veins

12

Describe the function of the deep lymphatics

drains everything else (deep tissues and organs)

13

What connects the deep and superficial lymphatic systems?

perforating lymphatics

14

What is lymph made of?

water, protein, dead/dying cells/cellular components, fatty acids, foreign material and debris

15

Describe the path lymph takes as it exits the interstitial spaces to

Lymph capillaries --> Lymph precollectors --> Lymph collectors --> Lymph nodes --> Lymph trunks

16

What is the functional unit of a lymph vessel that lies between two semilunar (half moon-shaped) valves?

Lymphangion

17

How many lymphangions are there in a typical arm collector? In a leg collector?

60-80

80-100

18

The total number of lymph nodes ranges from ___-___ with the majority located where?

600-700

mesentaries

19

Describe the path lymph takes from the LEs and the genitals

Passes through the inguinal nodes into the left and right lumbar trunks before emptying into the centrally located thoracic duct, which terminates into the left venous angle (the internal jugular vein and the subclavian vein)

20

Describe the path lymph takes from the LEFT upper extremity

Filters through the axillary lymph nodes before emptying into the subclavian vein

21

Describe the path lymph takes from the RIGHT upper extremity

Empties into the right subclavian vein aka the right venous angle

22

Lymphatic territories are areas of skin made up of several adjacent lymph collectors that drain into the same regional lymph nodes. These territories are separated by natural boundaries called what?

watersheds

23

What pressures govern fluid movement between capillaries, interstitium, and lymphatic system?

hydrostatic and osmotic pressure

24

What are the 5 ways in which lymph moves centrally in a healthy lymphatic system?

- skeletal muscle contractions
- respiratory pump
- pulsations of the aorta
- lymphangiomotoricity

25

What is Lymphangiomotoricity?

the contraction of the smooth muscle within the lymphagnions

26

Lymphangiomotoricity is the key to decreasing edema when?

overnight while the patients are recumbent

27

What are the 2 types/causes of lymphedema?

primary and secondary

28

Describe primary lymphedema

Congenital malformation or impairment of lymphatics

29

Primary lymphedema accounts for only __% of all cases

10

30

Primary lymphedema cases are usually described by what 2 things?

type of lymphatic vessel abnormality or the age of onset

31

What are the 4 types of vessel abnormalities that occur with primary lymphedema?

- Aplasia
- Hypoplasia
- Hyperplasia
- Lymph node fibrosis

32

Describe aplasia

Lack of lymphatic vessels in a body region therefore no lymphatic drainage in this area

33

Describe hypoplasia

Lymphatic vessels are narrower than normal leading to significantly less lymphatic drainage

34

Hypoplasia is comparable tow what?

arterial stenosis

35

Describe hyperplasia

Lymphatic vessels are wider than normal

36

Hyperplasia is comparable tow what?

varicose veins

37

Hyperplasia accounts for __% of all cases of primary lymphedema

15

38

Lymph node fibrosis is most commonly seen in what lymph nodes?

inguinal

39

Classify the following:

Congenital Lymphedema: __-__
Lymphedema Praecox: __-__
Lymphedema Tarda: __

birth to 1 year

1-35 years old

after 35 years old

40

Describe secondary lymphedema

Results form a disruption in, or damage to, the lymphatic system

41

What are 3 causes of secondary lymphedema?

- Filariasis
- Cancer treatment
- Chronic venous insufficiency

42

What causes filariasis?

the bite of a mosquito that is infected with a parasitic worm

43

In the US, secondary lymphedema is most often seen following what?

medical or surgical procedures that disrupt lymph flow

44

What can be defined as a bilateral, symmetrical increase in adipose tissue deposition?

Lipedema

45

Lipedema affects the abdomen, buttocks, lower extremities but spares what?

the feet

46

Increased compliance of fat associated with lipedema allows interstitial fluid to accumulate, leading to what?

lipolymphedema

47

What are 3 characteristics of lipolymphedema?

- painful
- bruise easily
- diet-resistant weight gain

48

What are the 9 risk factors contributing to lymphedema?

- lymph node status
- radiation therapy
- surgical complications
- time since surgery
- increased BMI
- air travel without compression
- inflammation/increased lymphatic load
- decreased lymphatic return
- individuals prone to scar tissue formation

49

What is a sentinel lymph node biopsy?

A biopsy that removes only the first lymph node receiving lymph from the tumor

50

What 2 things does radiation therapy lead to?

Perilymphatic and lymph node fibrosis

51

What type of skin changes occur with radiation therapy?

- Sclerosis/fibrosis
- Dermal atrophy
- Decreased sweat glands

52

__% of breast cancer patients who had lumpectomy and axillary radiation developed lymphedema

26

53

The risk of lymphedema increases as the time since surgery _____.

increases

54

Why does the risk of lymphedema increase as time after surgery increases?

Possibly due to lymphatic fatigue

55

Why does the risk of lymphedema increase with air travel?

There is decreased atmospheric pressure on the body while flying which allows the body to swell

56

It is recommended that individuals at risk for lymphedema wear compression, greater than __ mm Hg for an UE and greater than __ mm Hg for a LE, while flying.

20

30

57

Why are patients instructed to avoid strenuous activity of at-risk limbs?

It may cause muscle microtrauma and inflammation, which leads to increased fluid that the patient’s lymph system may not be able to accommodate

58

What are some things that may cause decreased lymphatic return?

- clothing
- jewelry
- tourniquets
- BP cuffs

59

Why are patients prone to excessive scar tissue formation (keloids) at risk for lymphedema?

The trauma of surgical lymph node removal can be exacerbated by an abdominal increase in collagen deposition post-surgery

60

What are 4 tests and measures PTs must perform on a patient with suspected lymphedema?

- Circumferential Measurements
- Body Mass Index
- Circulation
- Sensory Integrity

61

What is the gold standard for measuring limb circumferentially?

volumetric displacement

62

True or False

You can measure a limb every 3, 4, 8, or 12 cm without it significantly effecting limb volume calculations

True

63

How is BMI calculated in the US?

BMI = weight in pounds x 703 / height in inches squared

64

Classify the following:

Underweight: less than __
Normal weight: __-__
Overweight: __-__
Obese Class I: __-__
Obese Class II: __-__
Obese Class III: greater than __

18.5

18.5-24.9

25-29.9

30-34.9

35-39.9

40

65

What are 3 circulation tests a clinician must perform in patients with LE lymphedema?

- Doppler US
- capillary refill
- ABI

66

True or False

Monofilament testing must be performed on all patients with lymphedema

True

67

Nerve entrapments (carpal/tarsal tunnel, etc.) associated with lymphedema can lead to what?

tissue distention, edema, and inflammation

68

What lymphedema patient population is at risk for neuropathy?

- Those with diabetes
- Those who received chemotherapy

69

Lymphedema falls under what Cardiovascular/Pulmonary Practice Pattern?

6H

70

How many stages of lymphedema are there?

4 (0-3)

71

What is the descriptor for stage 0 lymphedema?

latent

72

What are the characteristics of stage 0 lymphedema?

- No edema present
- Reduced lymph system transport capacity
- Most commonly due to radiation or surgery

73

What is the descriptor for stage 1 lymphedema?

Reversible

74

What are the characteristics of stage 1 lymphedema?

- Pitting edema
- Greatly or completely reduces with elevation
- No secondary skin changes

75

What is the descriptor for stage 2 lymphedema?

Spontaneously irreversible

76

What are the characteristics of stage 2 lymphedema?

- Does not pit
- Does not substantially reduce with elevation
- Skin becomes brawny and fibrotic
- May have frequent skin infections

77

What is the descriptor for stage 3 lymphedema?

Lymphostatic elephantiasis

78

What are the characteristics of stage 3 lymphedema?

- Extreme increase in limb volume
- Deep skin folds
- Papillomas present
- Frequent skin infections

79

Mild Lymphedema = less than _ cm interlimb difference or less than __% limb volume increase

3

20

80

Moderate Lymphedema = between _-_ cm interlimb difference or between __-__% limb volume increase

3-5

20-40

81

Severe Lymphedema = greater than _ cm interlimb difference or greater than __% limb volume increase

5

40

82

Pain associated with lymphedema is typically described as what?

- deep ache or pressure sensation
- stretching type pain
- neuropathic pain
- discomfort or heaviness

83

Secondary lymphedema occurs ____ to the area of lymphatic obstruction or damage

distal

84

What is Lymphorrhea?

weeping

85

What type of drainage is most common in lymphedema?

serous

86

True or False

Copious wound drainage is the norm and wound beds are commonly covered with slough

True

87

What are 12 integumentary changes commonly seen in patients with lymphedema?

- xerosis
- hyperkeratosis
- fibrosis
- hair loss
- deep skin folds
- lichenification
- lipodermatosclerosis
- papillomas
- lymphorrhea
- vesicle of blister formation
- dermatitis
- ulceration
- infection

88

Thickening of the dorsal aspect of the digits may result in a positive ______ sign

Stemmer's

89

What is papillomatosis?

cobble-stone-like appearance of the epithelium

90

Are pulses typically normal or affected in patients with lymphedema?

normal

91

Is temperature generally affected in patients with lymphedema?

No, however it may be warm to the touch due to edema, inflammation, or infection

92

It has been determined that mild lymphedema will require _-__ visits. Whereas moderate lymphedema will require __-__ visits.

5-10

14-24

93

Generally one can expect a __-__% volume decrease within 6-36 visits

22-73

94

What are 5 things to instruct patients to do?

- protect from injury
- perform regular skin checks
- treat open areas
- weight management
- exercise
- utilize garments

95

What are 5 things to instruct patients not to do?

- get injections, piercings, or tattoos in affected area
- have BP taken in affected extremity
- avoid hot tubs/saunas
- do not walk barefoot

96

What are 3 things to be cautious of in patients with lymphedema?

- ensure cancer is not the cause of recurrent lymphedema
- refer spontaneous lymphedema to MD
- beware of patients with history of arterial insufficiency or DVT

97

Under what 3 circumstances should you request for further medical testing?

- signs and symptoms of infection
- to rule out recurrence
- if you cannot perform an ABI

98

What skin care suggestions should you advise a patient with lymphedema?

- keep the skin clean and dry
- avoid perfumes and high-alkaline soaps
- use low pH moisturizers
- keep open wounds clean and apply an antimicrobial over top

99

Who are the 4 leaders in the field of manual techniques for lymphatic drainage?

- Casley-Smith
- Foldi
- Leduc
- Vodder

100

What are 8 benefits of manual therapy?

- increase lymph formation
- propels lymph proximally
- increases lymph angiomotoricity
- reroutes stagnated lymph
- encourages development of collaterals
- reduces sympathetic and increases parasympathetic responses
- decreases pain/promotes relaxation
- decreases fibrosis

101

What are 7 precautions/contraindications of manual therapy?

- DVT
- active infection
- open wound
- metastatic disease
- CHF
- asthma
- abdominal inflammatory conditions (IBS, etc.) or currently pregnant

102

Describe the general process for manual therapy

Clear the proximal lymph system before moving distally. First at the venous angles of the neck then to the trunk, and then the affected extremity

103

What are 5 proposed benefits of compression therapy?

- Reduces ultrafiltration
- Enhances venous return
- Improves effectiveness of muscle pump
- Increases angiomotoricity
- May reduce fibrosis

104

What are 7 Precautions/Contraindications for Compression Bandaging?

- arterial insufficiency
- radiation damage with intact skin
- CHF
- DVT
- open wounds
- infection
- patients who are weak, immobile, insensate

105

What type of compression garment is used during high-risk activities?

Prophylactic

106

Use a __-__ mm Hg or light compression garment on patients with mild lymphedema or for a prophylactic UE

10-21

107

Use a __-__ mm Hg or medium compression garment on patients with moderate to severe UE lymphedema or for mild LE lymphedema

15-32

108

Use a __-__ mm Hg or strong compression garment on patients with moderate to severe LE lymphedema

30-40

109

Use a very strong compression garment with greater than __ mm Hg compression on patients with stage 3 LE lymphedema

40

110

Describe how compression pumps work and why they cannot be used on their own?

They remove the fluid from the area, but not protein. So once they are stopped the protein draws the fluid back into the area or the residual protein may lead to fibrosis

111

What are the 2 phases of intervention?

- intensive
- self-management

112

Describe the difference of short and long term compression therapy

- Multilayer compression bandage short term
- Compression garments long term