Lymphedema

Question 1

What is lymphedema?

Answer 1

Chronic disease with no cure

Cause by pooling of fluid in the interstitial space

Question 2

What is a characteristics of lymphedema?

Answer 2

Swelling

Question 3

T/F Swelling occurs due to impaired flow of lymph?

Answer 3

TRUE

Question 4

What layer of the skin do we see lymphedema?

Answer 4

subcutaneous fatty tissue

Question 5

Prevalence of lymphedema?

Answer 5

Pts with cancer living longer
Obesity rates are rising
population is aging

Question 6

How many cases of lymphedema globally?

Answer 6

140-250 million cases estimated to exsist

Question 7

The lymphatic system is regarded as the ____ component of the vascular system (or forgotten step child)

Answer 7

3rd

Question 8

What does the lymphatic system consist of?

Answer 8

Lymph vessels, capillaries, pre collectors, collectors(similar to veins)
Lymphatic tissue: nodes and trunks

Question 9

What is the purpose of the lymphatic system?

Answer 9

return fluid and protein from interstitial spaces to the vascular system (thick, more viscous)

Question 10

Lymphatic systems two main functions?

Answer 10

1. Maintain the pressure and volume of the interstitial fluid and blood by returning excess water and dissolved substances from the interstitial fluid to the circulation.
2. Assist the immune system at the lymph nodes and other lymphatic tissue with lymphocytes and macrophages

Question 11

What does lymph fluid consist of?

Answer 11

-Protein
-Water
-Fatty acids
-Salts
-WBCs
-Microogranisms
-Debris
(this is why the fluid is so thick)

Question 12

How is normal plasma volume maintained?

Answer 12

• Capillaries pick up interstitial proteins/etc
• Return fluid to vascular system
• Prevents interstitial edema

Question 13

Two systems are content by _______ vessels?

Answer 13

perforating

just like veins

Question 14

T/F capillaries –>pre collectors–>collector nodes–>trunks–>ducts

Answer 14

TRUE

Question 15

T/F lymph capillaries are smaller than blood vessels?

Answer 15

FALSE

-Larger because they have to absorb larger volume of fluid

Question 16

Which direction does fluid flow?

Answer 16

in the direction of low pressure

Question 17

Collectors have ______ prevent back flow

Answer 17

valves

Question 18

What happens in an overloaded lymphatic system?

Answer 18

• fluid/proteins accumulate in the interstitial space
• high-protein edema builds up in the tissue
• triggers inflammatory response with deposition of collagen

Question 19

What is acute lymphedema and how long does it last?

Answer 19

Lasts less than 6 months (reversible)
Pitting edema with pressure
lack of brawny skin changes

Question 20

What are some risk factors for acute lymphedema?

Answer 20

• surgical drains with leakage of drainage back into surgical site
• Acute injury to a limb compromising lymph system
• radiation therapy
• infections
• phelblitis

Question 21

What is chronic lymphedema?

Answer 21

Not reversible

skin changes likely

Question 22

What are the two types of chronic lymphedema?

Answer 22

Primary (idiopathic) lymphedema
–generally involves a LE, congenital absence or abnormalities in lymph system
Secondary (acquired) lymphedema
–most commonly associated with malignancy and treatment

Question 23

What are three classification of primary lymphedema?

Answer 23

-Congenital= detected at 35 years old

Question 24

In secondary lymphedema occurs at lymph node from?

Answer 24

Surgery
Radiation
Trauma
Infection
Malignancy
Scar Tissue

Question 25

Stage 0 of lymphedema includes..?

Answer 25

Reversible Swelling is not evident Damage to lymphatic function has occurred (tumors or cancer) May occur for months or years before swelling is detectable

Question 26

What occurs in stage 1 of lymphedema?

Answer 26

``` Reversible Lymph fluid with high protein content Fluid dissipates after the involved limb is elevated ---gravity helps Pitting edema begins distally No palpable fibrosis Negative or borderline stemmer sign ```

Question 27

What occurs in stage 2 of lymphedema?

Answer 27

``` Irreversible Pitting edema is present Non-pitting edema develops ---cant depress down into the skin Limb evolution does not reduce edema Tissue fibrosis starts Positive stemmer sign Skin thickens Skin has rough cobblestone appearance and texture ```

Question 28

What occurs in stage 3 lymphedema?

Answer 28

Irreversible Knows as elephantiasis Pitting edema not present Increased skin changes

Question 29

What is pitting edema?

Answer 29

Present when indentation in the skin remains longer than 5 seconds after pressure is removed (hold for 30 seconds, depth you can go in and how long does it stay there)

Question 30

What is Stemmer's sign/Test?

Answer 30

Indication of lymphedema | Inability to pinch a skin fold on the dorsal aspect of the 2nd toe

Question 31

Do false positives occur with the Stemmers test?

Answer 31

No | -negative tests don't necessarily rule out lymphedema could be at stages 0 to 1

Question 32

What is lipedema?

Answer 32

Fat deposition in irregular patterns/amounts | Predominantly found in the legs (bilaterally)

Question 33

T/F lipedema can lead to lymphedema?

Answer 33

TRUE | due to tissue congestion

Question 34

Cause not know for lipedema but suspect _______?

Answer 34

Female hormones - puberty - Pregnancy - Around time of menopause - Respond poorly to compression therapy