Lymphedema

Question 1

Lymphedema

Answer 1

Chronic collection of high protein fluid just under the skin
Usually in one or both arms or legs

Question 2

Areas of the body that do not have lymph vessels

Answer 2

Hair
Nails
Cornea
Cartilage

Question 3

Lymph capillaries

Answer 3

Larger than blood capillaries
Able to absorb large molecules from intersititium
Simple squamous epithelium
Overlapping ends
Anchoring filaments

Question 4

Lymph pre collectors

Answer 4

Connect lymph capillaries to lymph collectors

Can also absorb fluid

Question 5

Lymph collectors

Answer 5

3-layer wall but thinner than vein
Valves
Made up of lymphangions

Question 6

Extrinsic lymphangion contractions

Answer 6

Breathing
Exercise
Artery pulsation
Vein negative pressure
Compression on skin

Question 7

Intrinsic lymphangion contractions

Answer 7

ANS (smooth muscle)

Question 8

Lymph trunks and ducts

Answer 8

Collect and dump up into heart and veins

Most from thoracic duct into L venous angle

Question 9

Lymph nodes

Answer 9

Kidney shaped
Filter lymph
Produce lymphocytes
Usually in adipose

Question 10

Watersheds

Answer 10

Regions that drain to particular lymph nodes

Question 11

Anastomoses

Answer 11

Connection b/n lymph collectors;

Across watersheds

Question 12

Lymph system function

Answer 12

Return protein and fluid from interstitial to CV system
Absorbs fat and vitamins from small intestines —> CV system
Immune surveillance and functions
Filter fluid

Question 13

Lymph system removes these from insterstitium

Answer 13

Protein 
Water
Cell 
Fat
Carbs, electrolytes, creatinine, urea, coagulation factors

Question 14

Lymph time volume

Answer 14

Amount of fluid removed from intersititum per day
Normal 4L
Norm approx 10% of transport capacity

Question 15

Transport capacity

Answer 15

Max amount of fluid lymphatic system can carry

Question 16

Lymph functional reserve

Answer 16

Difference between normal lymph time volume and transport capacity
If system not running at transport capacity, lymph time volume can be increased to handle increased fluid

Question 17

Increased lymph capillary filtration

Answer 17

Hypermedia from inflammation, massage, heat, CHF, DVT, tumor growth, venous insufficiency
Hypoproteinemia

Question 18

Lymph system removes what percent of excess interstitial fluid?

Answer 18

90%

Question 19

Lymph high output failure

Answer 19

Too much fluid for lymphatic system to return

Question 20

Lymph low output failure

Answer 20

Damaged lymphatic system cant handle normal interstitial fluid

Question 21

Combination lymph system failure

Answer 21

Lymph system damaged due to chronic conditions

Question 22

Secondary lymphedema - damage

Answer 22

Surgery – mastectomy, prostate cancer removal,

hysterectomy, other •  Cancer •  Accident/injury •  Infection •  Radiation •  In 3rd world countries: filariasis

Question 23

Lymphedema secondary - overload

Answer 23

Obesity
•  Chronic Venous Insufficiency
•  Edema caused by cardiac, liver, or renal dysfunction

Question 24

Primary lymphedema

Answer 24

Aplasia
•  Hypoplasia
•  Hyperplasia Believed to be present at birth, symptoms usually develop later

Question 25

How does lymphedema start?

Answer 25

Feeling of heaviness, achiness, pain, fullness or tension in leg or arm •  Swelling of the arm or leg •  Reduced motion of arm, hand, leg, or foot •  MOST TREATABLE AT THIS STAGE

Question 26

Steamers sign

Answer 26

Pinch test base of 2nd toe or middle finger

Question 27

Lymphedema stages

Answer 27

Stage 0: no swelling •  Stage 1: mild edema, indents with pressure •  Stage 2: significant, skin thickening •  Stage 3: extreme edema, skin hardening

Question 28

Lymphedema Tx stages

Answer 28

Intensive decongestion phase 4-6wks, 3-5x/wk Maintenance phase

Question 29

Intensive decongestion phase

Answer 29

Complete decongestive therapy 1. Manual lymph drainage 2. Compression bandaging 3. Exercise 4. Self care

Question 30

Manual lymph drainage

Answer 30

Stimulates lymph nodes, vessels to pump fluid in greater volume, directs stagnant lymph to Exeter lymphatic vessels for removal Moves fluid around damaged or impaired lymph areas

Question 31

Lymph massage strokes

Answer 31

``` Stationary circle Pump Rotary Other Tissue mobe for fibrotic skin ```

Question 32

Manual lymph leg sequence

Answer 32

``` Neck lymph nodes Abdomen Inguinal nodes UA side Anastomoses front Buttock affected, anastomoses Post thigh Popliteal fossa, calf Anterior thigh Anterior leg, foot ```

Question 33

Lymph manual arm sequence

Answer 33

``` Neck lymph nodes Ab Axilla of UA Chest anastomoses Inguinal lymph nodes affected Lateral trunk affected Posterior interaxillary anastomoses Post lateral trunk Arm, forearm, dorsal hand and fingers ```

Question 34

Lymph - low impact exercise instructions

Answer 34

*swimming *walking Yoga Cycling Rebounding Cardio machines Light body strengthening

Question 35

Lymph maintenance phase

Answer 35

``` Manual lymph drainage at home Compression bandage/garmets Exercise Deep breathing Skin care Weight loss ```

Question 36

Compression garmets pre/contras

Answer 36

``` Active cancer CHF Arterial disease (okay at 0.8 ABI, light b/n 0.6-0.8) Peripheral neuropathy or paralyzed limb (1 hour, check capillary nail refill <2 sec) DM Acute DVT Hypertension Active cellulitis/infection ```

Question 37

Additional lymph tx options

Answer 37

``` Pneumatic pumps Kines tapes Bioimpedance 2 layer bandaging system manual edema mobilization Sx Meds Laser therapy Hyperbaric oxygen ```