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Cardio-Pulmonary > Lymphedema - CH24 Book > Flashcards

Lymphedema - CH24 Book Flashcards

(75 cards)

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1
Q

design of lymphatic system

A

one-way system

lymph through superficial and deep vessels

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2
Q

where are lymph nodes not at

A

brain and spinal cord

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3
Q

what causes lymph formation

A

blood plasma
leaves blood capillaries and enters the interstium
portion of that interstitial fluid that gets back into the lymph vessels is termed lymph

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4
Q

what is lymph made of

A

protein
water
fatty acids
cellular components

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5
Q

what cellular components are housed in lymph

A

white blood cells
bacteria
virus
cellular debris

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6
Q

what are the organs of the lymphatic system

A

lymph nodes
thymus
bone marrow
spleen
tonsils
peyer patches

– all produce lymphocytes

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7
Q

initial lymph vessel

A

first and smallest vessel
- aka lymph capillary

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8
Q

explain structure of initial lymph vessels

A

blind/dead-end sacs of endothelium that lack valves

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9
Q

where are initial lymph vessels

A

near blood capillaries just under the dermis

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10
Q

where do initial lymph vessels begin? why is this important

A

interstitium and form capillary networks surrounding blood capillaries

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11
Q

composition of initial lymph vessel walls

A

single layer of endothelial cells
- will either border each other or overlap

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12
Q

if endothelial cells overlap, what is made

A

openings via open junctions
or
inlet valves (larger substances)

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13
Q

explain function of the endothelial wall and passage of molecules

A

vessels are secured to connective tissue by anchoring filaments that pull on the cells of the wall

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14
Q

explain how the cells of the endothelial wall open

A

when filaments pull on the cells, the wall channels open

  • influx of proteins, cellular debris, fluid/macromolecules
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15
Q

how else can interstitial fluid/macromolecules enter the initial lymph vessels

A

muscle contractions, respiration, manual lymphatic drainage

– all elicit vascular pressure changes

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16
Q

what are precollectors

A

larger lymphatic vessels
- connect initial lymph vessels to collectors

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17
Q

what are collectors

A

larger than initial but not larger than trunks/nodes lymphatic vessels that collect lymph

follow the path of deep areteries/veins

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18
Q

what is the collector wall made of

A

3 layers

intima = inner layer
media = medium layer
adventitia = outermost layer

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19
Q

what is within the adventitia

A

contains the blood vessels / nerves

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20
Q

what is the lymphangion

A

functional unit of collectors between the two valves

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21
Q

what differentiates a lymphatic trunk and initial vessels

A

thicker smooth muscle in the media

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22
Q

what controls the contraction of lymphatic trunks

A

sympathetic nervous system

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23
Q

explain the drainage of right lymphatic duct

A

into right venous angle
- right arm and right head (1/4 of body)

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24
Q

where are the lymphatic nodes mainly concentrated

A

neck
axilla
chest
abdomen
groin

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25
what is a lymph node surrounded by
fibrous capsule - collagen and elastic fibers smooth muscle that can contract
26
function of lymph nodes
filter harmful material immune surveillance via T/B lymphocytes concentrate lymph
27
what is a lymphotome
specific regions of lymph drainage -- separated by watershed areas that have few lymph collectors
28
what pressures control fluid entry/exit
plasma hydrostatic pressure plasma colloidal osmotic pressure interstitial fluid hydrostatic interstitial colloidal osmotic pressure
29
what action is plasma hydrostatic pressure associated with
filtration then reabsorption
30
what action is plasma colloidal osmotic pressure involved in
reabsorption
31
what action is interstitial fluid hydrostatic pressure involved in
supports reabsorption of fluid into blood capillary
32
what is interstitial colloidal osmotic pressure
filtration
33
what causes the highest incidence of lymphedema
breast cancer surgery / treatment
34
describe lymphedema
inability of lymphatic system to handle demands placed upon it accumulation of protein-rich edema in the interstitium
35
effect of lymphedema
increased interstitial colloidal osmotic pressure -- increased blood capillary filtration and decreased capillary reabsorption
36
indication of external compression
microcirculation issues -- reversing high blood capillary filtration rate -- increase low blood capillary reabsorption
37
what is transport capacity
maximum ability to transport lymph
38
explain total capacity and the things that affect it
each person has an individual TC -- affected by surgery, trauma, infection or radiation
39
what is lymphatic load
amount of lymph transported by lymphatic system
40
what is the functional reserve
safety valve mechanism that controls any additional demands placed upon the lymphatic system
41
types of lymphatic system insufficiencies
mechanical dynamic combined
42
explain dynamic insufficiency
high-output insufficiency -- when lymphatic load exceeds total capacity
43
what can cause dynamic insufficiency
CHF Chronic Venous insufficiency (1/2 level) immobility hypoproteinemia pregnancy
44
explain indication of patient with dynamic insufficiency
can become medical emergency due its possibility to damage lymphatic system
45
explain mechanical insufficiency
low-output insufficiency -- impaired total capacity
46
what is the result of mechanical insufficiency
LYMPHEDEMA ya dingbat
47
what is defined as combined insufficiency
TC is reduced LL is abnormally high
48
explain the sequelae of issues with lymphedema development
lymph vessels dilate -- become incompetent lymphostasis accumulation of protein rich edema in the interstitium
49
how does the lymphatic system compensate
generating new initial lymphatics lymph-lymph anastomoses collateral lymphatics to bypass areas
50
primary lymphedema
resultant of abnormally developed lymphatic system that is congenital or hereditary
51
main abnormalities of lymphatic system? what do they cause?
hypoplasia - incomplete development hyperplasia - enlarged diameter, valve insuff aplasia - absence of lymph vessels -- impaired total capacity
52
explain characteristics of primary lymphedema
in LE more frequently classified based on stage of life
53
when is congenital lymphedema observed
birth-2 years
54
secondary lymphedema
resultant of insult to lymphatic system which causes a reduced TC
55
more common causes of secondary lymphedema
surgery / trauma radiation tumor infection venous insuff/arterial induced
56
what is lymphatic filariasis
tropical disease via mosquitos
57
stage 0 lymphedema
edema free latent stage - subclinical lymphedema no swelling, normal appearing tissue with reduced TC
58
stage 1 lymphedema
reversible stage -- tissue that has little fibrotic changes, but pitting edema that resolves or reduces w/elevation
59
stage 2 lymphedema
spontaneously irreversible stage - characterized by brawny nonpitting edema that does not reverse with elevation
60
explain what can be observed in stage 2 lymphedema and why?
stemmer sign at dorsum base of 2nd digit connective tissue is chronically inflamed and fibrotic
61
stage 3 lymphedema
elephantiasis most severe form of lymphedema characterized by extensive amounts of lymphedema fibrosis
62
what are the phases of CDT
treatment - 1 self-management - 2 manual lymph drainage compression exercise specific skin care
63
explain phase 1 of CDT
MLD compression = bandages then compression garments exercise = in bandage meticulous skin care
64
self-management phase
compression - garment at day and bandage at night exercise = limb compressed skin care and MLD as needed
65
main effects of manual lymph drainage
flow in initial lymph vessels can increase the frequency of lymph vessel contraction
66
explain effectiveness of phase 1 CDT
50% of success is made via compression -- MLD alone is not as effective
67
what additional aspects can compression assist with
support for tissue that has lost its elasticity -- can soften fibrotic areas
68
main type of compression bandage in lymphedema treatment
short-stretch
69
explain why short-stretch bandages
higher working pressure -- resistance as muscle contracts
70
contraindications for compression
ABI < 0.8 painful post-phlebitic syndrome
71
lipedema
gradual/progressive bilateral accumulation of fat in subcutaneous tissues
72
explain location of lipedema
always bilateral, not seen in UE as much -- proximal areas like butt and thighs will have a negative Stemmer sign
73
explain accessory conditions related to lipedema
skin bruising skin sensitive to pressure/touch loss of skin elasticity
74
differential diagnosis lymphedema vs lipedema
lipedema - almost exclusively women, familial history, Bilat LEs, no foot edema / Stemmer sign, pain with pressure and easy bruising
75
lipolymphedema
combination of lipedema and lymphedema

Cardio-Pulmonary (22 decks)

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