Lymphedema--Jen

Question 1

Lymphotomes

Answer 1

• anatomical regions that drain to same area

- left/right and upper/lower

Question 2

Lymph flows toward:

Answer 2

• nodes from peripheral tissues

- controlled by bicuspid valves of lymphangion

Question 3

lymphangion

Answer 3

• segment of lymph vessel that contains a bicuspid valve
• has smooth muscle
• lined with epithelial cells

Question 4

Smooth Mm Contraction of lymphangion

Answer 4

• initiatied by pressure increase outside the vessel
• pumps only 3-4 times per min
• need skeletal movement to move fluid

Question 5

lymph vessels empty into:

Answer 5

-veins near internal jugular and subclavian veins

Question 6

How many nodes in body

Answer 6

-600

• 160: head neck
• 200: digestive system

Question 7

Ducts/Trunks

Answer 7

• larger lymph vessels

- lumbar trunk and intestinal trunks flow to cisterna chili then to thoracic duct at venous angle

Question 8

Pressure change by respiration increases____

Answer 8

rate of lymph flow into the thoracic duct

Question 9

Function of Lymph System

Answer 9

• maintain balance of fluids
• return fluid/substances from interstitium to blood stream
• differentiate between foreign and self cells

Question 10

Lymph Fluid Contains

Answer 10

• water
• proteins
• cytokines
• enzymes
• lymphocytes
• macrophages
• –bacteria, fungi, viral, tumor cells

Question 11

Lymphadema

Answer 11

• abnormal collection of excessive tissue proteins, edema, chronic inflammation and fibrosis
• lymph load>total capacity

Question 12

complications of lymphadema

Answer 12

• recurrent infection (cellulitis etc)
• chylous reflux
• lymphocutaneous fistulae (weeping) pathways from lymph vessel to surface of skin
• lymphangiosarcoma

Question 13

chylous reflux

Answer 13

-backflow of intestinal lymph

Question 14

Lymphangiosarcoma

Answer 14

-cancer of lymphatic vessels

Question 15

Risk Factors

Answer 15

• axillary surgery (any cancer surgery)
• radiation therapy
• mastectomy
• axillary node dissection
• obese
• delayed wound healing
• tumor causing lymphatic obstruction
• scarring ducts from surgery/radiation
• intrapelvic/intra-abdominal tumors
• chronic venous insufficiency

Question 16

Medical Management

Answer 16

• no meds, no surgery

- PT

Question 17

Diagnosis

Answer 17

• lymphangiography
• Lymphoscintigraphy (gold standard)
• venography/dopplar US

Question 18

PT Tests/Measures

Answer 18

• stemmer’s sign: inability to pinch skin on dorsal hand/foot
• volumetrics: water displacement
• Circumferential: use formula to determine volume

-if it resolves with elevation then it’s not lymphadema

Question 19

Staging of Lymphadema

Answer 19

stage 1-3

Question 20

Stage 1

Answer 20

spontaneously reversible (elevation)

• pitting edema
• increased limb girth and heaviness

Question 21

Stage 2

Answer 21

• does not change with elevation
• spongy tissue feeling
• fibrotic changes

Question 22

Stage 3

Answer 22

-lymphostatic elephantiasis

Question 23

Precautions/Contraindications with lymphedema complicatiosn

Answer 23

• careful techniques (don’t cause genital edema)
• US
• Elastic tubular bandage
• skin irritation
• infection
• CHF
• cognition/communication
• DVT

Question 24

PT for Lymphadema

Answer 24

-Complete Decongestive Therapy (CDT)

Question 25

CDT

Answer 25

- Manual lymphatic drainage (MLD) - compression bandaging - exercise - skin care - risk reduction

Question 26

Manual Lymphatic Drainage

Answer 26

- increase movement of lymph & interstitial fluid - stretching of skin - pressure phase - relaxation phase - slow: 5-7 reps per area

Question 27

Stretching of skin effects:

Answer 27

-effects superficial lymph vessels

Question 28

Pressure Phase promotes:

Answer 28

fluid movement in desired direction

Question 29

Relaxation Phase causes:

Answer 29

-vacuum due to distention of tissue and leads to refilling of vessels

Question 30

Compression Bandaging

Answer 30

- short stretch, low elastic - low resting pressure - high working pressure - non stretch tubular layer (wick moisture) - layered with graduated pressure in limb

Question 31

Compression Garments

Answer 31

- maintain limb size (not reduce it) | - Graded: class 1-4

Question 32

Class 1 Garments

Answer 32

-20-30mmHg

Question 33

Class 2 Garments

Answer 33

- 30-40mmHg | - UE

Question 34

Class 3 Garments

Answer 34

- 40-50mmHg | - LE

Question 35

Class 4 garments

Answer 35

-60+mmHg

Question 36

Reason of Disuse of Garments

Answer 36

- not fit properly - not aesthetically pleasing - uncomfortable fabric - difficulty to don/doff - wrong amount of compression

Question 37

Exercise for Lymphadema

Answer 37

- moderate intensity - diaphragmatic breathing - muscle pump exercises

Question 38

Muscle Pump Exercises

Answer 38

- ball squeeze - elbow flex/ext - shoulder flex - cervical flex/ext - scap retraction - ankle pump - knee flex/ext - hip flex/abd/add

Question 39

Skin Care

Answer 39

- low pH moisturizer (Eucerin, Lindi) - keep clean - wash garmets - clean cuts and cover properly with anti-biotic - careful with nail cutting (podiatrist)

Question 40

Risk Reduction

Answer 40

- protect skin - avoid insect bites/public pools/burns - stay clean - exercise - avoid increased body temp (hot tub, sauna, steam) - minimize limb constriction (jewelry) - healthy nutrition - hydration

Question 41

Prognosis

Answer 41

- early detection and pt ability to self manage increases prognosis - progressive disorder - if unmanaged-->elaphantiasis

Question 42

Abdominal/Pelvic Lymphadema

Answer 42

- difficult to manage and bandage | - good results with pelvic floor Mm training and compression garments (spanks)