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Integ Patho (PTH 701) Quiz #1 > 6. Very Brief Lymphedema Review > Flashcards

6. Very Brief Lymphedema Review Flashcards

1
Q

What are Initial Lymphatics?

A

Lymphatic capillaries

  • Passive starting point of the lymph system
  • Unidirectional, single layer of endothelial cells
  • Located between the skin and muscle
  • Empty into collecting vessels
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2
Q

What are Collecting Vessels?

A

Thin vessels with weak muscular walls
Require pressure changes to move lymph fluid
Contain unidirectional valves that prevent back flow
Empty into lymph nodes

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3
Q

What are lymph nodes?

A

Filtering stations for cleansing lymph fluid
Trap bacteria, CA, broken cells
Centers for growth and storage for lymphocytes
Empty into ducts

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4
Q

What does the Thoracic Duct drain?

A

Drains LUE and B LEs. Empties into junction of left internal jugular and left subclavian veins (R thoracic duct does RUE and empties at same spot but on the R)

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5
Q

What is the Cisterna Chyli?

A

Most inferior part of the thoracic duct

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6
Q

What are functions of the Lymph?

A 
Immune System Defense 
Nutrition (intestinal lymph vessels absorb digested fats)
Fluid Balance (Filtration and Reabsorption)
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7
Q

What is Filtration?

A

Blood capillary pressure > Plasma osmotic pressure

Greater out

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8
Q

What is Reabsorption?

A

Plasma osmotic pressure > Blood capillary pressure

Greater in

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9
Q

What is Sterling’s Law of the Capillaries?

A

The direction and rate of fluid exchange (filtration/reabsportion) between capillaries and the interstitial space are dictated by the hydrostatic and osmotic pressures of the two fluids

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10
Q

What is Lymph Obligatory Load?

A

10% of capillary ultrafiltrate resorbed as lymph obligitory load - includes proteins too large to return through the venous system

Lymphatic capillaries resorb lymphatic fluid and transfer it back into the venous system

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11
Q

What is most common problem in lymphatic system?

A

Lack of ability to reabsorb

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12
Q

You see 2 swollen legs, what is likely wrong?

A

CV problem

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13
Q

What is Chronic Venous Insufficiency?

A

Occurs due to vein blockage or insufficient valves of the veins

Risk factors: age, female (progesterone), being tall, genetics, hx of LE DVT, obesity, pregnancy, sitting or standing for a long time

Increased pain with standing but decreased pain with LE elevation. Ulcers on legs and ankles. Fibrotic skin changes on the legs and ankles (lipodermatosclerosis)

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14
Q

Is Swelling a symptom?

A

Yes…a symptom that needs a diagnosis

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15
Q

How do you treat generalized clinical edema?

A

Proper dx and medical management (localized requires apporopriate therapy)

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16
Q

Is lymphedema often misdiagnosed?

A

Yes

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17
Q

What is Lymphocytosis?

A

Elevated WBC

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18
Q

Lymphomas?

A

Acquired injury to DNA of a lymphocyte, causing a malignant transformation into a liquid tumor (Hodgkin’s (young adults) and non-Hodgkin’s

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19
Q

IS HIV/AIDS a lymphatic system disorder?

A

yes

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20
Q

Lymphocele -

A

A lymph-filled collection in the retroperitoneum devoid of any epithelial lining; post-op complication of radical gyn surgery

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21
Q

Lymphadenitis?

A

Infection of the lymph nodes, often due to bacterial infections

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22
Q

Lymphangitis?

A

Infection of lymph vessels, often due to bacterial infections

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23
Q

What is LIPIDema?

A

Chronic disease of lipid metabolism

  • Symmetrical impairment of nodular fatty tissue distribution and storage combined with the hyperplasia of individual fat cells
  • Usually occurs in women w/ family hx
  • Diagnosis is based on clinical history and physical examination
  • Associated with HYPERmobility syndrome
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24
Q

Where does lipidema usually present?

A

In the upper arm and LEs (but SPARES THE FEET!)

  • Usually symmetrical
  • Often painful to palpation (secreted cytokines/toxic enzymes)
  • Negative for Stemmer’s Sign
  • Often assoicated with a estrogen/progesterone hormonal disturbance (estrogen metabolites in tissue can make fat cells develop)
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25
Q

When does lipidema usually onset?

A

Onset typically at puberty due to high hormone levels (pregnancy and menopause may also exacerbate)

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26
Q

When diagnosing Lipidema, what other causes must you rule out?

A

Superior VEna Cava syndrome, hypothyroidism, dental abcesses, Inferior Vena CAva Syndrome

27
Q

What is Hypoproteinemia?

A

Low protein levels in blood, high levels in urine

-Swelling due to increased lymph-to-plasma ratio

28
Q

Hypoalbuminemia?

A

Liver failure, cirrhosis, metastasis

29
Q

Amyloidosis?

A

Abnormal amyloid protein accumulation in tissues

30
Q

Multiple Myeloma?

A

Hematological cancer

31
Q

Diffuse myexedema?

A

Severe hypothyroidism, fluid accumulation assoicated with proteoglycans in the interstitial space of the dermis

32
Q

When does lymphedema occur?

A

When lymphatic load exceeds transport capacity - results in a stagnation and subsequent accumulation of protein-rich lymphatic fluid

Due to lymph drainage failure, obliterated lymphatics, or obstructed lymphatics

Can be orthopedic pain but usually no pain w/ palpation

33
Q

What is Primary Lymphedema and which gender is it more common in?

A

Lymphangiodysplasia - malformation of the lymph system in utero. Occurs more often in females; usually bilateral

Starts DISTALLY and progresses prox; possible genetic component

34
Q

What are the three different Primary Lymphedema Onset Categories?

A

Milroy’s Disease - presents at birth (LEs involved; congenital)

L. Praecox (before age 35; onset at puberty)

L. Tarda - After age 35 (non-hereditary)

35
Q

Is lipidema primary or secondary?

A

Primary

36
Q

What are Cystic Hygromas?

A

Forms in utero from embryonic lymphatic tissue

37
Q

Lymphangiomas?

A

Congenital malformations involving the skin and subcutaneous tissues

38
Q

Lymphangiectasias?

A

Represent superficial lymphatic dilation caused by a wide range of scarring processes

39
Q

Lymphangiomatosis?

A

Lymph vessel tumor or cyst most often found in bone and lung

40
Q

Difference between Grade I and II Lymphedema?

A

I - soft, pits, (mild, moderate, severe)

II - Fibortic, hard, no pitting

41
Q

What is Human Lymphatic Filariasis?

A

Infection secondary to nematode worms - larvae introduced through mosquito bite

Presentation: Emephantiasis, hydrocele, lymphedema - mainly seen in equator and southern hemipshere

42
Q

What are 4 reasons for a rise in secondary lymphedema?

A

Increasing age of population
Increasing incidences of obesity
Increased number of cancer survivors
Increased use of radiation therapy due to minimally invasive surgeries

*This is the greatest risk with cancer!

43
Q

What is the risk of lymphedema assoicated with?

A

ALND (Axillary LN Disease) and SLNB (Sentinal LN Biopsy)

Risk of Breast Cancer also associated with XRT to the breast post lumpectomy (SLNR and chemo too)

XRT to the axilla/supraclavicular nodes increased the risk of lymphedema, but SLNB has revolutionized the risk reduction of lymphedema

44
Q

LE Lymphedema risk factors?

A

LN removal from groin region (including melanoma)
RT to groin area increases risk
LE lymphedema risk is greater due to the gravity dependence of the LEs

45
Q

Risk factors of genital Lymphedema?

A

XRT to groin area
Inguinal dissection
LE COMPRESSION PUMPS! Can cause or worsen
(but compression garments can be beneficial)

46
Q

Head and neck lymphedema risk?

A

Resection of cervical lymph nodes results in a risk of head and neck lymphedema
XRT to the cervical lymph nodes also increases the risk

As the end point of the lymph system, compromise in this area can result in lymphedema in other regions

47
Q

Risk factors for cancer proven by research in women?

A

Obesity
Poor general health
Hx of cancer

48
Q

What is a Lymphangiography?

A

(aka lymph node angiogram) It is…a test which utilizes XR technology, along with the injection of a contrast agent, to view lymphatic circulation and lymph nodes for diagnostic purposes

49
Q

What is lympscintigraphy?

A

Imaging technique used to identify the lymph drainage basin and determine the number of sentinel nodes - can mark sentinal nodes in breast cancer

50
Q

Different lymphedema assessment techniques?

A

Measurements
Water displacement
Tissue tonometry - weighted device on skin measures depth of penatration
Perometry - infrared optoelectronic volumetry (creates circumference profile chart; used for assessment and garment fitting)
Bioelectrical Impedance Analysis - electrically measures water (good for UE edema in FEMALES)
Moisture meter (head and neck h2o content)
Near Infrared (NIR) Fluorescence Imaging

51
Q

What is Stemmer’s Sign?

A

A thickened fold of skin at the base of the second toe or second finger that can gently be pinched and folded
-More common in primary
POSITIVE when skin cannot be lifted
(Absence does not rule out possibility of lymphedema)

52
Q

What are some self-reported outcomes?

A

FACT-B (v4)
LBCQ
Morbidity Screening Tool
GCQL

53
Q

What are the 4 major components of Complete Decongestive Therapy?

A

Manual Lymphatic Drainage
Compression (dis to prox)
Exercise (inc in HR and RR pumps lymph)
Skin Care / Education (lower skin pH)

(avoid cuff weights and machines that press weight down thru shoulders)

54
Q

What is Charles Procedure?

A

Removes skin and all underlying at tissue down to the fascia then skin grafted

55
Q

Liposuction?

A

MUST wear compression garments of lymphedema recurs

56
Q

Microsurgery?

A

Lymphaticovenular Bypass uses lymphangiography to locate appropriate alternate lymphatic vessel to create anastomosis

57
Q

What is Vascularized Lymph Node Transfer?

A

Microsurgical node transplant/vessel connection for lymphangiogenesis in area of lymphedema

  • Donor sites of groin/contra supraclavicular, axillary
  • -Lympedema risk/incidence at donor site region
  • -Therefore, use lymphoscintigraphy to determine less significant nodes to harvest

Lifelong compression post-op

58
Q

Two investigationsal modalities?

A

High voltage pulsed current

Low level laser therapy

59
Q

What is Ascites?

A

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

60
Q

How does SLNB work?

A

If negative on frozen section, procedure is complete

If positive, surgeon will perform complete dissection of lymph nodes (most tumors aka 75% have 2+)

61
Q

Is there any data to prove air travel causes lymphedema?

A

Nope

62
Q

What is Axillary Reverse Mapping?

A

Modified lymph node mapping technique for identifying the SLN while preserving the functioning UE lymphatics to minimize the risk of lymphedema

Isosulfan blue dye in injected in the ipsilater upper inner arm along the intramuscular groove…and tracks in the lymphatics to the axilla and serves to identify the lymphatic channels of the arm

63
Q

What is LYMPHA (Lymphatic Microsurgical Preventive Healing Approach)?

A

Pioneered by Italian physician Boccardo

Procedure consists of performing lymphatic-venous anastomoses (LVA) at time of completion of AD

Integ Patho (PTH 701) Quiz #1 (8 decks)

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