Chapter 169 - Lymphedema nonoperative treatment

Question 1

Roles of the lymphatic system

Answer 1

1) immune response 2) maintain fluid balance 3) absorption of fat and fat-soluble nutrients

Question 2

Non-surgical therapy for lymphedema

Answer 2

1) manual lymphatic drainage 2) compression 3) pharmacotherapy 4) laser therapy 5) hyperbaric oxygen 6) intermittent negative pressure

Question 3

What type of lymphedema is CVD-induced

Answer 3

secondary lymphedema often mis diagnosed

Question 4

Lymphedema etiology tree

Answer 4

FIGURE 169.2

Question 5

Stages of lymphedema

Answer 5

FIGURE 169.3

Question 6

4 grades of lymphedema from the Common Terminology Criteria for Adverse Events

Answer 6

TABLE 169.1

Question 7

Attempts to prevent filariasis by mass admin of this drug

Answer 7

Diethylcarbamazine + ivermectin

Question 8

methods to reduce incidence of lymphedema for cancer treatments

Answer 8

sentinel lymph biopsy first

Question 9

Risk of lymphedema in developed countries

Answer 9

1) cancer treatment 2) recurrent cellulitis

Question 10

Characteristics of malignant lymphedema

Answer 10

1) sudden onset 2) rapid progression 3) pain 4) paresthesia, paresis or paralysis 5) skin changes 6) dilated superficial veis

Question 11

Characteristics of benign lymphedema

Answer 11

1) unilateral 2) normal skin color (unless stage III) 3) positive stemmer sign 4) no pain, paresis/paralysis 5) dorsum hand/foot involved with swelling 6) deep natural skin folds

Question 12

Preventing lymphedema progression

Answer 12

1) hygiene 2) low salt, high protein diet 3) proper compression 4) walking and aerobic 5) monitor limb volume 6) avoid infection and trauma 7) limb elevation 8) wear loose fitting clothes

Question 13

Complex decongestive therapy components

Answer 13

1) manual lymphatic drainage 2) compression bandage 3) compression garment 4) compression devices

Question 14

Complex decongestive therapy phases

Answer 14

PHASE 1 (reductive): reduce size of affected area; proper skin care PHASE 2 (maintenance): life-long self-maintenance

Question 15

Patient compliance to CDT

Answer 15

60-70%

Question 16

General volume reduction with CDT

Answer 16

50%

Question 17

Manual lymphatic drainage first developed by

Answer 17

Emil Vodder 1936

Question 18

Manual lymphatic drainage steps

Answer 18

1) divide into 6 areas of drainage territories: cervical, axillary and inguinal bilaterally 2) massage intact section adjacent to area of interest 3) massage area of interest not effective alone needs to use with compression

Question 19

Compression bandage key points

Answer 19

1) tubular bandage lining 2) foam polyester or cotton under cast padding 3) digit bandages 4) multiple layer of short bandages with limited stretch ability when pulled

Question 20

Two pressure types produced with compression bandage

Answer 20

1) low resting pressure 20-30 mmHg 2) high working pressure

Question 21

Adjustable compression wraps

Answer 21

Can be self-applied by patients replace compression bandages

Question 22

Compression garments key points

Answer 22

1) used in phase 1 and 2 and in prophylaxis in high risk 2) deliver 20-50 mmHg compression with higher pressure more distal

Question 23

Contraindication to compression garments

Answer 23

1) arterial insufficiency 2) acute cardiac failure 3) extreme limb shape distortion 4) very deep skin folds 5) extensive skin ulceration 6) severe peripheral neuropathy 7) lymphorrhea

Question 24

Non-elastic support devices

Answer 24

alternative to night time wrapping self-applied by patients no clear evidence yet

Question 25

Sequential (intermittent) pneumatic compression two phases

Answer 25

1) preparation phase: pressure applied in distal-to-proximal gradient 2) drainage phase: pressure applied again in same manner

Question 26

Best arrangement of SPC/IPC

Answer 26

Multi-compartmental gradient pressures

Question 27

Contraindication to IPC

Answer 27

1) malignancy local or proximal 2) infection 3) DVT 4) patients on anticoagulation

Question 28

Pressure limit for lymphedema treatment

Answer 28

60-70 mmHg controversial

Question 29

Benefits of exercise in lymphedema

Answer 29

1) weight loss 2) inspiratory phase drains lymph 3) improved pulmonary work drains lymph

Question 30

Level of evidence in different treatment modalities of lymphedema

Answer 30

MLD - not clear Compression bandage/garment - recommended IPC - not clear exercise - not clear skin care -expert opinion only

Question 31

Drugs to treat lymphedema

Answer 31

Diuretic - no evidence Coumarin - maybe but not clear

Question 32

Evidence on laser therapy and hyperbaric oxygen and intermittent negative pressure therapy

Answer 32

laser has some evidence the rest no evidence

Question 33

Stewart-Treves syndrome

Answer 33

Lymphagiosarcoma after mastectomy (but could refer to other causes too)

Question 34

Lymphangiosarcoma origin and symptoms

Answer 34

1) vascular endothelial cells origin 2) blue-red or purple skin lesion 3) macular or papular shape 4) <1% risk