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FF: cardio content > Class 3: lymphatic > Flashcards

Class 3: lymphatic Flashcards

1
Q

what is Lymph:

A

The portion of interstitial
fluid that enters the lymphatic
system

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2
Q

what are the Lymphatic Organs:

A

Nodes,
tonsils, thymus, spleen, thoracic
duct, bone marrow

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3
Q

what are the major Lymph Nodes:

A

Submaxillary, cervical, axillary,
iliac, mesenteric, inguinal,
popliteal, cubital, supraclavicular,
parasternal

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4
Q

what is the Flow of Lymph

A

Fluid is transported from lymphatic
capillaries

Lymphatic collecting vessels

Along the length of these vessels, lymph
nodes occur to filter the lymph

Lymphatic trunks

Lymphatic collecting ducts

Subclavian veins

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5
Q

what is the function of the lymphatic system

A

keeps body fluid levels in balance and defends the body against infections.

drain and prevent infection

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6
Q

what is Lymphatic Load:

A

Amount of lymphatic fluid transported

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7
Q

what is Transport Capacity:

A

Maximum amount of fluid that lymphatic system can transport

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8
Q

what is Lymphedema

A

chronic disorder characterized by an abnormal accumulation
of lymph fluid in the tissues of one or more body regions.

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9
Q

what is Primary Lymphedema

A

Congenital or genetic/ hereditary
abnormalities in the lymphatic system

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10
Q

what are the three types of Primary Lymphedema

A
  • Congenital Lymphedema : Milroy
    disease
  • Lymphedema Praecox (Meige disease)
  • Lymphedema Tarda
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11
Q

what is the lymphatic duct vs the thoracic duct

A

“lymphatic duct” right lymphatic duct, a smaller vessel that drains lymph from the upper right quadrant of the body

thoracic duct” is a much larger lymphatic vessel that drains lymph from the rest of the body, primarily the lower body and left side of the torso;

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12
Q

what is Injury to one or more components of the
lymphatic system

A

Injury to one or more components of the
lymphatic system

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13
Q

what causes 2ndary lymphatic

A
  • Lymph node removal
  • Infection
  • Tumor
  • Trauma
  • Chronic venous insufficiency
  • Fibrosis
  • Filariasis
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14
Q

what is Pitting edema:

A

Pressure on the edematous tissues with the fingertips causes an
indentation of the skin that persists for several seconds after the pressure is removed.

This reflects significant but short duration edema with little or no fibrotic changes in
skin or subcutaneous tissue.

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15
Q

what happens when the transport capcity decreases

A

there will be more fluid, a collection of fluid

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16
Q

what is Brawny edema:

A

Pressure on the edematous areas feels hard with palpation.

This reflects a more severe form of interstitial swelling with progressive, fibrotic changes in
subcutaneous tissues.

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17
Q

what happens when your transport capacity is less then your lmyphatic load

A

this leads to lymphedema

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18
Q

what is weeping edema

A

This represents the most severe and long duration form of
lymphedema.

Fluids leaks from cuts or sores; wound healing is significantly impaired.

Lymphedema of this severity occurs almost exclusively in the lower extremities.

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19
Q

where does weeping edema occur

A

only in the lower extremities

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20
Q

what is Stemmer Sign

A

physical exam that helps diagnose lymphedema, a condition that causes the skin to thicken and become fibrotic.

The test involves gently pinching the skin at the base of the toes or fingers to see if it can be lifted

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21
Q

what is venous insufficiency

A

a condition where the veins in the legs don’t return blood to the heart properly

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22
Q

can venous insufficiency lead to lymph

A

yes becuase the blood is pooling in this area

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23
Q

what is a positive stemmers sign

A

Positive if the skin on the dorsal surface of fingers or toes can not be
pinched (lifted) or is difficult to pinch compared with the uninvolved
limb

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24
Q

what does a positive stremmers sign indicate

A

indicative of a worsening condition

indication of stage II or III lymphedema

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25
Q

stage 0 - lymph

A
  • No clinical edema, occasional reports of heaviness
  • Stemmer sign negative
  • Tissue and skin appears normal
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26
Q

stage 1 - lymph

A

Edema present (soft and pitting)

Edema increases with standing and activity but reduces on elevation

Stemmer sign negative

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27
Q

stage 2 - lymph

A

Hard swelling present; progresses to non-pitting ”brawny” edema

  • Stemmer sign positive (although still may be negative at early stage II)
  • Tissue appears fibrosclerotic; proliferation of adipose tissue
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28
Q

stage 3 - lymph

A
  • Edema present; severe ”brawny” nonpitting edema
  • Stemmer sign positive
  • Skin changes (papillomas, deep skinfold, warty protrusions,
    hyperkeratosis, mycotic infections, etc.)
  • Repeated bacterial and viral infections are common
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29
Q

1+ - pitting edema

A

Mild, barely perceptible indentation; <1/4-inch pitting

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30
Q

2+ - pitting edema

A

Moderate, easily identified depression; return to normal

within 15 seconds; 1/4-to-1/2-inch pitting

31
Q

3+ - pitting edema

A

Severe, depression takes 15 to 30 seconds to rebound;

1/2-to-1-inch pitting

32
Q

4+ - - pitting edema

A

Very Severe, depression lasts for >30 seconds or more;

> 1 inch pitting

33
Q

what areas does Lipedema effect

A

bilateral condition affecting the
lower extremities

affects the proximal areas, such as
the buttocks and thighs, but not distal areas,
such as the feet

34
Q

what is lipedema

A

an abnormal build-up of fat in your legs and sometimes arm

35
Q

what does lipedema effect

A

affects skin’s elasticity, the skin
sensitive to pressure and touch, which makes
it bruise easily and painful

36
Q

Lymphedema vs Lipedema - distribution

A

lymph - Unilateral or bilateral with
one leg affected more
severely (asymmetric)

lip - Bilateral lower extremities
(rarely upper extremities)
symmetric involvement

37
Q

what is worse is pitting or non pitting edema worse

A

pitting is harder to treat

38
Q

Lymphedema vs Lipedema - Cellulitis

A

lymph - common

lip - rare

39
Q

Lymphedema vs Lipedema - Pain on pressure

A

lymph - absent

lip - present

40
Q

Lymphedema vs Lipedema - Distal edema in the foot

A

lymph - present

lip - absent

41
Q

Lymphedema vs Lipedema -Stemmer sign

A

lymph - +

lip - (-)

42
Q

what is Volumetric Measurements

A

Immerse the limb in a tank of water to a predetermined anatomical landmark and measure
the volume of water displaced

43
Q

what are Bioimpedance Measurements

A

Use of a low level alternating electrical current to measure the resistance to the flow through the
extracellular fluid in the upper extremity

44
Q

how do we read Bioimpedance Measurements

A

The higher the resistance to flow, the more
extracellular fluid present

45
Q

what measurement do we use for proximal UE/LE lymph

A

Girth Measurement

46
Q

what measurement do we use for distal UE/LE lymph

A

volumetric

47
Q

what measurement do we use for pre/post surgery lymph

A

Bioelectric Impedance

48
Q

what measure do we use for Lymphatic Insufficiency

A

Lymphoscintigraphy

Measured
during rest and exercise, identifies
lymphatic insufficiency

49
Q

what is dopplers US used for

A

use to measure the blood flow through your blood vessels

50
Q

what does being tender to palpation indicate

A

Indicative of inflammation or
infection

51
Q

what does Fixed, hard and non- tender to palpation indicate

A

Indicative of
malignancy

52
Q

where does lymphdema swelling start

A

distally

  • where do we assess stremmer sign at fingers and toes
53
Q

what is the progression of edema - pitting or non-pitting first

A

pitting first that progresses to non pitting

54
Q

Dynamic pressure changes within the body: lymph treatment

A

diaphragmatic
breathing or muscle contractions

55
Q

Manual Lymphatic Drainage: what is cleared first

A

Proximal areas (trunk, groin, buttocks or axilla)
cleared first; distal areas done later.

clear the traffic jam

56
Q

Manual Lymphatic Drainage: how do we perform

A

MLD is performed using circular movements and stroking.

Direction of the stroking is Distal to Proximal
and towards specific lymph nodes.

57
Q

Phase I: Intensive phase
lymph care

A

*Manual lymphatic drainage (MLD)

*Multiple layer compression bandaging

*Skin and nail care

*Exercise

58
Q

Phase Il: Maintenance phase
lymph care

A
  • Self-MLD by the patient Compression therapy
  • Compression garment during the day
  • Multiple layer bandaging in the
    evening/night
  • Skin and nail care
  • Exercise
59
Q

Compression therapy: Phase I bandages (Active reduction phase)

A

use only low-stretch bandages

60
Q

what are low-stretch/short bandages

A

non-elastic or rigid

short stretch compression bandages provide high working pressure (while you’re moving) and low resting pressure (while you’re inactive).

Because short stretch compression bandages simultaneously provide pressure and expand, they can help move lymphatic fluid out of a limb.

61
Q

High stretch sports bandage (ACE wraps) reccomended?

A

no

62
Q

info about short stretch

A
  • Has low resting pressure and high work pressure
  • From Distal-to-Proximal direction
  • Used during day and night
63
Q

Exercises: for lypmhdema

A

Active ROM, stretching, low
intensity resistance exercises
- performed wearing compression
garment or bandages

  • Proximal-to-Distal direction
64
Q

why do we look at nail and skin care for lymph

A

Attention to avoid skin breakdown,
infection and delayed wound
healing

65
Q

should lymph node be mobile

A

yes

66
Q

should lymph nodes be tender or non-tender

A

non-tender

67
Q

should lymph node be soft or hard

A

soft

68
Q

what is lymphadenopathy

A

Enlarged lymph nodes

69
Q

what is the goal of the intensive phase of decompression therapy

A

reduction as much as we can

70
Q

what type of bandages are used in phase 1 treatment

A

short/low stretch bandages

71
Q

when are high stretch bandages used

A

after an ankle sprain

it has a lot of stretch - low working pressure and high resting pressure

72
Q

should you do proximal or distal exercises first

A

proximal then distal

breathing exercises before arm exercises

73
Q

what kind of compression do we use in phase 2: matinence phase of lymph

A

compression garment - these are worn all day

no longer using short stretch during the day

short stretch are worn at night

FF: cardio content (11 decks)

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