Class 3: lymphatic Flashcards
what is Lymph:
The portion of interstitial
fluid that enters the lymphatic
system
what are the Lymphatic Organs:
Nodes,
tonsils, thymus, spleen, thoracic
duct, bone marrow
what are the major Lymph Nodes:
Submaxillary, cervical, axillary,
iliac, mesenteric, inguinal,
popliteal, cubital, supraclavicular,
parasternal
what is the Flow of Lymph
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
what is the function of the lymphatic system
keeps body fluid levels in balance and defends the body against infections.
drain and prevent infection
what is Lymphatic Load:
Amount of lymphatic fluid transported
what is Transport Capacity:
Maximum amount of fluid that lymphatic system can transport
what is Lymphedema
chronic disorder characterized by an abnormal accumulation
of lymph fluid in the tissues of one or more body regions.
what is Primary Lymphedema
Congenital or genetic/ hereditary
abnormalities in the lymphatic system
what are the three types of Primary Lymphedema
- Congenital Lymphedema : Milroy
disease - Lymphedema Praecox (Meige disease)
- Lymphedema Tarda
what is the lymphatic duct vs the thoracic duct
“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;
what is Injury to one or more components of the
lymphatic system
Injury to one or more components of the
lymphatic system
what causes 2ndary lymphatic
- Lymph node removal
- Infection
- Tumor
- Trauma
- Chronic venous insufficiency
- Fibrosis
- Filariasis
what is Pitting edema:
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.
what happens when the transport capcity decreases
there will be more fluid, a collection of fluid
what is Brawny edema:
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.
what happens when your transport capacity is less then your lmyphatic load
this leads to lymphedema
what is weeping edema
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.
where does weeping edema occur
only in the lower extremities
what is Stemmer Sign
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
what is venous insufficiency
a condition where the veins in the legs don’t return blood to the heart properly
can venous insufficiency lead to lymph
yes becuase the blood is pooling in this area
what is a positive stemmers sign
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
what does a positive stremmers sign indicate
indicative of a worsening condition
indication of stage II or III lymphedema
stage 0 - lymph
- No clinical edema, occasional reports of heaviness
- Stemmer sign negative
- Tissue and skin appears normal
stage 1 - lymph
Edema present (soft and pitting)
Edema increases with standing and activity but reduces on elevation
Stemmer sign negative
stage 2 - lymph
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
stage 3 - lymph
- 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
1+ - pitting edema
Mild, barely perceptible indentation; <1/4-inch pitting
2+ - pitting edema
Moderate, easily identified depression; return to normal
within 15 seconds; 1/4-to-1/2-inch pitting
3+ - pitting edema
Severe, depression takes 15 to 30 seconds to rebound;
1/2-to-1-inch pitting
4+ - - pitting edema
Very Severe, depression lasts for >30 seconds or more;
> 1 inch pitting
what areas does Lipedema effect
bilateral condition affecting the
lower extremities
affects the proximal areas, such as
the buttocks and thighs, but not distal areas,
such as the feet
what is lipedema
an abnormal build-up of fat in your legs and sometimes arm
what does lipedema effect
affects skin’s elasticity, the skin
sensitive to pressure and touch, which makes
it bruise easily and painful
Lymphedema vs Lipedema - distribution
lymph - Unilateral or bilateral with
one leg affected more
severely (asymmetric)
lip - Bilateral lower extremities
(rarely upper extremities)
symmetric involvement
what is worse is pitting or non pitting edema worse
pitting is harder to treat
Lymphedema vs Lipedema - Cellulitis
lymph - common
lip - rare
Lymphedema vs Lipedema - Pain on pressure
lymph - absent
lip - present
Lymphedema vs Lipedema - Distal edema in the foot
lymph - present
lip - absent
Lymphedema vs Lipedema -Stemmer sign
lymph - +
lip - (-)
what is Volumetric Measurements
Immerse the limb in a tank of water to a predetermined anatomical landmark and measure
the volume of water displaced
what are Bioimpedance Measurements
Use of a low level alternating electrical current to measure the resistance to the flow through the
extracellular fluid in the upper extremity
how do we read Bioimpedance Measurements
The higher the resistance to flow, the more
extracellular fluid present
what measurement do we use for proximal UE/LE lymph
Girth Measurement
what measurement do we use for distal UE/LE lymph
volumetric
what measurement do we use for pre/post surgery lymph
Bioelectric Impedance
what measure do we use for Lymphatic Insufficiency
Lymphoscintigraphy
Measured
during rest and exercise, identifies
lymphatic insufficiency
what is dopplers US used for
use to measure the blood flow through your blood vessels
what does being tender to palpation indicate
Indicative of inflammation or
infection
what does Fixed, hard and non- tender to palpation indicate
Indicative of
malignancy
where does lymphdema swelling start
distally
- where do we assess stremmer sign at fingers and toes
what is the progression of edema - pitting or non-pitting first
pitting first that progresses to non pitting
Dynamic pressure changes within the body: lymph treatment
diaphragmatic
breathing or muscle contractions
Manual Lymphatic Drainage: what is cleared first
Proximal areas (trunk, groin, buttocks or axilla)
cleared first; distal areas done later.
clear the traffic jam
Manual Lymphatic Drainage: how do we perform
MLD is performed using circular movements and stroking.
Direction of the stroking is Distal to Proximal
and towards specific lymph nodes.
Phase I: Intensive phase
lymph care
*Manual lymphatic drainage (MLD)
*Multiple layer compression bandaging
*Skin and nail care
*Exercise
Phase Il: Maintenance phase
lymph care
- Self-MLD by the patient Compression therapy
- Compression garment during the day
- Multiple layer bandaging in the
evening/night - Skin and nail care
- Exercise
Compression therapy: Phase I bandages (Active reduction phase)
use only low-stretch bandages
what are low-stretch/short bandages
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.
High stretch sports bandage (ACE wraps) reccomended?
no
info about short stretch
- Has low resting pressure and high work pressure
- From Distal-to-Proximal direction
- Used during day and night
Exercises: for lypmhdema
Active ROM, stretching, low
intensity resistance exercises
- performed wearing compression
garment or bandages
- Proximal-to-Distal direction
why do we look at nail and skin care for lymph
Attention to avoid skin breakdown,
infection and delayed wound
healing
should lymph node be mobile
yes
should lymph nodes be tender or non-tender
non-tender
should lymph node be soft or hard
soft
what is lymphadenopathy
Enlarged lymph nodes
what is the goal of the intensive phase of decompression therapy
reduction as much as we can
what type of bandages are used in phase 1 treatment
short/low stretch bandages
when are high stretch bandages used
after an ankle sprain
it has a lot of stretch - low working pressure and high resting pressure
should you do proximal or distal exercises first
proximal then distal
breathing exercises before arm exercises
what kind of compression do we use in phase 2: matinence phase of lymph
compression garment - these are worn all day
no longer using short stretch during the day
short stretch are worn at night
What finger and toe do we test stemmed sign
2nd toe
3rd finger
If someone has a positive stremmers sign, does that mean they have brawny or pitting edema?
Brawny
