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CardioPulm Exam 3 > CP Exam 3: Lymphedema > Flashcards

CP Exam 3: Lymphedema Flashcards

1
Q

What is lymphedema?

A

accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in arms, legs and other parts of body

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2
Q

What is another definition for lymphedema?

A

a chronic inflammatory lymphostatic disease caused by mechanical failure of the lymphatic system

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3
Q

What is 4 main roles of lymphatic system?

A
  1. filters harmful substances from blood
  2. produces lymphocytes (WBC)
  3. Immune system role- detects and combats pathogens
  4. circulatory system roles- drains waste products circulatory system at capillary beds
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4
Q

What are the two anatomical distributions of the lymphatic system?

A
  1. superficial- skin and fat

2. deep- organs, muscles and tissues

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5
Q

What are characteristics of lymphatic system?

A

its a one way system moving distal to proximal that starts in interstitium (3rd space)

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6
Q

What is lymphatic fluid made up of?

A

water, protein, broken up fat and cells

water will return to circulatory system

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7
Q

What do lymphatic vessels look like?

A

finger like cells that collect stuff, they are perpendicular to the capillary beds

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8
Q

What are the four types of lymphatic vessels?

A
  1. capillaries
  2. pre collectors
  3. collectors
  4. trunks
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9
Q

What are the primary lymphatic organs?

A

bone marrow and thymus

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10
Q

What are secondary L.O?

A

spleen, lymph nodes, tonsils, lymphatic tissue

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11
Q

What is the role of lymph collectors?

A

transport lymph to regional nodes and trunks, these are well developed valves

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12
Q

What are lymphangions?

A

these are smooth muscle between distal and proximal pair of valves

when they are stretched they begin to contract and pulse fluid through lymph system

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13
Q

What are other characteristics of lymphangions?

A

regulated by ANS, approx 10 contractions a minute

affected by muscle contractions and pulsation of blood- biggest factor!

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14
Q

What are lymph nodes function?

A
  1. protect- filters harmful material in lymph fluid
  2. immune- produced antigen stimulated lymphocytes
  3. thicken lymph fluid
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15
Q

Where are the five major regional lymph nodes?

A
  1. head, neck, cervical
  2. axillary
  3. cubital
  4. inguinal
  5. popliteal
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16
Q

What are the lymphatic trunks?

A

large vessels leading to the thoracic duct

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17
Q

Are there lymph nodes in the ankle?

A

No

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18
Q

What happens if there is lymphedema in the neck?

A

can raise HR and even drop it to point of stopping it aka “lizard neck”

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19
Q

How much circulatory plasma protein is there at any 1 time?

A

150-200 grams, atleast 1/2 leaves vasculature into insterstitial

20
Q

What is normal lymph fluid volume?

A

2-3 liters per day

21
Q

What is pathological lymph fluid volume?

A

over 3 liters per day

22
Q

What is difference between right and left side of lymph system?

A

only R UE drains into right side everything else goes to L side

Therefore left side harder to treat as there is more traffic

23
Q

What is primary lymphedema?

A

lymphatic vessels are missing or impaired, usually hereditary and can affect more than 1 body part, usually with vascular abnormalities

24
Q

What is secondary or acquired lymphedema?

A

self induced or trauma related, can develop immediately or may take years to develop

25
Q

What are the number causes of 2nd lymphedema world wide and in developed world?

A

world- infection (filariasis is #1, cellulitis, lymphangitis)

developed world- can treatment/ radiation

26
Q

What is something random associated with lymphedema?

A

long airplanes this is why cabins must be pressurized to 8000 ft

27
Q

What are most common locations of lymphedema in males and females?

A

M: genitals

F: lower extremity

28
Q

What is important to remember about bilateral lymphedema?

A

almost always asymmetrical

29
Q

What are most common cancers that cause lymphedema?

A

breast cancer, melanoma, head/neck

30
Q

What are some major concerns with head/neck lymphedema?

A

limited cervical ROM, difficulty swallowing, breathing, talking, malnutrition

31
Q

Who is at major risk for lymphedema?

A

high BMI, lymph node removal followed by chemo, radiation and low physical activity

32
Q

How is lymphedema diagnosed?

A
  1. history and physical examination

2. measures and tests (volume measurements, changes in electrical conductance)

33
Q

What are three cardinal signs for lymphedema?

A
  1. increased size of involved body part, bony landmarks less visible
  2. skin discoloration- due to broken down RBC
  3. tissue/ texture changes of skin- due to fibrosis and hardening
34
Q

What are other signs for lymphedema?

A
  1. pitting

2. stemmers sign- pinch skin and it stays up

35
Q

What are symptoms patients may complain of?

A

heaviness, tightness, fatigue that isn’t muscle soreness, coldness, pain but not unbearable

36
Q

What is CTCAE criteria for neck edema?

A

stage 1-asymptomatic localized neck edema

stage 2- moderate neck edema, slight obliteration of anatomic neck landmarks

stage 3- generalized neck edema, limiting self care ADL

37
Q

What is gold standard of care for lymphedema?

A

complete decongestive therapy

38
Q

What does CDT consist of?

A
  1. manual lymph drainage
  2. compression bandaging
  3. exercise
  4. self care
  5. compression garments
39
Q

What are the two phases of CDT?

A

phase 1. approx 2-4 weeks intensive phase usually directed by PT

Phase 2- improvement phase or pt management lifetime

40
Q

What is MLD?

A

decongestion of regional lymph nodes, begin proximally to make room for fluid movement then slowly move distally

light skin stretching technique to remove fluid by stimulating the lymphatic system

41
Q

How does compression bandaging help?

A

provides pressure to facilitate angiomotoricity, encourages movement of fluid, prevents refilling, softens tissues

42
Q

What is big difference in lymphedema type bandaging?

A

use short stretch rather than long stretch

43
Q

What does exercise do to help?

A

uses muscle contractions, performed with compression, includes active, repetitive non resistant movements

44
Q

What are contraindications of CDT?

A

absolute- CHF, renal failure, acute infection, PAD, pulm embolism, DVT

relative- high BP, arrhythmias, stenosis, polyarthritis

45
Q

Contraindications for MLD?

A

arrhythmia, thyroid disease, carotid sinus hypersensitivity, over age of 60 (relative)

CardioPulm Exam 3 (10 decks)

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