Exam 2 stuff Flashcards
Capillary (Plasma) hydrostatic pressure
- pressure inside vessel pushing fluid out
Interstitial fluid hydrostatic pressure
- pressure outside vessel pushing fluid in
Plasma colloid osmotic pressure
- pressure from proteins inside of vessel drawing fluid in
Interstitial fluid colloid osmotic pressure
- pressure from proteins outside of vessel drawing fluid out.
Primary v secondary lymphedema
primary = developmental abnormality
secondary = acquired disorder of lymphatics
What is the most common cause of lymphedema worldwide?
lymphatic filariasis
caused by mosquitos. parasitic infection
most common cause of lymphedema in US?
procedures used for dx and treatment of cancer
Lymphedema: stage 0
latent lymphedema
- lymph transport impaired. no clinical evidence of swelling
Lymphedema: stage 1
- reversible
- has pitting edema
min to no fibrosis or tissue change
Lymphedema: stage 2
- not reversible
- non-pitting edema
- mod to severe fibrosis
- may see skin changes
Lymphedema: stage 3
- Elephantiasis
- protein-rich edema
- severe fibrosis
- freq infections
prognosis of lymphedema
- life-long, progressive condition. no cure. needs to be managed
distinguishing causes of edema: pitting vs non-pitting
- pitting = early lymphedema, DVT, venous insuf.
- non-pitting = advanced lymphedema
Stemmer’s sign
pinch skin by toe. if you can lift skin = negative (lipedema is negative sign) if you cannot then positive for lymphedema
- dorm of foot spared in lipedema, but involved in lymphedema
Lipedema
- swelling due to deposits of subcutaneous adipose tissue.
- not a disorder of the lymphatic system
- treat swelling, address nutrition and exercise.
- negative stemmer sign
- ** feet uninvolved
Lymphedema risk reduction bolded stuff
- avoid BP on affected side
- avoid overheating (hot packs)
What do you do if you think someone has lymphedema?
- notify physician
- need script to treat for lymphedema
Very important to ask lymphedema pt about?
medical history. Cancer, surgeries, infections, etc.
Lymphedema severity grading. min, mod, severe
- min = 40% inc
Complete decongestive therapy (CDT) - for lymphedema
- manual lymph drainage (MLD) - massage
- compression bandaging
- exercise
- skin care
- edu, HEP
Low stretch bandages provide?
(for lymphedema)
- resistive force
- high working pressure, low resting pressure
High stretch bandages provide?
- compressive force
- high resting pressure, low working pressure.
Law of LaPlace
smaller the radius, higher the pressure
Levels of compression
Level 1 = 20-30 mmHg
Level 2 = 30-40 mmHg
Level 3 = 40-50 mmHg
Level 4 = >60 mmHg
< 20 mmHg considered a support stocking, not for treatment.
Exercises and lymphedema
- inc lymph flow 10X
- *always performed with use of compression bandages or garments
Other lymph tissues and organs that provide immune function
- thymus, bone marrow, spleen, tonsils, peyer’s patches in small intestine
What is the function of the lymph system?
- fluid back to circulation
- filters junk from lymph fluid
- absorbs fats in small intestines
- immunity
Circulatory review.
Filtration = fluid leaves capillary and go to tissue
- reabsorption = reentering circulation
- 90% thru venous network, 10% the lymphatic
What is the “true” cause of lymphedema
- reduce lymph drainage
What is cistern chyli?
lymph reservoir in abdomen at the end of the thoracic duct
Dynamic insufficiency vs mechanical insufficiency
dynamic = too much fluid. no damage to system
Mechanical = true lymphedema. problem with the system. (clogged sewer)
Does more lymph drain to right lymphatic or thoracic duct?
- 1/4 to right lymphatic
- rest = thoracic duct
Exercise dec BP by what for how long?
10-20 mmHg for up to 9 hours
wt reduction to normal BMI dec BP by what?
5-20 mmHg
Tunica intima
inner layer. smooth, prevent adherence of platelets, produces vasodilators (NO) and vasoconstrictors, semipermeable
Tunica media
- muscle
- SNS innervation
Tunica adventitia
-loose connective tissue (support and protection)
blood flow =
delta P/ resistance
resistance is related to length, viscosity, and 1/radius^4
essential vs secondary HTN
-essential = idiopathic (90%)
secondary = identifiable cause (10%)
what is the single most common characteristic of HTN?
inc TPR due to narrowing of peripheral arterioles
what is the most important preventative factor of HTN?
physical activity
FITT for HTN
F = 4-7 days/wk I = 40-60% HRR, RPE 11-13 T = 30-60 min/session T= large muscles, aerobic activities (walking)
a drop in what amount is considered orthostatic hypotension
20/10 (one or the other)
What is an aneurysm
abnormal stretching or dilation of vessel wall (50% greater than normal)
What is peripheral vascular disorders?
disorders or arterial and venous blood vessels. or both
important ischemic signs and symptoms
numbness, coldness, pallor ****
main risk factors for venous thrombosis
- previous DVT
- surgery/trauma
- prolonged bed rest
Wells clinical predictor rules
- active cancer
- immobilization of LE
- bedridden > 3 days , major surgery last 4 wks
- localized tenderness along distribution
- entire LE swelling
- unilat calf swelling >3 cm
- unilat pitting edema
- collateral superficial veins
- (-2) alt dx more likely
Key: -2 to 0 = low (3%)
1 to 2 = mod (17%)
3+ = severe (75%)
What is the goal of INR when thrombosis?
2.0-3.0
which is worse? arterial or venous insufficiency
arterial. treat it first
What is the gold standard for measuring edema?
volumetric
- detectable change is 10 mL
Does capillary refill test discriminated btw those with and without PAD?
no
Ankle brachial index (ABI)
systolic of leg / systolic of arm
*should be about 1
***post exercise drop >= 25% = PAD dx
<1 arterial disease
elevation pallor
- lift leg 45-60 degrees for 60 seconds
- normal = no change
- testing arterial insuf.
rumor of dependency
- if pallor with elevation, quickly stand
- normal = return in 15 sec
- arterial issue = >30 sec and will be dark red (positive)
venous fill time
- elevate for 1 min
- rapid change in position
- record how long it takes to fill veins
- too long = arterial issue
- too quick = venous issue
