Exam 4 Flashcards
Lymphathic organs
Lymph nodes (600-700 in body) “Filtering stations,” produce WBC, regulate proteins in lymph Lymph vessels Intrinsic contractions, 6-10x/minute Thymus gland Spleen Tonsils Peyer’s patches
Lymphatic vessels
Capillaries
Pre-collectors
Collectors
Trunks
Mechanisms of Transportation
Intrinsic contraction Respiration Arterial/venous pulsation Skeletal movement New lymph (creates pressure)
Lymph fluid consists of
Proteins
75-100 g of proteins are transported by the lymph vessels per day
Water
Cells (RBC, WBC, Lymphocytes)
Waste products and other foreign substances
Fat (intestinal lymph, chyle)
Filtration=
Resorption + Lymph Flow
Lympathic load
How much – water, proteins, cells, etc
Lymph Time Volume (LTV)
Amplitude and frequency of intrinsic contractions
Transport Capacity
=Max LTV
= 10x LL in intact system
Functional Reserve
Difference between TC and LL
Normal
LL< TC
Dynamic insufficiency –
overload lymphatic system
Venous insufficiency, cardiac edema, DVT, etc
Mechanical insufficiency – lymphatic system damaged
Surgery, trauma, radiation, etc
Lymphedema always includes mechanical insufficiency
Combined insufficiency
damaged system and overload
Obesity, CVI, lipedema
Lymphedema
An abnormal collection of protein-rich fluid in the interstitium, which causes chronic inflammation and reactive fibrosis of the affected tissues
The lymph load exceeds the total capacity of the system
Risk Factors of Lymphedema
Axillary, inguinal, etc surgery Radiation therapy Partial or total mastectomy Node dissection Obese or overweight Lipedema History of infection in at-risk limb Constriction Tumor causing lymphatic obstruction Scarring lymphatic ducts by either surgery or radiation Intra-pelvic or intra-abdominal tumors Chronic venous insufficiency Drain complications
Primary Lymphedema
Mechanical insufficiency of the lymphatic system
Malformation of lymphatic vessels
Congenital or hereditary
Secondary Lymphedema
Known cause for lymphedema Surgery Radiation Trauma Filariasis Cancer/tumor Infection Obesity Self-induced
Early signs of Lymphedema
Limb feels heavy Skin feels tight Limb is achy (not painful) Clothing or jewelry is tight Can’t see wrinkles in skin
Stage: Latency
no visible/palpable edema, subjective complaints possible
Stage 1:
reversible (elevation), pitting edema often present, increased limb girth and heaviness, no fibrosis
Stage 2:
consistent swelling- does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult
Stage 3:
lymphostatic elephantiasis, non-pitting, fibrosis and sclerosis, skin changes (hyperkeratosis)
Skin characteristics
Hyperkeratosis (Redding but it becomes hard)
Lichenification (leathery and hard)
Peau d’Orange Texture
Ulcers
May be more common with arterial, neutrotrophic, venous, or traumatic conditions
Vesicles (cysts)
Infection -lymphedema
Reflux
Weeping = lymphorea
Differential diagnosis
Deep vein thrombosis (DVT) Renal failure Postoperative complications Cysts Complex regional pain syndrome Cellulitis Cardiac edema Congestive heart failure Malignancy
Lipedema
Primarily women Bilateral, symmetrical swelling from ilium-> ankle Dorsum of feet not involved Little or no pitting Palpable nodules fat under skin Painful to palpation Bruise easily
Venous Edema
Mid/low calves, malleoli Skin discoloration Fibrosis of subcutaneous tissue Atrophic skin Wounds
Do medications help lymphedema?
no