Final Flashcards
Who discovered cisterna chyli and it’s continuum with thoracic duct?
Jean Pecquet
Which vertebrae do cisterna chyli exist
T11 - L2
Who used mercury injections to depict lymphatics?
Marie Sappey
Who created the term complete decongestive therapy (CDT)?
Földi
What are the components of CDT?
MLD Compression Skin care Decongestive exercises Patient education
Vodder said MLD should not be labeled massage. Why?
massages deep. MLD is superficial and ABOVE the fascia
Edema versus lymphedema
Edema is an accumulation of water in the tissue. Edema is a symptom. Dynamic insufficiency of the lymphatic system
Lymphedema is abnormal accumulation of water and protein. It is a disease process. Mechanical insufficiency of the lymphatic system
What does ALND stand for?
Auxiliary lymph node dissection
The most common cause for lymphedema in the United States is what?
ALND and breast cancer surgery
What is the most common cause of secondary llymphedema globally?
filariasis
Although not reported, we are discovering that ___ is also a frequent cause of lymphedema seen in practice today in the United States
obesity
The Lymphatic load of water is called what?
Net filtrate
How much water is returned to the Venous system via the thoracic duct in 24 hours?
2-4 liters
What is the pathway of FAT to the venous angle?
small intestines Gastrointestinal trunk cisterna chyli Thoracic duct Venous angle
What is the pathway for initial lymph capillaries?
initial lymph capillaries
Pre-collectors
Collectors
Lymph nodes
What is the responsibility of the perforating pre-collectors?
Transfers lymph from superficial to deep lymphatic system
What is the unorganized pathway towards lymph capillaries where interstitial fluid flows? It covers the entire body surface
initial lymph vessel plexus
Where do the lymphatic collectors reside?
located in the superficial fatty tissue above the fascia
How does a smooth muscle react to a smooth slow stretch?
Contraction
What is the pathway for the inguinal lymph nodes of the lymphatic system?
LR pelvic Inn LR lumbar inn LR lumbar trunk Cisterna chyli Thoracic duct Venous angle
auxiliary lymph nodes converge to form the ___?
subclavian trunk
Where are the bulk of auxiliary lymph nodes located?
located between the pectoralis and the latissimus dorsi muscles
Where do the auxiliary lymph nodes drain?
drains into both the supraclavicular lnn and auxiliary lnn
Where does the upper quadrant of the lymphatic system drain into?
auxiliary Lnn
Where does the lower quadrants of the lymphatic system drain into?
inguinal lnn
Where does the lymph above upper horizontal watershed drain into?
cervical lnn
name the five anastomoses
AAA: anterior axillo-axillary AII: anterior inter-inguinal AI or IA: axillo-inguinal or inguinal-axillary PAA: posterior axillo-axillary PII: posterior inter-inguinal
What is the pathway of lymph fluid to the left Venus angle?
L/R lumbar trunks Gastrointestinal trunk Cisterna chyli Thoracic duct Left venous angle
What’s another word for Venous angles?
Terminus
What is the junction of the Venus angle?
internal jugular and subclavian veins
Where are the Venous angles located?
Venous angles are located 2.5–3 inches deep into the supraclavicular fossa
what are the skin areas that drain into the left venous angle?
both lower quadrants Both lower extremities External genitalia Left upper quadrant Left side of head/face/shoulder Left Upper extremities
What are the skin areas that drain into the right Venous angle?
right upper quadrant
Right arm
Right head/face/shoulder
300ml (soda can)
What are the borders of the lateral cervical triangle for the deep cervical lymph nodes?
Anterior: SCM
Posterior: upper trapezius
Inferior: clavicle
What are the general effects of MLD?
increase in lymph production
Increase in lymphangiomotorcity
reverse of lymph flow
Increase in Venus return
Soothing
Analgesic
Describe stationary circles
Describe pump technique in MLD
Describe pump – push technique in MLD
describe “short neck” technique in MLD
describe neck/face sequence technique in MLD
1) lymph capillary
2) precollector
3) collector 
Is CDT a good plan of care for hypoproteinemia patients?
no
Dynamic insufficiency
– Healthy LS - TC is normal – LL load of water is higher than normal TC – Protein concentration in tissue is normal – High volume insufficiency - MLD/CDT not indicated - Max LTV equals TC - Edema
Mechanical insufficiency
– Unhealthy LS – TC is subnormal – LL could be normal but higher than subnormal TC – Protein concentration in tissue is higher than normal – low volume insufficiency – MLD/CDT indicated - max LTV = TC subnormal - lymphedema
Combined insufficiency
When mechanical insufficiency is present and something happens and causes an increase in lymphatic load causing lymphedema
Examples of dynamic insufficiency
Systemic Acute CHF Renal and liver failure System infection Acute sprain/strain Post op Trauma
Examples of mechanical insufficiency
surgery Dash a LND Severe burns Radiation Severe trauma Scars
what is the primary lymphedema classification?
– Congenital 10–25% (<2 yrs)
- Lymphedema precox 65 to 80% (ages 2-35)
- lymphedema tarda 11% (>35)
What is the most common cause of primary lymphedema?
hypoplasia - fewer collectors
List the stages of lymphedema
Stages 0-3
Define stage 0 Lymphedema
Lymphangiopathy, pre-stage, latency
No visible swelling
TC is subnormal
Normal consistency
Define stage 1 lymphedema
reversible
Edema is soft ( pitting )
Elevation reduces swelling
No secondary skin changes
define stage 2 lymphedema
Spontaneously irreversible. Skin hardens. Pitting is difficult. Frequent infections. Stemmer sign (+) Fibrosis
define stage 3 lymphedema
lymphostatic elephantitis. Skin breakdown Deepening of natural skin folds. Usually increase in limb size. Frequent infections 
Constant compression has a ___ effect
fibrinolytic
