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1
Q

Who discovered cisterna chyli and it’s continuum with thoracic duct?

A

Jean Pecquet

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2
Q

Which vertebrae do cisterna chyli exist

A

T11 - L2

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3
Q

Who used mercury injections to depict lymphatics?

A

Marie Sappey

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4
Q

Who created the term complete decongestive therapy (CDT)?

A

Földi

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5
Q

What are the components of CDT?

A 
MLD
Compression
Skin care
Decongestive exercises
Patient education
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6
Q

Vodder said MLD should not be labeled massage. Why?

A

massages deep. MLD is superficial and ABOVE the fascia

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7
Q

Edema versus lymphedema

A

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

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8
Q

What does ALND stand for?

A

Auxiliary lymph node dissection

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9
Q

The most common cause for lymphedema in the United States is what?

A

ALND and breast cancer surgery

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10
Q

What is the most common cause of secondary llymphedema globally?

A

filariasis

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11
Q

Although not reported, we are discovering that ___ is also a frequent cause of lymphedema seen in practice today in the United States

A

obesity

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12
Q

The Lymphatic load of water is called what?

A

Net filtrate

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13
Q

How much water is returned to the Venous system via the thoracic duct in 24 hours?

A

2-4 liters

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14
Q

What is the pathway of FAT to the venous angle?

A 
small intestines
Gastrointestinal trunk
cisterna chyli
Thoracic duct
Venous angle
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15
Q

What is the pathway for initial lymph capillaries?

A

initial lymph capillaries
Pre-collectors
Collectors
Lymph nodes

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16
Q

What is the responsibility of the perforating pre-collectors?

A

Transfers lymph from superficial to deep lymphatic system

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17
Q

What is the unorganized pathway towards lymph capillaries where interstitial fluid flows? It covers the entire body surface

A

initial lymph vessel plexus

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18
Q

Where do the lymphatic collectors reside?

A

located in the superficial fatty tissue above the fascia

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19
Q

How does a smooth muscle react to a smooth slow stretch?

A

Contraction

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20
Q

What is the pathway for the inguinal lymph nodes of the lymphatic system?

A 
LR pelvic Inn
LR lumbar inn
LR lumbar trunk
Cisterna chyli 
Thoracic duct
Venous angle
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21
Q

auxiliary lymph nodes converge to form the ___?

A

subclavian trunk

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22
Q

Where are the bulk of auxiliary lymph nodes located?

A

located between the pectoralis and the latissimus dorsi muscles

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23
Q

Where do the auxiliary lymph nodes drain?

A

drains into both the supraclavicular lnn and auxiliary lnn

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24
Q

Where does the upper quadrant of the lymphatic system drain into?

A

auxiliary Lnn

25
Where does the lower quadrants of the lymphatic system drain into?
inguinal lnn
26
Where does the lymph above upper horizontal watershed drain into?
cervical lnn
27
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 ```
28
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 ```
29
What’s another word for Venous angles?
Terminus
30
What is the junction of the Venus angle?
internal jugular and subclavian veins
31
Where are the Venous angles located?
Venous angles are located 2.5–3 inches deep into the supraclavicular fossa
32
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 ```
33
What are the skin areas that drain into the right Venous angle?
right upper quadrant Right arm Right head/face/shoulder 300ml (soda can)
34
What are the borders of the lateral cervical triangle for the deep cervical lymph nodes?
Anterior: SCM Posterior: upper trapezius Inferior: clavicle
35
What are the general effects of MLD?
increase in lymph production Increase in lymphangiomotorcity reverse of lymph flow Increase in Venus return Soothing Analgesic
36
Describe stationary circles
37
Describe pump technique in MLD
38
Describe pump – push technique in MLD
39
describe “short neck” technique in MLD
40
describe neck/face sequence technique in MLD
41
1) lymph capillary 2) precollector 3) collector 
42
43
44
45
46
Is CDT a good plan of care for hypoproteinemia patients?
no
47
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 ```
48
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 ```
49
Combined insufficiency
When mechanical insufficiency is present and something happens and causes an increase in lymphatic load causing lymphedema
50
Examples of dynamic insufficiency
``` Systemic Acute CHF Renal and liver failure System infection Acute sprain/strain Post op Trauma ```
51
Examples of mechanical insufficiency
``` surgery Dash a LND Severe burns Radiation Severe trauma Scars ```
52
what is the primary lymphedema classification?
– Congenital 10–25% (<2 yrs) - Lymphedema precox 65 to 80% (ages 2-35) - lymphedema tarda 11% (>35)
53
What is the most common cause of primary lymphedema?
hypoplasia - fewer collectors
54
List the stages of lymphedema
Stages 0-3
55
Define stage 0 Lymphedema
Lymphangiopathy, pre-stage, latency No visible swelling TC is subnormal Normal consistency
56
Define stage 1 lymphedema
reversible Edema is soft ( pitting ) Elevation reduces swelling No secondary skin changes
57
define stage 2 lymphedema
``` Spontaneously irreversible. Skin hardens. Pitting is difficult. Frequent infections. Stemmer sign (+) Fibrosis ```
58
define stage 3 lymphedema
``` lymphostatic elephantitis. Skin breakdown Deepening of natural skin folds. Usually increase in limb size. Frequent infections  ```
59
Constant compression has a ___ effect
fibrinolytic

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