Integumentary and Lymphedema Lecture Flashcards
what is the lymphatic system?
- the “drainage or sanitation” system
- includes lymph nodes, thymus, bone marrow, spleen, tonsils, Peyer patches of small intestine
what is the function of the lymphatic system?
- Remove waste products
- Remove excess fluid
- Alert immune system
- Return fluid and plasma proteins to the blood
-Fluid transport - Play a role in maintaining homeostasis
what are the stages of lymph formation?
A. Initial lymph vessel is empty and collapsed. The subsequent pre-collector is filled with lymph. The anchoring filaments and the fiber network are relaxed as the result of low interstitial pressure.
B. Filling phase - The interstitium is filled with fluid and thus the interstitial pressure exceeds the pressure in the initial lymph vessel. The interstitial fiber network and the anchoring filaments are tense and thus the outer swinging flap is pulled outside, whereas the inner ones are pushed inward by the fluid flowing inside: the inlet valves are open.
C. The initial lymph vessel is filled with lymph. The pressure in the initial lymph vessel exceeds the interstitial pressure and thus the inlet valves are closed.
D. The pressure inside the initial lymph vessels opens the valve to the pre-collector and thus the lymph flows toward the pre-collector.
how does lymph move?
-The valves function to move lymph in one-way
-Move 1-2 liters/day
-It moves fluid very slowly, has its own intrinsic contractions (not like vascular system that is moved by separate pump of the heart or active muscle pumping)
-There is no continuous column of fluid (vascular system moves fluid continuously)
what do the thoracic duct and lymphatic duct drain to?
The thoracic duct (green), discharges into the left subclavian vein, in the neck. The right lymphatic duct is also shown carries far less lymph than the thoracic duct, draining mainly the right arm and head, the heart and lungs, and the anterior chest wall
what is transport capacity and functional reserve?
- Transport capacity (TC) is the amount of fluid the system can move when working at maximum intensity
-Under normal conditions the system works at ~10% of normal capacity - Functional reserve (FR) is the difference between the TC and amount of fluid being transported at rest, known as the “lymphatic load” (LL)
-When additional fluid and protein increase in the soft tissues the lymphatic system will use FR to remove any excess
when does the lymphatic system become insufficient?
- Dynamic Insufficiency:
This can be caused in the healthy individual who sustains a sprained ankle, and the system has increased LL requiring it to work harder
Cause: immobility, CHF, sprained ankle…..anything increasing LL (higher output) - Mechanical Insufficiency:
This is caused by a damage to the lymphatic system, therefore unable to handle increased LL, i.e. Lymphedema which is the most common disruption to the system
Cause: surgery, infection, trauma…..anything reducing the transport capacity (TC) which is lowering the ability to remove fluid from the region - Combined Insufficiency
when does lymphedema develop? what are the consequences?
- Lymphedema develops when the TC drops below the LL amount resulting in accumulation of fluids in the subcutaneous tissue
- High-protein fluid causes fibrosis and sclerosis of the tissues and increases risk of infection
what is the clinical presentation of lymphedema?
- Slowly progresses
-Mild warmth - Rarely see color changes
- Usually, painless
- Sensation of fullness or heaviness in the limb
- Pitting edema or hard to palpation
- Asymmetrical comparison of limbs
what is the difference between lymphedema and edema?
lymphedema: +stemmer
pitting edema, underlying fibrosis of skin, tight and heavy limb, decreased mobility or loss of ROM, tingling or numbness in limb, pain or tenderness in surrounding joints, skin discolorations, common fungal infections, hardening of the skin, odor, wounds, decreased QOL
edema: - stemmer
Acute edema: rapid onset, red, warm, painful to palpation or movement, localized
Chronic edema: skin changes include hair loss, loss of tissue elasticity or skin creases, moderate warmth, hemosiderin staining, achy pain progressive through day, loss of normal contour in extremity
what are the lymphedema stages?
stage 0: latency; no clinical edema, - stemmer, normal skin, lymph transport capacity reduced
stage 1: reversible stage; soft and pitting edema, edema reversible with elevation, increased edema with standing, - stemmer, normal tissue
stage 2: spontaneously irreversible; edema present that can progress to nonpitting edema, not reversible with elevation, +stemmer, tissue is fibrosclerotic, frequent infection, skin changes
stage 3: lymphostatic elephantiasis; edema is severe and non pitting, does not reserve, +stemmer, tissue is fibrosclerotic, frequent infection, skin changes
What is cellulitis? what are common symptoms? when does it become a medical emergency?
-An infection of the skin caused by bacteria typically caused by an open wound
- common symptoms: redness, edema, tenderness, pain, warmth, blisters, fever, headache, chills, weakness, red streaks
- medical emergency when the area spread and becomes large, the skin changes color (black) or it affects the face
how is cellulitis diagnosed? what is the course of treatment? what are possible complications? what are prevention techniques?
- dx: blood tests and cell culture
- treatment: antibiotics, topical antibiotics, wound dressing, pain meds, surgery
- complications: extensive tissue damage, gangrene, infection to blood, sepsis, amputation, shock, death
-prevention: hygiene, protect dry skin, protective footwear, wound prevention
what are the layers of the skin organized from outermost to innermost layer?
- Epidermis is avascular and water-resistant and in normal, healthy conditions it repairs itself quickly
- Dermis is nearly 30x thicker than epidermis layer and contains blood vessels, lymphatic vessels, nerves, nerve endings, hair follicles, sweat glands
Dermis is surrounded by collagen, elastin, ground substance – provides elasticity, flexibility, structure to the skin - Subcutaneous layer is not part of integument but is the layer between dermis and underlying structures
Made up of connective tissue, fat = Protects underlying structures
what is the main function of the epidermis?
- maintain skin integrity as a physical barrier against bacteria, shear, friction, irritants, and protection against loss of fluid at the cellular level
what is the primary function of the dermis
provides tensile strength, support, retains moisture, blood, and O2 to the skin
how much blood circulates to the skin?
about 1/3 of circulating blood goes to the skin
what are the phases of wound healing? what if the phase is interrupted?
phase 1: inflammatory phase (1-10 days); if interrupted chronic inflammation cycle can occur
phase 2: proliferative phase (3-21 days); if interrupted can result in a chronic wound
phase 3: maturation phase (7days- 2 years); scar tissue will remodel but the strength will be 80% of normal tissue
what influences wound healing?
age, comorbidities, edema, inappropriate wound care, infection, lifestyle, stress, medications
what is essential for healthy skin? what will compromise a wound site?
- proper functioning peripheral vascular system and lymphatic system
- oxygen
- arterial insufficiency, edema, necrosis
what is essential in a wound healing environment? How do you promote that?
- a moist wound healing environment is the most important external factor for optimal wound healing
- barrier of the wound should be “breathable” and preserve fluid, maintain peri wound integrity, and change bandages when leakage occurs outside of borders
