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5 Pathology > L9 Lymphedema > Flashcards

L9 Lymphedema Flashcards

1
Q

Lymphedema definition

A
  1. chronic and slowly progressive disease that results in swelling in the body
  2. abnormal or excessive accumulation of protein enriched fluid in the tissue spaces of the body
  3. Impairment in the reabsorption/transportation of protein molecules within the lymph system
  4. Leads to fibrosis, abnormal adipose deposition and overgrowth of connective tissue
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2
Q

Purpose of lymphatic system

A

runs throughout your body
filter toxins and waste
keeps body fluids levels in balance
defends against infection
absorbs fat in digestive system

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3
Q

Lymphatic system is made up of

A

lymph organs, fluid, vessels, nodes

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4
Q

Lymph nodes

A

filter bacteria, waste and cellular debris

contain immune cells like lymphoctyes and macrophages

regulate fluid volume

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5
Q

Lymph fluid

A

derived from interstitial fluid
contains RBCs and WBCs, lymphocytes, fat, water, protein, cellular debris

approx 75-100 g of protein are transported by lymphatic system daily

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6
Q

Lymphatic Vessels

A

thin-walled tubes that carry lymph fluid

similar to blood vessels, but have valves that prevent backflow of fluid

collect lymph from interstital spaces and transport to lymph nodes

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7
Q

Lymph capillaries

A

tiny, microscopic vessels that collect excess fluid from interstitium

allow fluid, protein, and cellular debris to enter

drained by vessels and processed by nodes

can be crushed by adiposity

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8
Q

What tissues are lymphatic capillaries not present in?

A

CNS, bone marrow, avascular tissue

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9
Q

Once fluid enters the lymphatic capillaries it is called

A

lymphatic fluid
volume = lymphatic load

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10
Q

Lymphatic ducts

A

lymphatic vessels move into larger ducts that drain the lymph back into the bloodstream

Thoracic duct and right lymphatic duct

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11
Q

Thoracic Duct

A

largest lymphatic vessel
collects lymph from lower half of body and left side of the body

drains into the left subclavian vein, returns lymph to bloodstream

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12
Q

Right lymphatic duct

A

collects lymph from the right side of upper body
drains into right subclavian vein, returns lymph to blood stream

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13
Q

Lymphangion

A

functional unit of lymphatic vessel

segment of lymphatic vessel between two valves that contracts and propels lymph forward during lymphatic pumping mechanism

creates a unidirectional flow of lymph towards nodes

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14
Q

Lymphangion contracts

A

valves downstream close
prevents backflow of lymph fluid

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15
Q

Lymphangion relaxes

A

valves upstream open
lymph fluid moves upwards

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16
Q

Transport capacity

A

the max amount of fluid the lumpahtic system can carry

in healthy intact system, the transport capacity exceeds the lymphatic load almost 10x

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17
Q

When the lymphatic load exceeds the lymphatic transport capacity…

A

fluid balance is disrupted, protein rich fluid accumulates in the interstitium, and macroscopic swelling or lymphedema occurs

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18
Q

Transport capacity

A

maximum amount of lymph that can be transported by the body in a given length of time (size of the sink)

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19
Q

Under normal lymphatic circumstances

A

the lymph system can compensate for increases in lymphatic load (water filling the sink)

things exercising, sunbathing, and hot tubbing can increase load

20
Q

Lymph time volume

A

the amount of lymph transported per unit of time

21
Q

Dynamic Insufficiency

A

occurs when HEALTHY lymphatic system is overwhelmed

the drain can’t keep up with the faucet, the lymph time volume is maxed out

if dynamic insufficiency is present over time, secondary damage can occur

22
Q

Mechanical Insufficiency

A

transport capacity of lymph system is decreased

low volume insufficiency, there is something blocking the drain

caused by surgery, radiation, trauma, infections, chronic venous insufficiencies, congenital malformations

23
Q

Subjective Exam for Lymphedema

A

Family history of primary lymphedema

history of cancer treatment like radiation, lymph node dissection

travel to areas with high rates of mosquitos

BMI >50

progressive enlargement of area/limb

infection (increased risk of infection in people with lymphedema)

24
Q

Edema

A

accumulation of water in tissues
edema is a SYMPTOM
represents dynamic insufficiency of lymphatic system

25
Q

Lymphedema vs edema

A

lymphedema is an abnormal accumulation of protein and water in interstitial spaces (edema is just water)

protein rich swelling

disease process!

26
Q

Primary Lymphedema

A

congential
may come on at puberty, with hormonal fluctuations, later in life
lipidema

accumulation of protein rich fluid in intertitium to due to low volume of lymphatic system

27
Q

Secondary Lymphedema

A

acquired
due to trauma, surgery, infection
mechanical. insufficiency

28
Q

Causes of primary lympedema

A

Lymphangiodysplasia: malformation of lymphatic vessels

Inguinal node fibrosis: involves fibrosis, fibrosclerosis, fatty degeneration and other changes to iliac and inguinal nodes

29
Q

Hypoplasia

A

less than normal expected number of lymph collectors in affected region

30
Q

Hyperplasia

A

excessively dilated vessels
less fuctional due to valvular dysfunction

31
Q

Aplasia

A

absence of lymph collectors or lymph capillaries in an affected area

32
Q

Causes of Secondary Lymphedema

A

trauma to the lymphatic system

cancer treatments
plebolymphedema
obesity
filariasis (mosquitos)
accident or trauma like surgery, crush injury
infection (cellulitis)
self induced injury/trauma like repeated drug use

33
Q

Breast cancer is the

A

number one cause of lymphedema in the US

34
Q

Cancer-related lymphedema

A

can be caused by
1. surgery (lymph node dissection
2. radiation
3. cancer itself (cancer blocking pathways)

35
Q

Obesity related lymphedema

A

occurs with a BMI >40

BMI>50 causes impaired lymphatic drainage because capillaries are destroyed

non-reversible even with weight loss

36
Q

Complete Decongestive Therapy

A

Includes:

manual lymphatic drainage
compression
skin care
lymphatic drainage exercise
education of independent management

37
Q

Phases of Compression

A

Reduction
Maintenance

38
Q

Reduction phase

A

multi-layer compression bandaging
short stretch bandages for 4-6 weeks, 23 hours a day

take ff to shower and perform skin check

patient can wait until they are ready to get started with maintenance phase

39
Q

Maintenance phase

A

compression garments
off the shelf, ready to wear or custom

compression garment alternatives–> lifetime management, worn during the day but off at night, night garments

40
Q

Short Stretch COmpression bandages

A

can either be low resting pressure or high working pressure

inversely related to the size of the limb

have graduated compression, which is pressure gradient is greater distal to proximal. Helps move fluid out of limb

41
Q

Resting pressure

A

constant pressure externally applied by the bandage

constant pressure may hinder refill of superficial vessels

highest with elastic bandages

42
Q

Working pressure

A

temporary pressure that is generated with muscle contraction

increases efficiency of muscle pump

highest with short stretch or unna boot

43
Q

Compression garments types

A

compression sleeves
glvoes or gauntlets
compression bras, tank tops
compression stockings–> knee, thigh, pantyhose, leggings

44
Q

How compression stockings work

A
  1. improves microciculation and cutaenous oxygenation
  2. reduces risk of thromboembolism
  3. reduces edema and inflammation
  4. reduces venous reflux, improves the valve function
  5. increased volvume and rate of venous blood due to efficiency of skeletal muscle pump
    -6. improved lymphatic flow
45
Q

Lymphatic drainage exercises

A

daily exercises to activate muscle pump to stimulate lympahtic capillaries to absorb and transport fluid

improve mobility, strength, and endurance

follow lymphatic flow of central, proximal, distal

can and should be done with compression

better to do active vs resistive

monitor for increases in swelling

46
Q

Weight exercise is safe for lymphedema patients

A

LOW load
SLOW progression

47
Q

Skin care

A

education on proper skin care
inspect skin for cuts, rash, irritation, infection

daily cleansing/washing, including compression garments

drying skin

apply lotion as protective barrier

avoid sunburns and insect bites

5 Pathology (9 decks)

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