Lymphatic Flashcards
Flow of lymph
Capillaries > collecting vessels > nodes > trunks > ducts > subclavian veins.
Mnemonic: CV? Not To Day.
Lymphatic Duct drains from…
RUE
R face
Thoracic Duct drains from…
LUE
BLE
L face
Lymphatic Load definition
amount of fluid that must be transported
Lymphatic Capacity definition
max amount of fluid the lymphatic system can transport
What happens to lymphatic Load & Capacity with lymphedema?
Load increases.
Capacity decreases.
Lymph node removal causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease
d) capacity decrease
Venous insufficiency causes:
a) load increase
b) load decrease
c) capacity increase
d) capacity decrease
a) load increase
Primary Lymphedema: definition & examples
Caused by a disorder of the lymphatic system.
Milroy’s Disease (age 0-2)
Meige Disease (age 10-20)
Lymphedema Tarda (age 35+)
Secondary Lymphedema: definition & examples
Results from an injury to the lymphatic system.
Lymph node removal.
Infections, tumors, trauma.
Venous insufficiency.
Fibrosis.
Filariasis (mosquito infection).
List the types of edema from least to most severe
- Pitting
- Brawny
- Weeping
Pitting Edema definition
Takes several seconds to rebound.
Little to no fibrotic changes.
Brawny Edema definition
Hard to palpation.
No pit forms w/ pressure.
Progressive fibrotic changes.
Weeping Edema definition
Typically affects LE only.
Cuts & sores form.
Fluid leaks out.
Stemmer’s Sign
Pinch & lift on the dorsum of fingers/toes.
(+) if skin cannot be pinched/lifted.
(+) indicates Stage 2 or 3 Lymphedema.
Is Stemmer’s Sign reversible? (i.e., once it’s positive, can it later be negative?)
NO
Stage 0 Lymphedema
No edema, skin normal.
Stemmer’s (-).
Occasional reports of limb heaviness.
Stage 1 Lymphedema
Pitting edema.
Stemmer’s (-).
Edema increases w/ standing or activity.
Edema decreases w/ elevation.
Stage 2 Lymphedema
Hard edema (progresses to Brawny).
Stemmer’s (+) but may be (-) in early Stage 2.
Edema does NOT decrease w/ elevation.
Fibrosclerotic (hard) tissue.
Stage 3 Lymphedema
Severe Brawny edema.
Possible Weeping edema.
Stemmer’s (+).
Skin changes, frequent infections.
How is pitting edema graded?
Depth of pitting & time to rebound.
Grade 1+ Pitting Edema
Depth: <1/4in
Grade 2+ Pitting Edema
Depth: 1/4 to 1/2in
Time to rebound: 15s
Grade 3+ Pitting Edema
Depth: 1/2 to 1in
Time to rebound: 15-30s
Grade 4+ Pitting Edema
Depth: >1in
Time to rebound: >30s
What is Lipedema? How is it different from Lymphedema?
Lipedema: bilateral & symmetrical, affects proximal LEs (buttocks, thighs). Feet less often affected. Stemmer’s (-) bc feet intact.
Lymphedema: usually unilateral; can be bilateral, but will still be asymmetrical.
Methods of measuring edema
Girth: circumferences at landmarks 10cm apart along limb.
Volumetric: place limb in water tank.
Bioelectric Impedance: higher resistance = more fluid present.
Lymphoscintigraphy: tests for lymphatic insufficiency.
Best way to measure PROXIMAL edema?
Girth
Best way to measure DISTAL edema?
Volumetric
Best way to measure PRE-POST SURGERY edema?
Bioelectric Impedance
Palpating nodes: what’s NORMAL?
Soft
Non-tender
Non-palpable
<1cm
Palpating nodes: what’s ABNORMAL?
Hard
Tender
Immobile/fixed
Persistent enlargement
Complete Decongestive Therapy - Phase 1
Intensive Phase:
Manual Lymph Drainage (MLD).
Compression bandaging.
Skin & nail care.
Exercise.
Complete Decongestive Therapy - Phase 2
Maintenance Phase:
Self-MLD.
Compression garments.
Multiple layer bandaging at night.
Skin & nail care.
Exercise.
Manual Lymph Drainage
Work proximal to distal areas.
Stroking goes distal to proximal (towards specific nodes).
What type of compression bandage should be used? Why?
Low-Stretch (AKA Short-Stretch).
Has high working pressure & low resting pressure.
High Working Pressure: provides resistance to force mm to work harder, pushes fluid into vascular system.
Low Resting Pressure: not much resistance at rest, so OK to wear at night.
How should compression bandages be applied?
More pressure distally
How to take blood pressure with lymphedema?
NEVER on affected extremity
Exercise considerations
Proximal to distal: start w/ trunk, core, neck. Then progress to shoulder > elbow > wrist/hand.
Breathing exercises BEFORE proximal exercises (if breathing exercises included).
Lower intensity if wearing compression.
Aquatic/swimming good bc provides compression.
