Lymphatic

Question 1

What are the lymphatic organs?

Answer 1

lymph nodes; lymph vessels; thymus gland; spleen; tonsils; peyer’s patches

Question 2

What is the largest vessel of the lymphatic system?

Answer 2

thoracic duct

Question 3

What are the processing centers of the lymph systems?

Answer 3

lymph nodes

Question 4

What is the function of the tonsils?

Answer 4

trap bacteria entering mouth

Question 5

What do the thymus gland and spleen produce/store?

Answer 5

T cells via thymus and spleen stores WBC

Question 6

What are the various lymphatic vessels?

Answer 6

capillaries; pre-collectors; collectors; trunks

Question 7

Where does the most diffusion happen in the lymphatic system?

Answer 7

in the capillaries due to ability to take up larger proteins

Question 8

What are the various mechanisms for transportation in the lymphatic system?

Answer 8

intrinsic contraction; respiration; arterial/venous pulsation; skeletal movement; new lymph

Question 9

What are the lymph drainage field of the body?

Answer 9

belly button and up on R side is right thoracic duct….everything else is L thoracic duct

Question 10

What are watersheds?

Answer 10

part of the superficial lymph system that collect fluid allowing for movement up and not down; transport to nodes for processing

Question 11

What nodes handle processing?

Answer 11

above belly button goes to axillary nodes and below goes to inguinal nodes

Question 12

What does lymph fluid contain?

Answer 12

waste of the body (proteins); fluids protein content can cause fibrosis

Question 13

What are the parts of filtration?

Answer 13

resorption and lymph flow

Question 14

What effect can flying/diving have on lymphedema?

Answer 14

increase/decrease

Question 15

What is osmosis?

Answer 15

passage of fluid through semipermeable membrane

Question 16

What is diffusion?

Answer 16

movement from a region of high concentration to low

Question 17

What is ultrafiltration?

Answer 17

mechanical pressure separates water from protein and pushes water through membrane

Question 18

What is lymphatic load?

Answer 18

how much fluid is in our body at any given time

Question 19

What is Lymph Time volume (LTV)?

Answer 19

how quickly the fluid in the body can be moved (if can’t keep up swelling results)

Question 20

What is the transport capacity (TC)?

Answer 20

is a set amount of 10x the LL (can’t be increased, but can be decreased)

Question 21

What is the functional reserve (FR)?

Answer 21

the reserve to help make up for and increase of fluid or lost TC due to injury

Question 22

Is LL more or less than TC

Answer 22

less (swelling otherwise)

Question 23

What is dynamic insufficiency?

Answer 23

more fluid to be moved that the ability of the system to move it all (LL greater than TV)

Question 24

What is mechanical insufficiency?

Answer 24

an issue with the lymphatic system itself; all lymphedema has this type of insufficiency (cant pull out proteins causing high protein swellling)

Question 25

Can the lymph system regenerate?

Answer 25

no, damaged forever causing a decrease in TC

Question 26

What is combined insufficiency?

Answer 26

both mechanical and dynamic (damaged system and overload)

Question 27

What is fibrosis?

Answer 27

hardening of tissue from high protein content

Question 28

Primary vs secondary lymphedema?

Answer 28

P: mechanical insufficiency of the lymphatic system S: trauma, surgery, cancer, etc...

Question 29

What are the stages of lymphedema?

Answer 29

Latency: no visible/palpable edema Stage 1: reversible with elevation, pitting edema, no fibrosis Stage 2: consistent swelling, no change with elevation; fibrotic changes Stage 3: elephantiasis, non-pitting; fibrosis and sclerosis

Question 30

What is lichenification?

Answer 30

leathery, scaly, hard skin at high risk for infection

Question 31

What are the skin characteristics of lymphedema?

Answer 31

hyperkeratosis; lichenification; peau d'orange texture; ulcers

Question 32

What is lipedema?

Answer 32

common in wommen; painful to palpation; symmetrical; not consistent with UE

Question 33

What is a lymphoscintigraphy?

Answer 33

nuclear imaging method, tissue injection is transported by lymphatic system and allows assessment of superficial and deep lymphatics

Question 34

What is stemmer's sign?

Answer 34

thickening of skin on the dorsal hand/foot; inability to pinch skin in these areas

Question 35

What does complete decongestive therapy include (CDT)

Answer 35

``` Manual lymphatic Drainage compression bandaging exercise skin care self care and risk reduction ```

Question 36

Do compression garments decrease swelling?

Answer 36

no

Question 37

What are the effects of CDT?

Answer 37

decrease swelling; increase drainage; improve skin condition; improve QOL; reduce risk of infection

Question 38

What are the phases of CDT?

Answer 38

reductive: 5x/week until swelling down to lowest level Maintenance: working on it rest of life; compression for day and bandage at night

Question 39

Should we use ace bandage or short stretch?

Answer 39

short stretch because it has a high moving pressure and a low resting pressure

Question 40

What determines what direction lymphatic fluid will flow?

Answer 40

watersheds

Question 41

How should exercises be performed with lymphedema?

Answer 41

from distal to proximal (squeeze hand, move wrist, bend elbow, lift arm overhead); exercise should be graded and progressive

Question 42

What are the classes of compression garments?

Answer 42

Class 1: 20-30 mmHg Class 2: 30-40 mmHg (legs) Class 3: 40-50 mmHg

Question 43

What else should we wear with an arm sleeve?

Answer 43

a glove

Question 44

What amount of compression to ted hose provide?

Answer 44

10-15 mmHg