Lymphatic Anatomy/Physiology Flashcards
Components of Lymphatic System
- lymph vessels
- lymph nodes
- thymus gland
- lymphocytes
- tonsils
- spleen
- Peyer’s patches
Lymph Vessels
- capillaries
- pre-collectors
- collectors
- trunks
Right Drainage Area
- RUQ
- (drainage from right UE, right side of head, right upper trunk)
Left drainage area
-Everything but RUQ
drainage from LE, lower trunk, Left trunk, left UE, left side of head
70% of lymphatic system is______
-superficial
Cistema Chyli
-collects emulsified fats
True/False: the lymphatic system is symmetrical
-false
Lymphangion
-functional unit of muscle tissue around lymphatic valves to push fluid in correct direction
Lymph system relies on_____
-voluntary skeletal muscle contractions to move fluid
Lymph system circulates _____ l/day
2-2.5 liters/day
Chyle
-lymph plus emulsified fats
Lymph Vessels Function
- return protein to cardiovascular system
- remove excess fluid from interstitium
- transport chyle (intestinal lymph vessels)
- transport capacity>lymph load
Insufficiency
- Dynamic (high volume)
- Mechanical (low volume_
- Combined
Dynamic Insufficiency
- High volume
- lymph load exceeds transport capacity
Mechanical Insufficiency
- Low volume (normal load)
- decreased transport capacity due to injury/impairment
- more common
Forms of LE edema
- venous insufficiency
- Congestive heart failure
- lymphedema
Lymphedema
- transport capacity<lymph load
- abnormal accumulation of protein-rich fluid in interstitium
- cases inflammation and reactive fibrosis of affected tissue
Skin Characteristics of Lymphadema
- hyperkeratosis
- lichenification
- Peau d’orange texture
- ulcerations unusual
- elasticity/hydration of skin maintained longer than in venous disease
hyperkeratosis
-excess of keratin deposits
Peau d’orange texture
-skin textured like orange (little dimples, surrounding hair follicles)
Lymphadema does NOT cause_____
Ulcers, pain
Lymphedema Causes
- Primary
- Secondary
Primary Lymphadema Causes
- congenital/heredity
- born with it
Secondary Lymphadema Causes
- surgery
- radiation
- trauma
- filariasis
- CVI
- infection
- tumor growth
- artificial (self induced)
Lymphadema Staging
- latency
- stage 1: reversible
- stage 2: spontaneously irreversible
- stage 3: lymphostatic edemas
Latency Stage
- transport capacity reduced
- no visible palpable
- subjective complaints possible
Stage 1
- reversible
- accumulation of protein-rich fluid
- pitting edema
- reduces with elevation
- no fibrosis
Stage 2
- Spontaneously Irreversible
- proteins stimulate fibroblast formation
- pitting becomes progressively worse
- connective/scar tissue formation
Stage 3
- lymphostatic edema
- hardening of dermal tissues
- pitting absent
- fibrosis/sclerosis
- skin changes
- elephantiasis–filariasiss
Edema not detected clinically until______
-interstitial volume reaches 30% above normal
LVF
- location
- volume
- fibrosis
Primary Differential Diagnosis
- vascular anomaly
- tumor
Secondary Differential diagnosis
- DVT, venous insufficiency
- infection
- cardiopulmonary failure
- hepato-renal failure
- systemic disease (amyloidosis)
- lipedema
Causes of local edema
- lymphedema
- lipedema
- acute DVT or thrombophlebitis
- chronic venous insufficiency
- congenital vascular malformations
- arteriovenous fistula
- trauma
- infection, cellulitis
- ruptured synovial cyst (baker’s cyst)
- hematoma
- dependency
Diagnostic Lab Tests
- CBC
- Electrolytes
- Albumin
- SPE (serum protein electrophoresis)
Low Albumin
-too much fluid leaves vessels to insterstitium
Diagnostic Imaging
- US
- MRI
- Venous studies
- CT
- Microlymphography
- x-rays
- lymphoscintigraphy
Gold Standard diagnostic Imaging
-Direct Lymphography
Diagnosis
- med history
- physical exam
- measurements
- venous evaluation
- laboratory
Pneumatic Compression Pump
- NOT indicated
- and pressure will collapse superficial lymphatic drainage
- also fluid won’t be able to get past the blockage
Treatment
- surgery
- pharmocologic
- CDP-complex decongestive therapy
Phases of Complex Decongestive Therapy
- I: intensive daily treatments
- II: supportive
Comprehensive Management
- CDT/CDP
- nutritional counseling
- education
- psychosocial intervention
Manual Lymph Drainage
- increase lymph vessel contractions
- increases reabsorption of fluid
- direct superficial flow
- improve lymph transport capacity
Bandaging
- reduce ultrafiltration rate
- improve muscle pump efficiency
- provide support for tissues/joints
- prevent re-accum of evacuated fluid
- facilitate softening of fibrotic tissue
