Lymphatic system Flashcards
1
Q
Function of the lymphatic system
A
- maintains balance of fluids and fights infection
- absorb macromolecules that cannot go into the capillaries
2
Q
How do things flow in the lymphatic system and where do they drain
A
- pressure drives this system but there are some small muscles
- skeletal muscle contraction can help
- right UE + head = right subclavian
- everything else = left subclavian
3
Q
What are the components of the lympathic system
A
- lymph vessels
- lymph nodes
- spleen
- thymus gland
- tonsils
- peyer’s patches (small intestine)
- lymphocytes
- bone marrow
4
Q
Fluid exchange with capillaries and lymph vessels
A
- in CV system most filtrate reabsorbed at venous end
- 2-3% is NOT picked up
- this excess is transported as lymph in lymphatic vessels (use of valves)
- any fluid that exceeds the capacity of the venous removal is picked up by the lymphatics
5
Q
lymphangitis: defintion
A
- inflammation of the lymphatic vessel
6
Q
lymphadenitis: defintion
A
- inflammation of one or more lymph nodes
7
Q
lymphedema
A
- an increased amount of lymph fluid in the soft tissues
- results in accumulation or protein rich fluid in EXTRACELLULAR spaces
8
Q
lymphadenopathy
A
- enlargement of the lymph nodes
9
Q
Lymphedema cause
A
- decreases lympathic transport capacity or increased lympathic load/blockage
10
Q
Stage 0 lymphedema
A
- Lymph transport capacity is reduced;
- no clinical edema present;
- symptomatic complaints possible
11
Q
Stage 1: lymphedema
A
- Accumulation of protein rich, pitting edema
- Reversible with elevation
- Area affected may be normal size on walking in the morning
- Increases with activity, heat and humidity
12
Q
Stage 2: lymphedema
A
- accumulation of protein rich non-pitting edema with CT scaring
- Irreversible
- Does not resolve overnight
- Increasingly more difficult to pit
- Clinical fibrosis is present
- Skin changes present
13
Q
Stage 3: lymphedemia
A
- Lymphostatic elephantiasis
- Accumulation of protein-rich edema with significant increase in connective and scar tissue.
- Severe non pitting fibrotic edema.
- Atrophic changes (hardening of dermal tissue, skin folds, skin papillomas, and hyperkeratosis
14
Q
Usualy signs and symptoms of lymphedema
A
- Slow onset, progressive
- Pitting (early stages)
- Stemmer’s sign positive (try to pinch and can’t = positive)
- Dorsum of foot buffalo hump
- Rarely painful, however discomfort (heaviness and achiness) is common
- Skin changes in the LE lymph-edema may include hyperkeratosis, papillomas
- In contrast with venous disease the skin maintains hydration and elasticity for longer in the disease process
15
Q
What can go along with lymedema
A
-Cellulitis is common due to back up of fluid
16
Q
Edema grading scale
A
- Grading scale for pitting edema
1+ there is barely detectable 2 mm depression; not easily seen but can be felt. Immediate rebound
2+ There is a 4 mm deep pit. A few seconds to rebound
3+ there is a 6 mm deep pit. 10-12 seconds to rebound
4+ There is an 8 mm deep pit ( very deep) > 20 seconds to rebound
17
Q
Lymph Angiodysplasia:
A
- Varicosity
- Hema-angioma: discolorations; vessels stretched
- Neurological changes due to increase pressure
18
Q
Pathogenesis of lymphedema: decreased absorption of lymph
A
- intralympathic pressure increases
- lymph oozes into the wall of the lymphatics and into the perilymphatic tissues
- lymphangiosclerosis (hardening)
- lymph pump deterioration
- low output failure: lymphedeme
19
Q
Pathogenesis of lymphedema: subtotal lympatic blockage
A
- remaining lympathics increase their pumping activity
- intralympathic pressure increases
- Dilation of valvular insufficiency
- lymph oozes into the wall of the lymphatics and into the perilymphatic tissues
- lymphangiosclerosis (hardening)
- lymph pump deterioration
- low output failure: lymphedeme
20
Q
Clinical manifestations of Lymphedema
A
- positive stemmers sign
- full, heavy, tight sensation
- numbness, burning, aching, pain
- decreased flexibility
- difficulty with clothing/jewelry fitting
- increased girth and weight
- impaired speech, swallowing respiration (Swelling in face/neck)
- atrophic skin cahnges
21
Q
Complications of lymphedema
A
- atrophic skin changes
- keratotic patches
- lymphatic fluid leakage
- toe fungus
- functional impairments
22
Q
Medical management of lymphedema: diagnosis
A
- primary = stemmers sign
- secondary = medical history
- unilateral = doppler US
- CT/MRI
- lymphoscintigraphy (dye - newer)
- fluorescence lymphography
- magnetic resonance lymphangiography
23
Q
medical management of lymphedema treatment
A
- coordinated care
- medication s
- surgery to debulk
24
Q
PT clinical assessment with lymphedema
A
- caution with BP cuff
- Thorough history and systems review
- skin assessment
- pain, paresthesias, sensory impairments
- photographs
- functional impairments
25
Q
Lymphedema PT interventions
A
- manual lymph drainage
- multilayer short-stretch compression bandaging
- exercise (muscle pumping)
- Compression garments
- compression pumps
- education
- psychological and emotional support
26
Q
Comprehensive Lymphedema management:
A
- Initially intensive phase
- Once it is stage 2 it is not reversible
- Optimization (maintence) phase
- Manual lymph drainage
- Compression badaging
- Short-stretch compression bandaging
- Long-stretch compression bandaging
- Maintaining proper pressure gradient
- Exercise guidelines
- Compression garments
- Education and home program
- Importance and adherence
- Compression pumps: intermittent - - - Pneumatic compression
- Skin care
- Guidelines for job and lifestyle modifications
- Psychosocial considerations and quality of life
- Low level laser therapy
27
Q
Lymphagenitis/lymphangitis and cellulitis medical management
A
- diagnosis Hx
- treament:
- rest immobilization, cold
- oral antibiotics or IV
28
Q
Lipedema clincal manifestations
A
- symmetric swelling from fatty deposits from hips to ankles
- primarily women
- bruisability due to pressure breaking capillaries
- pain/heavy feeling
- orthostatic edema
- dieting does not change tissue
29
Q
lipedema stage 1
A
- skin soft and regular
- palpable nodules (fatty deposits)
30
Q
lipedema stage 2
A
- skin soft and regualr
- nodules tought, fatty lobules
- pitting edema
- skin color changes
31
Q
stage 3 lipedema
A
- massive fat deposition
32
Q
Lipedema medical management - diagnosis
A
- diagnosis:
- (-) stemmers sign
- symmetric swelling
- dieting doesnt help
- lymphoscintigram (dye)
33
Q
lipedema medical mangement - treatment
A
- symptomatic relief
- functional improvement
- compression garments
34
Q
Venous edema
A
- some pittin g
- brawny
- hemosiderin staining
- ulcers medial malleolus
- fibrosis of subcutaneous tissue
- atrophic skin
35
Q
Acute deep vein thrombosis clinical manifestation s
A
- sudden onset
- unilateral
- cyanosis
- positive homans sign
- potentially lethal disease
- venous doppler (US)
36
Q
Congestive heart failure Clinical manifestations
A
- edema is greatest distally
- pitting edema always bilateral
- complete resolution with elevation (early)
- no pain
- orthopnea, PND, dyspnea on exertion
- jugular venous distension
37
Q
CHF diagnosis
A
- physical exam,
- CXR
- cardiac echo
38
Q
Malignant lymphedema
Clinical manifestations
A
- pain, paresthesia, paralysis
- central location (proximal onset)
- rapid development, continuous progression
- swelling and nodules in supraclavicular fossa
- hematoma like discoloration
- ulcers, non-healing wounds
- recurrent malignancy
- sole presenting symptom of new malignancy
39
Q
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