Lymphatic System Flashcards
Lymphatic organs
nodes, tonsils, thymus, spleen, thoracic duct, bone marrow
Major lymph nodes
submaxillary, cervical, axillary, iliac, mesenteric, inguinal, popliteal, cubital, supraclavicular, parasternal
Flow of lymph
CV-NTD
Lymphatic capillaries > lymphatic vessels > lymph nodes filter > lymphatic trunks > lymphatic ducts > subclavian veins
Right lymphatic duct drains which area of body
RUE, R face, R trunk
Into subclavian veins
Thoracic duct drains which area of body
LUE, L face, L trunk, and rest of body
Into subclavian veins
Lymphatic load
Amount of lymphatic fluid transported
Transport capacity
maximum amount of fluid that lymphatic system can transport
can decrease with lymph node removal and lead to lymphedema
Primary lymphedema
Congenital or genetic/hereditary abnormalities in the lymphatic system
Milroy’s disease (0-2 y/o)
Lymphedema praecox/meige disease (10-20 y/o)
Lymphedema tarda (>35 y/o)
Secondary lymphedema
Injury to one or more components of the lymphatic system
lymph node removal
infection
tumor
trauma
chronic venous insufficiency
fibrosis
filariasis (elephantiasis)
Severity of lymphedema
Pitting
Brawny
Weeping
Pitting edema
rebounding
short duration
little to no fibrotic changes in skin or subQ tissue
least severe
Brawny edema
pressure on area feels hard with palpation
progressive, fibrotic changes in subcutaneous tissue
severe
Weeping edema
Fluid leaks from cuts or sores
Impaired wound healing
Only occurs in LEE
Uncommon
Most severe
Stemmer sign
Positive = indication of stage 2 or 3 lymphedema
Positive if skin on dorsal surface of fingers or toes cannot be pinched/lifted compared to uninvolved limb
Indicative of worsening condition
Stage 0 of Lymphedema
Latency stage
No clinical edema, occasional reports of heaviness
Negative stemmer
Tissue/skin normal appearance
Stage 1 Lymphedema
Reversible stage
Soft, pitting edema
Negative stemmer
Edema increases w/ activity/standing, reduces with elevation
Stage 2 lymphedema
Spontaneously irreversible stage
Hard swelling, progresses to brawny edema
Positive stemmer (can be neg in early stage 2)
Fibrosclerotic tissue
Stage 3 lymphedema
Lymphostatic elephantiasis stage
Severe brawny edema
Positive stemmer
skin changes (papillomas, deep skinfolds, warty protrusions, hyperkeratosis, mycotic infections)
Repeated bacterial/viral infections common
Pitting edema 1+
Mild
barely perceptible
<1/4 in pitting
Pitting edema 2+
Moderate
Easily identified depression
Rebound w/in 15 sec
1/4-1/2 in pitting
Pitting edema 3+
Severe
15-30 sec rebound
1/2-1 in pitting
Pitting edema 4+
Very severe
>30 sec rebound
>1 in pitting
Lipedema
Bilateral LE
Affects proximal extremities but not hands/feet
Affects skin elasticity
Skin sensitive to pressure/touch (easy bruising and painful)
Lymphedema vs lipedema
