Lymphatic System Flashcards
Lymphatic system is network of lymphatic vessels that withdraws excess ____ from body’s ____, filters through ____ ____, and returns it to bloodstream via _____.
Fluid (lymph)
Interstitial spaces
Lymph nodes
Venous system
Components
Lymphatic vessels Lymph fluid Lymph nodes Lymph tissues Organs
Name the lymph nodes of the UE
Supraclavicular -Axillary -Central -Subscapular -Pectoral -Humeral Cubital
Name the lymph nodes of the LE
Iliac
Inguinal
Popliteal
What are the other 2 lymph nodes (not UE or LE)?
Parasternal
Mesenteric
What are the lymph organs?
Spleen
Tonsils
Thymus
Bone marrow
Flow of lymph
Lymphatic capillaries > lymphatic vessels > large lymphatic ducts (R lymphatic due, thoracic duct) > subclavian veins
Lymphatic vessel contraction occurs by:
- ____ and ___ nerve stimulation
- Contraction of ___ ___.
- ___ and ___ cavity pressure changes during normal breathing
- Mechanical stimulation of ___ tissues
- ___ changes within individual lymph vessels
Autonomic and sensory Adjacent muscles Abdominal and thoracic Dermal Volume
Lymphedema
Chronic disorder characterized by excess accumulation of lymph fluid due to ___ ___ of lymphatic system (____ of lymph flow or ____ of ___ ___).
Mechanical insufficiency
Obstruction
Removal of lymph nodes
Lymphedema
What happens to fluid volume?
What does this result in?
Volume exceeds transport capacity/capability of lymph vessels. Results in swelling of soft tissues of UE/LE.
What is primary lymphedema?
Congenital or hereditary disorder with abnormal lymph node or lymph vessel formation
What is secondary lymphedema?
Acquired insult to lymphatic system
When is secondary lymphedema seen? What are possible causes?
Most common: After surgery breast or cervical cancer
- surgery, including lymph node removal
- tumors, trauma, or infection involving lymphatic system structures
- radiation therapy
- chronic venous insufficiency
- filariasis (parasitic infection of lymph system)
Stages of lymphedema:
Stage 0- at risk, swelling is ___ ___ ___ despite ___ transport capacity of system. Also called the ___ or ___ stage.
Not yet evident
Reduced
Latent
Pre-clinical
Stages of lymphedema:
Stage 1- ____, early accumulation of fluid with visible swelling; ___ edema that resolves with ____; _____ sign is negative
Reversible
Pitting
Elevation
Stemmer’s
Stages of lymphedema:
Stage 2- spontaneously ____; increase in swelling; ___ does not reduce swelling; (+) ____ ____
Irreversible
Elevation
Stemmer’s sign
Stages of lymphedema:
Stage 3- ______; fibrotic deep skinfolds; may change color; skin changes may limit ____
Elephantitis
Mobility
Differential diagnosis is ?
Lipedema
Lipedema: Excessive \_\_\_ \_\_\_ deposition Appearance may be similar to \_\_\_\_\_ Normal function of \_\_\_\_ \_\_\_\_ \_\_\_\_ swelling of extremities Negative \_\_\_ \_\_\_ Seen typically in \_\_\_\_
Subcutaneous fat Lymphedema Lymphatic system Symmetrical Stemmer’s sign Women
What is lymphadenopathy? What causes it?
Enlargement of lymph nodes, with or without tenderness
Usually from infection
Local vs generalized lymphadenopathy
Local is enlargement of nodes in 1 body segment, generalized is enlargement of nodes in 2+ body segments
What is lymphadenitis?
Lymphadenopathy accompanied by signs of inflammation (red, tender)
What is lymphangitis?
What does it appear as?
Acute bacterial (often streptococcus) or viral infection that spreads throughout lymphatic system Red streaks often seen in skin PROXIMAL to infection site
Known risk factors for lymphedema?
Primary
Primary (idiopathic): congenital abnormality— hypoplasia, hyperplasia, aplasia
Known risk factors: secondary (acquired) from known insult to lymphatic system
Most common from what kind of CA and what treatments?
Breast/cervical, lymph node removal or radiation therapy
Volumetric measurements: U/L disease lymphedema is considered present if > ____ % increase compared to unaffected side
10%
Dilation of lymph vessels, may appear as blister-like protuberances
Lymphangiectasia
Leakage of lymph from skin surface
Lymphorrhea
Development of warty growths on skin that contain dilated lymph vessel and fibrous tissue
Papillomatosis
Thickening and hardening of subcutaneous tissue and brown skin discoloration. Associated with CVI and when severe can damage lymph tissue.
Lipodermatosclerosis
Thickened fold of skin at base of 2nd toe or 2nd finger. Positive if skin cannot be lifted but only grasped as lump of tissue. Negative if skin can be normally grasped and pulled away from underlying tissue.
Stemmer’s sign
Vascular assessment- use (3) assessments
Pulse ox, distal pulses, tests for arterial and venous insufficiency
Do not assess _______ on affected side
BP
What does normal lymph node feel like?
Soft, moveable, nontender
What if lymph node is soft and tender but moves easily?
Sign of inflammation and/or infection
Pt should be referred to MD if lymph node is ___
Hard
___ and ___ lymph nodes are typically indicative of metastatic cancers.
Hard, immobile
Procedural pain is
Pain asssociated with tx of lymphedema
Incident pain is
Pain caused by daily activities
Background pain is
Intermittent or continuous pain at rest
Look for ___ with neurological assessment
Paresthesias
Diff dx lymphedema from other disorders that affect extremities U/L or B/L.
U/L:
Acute DVT, PTS, arthritis, Baker’s cyst
Diff dx lymphedema from other disorders that affect extremities U/L or B/L.
B/L:
CHF chronic venous insufficiency dependency or stasis edema renal dysfunction Hepatic dysfunction Lipedema
Dx testing that may be used?
U/S: assess soft tissue for fibrosis/thickening
Doppler U/S: rule out DVT
Lymphoscintigraphy: identifies lymphatic insufficiency (at rest/exercise)
CT/MRI: skin thickening, “honeycomb” patterns in soft tissue
Lymphedema vs. lipedema
Which swells into hands/feet, which stops at ankles/wrists
Lymphedema into feet/hands, lipedema stops
Lymphedema vs. lipedema
Stemmer sign results
Stemmer sign may be positive in lymphedema, negative in lipedema
Lymphedema vs. lipedema
Which is hormone related?
Lipedema: appears to be estrogen-related, starts at time of hormonal change
Interventions for asymptomatic patients who are at risk for lymphedema: includes what? (5 things)
- Meticulous skin/nail care (moisturize, prevent infections)
- Lifestyle management (weight, sunscreen)
- Avoid limb constriction
- Compression garments
- Avoid temperature extremes (no temp above 102 degrees)
Phase I management: edema secondary to lymphatic dysfunction
what is the main treatment?
Complete decongestive therapy (CDT)
Phase I management: edema secondary to lymphatic dysfunction
What does CDT include? (5)
- MLD
- Compression bandaging/garments
- Exercise
- Skin care
- Pt education
For MLD:
Massage technique is what?
Decongest prox or distal first?
Low pressure effleurage strokes
Decongest PROXIMAL segments first
MLD:
Decongest proximally at R lymphatic duct for ____ involvement
Decongest proximally at thoracic duct for ___ involvement
RUE
LUE, trunk, LEs
Bandages preserve and advance changes associated with MLD and account for ___ of improvement in symptoms
50%
RED FLAG: Pts with poorly controlled ___ ___ may become unstable if unable to tolerate potential increase in ___ ___ caused by lymphedema reduction
Cardiopulmonary disease
Plasma volume
Phase I short-stretch compression bandages should be worn ____ hrs/day
24
RED FLAG: excessively high pressures will occlude ___ ___ capillaries and restrict fluid ____
Superficial lymph
Absorption
Should pts exercise with bandaging?
YES
RED FLAG: strenuous activities (jogging, ballistic movements, ___ activities contraindicated) as they ___ ___
Rotational
Exacerbate lymphedema
Be aware of lymph overload symptoms including? (4)
- Discomfort
- Aching
- Pain in proximal lymph areas
- Change in skin color
What should skin pH be maintained at?
5.0
Contraindicated modalities include?
Electrotherapeutic modalities greater than 30Hz
Modalities that increase vasodilation or increase lymph load (paraffin, heat, ice, hydrotherapy, saunas, contrast bath)
Phase II Management-
Continue with CDT, skin care, compression bandaging, exercise, pneumatic compression pumps with caution— what kind of pump is preferred and why?
Low pressure sequential pumps preferred—
- High pressures can damage lymph nodes
- May move water instead of proteins
- Use on LE increases risk of genital lymphedema
Phase II management- pneumatic compression pumps can only be used for pts in stage __ lymphedema
I
RED FLAG: pneumatic compression pumps with pressure >___ mmHg is contraindicated
45
Surgical reduction: _____ subcutaneous tissue and skin in severe cases of those who are risk and considerably symptomatic. Significant risk of ____ post-op.
De-bulking
Morbidity
Restoring lymph flow: lymphovenous anastomoses and lymphatic vessel grafting and lymph node transplantation. Successful in pts with _____ distal/proximal lymph obstruction
Intact
Liposuction: may be considered for pts with _____ _____ and when other conservative measures have failed. Must use ____ ____ post-op.
Nonpitting edema
Pressure garments
