Lymphatic System Flashcards by Jessica Deak

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

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Components

Lymphatic vessels
Lymph fluid
Lymph nodes
Lymph tissues
Organs

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Name the lymph nodes of the UE

Supraclavicular
-Axillary
-Central
-Subscapular
-Pectoral
-Humeral
Cubital

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Name the lymph nodes of the LE

Iliac
Inguinal
Popliteal

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What are the other 2 lymph nodes (not UE or LE)?

Parasternal

Mesenteric

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What are the lymph organs?

Spleen
Tonsils
Thymus
Bone marrow

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Flow of lymph

Lymphatic capillaries > lymphatic vessels > large lymphatic ducts (R lymphatic due, thoracic duct) > subclavian veins

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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

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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

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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.

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What is primary lymphedema?

Congenital or hereditary disorder with abnormal lymph node or lymph vessel formation

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What is secondary lymphedema?

Acquired insult to lymphatic system

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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)

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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

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Stages of lymphedema:
Stage 1- ____, early accumulation of fluid with visible swelling; ___ edema that resolves with ____; _____ sign is negative

Reversible
Pitting
Elevation
Stemmer’s

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Stages of lymphedema:

Stage 2- spontaneously ____; increase in swelling; ___ does not reduce swelling; (+) ____ ____

Irreversible
Elevation
Stemmer’s sign

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Stages of lymphedema:

Stage 3- ______; fibrotic deep skinfolds; may change color; skin changes may limit ____

Elephantitis

Mobility

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Differential diagnosis is ?

Lipedema

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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

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What is lymphadenopathy? What causes it?

Enlargement of lymph nodes, with or without tenderness

Usually from infection

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Local vs generalized lymphadenopathy

Local is enlargement of nodes in 1 body segment, generalized is enlargement of nodes in 2+ body segments

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What is lymphadenitis?

Lymphadenopathy accompanied by signs of inflammation (red, tender)

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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

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Known risk factors for lymphedema?

Primary

Primary (idiopathic): congenital abnormality— hypoplasia, hyperplasia, aplasia

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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

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)

1. Meticulous skin/nail care (moisturize, prevent infections) 2. Lifestyle management (weight, sunscreen) 3. Avoid limb constriction 4. Compression garments 5. 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)

1. MLD 2. Compression bandaging/garments 3. Exercise 4. Skin care 5. 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

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)

1. Discomfort 2. Aching 3. Pain in proximal lymph areas 4. 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— 1. High pressures can damage lymph nodes 2. May move water instead of proteins 3. Use on LE increases risk of genital lymphedema

Phase II management- pneumatic compression pumps can only be used for pts in stage __ lymphedema

RED FLAG: pneumatic compression pumps with pressure >___ mmHg is contraindicated

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