Lymphatics Flashcards
What are the 4 functions of the lymphatic system?
- immune defense
- transport and drainage of excess fluids, proteins, and cellular debris
- sanitation system of the body
- maintains proper fluid levels in the blood capillaries
How does lymphedema occur?
If the lymphatic system is unable to maintain proper fluid levels in the blood
T/F the lymphatic system drains into the venous system
True
T/F the lymphatic system is a closed system
False- the cardiovascular system is a closed system but the lymphatic system is NOT
What is the most effective treatment for any disorder of the lymph system?
Conservative treatment: PT
Why does lymph originate?
from the blood plasma that leaves the capillaries and enters the interstitium - then the interstitial fluid that enters the lymphatic system is called lymph
What is lymph made up of?
proteins, water, fatty acids, and cellular components
Purpose of the right lymphatic duct
drains 1/4 of the body’s lymph- from the R UE and R side of head
Purpose of Thoracic duct
Largest lymph vessel of the body- drains from the L UE, L side of head, and bilateral LEs
How many lymph nodes are in the body? && where are the located?
600-700
-neck
-axilla
-chest
-abdomen
-groin
Function of Lymph nodes
involved in filtration and immune surveillance using T and B lymphocytes
T/F lymph vessels are similar to arteries
False- similar to veins since they lack thick musculature in the walls and have valves
How can PTs reduce lymphedema in patients?
They need to use the few lymph vessels that do not cross the watersheds to help move lymph away from edematous areas and to facilitate the development of collateral vessels
What is the most common disruption of the lymphatic system?
Lymphedema- most commonly occurs after breast cancer surgery and treatment
What is lymphedema?
When the lymphatic system is unable to handle the demands placed on it, so fluid builds up in the interstitium
T/F if lymphedema is not reversed, the body part will continue to increase in size
True
Why is pressure used to treat lymphedema?
to reduce the abnormally elevated blood capillary filtration rate and elevate the blood capillary reabsorption rate to normal
What is transport capacity?
The maximum ability of the lymphatic system to transport lymph
-it can be reduced due to surgery, trauma, infection, or radiation
-normally our lymphatic system is only working at 10% of its capacity
What are the 3 types of lymphatic insufficiency?
- mechanical: caused by an impaired transport capacity
-causes lymphedema when lymphatic load is high - dynamic: lymphatic load exceeds the transport capacity- most common
-causes pitting edema with CHF and venous insufficiency - combined
What are the causes of Dynamic Lymphatic Insufficiency
-heart failure
-chronic venous insufficiency
-pregnancy
T/F excess body weight is a risk factor for lymphedema
True- PTs need to promote healthy lifestyle changes and weight management to prevent lymphedema in high-risk patients
T/F the myocardium has many initial lymph vessels
True- it is essential that a patient has a functioning cardiac lymphatic system after heart surgery in order control myocardial edema
How to diagnosis Lymphedema
-Nonpitting edema
-Stemmer Sign: unable to pinch the skin on the dorsum of the foot
Primary Lymphedema
-results from an abnormally developed lymphatic system that is congenital or hereditary
-occurs most in LEs
-more common in females
-Milroy’s disease: family inheritance of lymphedema
Secondary Lymphedema
-results from unknown insult to lymphatic system that impacts transport capacity (surgery, radiation, trauma, tumor)
-common after breast cancer surgery
-lymphatic filariasis: tropical disease from mosquitos
Stages of Lymphedema
0: latency- no clinical edema but transport capacity reduced
1: reversible- edema present, but reversible with elevation
2: spontaneously irreversible- edema progresses to nonpitting and does not disappear with elevation, positive Stemmer Sign, skin changes
3: lymphostatic elephantiasis- severe nonpitting edema, positive Stemmer Sign, skin changes
T/F intermittent pneumatic compression devices are very effective for lymphedema treatment
False- they are not very effective b/c they move water but not the proteins within the fluid
-can cause lymphedema in more proximal regions (genitalia)
T/F diuretics are a great choice for treatment of lymphedema
false- they are NOT used
Surgical treatment options for lymphedema
-debulking: removal of excess skin and subcutaneous tissue
-liposuction
**both can cause damage to superficial lymph vessels
What does Complete Decongestive Therapy (CDT) consist of?
Phase I: Treatment- manual lymphatic drainage, compression, exercise, and meticulous skin care
Phase II: Self management: compression, exercise, meticulous skin care, MLD as needed
**compliance in phase II is essential for long-term outcomes
Manual lymphatic drainage (MLD)
Gentle massage based on anatomy and physiology of lymphatic system while patient is lying down and the affected extremity is elevated
-treat central areas and uninvolved lymph nodes first to prep those to receive the lymph
-causes increased lymph flow into desired areas around blockages and across watersheds
Conservative treatment methods for lymphedema
- Manual Lymph drainage
- Compression/bandages
- Exercise
Compression treatment
External compression is a key component to Complete Decongestive Therapy and it should immediately follow MLD
-compression garments are used in addition to bandages in phase II of CDT
T/F bandages used in lymphedema are called “long-stretch”
False- they are called “short-stretch” which is the opposite of ACE bandages
-bandages are the key component of compression during phase I of CDT
What are the exercise benefits for pts with lymphedema?
-support and improve lymphatic function
-enhance overall functional mobility
T/F compression stockings are worn during exercise
True- they must be in place while exercising
What is Lipedema?
Gradual and progressive symmetrical accumulation of fat in the subcutaneous tissue- typically within the butt and LEs
-often confused with lymphedema
-typically appears during puberty, pregnancy, or menopause
Differential diagnosis between lymphedema and lipedema
Lymphedema:
-unilateral
-positive stemmer sign
-affects both LE and UE
Lipedema:
-bilateral
-rarely affects UE
-does not affect distal areas (feet)
-negative stemmer sign
Treatment of Lipedema
Can use MLD- lymphedema patients will respond quicker to this treatment
-pts pain may affect their tolerance to this technique
