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Cardiopulmonary Exam II > Lymphatics > Flashcards

Lymphatics Flashcards

1
Q

What are the 4 functions of the lymphatic system?

A
  1. immune defense
  2. transport and drainage of excess fluids, proteins, and cellular debris
  3. sanitation system of the body
  4. maintains proper fluid levels in the blood capillaries
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2
Q

How does lymphedema occur?

A

If the lymphatic system is unable to maintain proper fluid levels in the blood

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3
Q

T/F the lymphatic system drains into the venous system

A

True

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4
Q

T/F the lymphatic system is a closed system

A

False- the cardiovascular system is a closed system but the lymphatic system is NOT

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5
Q

What is the most effective treatment for any disorder of the lymph system?

A

Conservative treatment: PT

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6
Q

Why does lymph originate?

A

from the blood plasma that leaves the capillaries and enters the interstitium - then the interstitial fluid that enters the lymphatic system is called lymph

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7
Q

What is lymph made up of?

A

proteins, water, fatty acids, and cellular components

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8
Q

Purpose of the right lymphatic duct

A

drains 1/4 of the body’s lymph- from the R UE and R side of head

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9
Q

Purpose of Thoracic duct

A

Largest lymph vessel of the body- drains from the L UE, L side of head, and bilateral LEs

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10
Q

How many lymph nodes are in the body? && where are the located?

A

600-700
-neck
-axilla
-chest
-abdomen
-groin

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11
Q

Function of Lymph nodes

A

involved in filtration and immune surveillance using T and B lymphocytes

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12
Q

T/F lymph vessels are similar to arteries

A

False- similar to veins since they lack thick musculature in the walls and have valves

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13
Q

How can PTs reduce lymphedema in patients?

A

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

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14
Q

What is the most common disruption of the lymphatic system?

A

Lymphedema- most commonly occurs after breast cancer surgery and treatment

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15
Q

What is lymphedema?

A

When the lymphatic system is unable to handle the demands placed on it, so fluid builds up in the interstitium

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16
Q

T/F if lymphedema is not reversed, the body part will continue to increase in size

A

True

17
Q

Why is pressure used to treat lymphedema?

A

to reduce the abnormally elevated blood capillary filtration rate and elevate the blood capillary reabsorption rate to normal

18
Q

What is transport capacity?

A

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

19
Q

What are the 3 types of lymphatic insufficiency?

A
  1. mechanical: caused by an impaired transport capacity
    -causes lymphedema when lymphatic load is high
  2. dynamic: lymphatic load exceeds the transport capacity- most common
    -causes pitting edema with CHF and venous insufficiency
  3. combined
20
Q

What are the causes of Dynamic Lymphatic Insufficiency

A

-heart failure
-chronic venous insufficiency
-pregnancy

21
Q

T/F excess body weight is a risk factor for lymphedema

A

True- PTs need to promote healthy lifestyle changes and weight management to prevent lymphedema in high-risk patients

22
Q

T/F the myocardium has many initial lymph vessels

A

True- it is essential that a patient has a functioning cardiac lymphatic system after heart surgery in order control myocardial edema

23
Q

How to diagnosis Lymphedema

A

-Nonpitting edema
-Stemmer Sign: unable to pinch the skin on the dorsum of the foot

24
Q

Primary Lymphedema

A

-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

25
Q

Secondary Lymphedema

A

-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

26
Q

Stages of Lymphedema

A

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

27
Q

T/F intermittent pneumatic compression devices are very effective for lymphedema treatment

A

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)

28
Q

T/F diuretics are a great choice for treatment of lymphedema

A

false- they are NOT used

29
Q

Surgical treatment options for lymphedema

A

-debulking: removal of excess skin and subcutaneous tissue
-liposuction

**both can cause damage to superficial lymph vessels

30
Q

What does Complete Decongestive Therapy (CDT) consist of?

A

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

31
Q

Manual lymphatic drainage (MLD)

A

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

32
Q

Conservative treatment methods for lymphedema

A
  1. Manual Lymph drainage
  2. Compression/bandages
  3. Exercise
33
Q

Compression treatment

A

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

34
Q

T/F bandages used in lymphedema are called “long-stretch”

A

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

35
Q

What are the exercise benefits for pts with lymphedema?

A

-support and improve lymphatic function
-enhance overall functional mobility

36
Q

T/F compression stockings are worn during exercise

A

True- they must be in place while exercising

37
Q

What is Lipedema?

A

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

38
Q

Differential diagnosis between lymphedema and lipedema

A

Lymphedema:
-unilateral
-positive stemmer sign
-affects both LE and UE

Lipedema:
-bilateral
-rarely affects UE
-does not affect distal areas (feet)
-negative stemmer sign

39
Q

Treatment of Lipedema

A

Can use MLD- lymphedema patients will respond quicker to this treatment
-pts pain may affect their tolerance to this technique

Cardiopulmonary Exam II (11 decks)

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