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Cardiopulmonary > Lymphatics > Flashcards

Lymphatics Flashcards

1
Q

Four main functions of lymphatic system?

A
  1. Immune defense
  2. Transport/Drainage of excess fluid, protein & debris
  3. Sanitation system
  4. Maintain proper fluid levels in capillaries
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2
Q

When would lymphedema present?

A

If there is an abnormality in the maintenance of proper fluid levels within the blood capillaries (#4)

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3
Q

T/F - The lymphatic system is a closed system

A

False – Drains into venous system

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4
Q

What is lymph?

A

Fluid made of proteins, water, fatty acids, & cellular components (WBC, bacteria/viruses, debris, etc)

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5
Q

What other organs/tissues exist in the lymphatic system?

A

Lymph nodes, thymus, bone marrow, spleen, tonsils, Peyer patches of small intestines

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6
Q

Path of Lymph Flow

A

Initial lymph vessels (smallest) > Precollectors > Lymph collectors (path of deep arteries/veins) > Lymphatic trunks (Right vs Thoracic)

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7
Q

What system controls the lymphatic trunks?

A

SNS

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8
Q

Right lymphatic duct vs Thoracic duct

A

Right - Drains 1/4 of body (R UE + R head + R chest)
Thoracic - Drains 3/4 of body (everything else)

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9
Q

Whats important to know about watersheds?

A

There is sparse lymphatic connections within these areas, so lymph flow is in different directions as it moves towards collecting ducts

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10
Q

Why should PTs use watersheds?

A

Moving the lymph away from the edematous areas using the few lymph vessels crossing the watersheds will help reduce lymphedema by creating collateral vessels

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11
Q

What % of fluid is the lymphatic system responsible for returning to the venous system?

A

10%

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12
Q

What condition will predispose patients to lymphedema?

A

Breast cancer treatment (radiation)/mastectomy
Lymph node removal
Cardiovascular disease (myocardial edema)

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13
Q

Define lymphedema

A

Build-up of protein rich fluid in the interstitium due to the inability of the lymphatic system to keep up with the fluid demand. Will continue to build until treatment is performed.

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14
Q

What is the idea behind adding light pressure to lymphedema within the extremities?

A

Reverse the capillary filtration & reabsorption rates. Filtration will be elevated, so the pressure will work to REDUCE filtration and INCREASE reabsorption.

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15
Q

What is transport capacity?

A

Maximum ability of lymphatic system to transport lymph. Can be reduced after surgery, trauma, infection or radiation. Normal patients will only use ~10% of transport capacity, meaning there is a lot of reserve to handle increased fluid demands.

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16
Q

What are the three types of lymphatic insuffiency?

A
  1. Mechanical - Impaired transport capacity
  2. Dynamic - Volume insufficiency (*most common)
  3. Combined
17
Q

Physiologic compensations for lymphedema

A

New anastomoses & collateral lymphatics
(If these don’t work, chronic inflammation will occur and lead to fibrosis & infection)

18
Q

T/F - Excess body weight is a risk factor

A

True - Healthy lifestyle education is needed in high-risk populations

19
Q

Key diagnostic features

A

Positive Stemmers Sign + Non-pitting edema

20
Q

Stemmer Sign

A

Pinch skin on dorsum of foot or hand. If the examiner CANNOT pinch the skin, the test is positive.

21
Q

Primary lymphedema

A

Congenital or Hereditary - Results in abnormally developed lymphatic system (Milroy’s disease)
*Most often seen in LEs and in females

22
Q

Secondary lymphedema

A

Insult to lymphatic system impacting transport capacity. Often due to surgery, radiation, trauma, or tumor growth. (Lymphatic filariasis - Mosquitos)

23
Q

Diagnose: No clinical edema, negative Stemmer, tissue/skin normal, reduce lymph transport capacity

A

Stage 0 - Latency

24
Q

Diagnose: Soft, pitting edema that is reversible with elevation, increased edema with standing, negative Stemmer, normal tissue appearance

A

Stage 1 - Reversible

25
Q

Diagnose: Edema progresses to non-pitting and brawny, no effect with elevation, positive Stemmer, fibrosclerotic tissue/skin changes & frequent infections

A

Stage 2 - spontaneously Irreversible

26
Q

Diagnose: Severe brawny and non-pitting edema, no effect with elevation, positive Stemmer, fibrosclerotic tissue/skin changes, and frequent infections

A

Stage 3 - Lymphostatic Elephantiasis

27
Q

Difference in treatment - Primary vs Secondary

A

Primary: Conservative
Secondary: Treat underlying cause

Start treatment ASAP to avoid cellulitis and cancer

28
Q

T/F - Diuretics are a good treatment option for lymphedema

A

False - Does not typically affect lymphatic fluid (also not a matter of too much fluid, just need to get it back to where it belongs)

29
Q

Surgical Options

A

Debulking + Liposuction

30
Q

T/F - Intermittent pneumatic compression is the best option for lymphedema

A

False - Not effective due to movement of water, not protein-rich aspects of the fluid. Move proximally, increasing risk of genital lymphedema

31
Q

What is complete decongestive therapy?

A

Two phase treatment model:
Phase 1: TREATMENT - Manual drainage, compression, exercise, & skin care
Phase 2: SELF-MANAGEMENT - Compression, exercise, skin care, & drainage as needed

32
Q

What is manual lymphatic drainage?

A

GENTLE massage that increases lymph flow to desired areas and around blockages (across watersheds)

33
Q

Where should the PT start MLD?

A

CENTRAL areas and UNINVOLVED lymph nodes first. This preps the uninvolved side to receive lymph

34
Q

What kind of compression is beneficial?

A

External compression & bandages immediately following MLD.
*Key components to complete decongestive therapy

35
Q

What kind of bandages are used?

A

Short-Stretch

36
Q

How often do bandages need to be replaced?

A

Every 6 months

37
Q

Diagnose: Patient presents with PAIN and BILATERAL, SYMMETRICAL accumulation of fat within her buttocks and lower extremities after giving birth to her second child. Negative Stemmer

A

Lipedema

*Women, Buttocks/LEs, post-menopause/pregnancy/puberty, fat deposits

Cardiopulmonary (8 decks)

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