Lymphatics Flashcards
First lymph vessel is known as ____ and is the smallest. IT is near blood capillaries and is responsible for….
initial lymph vessel
collecting fluid from interstitium that is not picked up by venous system.
Lymphatic system transports _____ _____.
It is responsible for ___-___% of interstitial fluid while venous system does the other percentage.
extracellular proteins
10-20%
Initial lymph vessels transport towards larger lymph vessels known as
lymph collectors
Lymph collectors transport to even larger lymph vessels known as
lymphatic trunks
The two main lymphatic trunks are
R lymphatic duct and thoracic duct
R lymphatic duct drains
R arm and R side of head
Thoracic duct drains
remainder of body
Lymphatic trunks empty lymph directly into
venous system via subclavian veins
Lymphatic system is under control of
autonomic nervous system
Other components of lymphatic system include
thymus
bone marrow
spleen
tonsils
Peyer patches in the small intestine
Lymphedema is
chronic and incurable
Primary lymphedema
occurs due to abnormal development of lymphatic system
Secondary lymphedema
occurs as a result of some other disease or injury that causes damage to lymphatics
Three types of lymph insufficiencies
dynamic
mechanical
combined
Dynamic insufficiency
most common
occurs when there is excess lymph circulating that exceeds the transport capacity
pitting edema
Examples: venous insufficiency, CHF, pregnancy
Mechanical insufficiency
occurs when transport capacity is reduced due to damage to the lymph system
results in more protein rich lymphedema
non-pitting
Combined insufficiency
both increase in lymph fluid and decrease in transport capacity
Individuals at greater risk for lymphedema
lymph node removal
extensive chest surgeries
radiation therapy
obesity
Those at greater risk should
avoid injury to skin
avoid constriction of extremity
diet and exercise to maintain healthy weight
when exercising, observe any changes in limb
avoid extreme hot and cold
wear compressions during strenuous activity and when standing or sitting for long periods of time
Procedure for limb circumference measuring
7 circumferences recommended for upper and lower extremities to see if fluid has been removed and not just redistributed
A difference of ___-___cm between 4 comparative circumferences on bilateral UE is evidence of lymphedema.
2-3
Mild lymphedema is classified as
<3 cm between affected and unaffected limbs
Moderate lymphedema is classified as
3-5 cm
Sever lymphedema is classified as
> 5 cm
Staging of Lymphedema:
0
latent or preclinical stage
no visible edema
transport capacity is affected
Staging of Lymphedema:
1
reversible
pitting edema present and increases with activity or heat but diminishes with elevation and rest.
Staging of Lymphedema:
2
spontaneously irreversible
non-pitting edema and does not change with elevation or rest
skin begins to show fibrotic changes
stemmers sign is positive
Staging of Lymphedema:
3
elephantiasis stage
extensive non-pitting edema
significant fibrotic changes
papillomas
skinfolds
kyperkeratosis
infection is common
Treat lymphedema with
complete decongestive therapy
CDT two phases:
Phase I is acute treatment in outpatient 4-6 weeks
Phase II is self-management
Can return to phase I when significant changes are noted.
CDT consists of
manual lymphatic drainage
compression therapy
exercise
skin care
Compression therapy is in phase ___.
___-____bandages are used because they have a ____ resting pressure.
Phase II consists a ___ of compression during the day and night.
Bandages and garment should have ____ pressure distally.
I
short stretch
low
combination
higher
Basic guidelines for exercise should start with
trunk exercises
followed by extremity working from proximal to distal
end with trunk again and deep breathing
wear compression during exercise
Soaps and moisturizers in lymphedema
low or neutral pH
Contraindications to CDT
acute infection
cardiac edema
diabetes
HTN
malignancy
renal insufficiency
DVT
Filariasis
parasitic infection most often seen in tropical climates
most common causes of secondary lymphedema
hyperkertosis
thickening of outermost layer of skin
observed in stage 3 lymphedema
Lymphadenitis
inflammation and infection of lymph nodes
Lymphadenomegaly
enlargement of lymph nodes
secondary to cancer, infection, allergic reactions
Lymphadenopathy
affects size, number or consistency of lymph nodes
Lymphangitis
infection and inflammation of lymphatic sys
Milroy’s disease
inherited type of primary lymphedema that typically presents in infancy. BLE
Papilloma
benign wart in stage 3
Spleen
upper left quadrant
responsible for filtration of RBCs as well as production of antibodies to fight infection
Stemmers sign
positive if dorsal base of second toe/finger cant be easily lifted away from bone which indicates thickening of skin due to fibrotic changes
Thymus
posterior to sternum and anterior to heart that produces T cells and T lymphocytes to help combat infection
