lymphatics

Question 1

organs of the lymphatic system

Answer 1

thymus
bone marrow
spleen
tonsils
peyer’s patches of the SI

Question 2

what is the overview of lymphedema

Answer 2

normal transport mechanisms of the lymphatic system being disrupted allowing for significant accumulations of water and protein to remain in tissue spaces

Question 3

explain the protein in the lymph fluid

Answer 3

result of cellular metabolism not proteins ingested from food

Question 4

tell me about the fluid dynamics / sterling’s law

Answer 4

flow from area of high to low pressure
sterling - fluid at the arterial end of the capillary will tend to flow into the tissue spaces

Question 4

where do the anterior vs posterior head, neck, and face drain

Answer 4

cervical nodes that then drain into the supraclavicular nodes

post - vertebral lymphatics

Question 5

where do the right and left UE drain

Answer 5

right - right thoracic into the right lymphatic

left - left thoracic and LE / abdominal and genital drain into left subclavian vein

Question 6

what is lymphedema

Answer 6

swelling of soft tissue that results in accumulation of protein-rich fluid in extracellular spaces

Question 7

what are the two types of lymphedema

Answer 7

primary (idiopathic)
secondary (acquired)

Question 8

where is lymphedema most commonly seen

Answer 8

extremities but can occur in head, neck, abdomen and genitals

Question 9

tell me about stage 0 or latent lymphedema

Answer 9

lymph transport is impaired but no clinical evidence of swelling

can take months to years for obvious symptoms to occur

Question 10

tell me about stage 1 lymphedema

Answer 10

swelling is soft, pits on pressure and reverses with elevation

Question 11

tell me about stage 2 lymphedema

Answer 11

swelling is nonpitting and does not reduce with elevation

clinical fibrosis is present

Question 12

tell me about stage 3 lymphedema? what is another name for it

Answer 12

nonpitting fibritic edema
atrophic skin changes
warty protrusions
leaking lymph fistulae
aka lymphostatic elephantiasis

Question 13

what are some possible causes/etiology of lymphedema

Answer 13

a failure of the safety valve mechanisms

decreased absorption of lymph in lymph nodes

increased lymphatic load and subtotal lymphatic blockage

chronic inflammation that decreases tissue oxygenation, furthering the cycle of chronic inflammation/risk of infection

Question 14

what are some clinical manifestations of lymphedema

Answer 14

full sensation in affected body part
– often that of skin tightness
decreased flexibility
inability to fit into clothes
tightness of jewlery

Question 15

what physical impairments are caused by lymphedema

Answer 15

> circumference of area
postural changes
discomfort in specific area
neuromuscular deficits
integumentary complications (loss of hair/sweat glands)

chronic fungus and reflux of infections

Question 16

what is the stemmer sign

Answer 16

thickened cutaneous fold of skin over the 2nd toe

typically present in the early / differential diagnosis of primary ascending lymphedema

Question 17

what are some precautions when treating a patient with lymphedema

Answer 17

observe for possible signs of cellulitis
blood pressure cuff is a no-no
application of heat (be careful)

Question 18

what are exercise precautions when treating a patient with lymphedema

Answer 18

exercise needs to activate muscles and joints in affected extremity
– can be beneficial to add an element of compression when doing these

low risk activities need to be considered
- biking, walking, cycling, swimming, tai chi