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UM - Integumentary > Lymphatics & Lymphedema > Flashcards

Lymphatics & Lymphedema Flashcards

1
Q

Stage 0 Lymphedema

A
  • No visible changes but may have mild tingling, unusual tiredness, or slight heaviness
  • reduced transport capacity
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2
Q

Stage 1 Lymphedema

A
  • Mildly swollen arm, hand, trunk, breast or other
  • Pitting edema
  • reversible w/treatment
  • swelling resolves w/elevation
  • pt may CO heaviness, tightness, sensory changes, or pain in the limb
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3
Q

Stage 2 Lymphedema

A
  • non-pitting edema that is not relieved by elevation
  • changes to tissue under skin: inflammation, hardening, or thickening
  • can be treated but is not reversible
  • positive stemmer sign
  • inc likelihood of skin infection
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4
Q

Stage 3 lymphedma

A
  • most advanced stage (rare in breast cancer)
  • large and misshapen limb w/leathery wrinkled appearance
  • skin is fibrotic
  • positive stemmer
  • lack of pitting edema
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5
Q

List some OM that can be used for lymphedma

A
  • Lymph- ICF
  • Lymphoedema QOL Tools (LYMQOL arm/leg)
  • Lymphedema Life Impact Scale (LLIS)
  • SPADI
  • DASH
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6
Q

What is the anatomy of the lymphatic system?

A
  • spleen
  • thymus
  • tonsils
  • peyer’s patches (in small intestine)
  • bone marrow
  • lymph nodes
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7
Q

What are peyer’s patches?

A

Located in the small intestine, they destroy bacteria and generate “memory lymphocytes” for long-term immunity

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8
Q

What are the superficial vessels of the lymphatic system responsible for?

A
  • located directly under the skin and above the fascia, they drain the dermis and subcutaneous tissue
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9
Q

What are the deep vessels of the lymphatic system responsible for?

A

Located below the fascia they drain all the tissue deep to fascia

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10
Q

What is the lymphatic system composed of?

A
  • lymph capillaries
  • lymphatic pre-collectors
  • collectors
  • ducts
  • trunks
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11
Q

What are initial lymphatics

A

The smallest diameter vessels that consist of a single layer of overlapping flat endothelial cells that with no valves (fluid can move in any direction) and become pre-collectors
- more permeable than vascular capillaries & absorb larger molecules of protein and fat

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12
Q

What are lymphatic pre-collectors?

A
  • w/an overlapping endothelial anatomy allowing them to absorb interstitial fluid, they have a limited # of valves & some smooth mm structure that allows them to initiate transportation of the collected fluid
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13
Q

What are lymphatic collectors

A
  • have 3 distinct layers and valves so that flow can only go towards the heart
  • have lymphangions between the two valves
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14
Q

What is alymphangion?

A

A segment b/t two valves made up of innervated smooth muscle in lymph collectors that transports lymph fluid by distention, autonomic nervous system, and muscle pump/changes in total tissue pressure

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15
Q

What is a lymphatic watershed?

A
  • describes the border where each area of lymph drains
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16
Q

What are the major watersheds of the body?

A
  • midline of the body
  • transect at the umbilicus
  • divides head from torso
  • down posterior surfaces of the limbs
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17
Q

How many lymph nodes do we have?

A

600-700 but it varies b/t individuals

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18
Q

Where are the major groups of lymph nodes?

A

armpits
groin
neck
abdomen

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19
Q

Functions of lymph nodes?

A
  • help remove waste products & water from cells
  • start immune response (biological filer stations)
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20
Q

Qualities of an acute infected lymph node

A
  • tender to touch
  • asymmetric
  • enlarged
  • matted together
  • potential for redness of overlying skin
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21
Q

What are lymphatic trunks?

A

where superficial & deep collectors converge, they are similar to collectors except larger in diameter w/more smooth muscle

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22
Q

What are the lymphatic trunks (named)?

A
  • Right and left lumbar trunks
  • gastrointestinal trunk
  • jugular trunk
  • supraclavicular trunk
  • subclavian trunk
  • peristernal trunk
  • bronchial-mediastinal trunk
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23
Q

What is cisterna chyli?

A

An enlarged lymphatic vessel (6 cm long) in the lumbar region (~L2) of the abdominal cavity that receives and temporarily stores lymph as it travels upward from the lower portion of the body

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24
Q

List the major lymphatic ducts

A

Thoracic Duct
Right lymphatic duct

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25
Q

What it the thoracic duct?

A

Where the bil LE, left side of trunk, L UE & left head and neck drains before emptying into the left internal jugular and subclavian veins

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26
Q

What is the right lymphatic duct?

A

drains the Right UE, right head neck and trunk into the right subclavian vein

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27
Q

What is lymphatic fluid composed of

A

water, proteins, macrophages, waste products (not CO2)

28
Q

How many liters of lymph flow into the blood circulation daily?

A

2 L

29
Q

How does starlings law of equilibrium work?

A

It describes how osmotic & hydrostatic pressures in the capillaries and interstitial tissue determine the direction of fluid movement - promoting filtration from the arterial end and reabsorption from the venous end of the capillaries to maintain homeostasis

30
Q

Define lymphedma

A

chronic inflammatory condition that develops as a result of lymphatic insufficiency (from dec in reabsorption or dec in transport capacity in the venous syndrome)

31
Q

Etiology of lymphedema

A

When lymphatics are unable to accommodate for and remove the protein rich fluid from the interstitial space causing fluid stagnation and edema

32
Q

What is dynamic insufficiency?

A

Lymphatic system is unable to accommodate for and transport an increase in lymphatic load (above the normal lymph transport capacity)

33
Q

What is mechanical insufficiency?

A

Lymphatic load may be normal but the lymphatic system is unable to transport this load (decreased functional reserve capacity)

34
Q

What is the functional reserve capacity for lymph node system?

A

The difference b/t the normal lymph transport capacity and the normal lymph load

35
Q

What is primary lymphedema?

A

congenital defect that can be present at birth or develop later on in a person’s lifetime

36
Q

What is secondary lymphedema?

A

result of acquired damage (sx, radiation, trauma, tumor, CVI, or infection) to the lymph vessels or nodes and therefore impaired reabsorption and/or transportation of lymphatic fluid

37
Q

What is the only clinical test that has been shown to be reliable and valid to dx lymphedema?

A

stemmer’s sign

38
Q

What is stemmer’s sign

A

a thickening of the skin over the proximal phalanges of the toes/fingers of the involved limb and the ability to “tent” (pick up the skin)

39
Q

Define lipedema

A

a metabolic dysfunction with bilateral/quadrilateral non-pitting soft edema but a lack of edema in the feet
typically is VERY painful

40
Q

Lipedema vs Lymphedema
- symmetry
- swelling
- pain
- bleeding
- stemmers

A
  • Lipedema = symmetrical, Lymph = asym
  • Lipedema = no welling in foot w/characteristic ring at ankle, Lymph = swelling BEGINS at food
  • Lipedema = extremely painful, lypmh - not painful, but heavy
  • lipedema = bruising and subcutaneous bleeding, lymph - no
  • lip = no stemmer, lymph = stemmer
41
Q

List some common skin complications from lymphedema

A
  • thickening
  • subcutaneous fibrosis
  • chronic inflammation
  • ulceration
  • papillomas
  • warts
  • skin flaps, folds, rolls
42
Q

What are the two main complications from the failure of a primary lymphatic valve?

A
  • fluid clx is less efficient = inc edema
  • leaking initial lymphatics = accumulation of inflammatory mediators in tissue = increased inflammatory rxns
43
Q

What happens in an acute inflammation?

A

the function of the initial lymphatics is compromised leading to increased edema due to decreased fluid clearance and increased inflammatory markers & therefore rxns in the tissue

44
Q

What can occur in a secondary acute infection (lymphedema)

A
  • cellulitis
  • chronic fungal infections
  • sepsis
45
Q

What is lymphangitis

A

A serious, potentially life-threatening bacterial infection that spreads freely, quickly, and uncontrollably through the deeper tissues and the lymphatic or circulatory systems

46
Q

What is fungal paronchia?

A

a fungal infection that affects the tissues surrounding a fingernail or toenail (secondary acute infection)

47
Q

What functional mobility complications are seen due to lymphedema?

A
  • dec ROM and strength
  • gait deviations
  • limitations in ADLs
48
Q

What is lymphadenitis

A

An infection (usually strep or staph) of the lymph nodes when glands (usually near the site of underlying infection, tumor, or inflammation) become enlarged

49
Q

What are the symptoms of lymphadenitis

A
  • swollen, tender, or hard lymph nodes
  • red, tender skin over lymph node
  • may feel rubbery
50
Q

What is lymphangitis

A

An infection (acute strep) of the lymph vessels causing an inflammation of the vessels and is sometimes confused w/a DVT

51
Q

What are the symptoms of lymphangitis?

A
  • red streaks from infected area to armpit/groin
  • enlarged lymph nodes above red-streaks
  • throbbing pain along affected area
  • fever 100-104 deg F
  • chills
  • malaise
  • HA
  • loss of appetite
  • mm aches
52
Q

What should you do if you suspect lymphangitis?

A

send to ER

53
Q

Risk factors for development of lymphedema?

A
  • lymph node status
  • radiation therapy
  • sx complications
  • time since sx
  • increased BMI
  • air travel w/o compression
  • inflammation/inc lymphatic load
  • dec lymphatic return
  • individ prone to scar tissue formation
54
Q

What are the current treatment options for lymphedema?

A

-

55
Q

T or F: a low protein diet is advised w/lymphedema

A

False - there is no evidence that any diet plan helps

56
Q

Diuretics & lymphedema

A

Diuretics are NOT effective bc it increases the concentration of proteins in the interstitial space exacerbating fibrosis rather than dec. the edema

57
Q

What is lymphoscintigraphy?

A

A nuclear medicine imaging that provides pictures of the lymphatic system used to ID the sentinel lymph node, plan a biopsy/sx, and ID points of blockage in the lymphatic system

58
Q

What types of imaging can be done for lymphedema?

A
  • CT - shows honeycomb pattern of subcutaneous tissue
  • dual energy x-ray (DEXA) - ST composition
  • MRI- expensive
  • US - skin thickness
59
Q

What do you examine the integ system for w/lymphedema?

A
  • texture
  • color
  • pitting
  • fibrosis
  • temp
  • deepening of skin folds
  • scars
  • nail quality
  • stemmer sign
  • open wounds
  • tissue mobility
  • cyst, fistula, papilloma, and ulcer presence
60
Q

Grade scale for pitting edema

A

1+ = trace, slight depression
2+ = mild, 0-0.6cm depression w/rebound <15 s
3+ = mod, 0.6-1.3cm, rebound 15-30 s
4+ = severe, 1.3-2.5 cm, rebound > 30 s

61
Q

What is tonometry?

A

Measure of resistance of lymphedema tissues to compression by measuring “softness”

62
Q

Why would you or would you not want to use water displacement to measure lymphedema?

A
  • highly reliable & allows for measurement of irregular shaped objects
  • hygiene concerns
63
Q

What do you need to consider w/girth measurements and lymphedema?

A
  • be consistent!!!!
  • do not pull it tight
  • high amount of user error, especially interrater reliability
64
Q

What is optoelectric volumetry?

A
  • use of infrared sensors to capture a 2D image of the limb w/volume calculated via a computer
  • very outdated
65
Q

What is a bioimpedance analysis

A

the use of electrical impedance of the current in the limb to estimate water content that MUST be done at the same time of day
- a lot of error as water content in the body is influenced by multiple factors

UM - Integumentary (6 decks)

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