Lymphedema Flashcards
What is Lymphedema?
An excessive and persistent accumulation of extravascular and extracellular fluid and proteins in the tissue spaces.
What is Primary Lymphedema?
- Very uncommon due to insufficient development or congenital malformation of the lymphatic system.
What is Milroy’s Disease?
Form of congenital (primary lymphedema) that is present at birth.
Most common form Primary Lymphedema
What is Secondary Lymphedema?
Most common type. Secondary to the management of cancers the breast, pelvis and abdomen.
- Surgery
- Radiation
[Due to injury to one or more components of lymphatic system]
Secondary Lymphedema - Combined Venous Lymphatic Dysfunction. How does position effect edema?
Dependent, peripheral edema, occurring with long periods of sitting or standing.
Edema is decreased if the limb is elevated
What skin changes can occur due to - Combined venous lymphatic dysfunction
When edema persists the skin becomes less supple and over time takes on a brownish pigmentation
Stage 0 - Latency Stage
- No outward swelling
- Asymptomatic with occasional reports of heaviness in the extremity; subjective complaints
“Lymphe03dema”
Stage 1 - Reversible Stage
- Elevation Reduces Swelling
- No tissue fibrosis
- Swelling is soft or pitting
“Lymphe03dema”
Stage 2 - Spontaneously Irreversible
- Fibrosis of tissue, hard, “brawny” swelling
- (+) Stemmer Sign
- Elevation DOES NOT reduce swelling
“Lymphe03dema”
Stage 3 - Lymphostatic Elephantiasis
- (+) Stemmer Sign
- Skin Changes - Hyperkeratosis, papillomas, deep skin folds.
“Lymphe03dema”
What is a (+) Stemmer Sign? What stage is this indicative of?
Examiner cannot pinch the skin of the dorsum of the fingers or toes
- Indication of Stage 2 or 3 lymphedema
What is the most practical method of measuring/comparing amount of lymphedema in a limb? When do we choose this?
Circumferential/Girth Measurements
Done in the more proximal areas, done in 10 cm intervals.
Are hot baths, whirlpool and saunas appropriate to use in this population?
No, these should be avoided as they elevate the body’s core temperature.
Manual Lymphatic Drainage (MLD); What areas are cleared first, proximal or distal?
Proximal congestion in the trunk, groin, buttock and axilla is cleared first to make room for the more distal areas
During Manual Lymphatic Drainage (MLD) what is the direction of the stroking?
Distal-to-Proximal Stroking
Compression Therapy: Pressures provided by Low/Short-Stretch bandages? What phase of CDT are these utilized?
Low Resting Pressure
High Working Pressure
- Bandage can be worn during the (day and night) secondary to the low resting pressure.
- Most effective for mobile limbs
Used during Phase 1; Intensive Phase
Compression Therapies: Pressures provided by high/long stretch. What phase of CDT are these utilized?
High Resting Pressure
Low Working Pressure
- Best for immobile limbs
- Such as Ace Wraps
Used during the day, Phase 2
- Really for sprains, strains and the like
In tropical and subtropical regions, what is the most common cause of secondary lymphedema?
Filariasis: causing inflammation and blocked lymph vessels.
What quadrants are received from the Right Lymphatic Duct?
Receives lymph ONLY from the right upper quadrant
- Empties into the Right Subclavian Vein
What quadrants are received from the Thoracic Duct?
Received lymph from the other 3 body quadrants (other than the upper right quadrant)
- LUQ, LLQ, RLQ
- Empties in the Left Subclavian Vein
How is lymphedema formed in terms of Lymphatic Load and Transport Capacity?
Lymphatic Load > Transport Capacity
= Lymphedema
What is Lipedema? Is this condition bilateral or unilateral?
Is a bilateral condition affecting the lower extremities.
Due to excess fat production/deposits in the legs.
(Photo: Lymphedema Left, Lipedema Right)
What are volumetric measurements and when are they utilized?
Placing the hands or feet in fluid to see amount of displacement.
For the more distal areas, when measuring the hands and feet.
When/what are bioelectric impedance measurements used for?
Utilizing alternating electrical current to measure the resistance to flow through extracellular fluid in the extremity.
(The higher the resistance to flow, the more extracellular fluid present.)
Taken prior to and after surgery.
