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
Are low/short stretch bandages better for mobile or immobile limbs?
Mobile
(Due to High Working Pressures)
Are high/long stretch bandages better for mobile or immobile limbs?
Immobile
(Due to High Resting Pressures)
What is Pitting Edema?
Pressure on the skin causes an indentation to form that can persist for many seconds after the pressure is removed.
What is Brawny Edema?
Feels hard with palpation
Progressive fibrotic changes in the subcutaneous tissues.
(Cannot_ make an indentation)
What is Weeping Edema?
Most severe and long duration.
- Lymph leaks from cuts and sores
- Wound healing significantly impaired.
What is Lymphatic Load?
The amount of lymphatic fluid to be transported
(Amount of Lymph in the system)
What is Transport Capacity?
The maximum amount of fluid that the lymphatic system can transport.
How is lymphedema formed in terms of Lymphatic Load and Transport Capacity?
Lymphatic Load > Transport Capacity
= Lymphedema
How does Venous Insufficiency lead to Lymphedema?
The veins are not able to move blood back to the heart, leading to a fluid accumulation in the distal extremities.
Increases overall lymphatic load, while Transport Capacity has not changed!
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)
Does lipedema affect proximal or distal areas more? Will there be a positive or negative Stemmer sign?
Affects the proximal areas, such as the buttocks and thighs. Does not affect the distal areas, such as the feet.
[Stemmer sign will be negative]
How does lipedema affect the skin?
- Affects skin elasticity
- Sensitive to pressure and touch
- Bruises easily and can be painful
Are patients with Lymphedema or Lipedema more susceptible with producing Cellulitis?
Common to form Cellulitis with Lymphedema
(RARELY occurs in lipedema)
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.
What is and when is lymphoscintigraphy utilized?
Measured during rest and exercise!
Used to identify lymphatic insufficiency!
How should lymph nodes feel on palpation
- Soft, Squishy
- Non-Tender
- Mobile
- < 1 cm
(Usually non-palpable)
What is an Abnormal finding to lymph node palpation.
- Tender
- Firm-Hard
- Immobile
- > 1 cm
Needs to be reported to referring physician.
What is Lymphangitis?
Inflammation of the lymph vessels
What is Lymphadenitis?
Inflammation of the lymph nodes
What is lymphadenopathy?
Swelling/Enlargement of the lymph nodes
What are the components of Complete Decongestive Lymphatic Therapy Program (CDT): Phase 1: Active; Intensive
- Manual Lymphatic Drainage (MLD)
- Multiple Layer Compression Bandaging (low/short stretch)
- Skin and Nail Care (Both Stage 1 and 2)
- Exercise (Both Stage 1 and 2)
What are the component of Decongestive Lymphatic Therapy Program (CFT): Phase 2: Maintenance
- Self-Manual Lymphatic Drainage
- Compression Therapy:
Compression garment during the day (High/long Stretch), Multiple layer bandaging in the evening/night (low/short stretch) - Skin and Nail Care (Both Stage 1 and 2)
- Exercise (Both Stage 1 and 2)
