Lymphedema Flashcards
What are the 4 stages of Lymphedema?
0) Pre-Stage (sub-clinical, latency stage)
1)Reversible Lymphedema
2)Spontaneously (Chronic) Irreversible
3) Lymphostatic Elephantiasis
Characteristic of Transport Capacity in Stage 0
Subnormal but still greater than lymphatic load and sufficient to manage normal loads. Functional reserve is reduced/limited.
Anyone who has had surgery or trauma involving the lymphatic system and does not develop visible lymphedema is considered to be in what stage?
Stage 0 (latency stage)
58% of post-mastectomy women
Malformation or Dysplasia of the lymphatic system is called _____.
Lymphagiopathy
What type of malformations are there in the lymphatic system? (4)
1) Hypoplasia (lack of cells)
2) Hyperplasia (increase in cells)
3) Aplasia (not developed)
4) Inguinal Lymph Node Fibrosis
Most common type of Dysplasia (85%)
Fewer and smaller diameter Collectors
Both Upper and Lower extremities (more common in lower)
Hypoplasia
Dysplasia that has collectors with larger diameters due to insufficient valvular system. Transport capacity is compromised leaving to retrograde flow of lymph.
Hyperplasia (megalymphatics)
Dysplasia with absence of lymphatic capillaries/nodes in certain areas of the body. Dorsum of the foot is the most common area.
Aplasia
Dysplasia that affects the lymph transport in the afferent lymph collectors, is fibrosis of the capsular and trabeculae are of lymph nodes.
Inguinal Node Fibrosis
AKA Kinmonth Syndrome
Characteristics of Stage 1 Lymphedema (5)
1) Possible to completely remove swelling.
2) No fibrotic tissue (pitting easily induced)
3) No secondary skin changes
4) No papillomas (benign skin tumors)
5) May recede overnight (early stage 1)
Stage 2 lymphedema is primarily defined by what?
Degree of Lymphostatic Fibrosis
Long-standing accumulation of protein-rich fluid causes …. (3)
1) Tissue proliferation and subsequent fibrosis
2) Limb volume and skin folds increase
3) Weakened immune defense and frequent infections
Stemmer Sign is positive if …..
the skin on the dorsum of the fingers and toes cannot be lifted.
Why does compression therapy assist with reducing fibrosis in stage 2?
Constant compression has a fibrinolytic effect.
Stage 2 - late stage charactersistic include ….. (4)
- proliferation of connective tissue
- production of collagen fibers
- increase in fatty deposits
- fibrotic changes
Stage III characteristics (3)
- Secondary skin changes (fungus, ulcers, cysts, fistulas, papillomas)
- frequent infections/cellulitis
- lymphorrhea (lymph fluid leaking on the skin)
Stage III can have an overgrowth of skin that appears like thick callus called ….
Hyperkeratosis
Stage III can have raised wart-like growths that often require surgical removal called…..
Papillomas
A Pediatric Lymphedema that occurs at (<2yr) , has a associated family history and typically involves lower extremities.
Milroy’s Disease
Primary lymphedema that occurs after birth but before the age of 35 (generally onset in adolescence).
Meige’s Disease
Pediatric Manual Lymph Drainage Considerations
- treat at least 1x/day (best when asleep)
- soft stationary circles and pump techniques best
- NO abdominal techniques
Pediatric Compression Therapy Considerations
- difficult with infants
- careful application (not able to provide feedback)
- must not interfere with growth
- should not restrict the ability to walk
Pediatric Compression-Specific Guidelines
- small bandages only
- need to be reapplied several times per day
- compression garments not for <1yr
- 20-30 mm/Hg should not be exceeded
Primary Lymphedema disease that includes a triad of port-wine stain, varicose veins and bony/soft tissue hypertrophy involving an extremity.
Klippel-Trenaunay-Weber Syndrome (KTWS)
Lymphatic filariasis is caused by ……
parasitic filarial worms which proliferate in the lymphatic system.
