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Fundamentals of PT > Lymphedema > Flashcards

Lymphedema Flashcards

1
Q

What is lymph?

A

Interstitial fluid once it enters the lymph vessels

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2
Q

What are the only organs that do not secrete lymph?

A

THe brain and spinal cord

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3
Q

What does lymph contain?

A

protein, water, fatty acids and cellular components of bacteria, viruses and debris

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4
Q

What is the function of lymph?

A

Keeps connective tissue in a healthy state
Removes fluid, foreign particles from tissues and fats from intestines and returns to bloodstream
Protects body from infection and disease via immune response (lymphocytes)

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5
Q

What are the components of the lymphatic system?

A 
Lymph vessels 
Lymph nodes
Spleen
Thymus gland
Tonsils
Peyers patches
Lymphocytes
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6
Q

What are the two segments of a lymph vessel?

A 
The superficial portion (contains Capillaries and pre-collectors-NO VALVES)
Deep portion (contains collectors and Trunks. HAVE VALVES)
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7
Q

What are lymphangions?

A

Valves that separate collectors into functional segments. Resemble veins but have thinner walls and valves in shorter intervals. FROM ONE VALVE TO ONE VALVE.

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8
Q

What does lymphatic fluid flow rely on?

A

Intrinsic muscle contractions from the smooth muscle within walls of the vessels (lyphangions)

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9
Q

How often do Lymphangions contract at rest? During exercise, heat or inflammation?

A

6-10x/min. Increases 10 x with exercise, heat or inflammation

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10
Q

What is a lymphotome/watershed?

A

Distinct, anatomic areas of lymph drainage that drain to regional lymph nodes.

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11
Q

What is lymph drained through to get across a watershed?

A

Through anastomoses

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12
Q

What are lymph nodes?

A

Small kidney shaped vessels arranged in chains.

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13
Q

How many lymph node are there in the body? How big are they?

A

600-700 lymph nodes. About 2-25mm in diameter

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14
Q

Lymphatics vs. Circulation: direction

A

lymphatics-one way

circulation-circular

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15
Q

Lymphatics vs. Circulation: Amount

A

lymphatics-1/2 litres/day

circulation-4-8 L/min

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16
Q

Lymphatics vs. Circulation: Contraction

A

Lymphatic- intrinsic contractions (can also be aided by skeletal muscle contractions)
Circulation-seperate pump (heart)

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17
Q

Lymphatics vs. Circulation: Obstruction

A

Lymphatics-Obstruction leads to accumulation of high protein fluid (>1.5 gm/dl) doesn’t move well with gravity changes
Circulation-Obstruction leads to collection of low protein fluid (<1gm/dl) moves better with gravity changes

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18
Q

Lymphatics vs. Circulation: Filtering

A

lymphatics-fluid filtered by lymph nodes

Circulation-no filtering

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19
Q

What is microcirculation?

A

The 10% of fluid that leaves the arterial end of a capillary that is not reabsorbed by the venous end is reabsorbed by the lymphatic system and returns to circulation.

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20
Q

What are some clinical implications of microcirculation?

A
  • Accumulation of proteins in interstitum w/ impaierd lymphatic system. Will pull water across cell membrane to maintain osmotic equilibrium.
  • Loss of elasticity of skin
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21
Q

What is dynamic insufficiency?

A

Healthy lymphatic system but LL exceeds TC

Happens during sprained ankle, DVT, cardiac edema

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22
Q

What is mechanical insufficiency?

A

Diseased lymphatic system, normal LL exceeds impaired TC

Lymph node removal

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23
Q

What is lymphedema?

A

Abnormal accumulation of protein-rich fluid in the interstitial that occurs when the lymph load exceeds the lymph transport capacity (general but heavily debated)

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24
Q

What are the signs and symptoms of lymphedema?

A

slow, progressive onset
pt feels limb is heavy, not painful
usually starts distally and is asymmetrical

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25
Q

What is Primary lymphedema?

A

Hereditary or congenetial

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26
Q

What is secondary lymphedema?

A

Acquired
Result of damage to soft tissue, lymph vessels or nodes
secondary to radiation, surgery, tumor infection
mosquito bite (Filariasis)

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27
Q

What are the 4 stages of lymphedema?

A

Sub-clinical stage 0-feeling of heaviness in limb w/o any visible swelling
Stage 1- pits on pressure, high water content, reduces with elevation, reversible
Stage 2-Non-pitting, not reduced by elevation, moderate to severe clinical fibrosis
Stage 3-Elephantiasis-skin changes, lobules

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28
Q

Who experiences primary lymphedema most?

A

females 87%

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29
Q

What is lymphadema praecox?

A

primary lymphedema that occurs before 35 (83% of cases)

30
Q

What is lymphedema tardum?

A

primary lymphedema that occurs after age 35

31
Q

Where is primary lymphedema most common? What can trigger it?

A

Lower extremities. Triggered or exacerbated by infection, trauma or pregnancy

32
Q

What is aplasia?

A

Lack of lymphatics incompatible with life

33
Q

What is hypoplasia?

A

most common type of lymphatic dysfunction, decrease collectors and capillaries

34
Q

What is hyperplasia?

A

Increase in width of lymphatic collectors, insufficient valves

35
Q

What is inguinal node fibrosis?

A

Kinmonth syndrome, nodes cannot drain properly

36
Q

What is inguinal node fibrosis?

A

Kinmonth syndrome, leg edema ***

37
Q

What are the 3 watersheds of the body?

A

Transverse, longitudinal, and superclavicular

38
Q

What is LL?

A

Lymphatic load, LL

-Amt of fluid and cells to be removed from the interstitium

39
Q

What is LTV?

A

Lymph Time volume, LTV (lymph transported/time)

-Amount of lymph transported per unit of time

40
Q

What is TC?

A

Transport capacity TC

-Maximum lymph time volume

41
Q

What is secondary lymphedema?

A

Result of an insult to the lymphatic system (often in the treatment of cancer)

42
Q

What factors have a role in secondary lymphedema?

A

surgery, radiation, BMI, and cellulitis

43
Q

When does 2ndary lymphedema usually happen?

A

Within 4 years but can occur over 10 yrs later

44
Q

What are some differential diagnosis for lymphedema?

A 
Chronic Venous insufficency
Acude DVT
CHF
Lipedema
CRPS
Myxedema
Malignant Lymphedema
45
Q

What are some presentations of Acute DVT?

A 
Sudden onset (usually unilateral)
May be painful
Cyanosis or erythema
\+/- Homans's sign
Potential for pulmonary embolus
Venous doppler ultrasound
46
Q

What are some presentations of CHF?

A 
Swelling distally
Sudden weight gain of greater than 2 lbs overnight
Bilateral and symmetrical
Pitting
swelling decreases w/ elevation
painless
jugular venous distention
47
Q

What are some presentations of lipedema?

A 
Usually in women
Bilateral from iliac crest to ankles
dorsum of feet not involved
no pitting 
no cellulitis
pain on palpation w/ bruising
48
Q

What are some presentations of Malignant Lymphedema?

A 
Pain, paraesthesias, paralysis
Proximal swelling
Rapid development, continuous progress
Lymph node enlargement
Ulcers
Heatoma-like discoloration
49
Q

What are the six ways of measuring lymphedema?

A

Circumferential (high intrarater, low interrupter)
Water displacement
Weight
Optoelectrical: perometer
Tonometry
Bioimpedance (ratio of extracellular to intracellular fluid volumes)

50
Q

What are the negatives of measuring lymphedema?

A

none can measure face, hands, feet, breast or trunk
Dont measure differences btwn R and L limbs
do not factor change in noninvolved armo ver time

51
Q

What is a Stemmers sign?

A

Can’t quite pinch the skin on the toes and so you bring extra tissue with it. Presence of lymphedema

52
Q

What is 1+?

A

visible edema

53
Q

What is 2+?

A

5–15 seconds

54
Q

What is 3+?

A

15-30 seconds

55
Q

What is 4+?

A

> 30 seconds

56
Q

What are some interventions for Lymphedema?

A 
Nothing
Pt education
Compression garment, no bandage
Bandage then compression carnet
Complete decongestive therapy (CDT)
compression pump
57
Q

What is phase one of CDT?

A

skin care
MLD
Compression bandage up to 24 hrs a day
exercise in bandage

58
Q

What happens in phase 2 of CDT

A

Skin care self/partner massage

Compression stockings days, bandage nights

59
Q

What are general contraindications for CDT?

A 
Acute infection
Cardiac edema
Malignant disease (relative)
Renal Dysfunction
Acute DVT
60
Q

What are some contraindications for bandaging?

A

Arterial disease

precaution in case of HTN, paralysis, diabetes, bronchial asthma and CHF

61
Q

What are some contraindications for MLD of abdomen?

A

pregnancy
Recent abdominal surgery
intestinal problems
Aortic aneurysm

62
Q

What are some contraindications for MLD of Neck?

A

Cardiac arrhythmia
Hypo/hyper thyroidism
Hypersensitivity or carotid sinus
Over age 60 (relative)

63
Q

Education

A

Fill out

64
Q

What are the effects of MLD?

A

Increased freq. of lymph vessels contractions
increase volume of lymph transported
increased pressure in collectors
redirects lymph flow towards collateral vessels and across watersheds

65
Q

What are the characteristics of MLD techniques?

A 
specific
light
do not cause increased blood flow
superficial (dermis, sub-dermis)
2 phase stretch and release
slow every six to ten seconds
66
Q

What type of bandages are used for lymphedema?

A

Short stretch bandages

67
Q

How much pressure is exerted by a class 1 compression stocking?

A

20-30 mmHg

68
Q

How much pressure is exerted by a class 2 compression stocking?

A

30-40 mmHg

69
Q

How much pressure is exerted by a class 3 compression stocking?

A

40-50 mmHg

70
Q

How much pressure is exerted by a class 4 compression stocking?

A

50-60 mmHg

71
Q

What is exercise thought do do for lymphedema?

A

activate muscle and joint pumps

Fundamentals of PT (10 decks)

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