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Fundamentals of PT > Lymphedema > Flashcards

Lymphedema Flashcards

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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
What is Primary lymphedema?
Hereditary or congenetial
26
What is secondary lymphedema?
Acquired Result of damage to soft tissue, lymph vessels or nodes secondary to radiation, surgery, tumor infection mosquito bite (Filariasis)
27
What are the 4 stages of lymphedema?
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
28
Who experiences primary lymphedema most?
females 87%
29
What is lymphadema praecox?
primary lymphedema that occurs before 35 (83% of cases)
30
What is lymphedema tardum?
primary lymphedema that occurs after age 35
31
Where is primary lymphedema most common? What can trigger it?
Lower extremities. Triggered or exacerbated by infection, trauma or pregnancy
32
What is aplasia?
Lack of lymphatics incompatible with life
33
What is hypoplasia?
most common type of lymphatic dysfunction, decrease collectors and capillaries
34
What is hyperplasia?
Increase in width of lymphatic collectors, insufficient valves
35
What is inguinal node fibrosis?
Kinmonth syndrome, nodes cannot drain properly
36
What is inguinal node fibrosis?
Kinmonth syndrome, leg edema *******
37
What are the 3 watersheds of the body?
Transverse, longitudinal, and superclavicular
38
What is LL?
Lymphatic load, LL | -Amt of fluid and cells to be removed from the interstitium
39
What is LTV?
Lymph Time volume, LTV (lymph transported/time) | -Amount of lymph transported per unit of time
40
What is TC?
Transport capacity TC | -Maximum lymph time volume
41
What is secondary lymphedema?
Result of an insult to the lymphatic system (often in the treatment of cancer)
42
What factors have a role in secondary lymphedema?
surgery, radiation, BMI, and cellulitis
43
When does 2ndary lymphedema usually happen?
Within 4 years but can occur over 10 yrs later
44
What are some differential diagnosis for lymphedema?
``` Chronic Venous insufficency Acude DVT CHF Lipedema CRPS Myxedema Malignant Lymphedema ```
45
What are some presentations of Acute DVT?
``` Sudden onset (usually unilateral) May be painful Cyanosis or erythema +/- Homans's sign Potential for pulmonary embolus Venous doppler ultrasound ```
46
What are some presentations of CHF?
``` Swelling distally Sudden weight gain of greater than 2 lbs overnight Bilateral and symmetrical Pitting swelling decreases w/ elevation painless jugular venous distention ```
47
What are some presentations of lipedema?
``` Usually in women Bilateral from iliac crest to ankles dorsum of feet not involved no pitting no cellulitis pain on palpation w/ bruising ```
48
What are some presentations of Malignant Lymphedema?
``` Pain, paraesthesias, paralysis Proximal swelling Rapid development, continuous progress Lymph node enlargement Ulcers Heatoma-like discoloration ```
49
What are the six ways of measuring lymphedema?
Circumferential (high intrarater, low interrupter) Water displacement Weight Optoelectrical: perometer Tonometry Bioimpedance (ratio of extracellular to intracellular fluid volumes)
50
What are the negatives of measuring lymphedema?
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
What is a Stemmers sign?
Can't quite pinch the skin on the toes and so you bring extra tissue with it. Presence of lymphedema
52
What is 1+?
visible edema
53
What is 2+?
5--15 seconds
54
What is 3+?
15-30 seconds
55
What is 4+?
>30 seconds
56
What are some interventions for Lymphedema?
``` Nothing Pt education Compression garment, no bandage Bandage then compression carnet Complete decongestive therapy (CDT) compression pump ```
57
What is phase one of CDT?
skin care MLD Compression bandage up to 24 hrs a day exercise in bandage
58
What happens in phase 2 of CDT
Skin care self/partner massage | Compression stockings days, bandage nights
59
What are general contraindications for CDT?
``` Acute infection Cardiac edema Malignant disease (relative) Renal Dysfunction Acute DVT ```
60
What are some contraindications for bandaging?
Arterial disease | precaution in case of HTN, paralysis, diabetes, bronchial asthma and CHF
61
What are some contraindications for MLD of abdomen?
pregnancy Recent abdominal surgery intestinal problems Aortic aneurysm
62
What are some contraindications for MLD of Neck?
Cardiac arrhythmia Hypo/hyper thyroidism Hypersensitivity or carotid sinus Over age 60 (relative)
63
Education
Fill out
64
What are the effects of MLD?
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
What are the characteristics of MLD techniques?
``` specific light do not cause increased blood flow superficial (dermis, sub-dermis) 2 phase stretch and release slow every six to ten seconds ```
66
What type of bandages are used for lymphedema?
Short stretch bandages
67
How much pressure is exerted by a class 1 compression stocking?
20-30 mmHg
68
How much pressure is exerted by a class 2 compression stocking?
30-40 mmHg
69
How much pressure is exerted by a class 3 compression stocking?
40-50 mmHg
70
How much pressure is exerted by a class 4 compression stocking?
50-60 mmHg
71
What is exercise thought do do for lymphedema?
activate muscle and joint pumps

Fundamentals of PT (10 decks)

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