Lymphedema Flashcards
What does the lymphatic system do
- works with the peripheral vascular system to remove fluid from the interstitial spaces
- excess fluid in the interstitial space is absorbed by the lymphatic ystem and carried to the lymph nodes, eventually entering the venous system
what happens
Lymph vessles during circulation and perfusion
- O2 and nutrient rich fluid is forced out of the arterial end of the capillary into the tissue interstitial space, and then into cells
- waste products flow from the cells through the.interstitial space to the venous end of the capillary
What are the lymphatic organs and describe the flow of fluid through the lympatic system
- spleen
- thymus
- tonsils
- lymph nodes
- flow: lymph capillaries => precollectors => collectors => lymph nodes => venous system
*lymph capillaries are intertwined
Review the anatomy of the lymph system
Role of lymphatic system
- immune surveillance
- maintain fluid homeostasis
- aide in digestive system in the breakdown of long-chain fatty acids
What is lymphedema and what causes it
- a chronic inflammation condition that develops as a result of lympatic insufficiency
causes:
- decrease in reabsorption
- decrease in transport capacity
primary lymphedema
- congential malformation of lymphatic system
secondary lymphedema
- damage to lymph vessels/nodes, and subsequent impaired reabsorption and or transportation
most common
What causes secondary lymphedema
- trauma
- radiation
- tumor obstruction
- infection
- surgery
patietns with cancer treatments are likely to get this
- look to see if cancer Metastasized to a lymph node
What are some causes of primary lymphedema
- inherited mutations that result in abnormal lymph system development
- milroy’s disease
- meige’s disease
- lymphedema tarda (onset >35 years oof age)
*often accompanied by other anomalies-hypoparathyroidism, cerevral vascular anomalies, congential heart defects
What are risk factors for secondary lymphedema
- history of UE/LE venous pathologies
- surgical removal of lymph nodes
- mastectomy
- prostate cancer
- multiple pregnancies
- abdominal surgery
- chemo/radiation
- HTN, smoking, obesity
- scar tissue
- infection
how to determine if its edema vs lymphedema
- lymphedema is an abnormal collection of excessive tissue Proteins, edema, chronic inflammation and fibrosis
- lymphedema results from increased fluid and damaging products remaining in the tissue (initially soft and pitting but becomes firm and less compressible)
- infection is one of the primary causes of lymphedema progression
Protein is found in lymph fluid
How can edema of any nature be a problem in maintaining skin integrity and healing wounds
- impedes diffusion of oxygen and nutrients
- edema fluid is a good culture medium and predisposes one to infeciton
- inhibits mitogenic activity and DNA synthesis, maintaining high levels of pro-inflammatory cytokines
- induces a state of cell senscence
- can compress small blood vessels resulting in ischemia
- can be a sign of underlying disease and also contribute to other impairmetns/function limitations
stages of lymphedema:
subclinical
- no swelling or pitting
- limb “heaviness”
- see fibrotic changes
- joints feel stiff
- lymph transport is impaired but load does not exceed capacity
stages of lymphedema
stage 1
- edema variable and decreases with elevation or sleep
- edema is soft, easily pits, little to no fibrosis
- decreases with positional changes
stages of lymphedema
stage 2
- edema doesnt decrease with elevation
- range from soft to non-pitting
- skin becomes fibrotic
- +stemmers sign
keep in mind beginning stage 2 vs ending of stage 2
What is lipedema
- a chronic disease of lipid metabolism generally affecting the legs which causes the legs and sometimes the arms to accumulate fatty tissue
feet ususally spared
stages of lymphedema
stage 3
- elephantiasis
- hyperpigmentation
- dermal hardening and minimal pitting
- papillom’s of skin
- often recurrent infections
- (+) stemmer’s sign
what are some charateristics of LIPEDEMA
- symmetric and buttocks involved
- foot not involved
- not pitting
- stemmers sign negative
- tissue feels rubbery
- painful to touch
- easy bruising
- hormonal disturbances frequent
what are some characteristics of lymphedema
- not symmetric usually
- foot involved
- pitting edema
- stemmers sign positive
- tissue feels firmer
- generally not painful to touch
- generally no bruising
- generally no hormonal disturbances
What can be used for diagnosis/differential diagnosis
- BMI
- abdominal exam
- signs of systemic disease
- unilateral vs bilateral
- presence of pain
- varicosities
- stemmers sign
- hyperkeratosis vs hemosiderin staining
- palpable lymph nodes
what are some integumentary integrity changes with lymphedema
- rough texture (orange peel like)
- color (red, brown, darker than natural)
- pitting status
- fibrosis
- temperature
- deepening of skin folds
- nail quality
- stemmers sign
- lymphorrhea
what is lymphorrhea
- leakage of lymph onto the skin
- milky looking
lymphedema interventions
Exercise
- diaphragmatic breathing: main pressure changes
- ROM< joints proximal to distal
- aerobic exercise
compression
- cornerstone tx (can vary depending on stage)
- multi-layer compression bandages/garments
- intermittent compression pumps
- garments to maintain edema reduction
CDT: complete decongestive therapy
- opening collateral lymphatic drainage pathways with manual lymphatic drainage and compression
- self management
skin care
general skin care for lymphedema
- keep skin clean and dry
- use mild soaps
- use low pH moisturizers, lotions to improve texture
- thoroughly dry between skin folds and digits
- topical antifunglals to prevent fungal infections
- tpical steriods to decrease inflammation (short term)
- protect papilloma’s from shearing
