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Med Surg II Final Exam > Lymphedema > Flashcards

Lymphedema Flashcards

1
Q

what is the lymphatic system a component of?

A

cardiovascular system

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2
Q

where does the lymphatic system originate?

A

terminal capillaries of the arterial and venous system (works along side the veins/arteries)

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3
Q

The lymphatic system is the main remover of excess fluid, removing ___% of the fluid

A

90%

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4
Q

the _____ _____ is the back up system and removes ____%

A

venous system; 10%

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5
Q

Lymph nodes aid in _____.

A

1.production of WBC, 2. filter debris and foreign materials

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6
Q

Lymphatic system is throughout the body except:

A

CNS, toenails, hair, bone, and eyes

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7
Q

What color is lymph?

A

clear and colorless (except chyle) - infected lymph is NOT a milky color

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8
Q

what is chyle?

A

lymphatic fluid that comes from the intestines (result of fatty foods)

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9
Q

what does lymph contain?

A

water, proteins, fat, pain chemicals, debris/waste products, bacteria, and lymphocytes (WBC)

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10
Q

where does the lymphatic system begin and end?

A

superficial and move deep; distal to proximal

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11
Q

where are lymph?

A

interstitial tissue spaces and organs (superficial, subdermal, sub fat, and deeper)

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12
Q

what is the process that involves the anchoring filaments and the change of pressure inside capillary/interstitium space

A

osmotic pressure in the intersitium gets greater than the pressure inside the capillary, the anchoring filaments pull up and the fluids flow into the capillary. When the pressure is large on the inside, the anchoring filaments close

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13
Q

what helps with the mechanisms of lymph flow?

A

contraction of lymphangions (10-20/min)

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14
Q

what are lymphangions?

A

segments in the lymphatic trunk that contract

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15
Q

what are the active and passive body movements that help with lymph flow?

A
  1. intestinal peristalsis, 2. skeletal muscle pumps, 3. arterial pulsation, 4. respiration, 5. massage, and 6. vibration
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16
Q

massage causes ___ more to be picked up than normal

A

10x

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17
Q

how much vibration to stimulate the lymphatic system?

A

32-45 Hz

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18
Q

how does breathing help with the mechanism of lymph flow?

A

the thoracic duct pierces through the diaphragm and stimulates the lymph in the lymphatic system

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19
Q

what are lymphatic trunks?

A

largest collecting vessels in the lymphatic system

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20
Q

what is the primary “main trunk”

A

thoracic duct

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21
Q

where does the thoracic duct form?

A

lymphatic vessels come up from the legs and go deep into the abdomen, thoracic duct comes into the circulatory system at venous angle

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22
Q

the cysterna chyli receives lymph from

A

lumbar trunks, both legs, and the lower half of the torso, genitals, and adrenal glands

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23
Q

what else does the cysterna chyli receive lymph from?

A

GI trunk, small intestine, stomach, pancreas, spleen and lever

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24
Q

where does the cysterna chyli drain?

A

thoracic duct

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25
Q

what is unique about the cysterna chyli?

A

expandable to hold excess fluid

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26
Q

the thoracic duct receives lymph from?

A

both legs, trunk below the ribs, major pelvic and abdominal organs, left thorax,, and left side of neck and head

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27
Q

where is the thoracic duct located?

A

along the spine in the thorax and curves left towards left clavicle

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28
Q

where does the thoracic duct drain?

A

left venous angle (where the internal jugular and subclavian go together)

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29
Q

how much lymph does the L venous drainage patterns have?

A

2L

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30
Q

how much lymph does the R venous drainage pattern have?

A

300-400 mL

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31
Q

what does the right venous angle receive lymph from?

A

R face,neck and shoulder, upper quadrant, and R UE, and L lower lobe of the lung

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32
Q

what does the left venous angle receive lymph from?

A

L face, neck, shoulder, upper quadrant, L UE, abdomen, genitalia and B LE (thoracic duct drains into this)

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33
Q

how many lymph nodes are in the body?

A

600-700

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34
Q

what do the lymph nodes do? (3)

A
  1. filter bacteria, toxins, and debris, 2. produce lymphocytes to fight infection, and 3. regulate protein content
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35
Q

what are the patterns of drainage?

A

5 quadrants = head/neck and each extremity/truncal quadrant

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36
Q

what are the major lymph node areas?

A

axillary, inguinal, abdominal and supraclavicular

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37
Q

what are watershed areas?

A

boundaries between lymph territories that provide collateral circulation

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38
Q

what does the manual lymph drainage (MLD) do to the water shed areas?

A

activates the anastamoses to redirect fluid from congested quadrants to healthy adjacent quadrants

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39
Q

TRUE/FALSE: normally, fluid does not cross at watershed areas.

A

true

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40
Q

what are the 5 watershed areas?

A

spina-scapular, clavicular, sagittal, horizontal, and gluteal

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41
Q

what are some “anastomosis” areas?

A

ant/posterior inter-inguinal anastomosis, axillo-inguinal anastomosis, and anterior/posterior axillo-axillary anastomosis

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42
Q

what is the progression of the lymph starting at blood vessels and then going to heart?

A

capillaries - initial lymphatic vessels - collecting vessels - lymph nodes - lymphatic trunks - lymphatic ducts - veins

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43
Q

lymph capillaries are located?

A

right under the skin… easy to stimulate

44
Q

what are the four things that make up the lymphatic load?

A

protein, water, cells (WBC, dead cells, debris), and fat

45
Q

what percentage of lymph is made up of water?

A

70-90%

46
Q

what is transport capacity?

A

maximum amount of fluid the lymphatic system can transport in a given amount of time

47
Q

what is the normal lymph load?

A

2L/day

48
Q

what is the max lymph load?

A

24L/day

49
Q

what is dynamic insufficiency?

A

normal system - lymphatic load exceeds the transport capacity

50
Q

dynamic insufficiency results in =

A

edema (lymph > normal transport capacity)

51
Q

what is mechanical insufficiency?

A

transport capacity of the lymphatic system drops below the normal lymphatic load

52
Q

mechanical insufficiency results in =

A

lymphedema

53
Q

what happens when there is dynamic insufficiency?

A

body speeds up processing of lymph system (contracts faster) to get swelling back down to 2L level

54
Q

what could cause mechanical insufficiency?

A

removal of lymph nodes, radiation, crush injury

55
Q

what is lymphedema?

A

accumulation of protein rich fluid within the skin and subcutaneous tissues due to lymphatic dysfunction… aka mechanical insufficiency

56
Q

what is primary lymphedema caused from and what are some examples?

A

developmental abnormalities…. ex: hypoplasia, hyperplasia, aplasia, and inguinal node fibrosis

57
Q

what is hypoplasia?

A

malformation of the lymph vessels = too few vessels or vessels smaller than normal (inefficient in processing fluid)

58
Q

what is hyperplasia?

A

lymph vessels larger than normal resulting in insufficient valve function (don’t help with propulsion)

59
Q

what is aplasia?

A

absence of lymph vessels or capillaries

60
Q

what is another name for inguinal node fibrosis?

A

kinmonth syndrome - results in swelling of LE

61
Q

what are the 2 types of familial lymphedema?

A

Type I - milroy syndrome (aplastic vessels - LE - congenital)
Type II - Meigs syndrome (during puberty - LE - lymph vessels can’t keep up with growth)

62
Q

what is the most common primary lymphedema?

A

Type II - Meigs (85%)

Type I - Milroy (15%)

63
Q

what are some s/s of type II?

A

distichiasis (extra row of eyelashes), yellow nails, cleft palate

64
Q

what is the name of the non-familiar type of lymphedema?

A

klippel-trenaunay-weber syndrome (hypo and aplasia)

65
Q

what is the cause of secondary lymphedema?

A

surgery, radiation tx, trauma, cancer, infection, and filariasis; frequent bouts of cellulitis

66
Q

what is filariasis

A

infection transmitted through mosquitoes - must get rid of this before treating for the lymphedema.

67
Q

what is the most common cause of secondary lymphedema?

A

chronic venous insufficiency followed by filariasis

68
Q

what is the 3rd most common?

A

breast cancer

69
Q

describe the pre-stage of lymphedema

A

“latency” - no visible edema but system is compromised (achy, heavy feeling)

70
Q

describe stage 1 of lymphedema

A

“reversible” - lymphedema is soft and pitting; limb swells during day and resolves at night; no size difference in limbs

71
Q

describe stage 2 of lymphedema?

A

“spontaneously irreversible” - tissue fibrotic with some pitting; does not resolve overnight; limb reduces but not to normal size; frequent infections

72
Q

describe stage 3 of lymphedema?

A

“lymphostatic elephantiasis” - tissue hard and sclerotic; deepening skin folds; dramatic increase in limb circumference

73
Q

what is cellulitis?

A

extra fluid just a breeding ground for bacteria; harder for WBC to fight off infection in the area with extra fluid over time, converts to “fatty tissue” that won’t reduce

74
Q

What are the four exercises for complete decongestive therapy?

A

Manual Lymphatic Drainage, compression, decongestive exercises, and skin care

75
Q

what does MLD do?

A

gentle manual technique that re-routes lymph from a blocked area to areas that are functioning

76
Q

what does compression do?

A

short stretch bandages have a HIGH working pressure and LOW resting pressure

77
Q

when are bandages used for compression?

A

phase 1

78
Q

when are garments used for compression?

A

phase 2

79
Q

when are decongestive exercises done?

A

while patient wearing compression - helps aid the joint and muscle pumps

80
Q

what kind of patients do you need to be careful with decongestive therapy?

A

CHF

81
Q

how do you stimulate the lymph system?

A

stretch the skin - gentle

82
Q

what are the effects of compression therapy?

A

reduce ultrafiltration rate, improve efficiency of muscle/joint pumps, prevent re-accumulation of fluid, and helps to break up accumulated scar and CT

83
Q

for phase I of treatment, what is the goal?

A

CDT is directed by the therapist until the volume stabilizes (PT needed)

84
Q

for phase II of treatment, what is the goal?

A

patient is fit with compression garment and continues self-direction treatment with all components of CDT

85
Q

what are the treatment goals for CDT

A

utilize remaining lymph vessels, decongest affected area and ipsilateral trunk quadrant, eliminate scar tissue, avoid re-accumulation, prevent infectsions and maintain normal size of limb

86
Q

is there a cure for lymphedema?

A

no, we can only manage it

87
Q

________ draws the fluid away from the swelling and then ___________ does not allow it to go back

A

massage; compression

88
Q

what do you do if there is fluid in the R UE

A

route the fluid to the other UE around the back or front, and down towards the inguinal area

89
Q

what are the advantages of the pump? (2)

A

used at home; easy to use

90
Q

disadvantages of the pump (5)

A

doesn’t take into consideration the ipsilateral quadrant; increase fibrosis at prox limb; damage to existing lymphatics; genital swelling, and doesn’t help scar or CT

91
Q

what are surgical options for treatment?

A

charles procedure and micro-surgeries

92
Q

what are some differential diagnosis? (7)

A
  1. DVT
  2. ruptured baker’s cyst
  3. filariasis (treated prior to treatment of lymphedema)
  4. CRPS
  5. malignancy
  6. arterial insufficiency
  7. kidney, liver, or thyroid dysfunction
93
Q

what is lipedema?

A

abnormal accumulation of fatty tissue

94
Q

where is lipedema commonly found?

A

LE from waist down - FEET are NOT involved

95
Q

swelling for lipedema is _____.

A

symmetrical (cork screw configuration)

96
Q

describe stage 0 of chronic venous insufficiency?

A

varicose veins present

97
Q

describe stage 1 of chronic venous insufficiency?

A

“phlebolymphodynamic insufficiency” - edema present during day, resolves at night

98
Q

describe stage 2 of chronic venous insufficiency?

A

“phlebolymphostatic insufficiency” - lymphedema is present; hemosiderin and + stemmers sign

99
Q

describe stage 3 of chronic venous insufficiency?

A

“phlebolymphostatic elephantiasis” - ulcers are present, skin breakdown

100
Q

what is stemmers sign?

A

accurate way of checking if a person has lymphedema… LE: 2nd toe; UE: middle finger

101
Q

The horizontal watershed has a normal flow of:

A

up the axillary and down to the inguinal

102
Q

why is it best to get a thorough patient history?

A

to do no harm during treatment…

103
Q

best description of MLD strokes

A

superficial, gentle compression that are stretching the skin

104
Q

best principles of compression bandaging

A

layered more distally and less proximally to create a gradient

105
Q

training for lymphedema….

A

135 hours

Med Surg II Final Exam (9 decks)

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