Lymphedema Flashcards
What are the 2 main functions of the lymphatic system?
- Regulate fluid balance
- Assist with infection control
How many liters of fluids are removed from the interstitial space per day?
18 L
Of the 18 liters removed, __-__% via the veins and __-__% via the superficial and deep lymphatic vessels. How many liters via the lympathics?
80-90
10-20 (2-4L)
What occurs when the lymphatics cannot remove the remaining interstitial fluid?
Lymphedema
__-__% of women with breast cancer will develop lymphedema
23-45
__% of women with ovarian cancer will develop lymphedema
21
__% of patients with endometrial cancer will develop lymphedema
28
Up to __% of men with prostate cancer will develop lymphedema
70
What are the chief complaints of lymphedema?
- limb heaviness
- paresthesias
- achiness
- skin tightness
- poor-fitting clothes
- altered cosmesis
- decreased ADLs
- reduced ROM
The lymphatic system is composed of 2 interconnecting drainage systems, what are they?
superficial and deep lymphatics
Describe the function and arrangement of the superficial lymphatics
Drains the skin and subcutaneous tissue
Roughly parallels the veins
Describe the function of the deep lymphatics
drains everything else (deep tissues and organs)
What connects the deep and superficial lymphatic systems?
perforating lymphatics
What is lymph made of?
water, protein, dead/dying cells/cellular components, fatty acids, foreign material and debris
Describe the path lymph takes as it exits the interstitial spaces to
Lymph capillaries –> Lymph precollectors –> Lymph collectors –> Lymph nodes –> Lymph trunks
What is the functional unit of a lymph vessel that lies between two semilunar (half moon-shaped) valves?
Lymphangion
How many lymphangions are there in a typical arm collector? In a leg collector?
60-80
80-100
The total number of lymph nodes ranges from ___-___ with the majority located where?
600-700
mesentaries
Describe the path lymph takes from the LEs and the genitals
Passes through the inguinal nodes into the left and right lumbar trunks before emptying into the centrally located thoracic duct, which terminates into the left venous angle (the internal jugular vein and the subclavian vein)
Describe the path lymph takes from the LEFT upper extremity
Filters through the axillary lymph nodes before emptying into the subclavian vein
Describe the path lymph takes from the RIGHT upper extremity
Empties into the right subclavian vein aka the right venous angle
Lymphatic territories are areas of skin made up of several adjacent lymph collectors that drain into the same regional lymph nodes. These territories are separated by natural boundaries called what?
watersheds
What pressures govern fluid movement between capillaries, interstitium, and lymphatic system?
hydrostatic and osmotic pressure
What are the 5 ways in which lymph moves centrally in a healthy lymphatic system?
- skeletal muscle contractions
- respiratory pump
- pulsations of the aorta
- lymphangiomotoricity
What is Lymphangiomotoricity?
the contraction of the smooth muscle within the lymphagnions
Lymphangiomotoricity is the key to decreasing edema when?
overnight while the patients are recumbent
What are the 2 types/causes of lymphedema?
primary and secondary
Describe primary lymphedema
Congenital malformation or impairment of lymphatics
Primary lymphedema accounts for only __% of all cases
10
Primary lymphedema cases are usually described by what 2 things?
type of lymphatic vessel abnormality or the age of onset
What are the 4 types of vessel abnormalities that occur with primary lymphedema?
- Aplasia
- Hypoplasia
- Hyperplasia
- Lymph node fibrosis
Describe aplasia
Lack of lymphatic vessels in a body region therefore no lymphatic drainage in this area
Describe hypoplasia
Lymphatic vessels are narrower than normal leading to significantly less lymphatic drainage
Hypoplasia is comparable tow what?
arterial stenosis
Describe hyperplasia
Lymphatic vessels are wider than normal
Hyperplasia is comparable tow what?
varicose veins
Hyperplasia accounts for __% of all cases of primary lymphedema
15
Lymph node fibrosis is most commonly seen in what lymph nodes?
inguinal
Classify the following:
Congenital Lymphedema: __-__
Lymphedema Praecox: __-__
Lymphedema Tarda: __
birth to 1 year
1-35 years old
after 35 years old
Describe secondary lymphedema
Results form a disruption in, or damage to, the lymphatic system
What are 3 causes of secondary lymphedema?
- Filariasis
- Cancer treatment
- Chronic venous insufficiency
What causes filariasis?
the bite of a mosquito that is infected with a parasitic worm
In the US, secondary lymphedema is most often seen following what?
medical or surgical procedures that disrupt lymph flow
What can be defined as a bilateral, symmetrical increase in adipose tissue deposition?
Lipedema