Lymphedema Flashcards
What is lymphedema?
Chronic disease with no cure
Cause by pooling of fluid in the interstitial space
What is a characteristics of lymphedema?
Swelling
T/F Swelling occurs due to impaired flow of lymph?
TRUE
What layer of the skin do we see lymphedema?
subcutaneous fatty tissue
Prevalence of lymphedema?
Pts with cancer living longer
Obesity rates are rising
population is aging
How many cases of lymphedema globally?
140-250 million cases estimated to exsist
The lymphatic system is regarded as the ____ component of the vascular system (or forgotten step child)
3rd
What does the lymphatic system consist of?
Lymph vessels, capillaries, pre collectors, collectors(similar to veins)
Lymphatic tissue: nodes and trunks
What is the purpose of the lymphatic system?
return fluid and protein from interstitial spaces to the vascular system (thick, more viscous)
Lymphatic systems two main functions?
- Maintain the pressure and volume of the interstitial fluid and blood by returning excess water and dissolved substances from the interstitial fluid to the circulation.
- Assist the immune system at the lymph nodes and other lymphatic tissue with lymphocytes and macrophages
What does lymph fluid consist of?
-Protein
-Water
-Fatty acids
-Salts
-WBCs
-Microogranisms
-Debris
(this is why the fluid is so thick)
How is normal plasma volume maintained?
- Capillaries pick up interstitial proteins/etc
- Return fluid to vascular system
- Prevents interstitial edema
Two systems are content by _______ vessels?
perforating
just like veins
T/F capillaries –>pre collectors–>collector nodes–>trunks–>ducts
TRUE
T/F lymph capillaries are smaller than blood vessels?
FALSE
-Larger because they have to absorb larger volume of fluid
Which direction does fluid flow?
in the direction of low pressure
Collectors have ______ prevent back flow
valves
What happens in an overloaded lymphatic system?
- fluid/proteins accumulate in the interstitial space
- high-protein edema builds up in the tissue
- triggers inflammatory response with deposition of collagen
What is acute lymphedema and how long does it last?
Lasts less than 6 months (reversible)
Pitting edema with pressure
lack of brawny skin changes
What are some risk factors for acute lymphedema?
- surgical drains with leakage of drainage back into surgical site
- Acute injury to a limb compromising lymph system
- radiation therapy
- infections
- phelblitis
What is chronic lymphedema?
Not reversible
skin changes likely
What are the two types of chronic lymphedema?
Primary (idiopathic) lymphedema
–generally involves a LE, congenital absence or abnormalities in lymph system
Secondary (acquired) lymphedema
–most commonly associated with malignancy and treatment
What are three classification of primary lymphedema?
-Congenital= detected at 35 years old
In secondary lymphedema occurs at lymph node from?
Surgery Radiation Trauma Infection Malignancy Scar Tissue
Stage 0 of lymphedema includes..?
Reversible
Swelling is not evident
Damage to lymphatic function has occurred (tumors or cancer)
May occur for months or years before swelling is detectable
What occurs in stage 1 of lymphedema?
Reversible Lymph fluid with high protein content Fluid dissipates after the involved limb is elevated ---gravity helps Pitting edema begins distally No palpable fibrosis Negative or borderline stemmer sign
What occurs in stage 2 of lymphedema?
Irreversible Pitting edema is present Non-pitting edema develops ---cant depress down into the skin Limb evolution does not reduce edema Tissue fibrosis starts Positive stemmer sign Skin thickens Skin has rough cobblestone appearance and texture
What occurs in stage 3 lymphedema?
Irreversible
Knows as elephantiasis
Pitting edema not present
Increased skin changes
What is pitting edema?
Present when indentation in the skin remains longer than 5 seconds after pressure is removed
(hold for 30 seconds, depth you can go in and how long does it stay there)
What is Stemmer’s sign/Test?
Indication of lymphedema
Inability to pinch a skin fold on the dorsal aspect of the 2nd toe
Do false positives occur with the Stemmers test?
No
-negative tests don’t necessarily rule out lymphedema could be at stages 0 to 1
What is lipedema?
Fat deposition in irregular patterns/amounts
Predominantly found in the legs (bilaterally)
T/F lipedema can lead to lymphedema?
TRUE
due to tissue congestion
Cause not know for lipedema but suspect _______?
Female hormones
- puberty
- Pregnancy
- Around time of menopause
- Respond poorly to compression therapy
