Lymphedema Flashcards
Lymphedema
who can develop lymphedema
anyone, at any age
Lymphedema
true or false: one patient developed lymphedema 20 years after having axillary lymph nodes resected.
true
Lymphedema
most common causes of lymphedema
- Chronic Venous insufficiency
- CHF
- Idiopathic (Cyclic) Edema (only affects females)
- Pulmonary Hypertension
Lymphedema
It happens when fat is distributed in an irregular way beneath your skin, usually in the buttocks and legs (only affect females, spares the ankles, painful to touch)
lipidema
Lymphedema
Less common causes of lower extremity edema
lipidema
Lymphedema
true or false: Medications and diuretics will not treat or cure lymphedema.
true
Lymphedema
Plasma/Blood → Interstitial fluid → Lymphatic fluid → Lymph capillaries → Lymph nodes →
Blood stream
Lymphedema
The lymphatic system is the body’s “Drainage System.”
The lymph nodes are the
“Plumbers.”
Lymphedema
How many lymph nodes does a human have?
500 - 600
Lymphedema
do lymphatic vessels have valves?
yes
Lymphedema
When there’s a problem with the transportation and/or absorption of lymph fluid, lymphedema occurs. This is called
“mechanical insufficiency”
(this is different from “dynamic insufficiency”)
Lymphedema
dynamic insufficiency
when there is too much lymph fluid and the lymphatic system can not keep up
Lymphedema
What causes lymphedema?
Proteins are “hydrophilic sponges.” When there is a “mechanical insufficiency” of the lymphatic system, lymph fluid remains in the interstitium (the area between cells), depositing proteins. As these proteins remain in the interstitium, they continuously absorb water, grow bigger, and cause inflammation, fibrotic tissue build-up, and visible swelling.
Lymphedema
There are four stages of lymphedema. Lymphedema becomes permanently incurable during…
Stage II, the “Irreversible Stage.”
Lymphedema
Reversible stage of lymphedema, pitting edema occurs, weepy skin
stage I
Lymphedema
stage 0 (lymphedema)
At lifetime risk for developing lymphedema
(every time someone has a disruption to a lymp node
Lymphedema
Irreversible stage of lymphedema, non-pitting edema occurs, recurrent cellulitis
stage II
Lymphedema
Elephantiasis lymphedema; skin fibrosis, hardening, deformation, warts
(stage?)
Stage III/IV
Lymphedema
Hereditary lymphedema, something is inherently wrong with the lymphatic system at birth…
Primary lymphedema
Lymphedema
Praecox lymphedema
before age 35 onset
due to aplasia (no lymphatics), hypoplasia (less lymphatics) or hyperplasia (more lymphatics) of lymphatic system
Lymphedema
congenital lymphedema tarda
onset after age 35
due to aplasia (no lymphatics), hypoplasia (less lymphatics) or hyperplasia (more lymphatics) of lymphatic system
Lymphedema
what type of lymphedema is caused by any “external” factor, but the origin can be internal?
Secondary lymphedema
Lymphedema
Parasites living in the lymph nodes cause ________, resulting in Elephantiasis (90 million + affected)
filariasis
Lymphedema
Signs of Lymphedema:
- Positive Stemmer’s sign*
- Dorsal “hump” on hand
- No pain complaint, usually
- Fatigue, heaviness, soreness and discomfort
Lymphedema
Stemmer sign is positive when
the skin has no turgor (rigid) between the fingers’ web spaces
Lymphedema
signs of lymphedema start proximally or distally?
distally
- Suddenly, clothing and jewelry feel tighter
- Recurrent cellulitis infections
Lymphedema
_____ ________ occur in cases of phlebostatic-lymphedema (compromised venous and lymphatic return)
Venous ulcers
Lymphedema
Lymphedema Complications
- Recurrent cellulitis
- Fungi infections
- Breakdown of the skin
- Discomfort, heaviness, soreness, fatigue (pain if
there is also lipiedema)
Lymphedema
Signs of cellulitis:
- Fever of 100 degrees F or more
- Pain in the limb
- Itchiness and redness
- Clear, map-like bordered rashes
- Flu-like symptoms
Lymphedema
______ is a skin infection that most often requires patients to take antibiotics via IV in the hospitals.
Cellulitis
Lymphedema
In the past, _________ was the treatment of choice i.e. surgical removal of elephantiasis skin tissue. Surgery is invasive as it further disrupts the lymphatic system. There is no value in surgical repair.
surgery
Lymphedema
________ should not be used to treat lymphedema unless they are prescribed to treat other comorbidities such as hypertension and congestive heart failure.
Diuretics
- Diuretics: Removal of water load, but does not remove proteins.
- Produces a “vicious cycle.” Water leaves the body, but “water-hungry” proteins stay behind in the skin
Lymphedema
Low-level Laser Treatment: Requires outpatient treatments. Effective in decreasing _____ ______. Needs more evidence-based practice research.
skin fibrosis
Lymphedema
Compression pumps: not recommended except for the
Flexitouch machine.
- Standard compression pumps do not direct the flow of lymph fluid, with the exception of the Flexitouch machine, which mimics Manual Lymphatic drainage.
Lymphedema
Complete Decongestive Therapy begins with
- Manual Lymphatic Drainage (MLD) in the acute phase to decrease lymphedema and decongest the affected limbs (or head, neck, genitals).
- Then the patient also receives daily compression bandaging. After the acute phase, the patient is taught how to self- bandage and maintain the decongested limb size with compression garments (custom versus OTC).
Lymphedema
Phases 1 of Complete Decongestive Therapy is called the…
and the goals are
The Intensive Phase:
- Goals: Reduction of swelling with
- Manual Lymphatic Drainage
- Compression Bandaging.
- Skin care, therapeutic exercises, and patient education also begin in this phase
Lymphedema
Phases 2 of Complete Decongestive Therapy is called the…
and the goals are?
The Maintenance Phase
- Goals: Maintain Phase 1’s progress .
Lymphedema
Manual Lymph Drainage utilizes gentle hands-on techniques to
stretch and stimulate lymphangioactivity, re-directing lymph flow from areas of compromised lymphatics to healthy lymphatics.
Lymphedema
A full Manual Lymphatic Drainage sequence is ___ minutes.
45
Lymphedema
true or false: In order to perform MLD/CDT, one must be certified.
true
Lymphedema
Compression bandaging uses ________ bandages to provide a high working pressure and low resting pressure.
short- stretch
Lymphedema
“To achieve an effective compression gradient, short‐stretch bandages must be strategically applied with low‐to‐moderate tension using more layers at
the ends of the extremities than higher up.”
Lymphedema
Short-stretch bandages rely on ______ , not increased tension.
layering
Lymphedema
Another property of short-stretch bandages is to reduce the
tissue hardening (fibrosis).
Lymphedema
“Compression Bandaging is always a part of Phase _____ CDT.
I
Some individuals with more severe forms of lymphedema may need to use home compression bandaging longer term as part of Phase II. Some locations of the body, such as the head and neck, are not amenable to standard short ‐stretch bandaging so other compression techniques have to be used
Lymphedema
layers of lymphedema wrapping
- First layer: Lotion (low pH = more acidic)
- Second layer: Tubular bandage
- Third layer: Digit bandages
- Fourth layer: Cotton padding
- Fifth to seventh layers: Short-stretch bandages
Lymphedema
what is the gold standard of lymphedema treatment?
Complete Decongestive Therapy
According to the National Lymphedema Network (NLN), CDT is the main, gold standard, and international treatment for patients with lymphedema. CDT can effectively reduce limb volume by 50-70%, improve limb appearance, reduce the severity of symptoms, and improve quality of life for compliant patients. Even patients who have chronic lymphedema for over thirty years have responded well to CDT.
Lymphedema
Therapeutic “Remedial” Exericises:
- Recommend swimming when patient is no longer homebound
- Recommend jogging, speed-walking
- Recommend strength training and skilled therapeutic exercises as long as the patient wears a well-fitting compression garment to the affected extremities
Lymphedema
Contraindications for Complete Decongestive Therapy and Manual Lymph Drainage:
- Untreated CHF or cardiac edema
- Acute cellulitis
- Pregnancy
- Fresh, open wounds
- Non-compliancy
- Advanced malignant cancer of skin
- Malignant lymphedema or lymphangiosarcoma
- Inability to follow commands, no support, etc…
- Acute irradiation areas
- Acute deep vein thrombosis
- Complete paralysis or complete lack of sensation in affected extremity
- Palliative treatment for comfort
- Other co-morbidities
- Decreased sensation
- Intravenous ports
- Abdominal pain
- Adults over the age of sixty, avoid neck massage over carotid arteries (stenosis)
