Lymphedema Flashcards
Lymphedema occurs when _ and _ happens in the dependent tissues due to an _ in blood circulation in which the _ _ is unable to transport the _ to a designated region.
Occurs when EDEMA and INFLAMMATION happen in the dependent tissues due to an INCREASE in blood circulation in which the LYMPHATIC SYSTEM is unable to transport the FLUID to a designated region.
Lymph _, lymph _, _ gland, bone _, _ patch, _ and _ are lymph organs.
Lymph NODES, lymph GLANDS, THYMUS gland, bone MARROW, PEYER’S patch, SPLEEN and TONSILS are lymph organs.
The _ _ is the lymphatic structure that empties 3/4 of the body’s lymph fluid. What regions of the body does it drain of lymphatic fluid? (2)
THORACIC DUCT is the lymphatic structure that drains 3/4 of the body
It drains the lower 1/2 of the body + left upper 1/2 of the body
Which structure is responsible for draining 1/4 of the body’s lymph fluid? Which region does it drain?
Right lymphatic duct
Drains the RIGHT UPPER QUARTER, DIRECTLY BEHIND THE ANTERIOR SCALENES
Where does the thoracic duct begin? End? Spinal level?
Thoracic duct:
Begins at the subclavian artery
Ends at the cisterna chyli (Kiley), at the L2 spinal level
Lymph begins? What are the 2 forces involved in the exchange?
Begins at the CAPILLARY
HYDROSTATIC AND OSMOTIC PRESSURE
At the capillary bed- _% filtration occurs as fluid is _ _ of the _ into the interstitial fluid moving down the _ _. _ pressure is greater than _ pressure.
At the capillary bed- 100% filtration occurs as fluid is PUSHED OUT of the ARTERIOLE into the interstitial fluid moving down the PRESSURE GRADIENT.
HYDROSTATIC pressure is GREATER THAN OSMOTIC pressure
At the capillary bed- _% is _ into the _, where _ pressure is greater than _ pressure. _% is taken up by the _ _ for?
At the capillary bed- 90% is REABSORBED into the VENULE, where OSMOTIC pressure is greater than HYDROSTATIC PRESSURE
10% is taken up by the LYMPH CAPILLARY for removal/ processing via the thoracic or right lymphatic ducts.
If the protein remains in the interstitial space and is not taken up by the lymph capillary/ system due to infection or injury it attracts _ and results in _.
. . . .If protein is not taken up by the lymph system due to infection or injury it attracts H2O/ FLUID and results in LYMPHEDEMA.
The _ _ is the smallest unit of the lymph vessel and is located between _ _.
The LYMPH ANGION is the smallest unit of the lymph vessel and is located between EACH VALVE.
Phagocytosis, antigen presentation, and immune cells are all the primary functions of?
Primary functions of LYMPH NODES
Arterial pulsation, external pressure, muscles and joint functions, respiratory pressure changes, and negative pressure in central veins all control _ _.
. . .all control LYMPH TRANSPORT
What are the 2 type of lymphedema? And description of each.
Primary- due to congenital defect of the lymphatic vessels and/ or nodes
Secondary- due to damage from injury or infection
Hypoplasia, hyperplasia, aphasia, and Kinmoth syndrome are all examples of?
Examples of PRIMARY LYMPHEDEMA CAUSES
Cancer surgery, radiation therapy, trauma, filariasis (elephantitis), tumor and/ or infection are all examples of?
Causes of SECONDARY LYMPHEDEMA
Swelling, loss of mobility, numbness, heaviness, infections, impaired wounds, fibrosis, papillomas, and hyperkeratinosis are all examples of?
All examples of SIGNS/ SYMPTOMS seen with lymphedema
What is the #1 cause of secondary lymphedema in the US? In the world? Usually due to?
US- cancer treatment/ surgery
World- Filariasis/ elephantitis, usually due to a mosquito bite
How many stages of lymphedema are there?
4 stages (0-3)
What stage of lymphedema is being described: No obvious swelling?
Stage 0
What stage is being described: early accumulation of high protein fluid in the capillary bed, pitting edema is soft without fibrosis. Edema can be reduced with _ _ at this stage.
Stage I
Edema can be reduced with LIMB ELEVATION at this stage
What stage is being described: scarring and thickening of connective tissue, limb becomes asymmetrical, elevation no longer returns the limb to normal.
Stage II
What stage is being described: Trophic change in the skin, papillomas and hyperkeratinosis are present, worsening fibrosis as skin becomes rigid due to excess protein rich fluid, lobular folds are present and there is potential for creation of non- healing wounds.
Stage III
How many classifications of lymphedema are there? Name each.
3 classifications:
- Minimal
- Moderate
- Severe
Which classification is being described: 3 cm difference between both limbs, less than 20% increase in limb volume?
Minimal
Which classification is being described: 3-5 centimeters difference between limbs, 20-40% increase in limb volume?
MODERATE
Which classification is being described: greater than 5 cm difference between limbs, greater than 40% increase in limb volume?
Severe
Which 2 classifications will you see a + stemmer’s sign? Description.
Is seen during in moderate and severe classes of lymphedema
Stemmer’s sign is a thickened skin fold at the base of the 2nd toe or fringe that is diagnostic sign for lymphedema. It is positive if tissue cannot be lifted by can only be grasped as lump of tissue.
What is the name of the therapy used to treat lymphedema? How many phases are there?
Complete Decongestive Therapy (CDT)
2 phases
What are the names of the 2 phases of CDT and the timeframes associated with each?
Decongestive phase- lasts for 2-6 weeks
Self-care phase- lasts lifetime
Each phase of CDT has _ steps.
Each phase has 4 steps
4 steps of each phase of CDT include: _ care, manual _ _, _ _ bandaging, and limb clearance _.
Includes:
- SKIN care
- manual LYMPHATIC DRAINAGE
- SHORT STRETCH bandaging
- limb clearance EXERCISES
Manual lymph drainage stimulates the _ _ _ and _ to remove waste products, excess protein, and fluid from the skin and subcutaneous tissue. Specific strokes _ the _ _ of lymph node and lymph angion contraction.
Manual lymph drainage stimulates the SUPERFICIAL LYMPH NODES and VESSELS to remove waste products . . .
Specific strokes MIMIC the NATURAL MECHANISM of lymph node and lymph angion contraction.
Stimulating lymph vessel transport, reducing edema, relaxing the sympathetic nervous system, decreasing pain, reducing scarring, removing waste, promoting healing and support of the immune systems are all?
Are all EFFECTS OF MANUAL LYMPH DRAINAGE (MLD)
Edema, lymphedema, immobility, wounds, arthritis, chronic pain, some medications, fibromyalgia, and CRPS (complex regional pain syndrome) are all?
Are all indications for Manual lymphatic drainage treatment
Tumor, acute infection, malnutrition, cardiac edema/ CHF, kidney disease, hyperthyroidism, thyroid or liver disease, hypersensitivity of the carotid sinus, recent abdominal surgery, radiation fibrosis, aortic aneurysm, acute DVT, pregnancy, menstration, diverticulitis, Crohn’s disease, or unexplained pain are all?
Are all GENERAL CONTRAINDICATIONS FOR MLD
How many strokes are used in MLD? Name them.
5
PR SSS
- pump
- rotary
- stationary circle
- Spiro
- scoop
Which stroke is being described: flat hand contact on skin, slowly move hand in large circles while stretching tissue?
Stationary
What stroke is being described: crescent overlapping shaped movement with the palmar surface of the hand to function region?
Spiro
What stroke is being described: hand is flat during corkscrew movement?
Scoop
Which stroke is being described: lift inner hand web contact, flatten hand, gentle glide to function region, recoil and repeat?
Pump
What stroke is being described: fingertips on skin, slide thumb to fingers, flatten hand and glide, and repeat?
Rotary
MLD protocol- 4 steps.
TTNA Trunk (breathing and lymph node groups) Terminus New Pathways Affected limb
Benefits of short stretch bandaging: reduces capillary _, _ muscle joint pump, prevents _, and _ indurated tissue.
Reduces capillary FILTRATION, INCREASES muscle joint pump, prevents RE-ACCUMULATION, and SOFTEN indurated tissue.
Swimming, abdominal breathing, AROM, and functional activities are all?
Are all examples of limb clearance exercises that are significant in lymphedema.
General treatment protocol is clear _ first, then work on most _ part of limb to most _ part of limb. Repeat in _ and then _.
- Clear TRUNK first
- Then work on MOST PROXIMAL part of limb to MOST DISTAL part of limb
- Repeat in SUPINE and then PRONE
Which part of the body has the highest number of lymph nodes? Which part of the body has the highest concentration per area?
Highest number- abdomen
Highest concentration per area- neck
