Lymphedema

Question 1

Superficial layer of lymphatics have_______ where they only drain to certain areas.

Answer 1

water shed

Question 2

What makes up lymphatic fluid?

Answer 2

Proteins
75-100 g of proteins are transported by the lymph vessels per day
Water
Cells (RBC, WBC, Lymphocytes)
Waste products and other foreign substances
Fat (intestinal lymph, chyle)

Question 3

Filtration = _____ + ______

Answer 3

resorption + lymph flow

Question 4

How much water, proteins, cells, etc your body creates in one day

Answer 4

lymphatic load

Question 5

How much your lymphatic system can pick up per day (intrinsic contractility)

Answer 5

Lymph time volume

Question 6

Max lymph time volume. The max amount of lymphatic load that your body could handle in a day.

Answer 6

total capacity

Question 7

Difference between total capacity and lymphatic load

Answer 7

functional reserve

Question 8

lymphatic load increases and is above the total capacity. Lymphatic system is still functioning normally. Low protein swelling.

Answer 8

dynamic insufficiency

Question 9

Total capacity decreases. Lymphatic system is damaged. High protein swelling.

Answer 9

mechanical insufficiency

Question 10

Lymphedema always includes ______ insufficiency

Answer 10

mechanical

Question 11

Type of insufficiency where you have a damaged system and overload

Answer 11

combined insufficiency

Question 12

risk factors of lymphedema

Answer 12

Axillary, inguinal, etc surgery 
Radiation therapy
Partial or total mastectomy 
Node dissection
Obese or overweight
Lipedema
History of infection in at-risk limb
Cellulitis 
Constriction
Tumor causing lymphatic obstruction
Scarring lymphatic ducts by either surgery or radiation
Intra-pelvic or intra-abdominal tumors 
Chronic venous insufficiency
Drain complications

Question 13

Early s/s of lymphedema

Answer 13

Limb feels heavy
Skin feels tight
Limb is achy (not painful)
Clothing or jewelry is tight
Can’t see wrinkles in skin

Question 14

stage of lymphedema where there is no visible/palpable edema, subjective complaints possible

Answer 14

latency

Question 15

stage of lymphedema that is reversible (elevation), pitting edema often present, increased limb girth and heaviness, no fibrosis

Answer 15

Stage 1

Question 16

stage of lymphedema with consistent swelling- does not change with elevation, spongy tissue feeling and often fibrotic changes, pitting becomes progressively more difficult. Feels thicker.

Answer 16

Stage 2

Question 17

Stage of lymphedema: lymphostatic elephantiasis, non-pitting, fibrosis and sclerosis, skin changes (hyperkeratosis

Answer 17

Stage 3

Question 18

What is one of the primary discerning symtpoms between lipedema compared to lymphedema

Answer 18

Dorsum of feet not involved

Question 19

thickening of skin on the dorsal hand/foot; inability to pinch skin in these areas

Answer 19

Stemmer’s sign

Question 20

Treatment of lymphedema includes:

Answer 20

Complete Decongestive Therapy (CDT)
Manual Lymphatic Drainage (MLD)
Compression Bandaging (multi-layer, short-
stretch)
Exercise
Skin Care
Self Care & Risk Reduction / Education

Question 21

Effects of complete decongestive therapy

Answer 21

Decrease swelling (>50%)
Increase lymph drainage from the congested areas
Improve skin condition
Improve patient’s function, quality of life
Reduce risk of infection

Question 22

CDT precautions/contraindications

Answer 22

Careful techniques, do not cause genital lymphedema
Do not use long-stretch bandages/ACE wraps
Can create more restriction and damage lymphatic vessels
Skin irritation
Infection
Cognition/communication
Wounds