Lymphedema Flashcards
Lymphedema
Chronic collection of high protein fluid just under the skin
Usually in one or both arms or legs
Areas of the body that do not have lymph vessels
Hair
Nails
Cornea
Cartilage
Lymph capillaries
Larger than blood capillaries Able to absorb large molecules from intersititium Simple squamous epithelium Overlapping ends Anchoring filaments
Lymph pre collectors
Connect lymph capillaries to lymph collectors
Can also absorb fluid
Lymph collectors
3-layer wall but thinner than vein
Valves
Made up of lymphangions
Extrinsic lymphangion contractions
Breathing Exercise Artery pulsation Vein negative pressure Compression on skin
Intrinsic lymphangion contractions
ANS (smooth muscle)
Lymph trunks and ducts
Collect and dump up into heart and veins
Most from thoracic duct into L venous angle
Lymph nodes
Kidney shaped
Filter lymph
Produce lymphocytes
Usually in adipose
Watersheds
Regions that drain to particular lymph nodes
Anastomoses
Connection b/n lymph collectors;
Across watersheds
Lymph system function
Return protein and fluid from interstitial to CV system
Absorbs fat and vitamins from small intestines —> CV system
Immune surveillance and functions
Filter fluid
Lymph system removes these from insterstitium
Protein Water Cell Fat Carbs, electrolytes, creatinine, urea, coagulation factors
Lymph time volume
Amount of fluid removed from intersititum per day
Normal 4L
Norm approx 10% of transport capacity
Transport capacity
Max amount of fluid lymphatic system can carry
Lymph functional reserve
Difference between normal lymph time volume and transport capacity
If system not running at transport capacity, lymph time volume can be increased to handle increased fluid
Increased lymph capillary filtration
Hypermedia from inflammation, massage, heat, CHF, DVT, tumor growth, venous insufficiency
Hypoproteinemia
Lymph system removes what percent of excess interstitial fluid?
90%
Lymph high output failure
Too much fluid for lymphatic system to return
Lymph low output failure
Damaged lymphatic system cant handle normal interstitial fluid
Combination lymph system failure
Lymph system damaged due to chronic conditions
Secondary lymphedema - damage
Surgery – mastectomy, prostate cancer removal,
hysterectomy, other • Cancer • Accident/injury • Infection • Radiation • In 3rd world countries: filariasis
Lymphedema secondary - overload
Obesity
• Chronic Venous Insufficiency
• Edema caused by cardiac, liver, or renal dysfunction
Primary lymphedema
Aplasia
• Hypoplasia
• Hyperplasia Believed to be present at birth, symptoms usually develop later
How does lymphedema start?
Feeling of heaviness, achiness, pain, fullness or tension in leg or arm
• Swelling of the arm or leg
• Reduced motion of arm, hand, leg, or foot
• MOST TREATABLE AT THIS STAGE
Steamers sign
Pinch test base of 2nd toe or middle finger
Lymphedema stages
Stage 0: no swelling
• Stage 1: mild edema, indents with pressure
• Stage 2: significant, skin thickening
• Stage 3: extreme edema, skin hardening
Lymphedema Tx stages
Intensive decongestion phase 4-6wks, 3-5x/wk
Maintenance phase
Intensive decongestion phase
Complete decongestive therapy
- Manual lymph drainage
- Compression bandaging
- Exercise
- Self care
Manual lymph drainage
Stimulates lymph nodes, vessels to pump fluid in greater volume, directs stagnant lymph to Exeter lymphatic vessels for removal
Moves fluid around damaged or impaired lymph areas
Lymph massage strokes
Stationary circle Pump Rotary Other Tissue mobe for fibrotic skin
Manual lymph leg sequence
Neck lymph nodes Abdomen Inguinal nodes UA side Anastomoses front Buttock affected, anastomoses Post thigh Popliteal fossa, calf Anterior thigh Anterior leg, foot
Lymph manual arm sequence
Neck lymph nodes Ab Axilla of UA Chest anastomoses Inguinal lymph nodes affected Lateral trunk affected Posterior interaxillary anastomoses Post lateral trunk Arm, forearm, dorsal hand and fingers
Lymph - low impact exercise instructions
*swimming
*walking
Yoga
Cycling
Rebounding
Cardio machines
Light body strengthening
Lymph maintenance phase
Manual lymph drainage at home Compression bandage/garmets Exercise Deep breathing Skin care Weight loss
Compression garmets pre/contras
Active cancer CHF Arterial disease (okay at 0.8 ABI, light b/n 0.6-0.8) Peripheral neuropathy or paralyzed limb (1 hour, check capillary nail refill <2 sec) DM Acute DVT Hypertension Active cellulitis/infection
Additional lymph tx options
Pneumatic pumps Kines tapes Bioimpedance 2 layer bandaging system manual edema mobilization Sx Meds Laser therapy Hyperbaric oxygen
