lymphedema

Question 1

at the arterial end of the capillary, which is higher, capillary hydrostatic pressure or blood colloidal osmotic pressure?

Answer 1

capillary hydrostatic pressure

Question 2

what happens at the arterial end of the capillary?

Answer 2

filtration, fluid exits the capillary

Question 3

is the net filtration + or - at the arterial end of the capillary?

Answer 3

+

Question 4

why does reabsorption occur at the venous end of the capillary?

Answer 4

fluid re-enters the capillary because chp is less than blood colloidal osmotic pressure

Question 5

is net filtration pressure + or - at the venous end of the capillary?

Answer 5

-

Question 6

what causes active hyperemia?

Answer 6

heat 
friction
trauma 
infection
inflammation

Question 7

what is the physiological process behind active hyperemia?

Answer 7

vasodilation increases blood capillary pressure via increased arterial flow

Question 8

what is the physiological process behind passive hyperemia?

Answer 8

vasodilation increases bcp via decreased venous outflow due to venous obstruction

Question 9

what causes passive hyperemia?

Answer 9

DVT
CHF
chronic venous insufficiency
tumor

Question 10

what are the two forces that starling didn’t take into account when thinking about lymphedema? what is the effect of that?

Answer 10

colloid osmotic pressure (assists ultrafiltration)
interstitial pressure (resists ultrafiltration)
no changes across capillary bed in normal situation

Question 11

what happens to cop in lymphatic dysfunction? what is the net effect?

Answer 11

increases

net effect: increased ultrafiltration

Question 12

what happens to interstitial pressure in lymphedema?

Answer 12

decreases w reduced atmospheric pressure
decreases w aging and decreased collagen
net effect: increased ultrafiltration

Question 13

is lymphedema unilateral or bilateral?

Answer 13

both

Question 14

what is a major concern in unilateral sweling?

Answer 14

acute dvt

Question 15

what is homan’s sign and what can it indicate?

Answer 15

passively and abruptly dorsiflex the foot and squeeze the calf, pain =positive sign, indicate possible DVT

Question 16

how many points on the wells rule does a patient need to have to be a high risk for DVT?

Answer 16

> 3,

Question 17

what are a few signs of chronic venous insufficiency?

Answer 17

fibrosis of skin
atrophy of skin: dry, no hair
pain above medial mallelous

Question 18

what does a low albumin level mean?

Answer 18

malnutrition
inflammation
liver disease

Question 19

what does a high albumin level mean?

Answer 19

dehydration

Question 20

what is the cause of primary lymphedema?

Answer 20

developmental anomalies of vessels/nodes

Question 21

what is the cause of secondary lymphedema?

Answer 21

known trauma to lymphatics
surgery
radiation
filariasis (parasite)
infection
cancer (metastic)
iatrogenic

Question 22

what is lipedema?

Answer 22

pathological deposition of fatty tissue below the waist resistant to diet

Question 23

what is stemmers sign?

Answer 23

positive if fold of skin lifted at base of toe is thickened or impossible to lift
indicative of the reactive fibrosis of soft tissue tissue that is characteristic of lymphedema

Question 24

what are the 5 effects of manual lymphatic drainage?

Answer 24

increase absorption of fluid/protein by capillaries
increase lymphangion activity/transport
diuresis
relaxation response
analgesic

Question 25

what are two benefits of compression?

Answer 25

increases interstitial pressure | reduces ultrafiltration

Question 26

what are three contraindications for compression?

Answer 26

acute infection arterial disease acute chf

Question 27

what are two precautions for compression?

Answer 27

decreased sensation | limb paralysis

Question 28

what are the indications for use of a high stretch ace bandage?

Answer 28

short term use, somewhat effective | not safe to wear full time due to hi resting pressure

Question 29

what are the indications for use of a low stretch ace bandage?

Answer 29

long term use, highly effective | safe for wear full time due to low resting pressure

Question 30

``` Hi or Lo stretch bandage? Increase interstitial pressure and reduce ultrafiltration Increase musculoskeletal pump Reshape irregular limp profile Reduce fibrotic changes ```

Answer 30

Lo stretch bandage

Question 31

do elastic garments reduce limb in size?

Answer 31

no

Question 32

what enhances the musculoskeletal pump more: elastic or low stretch bandages?

Answer 32

low stretch

Question 33

what are 5 contraindications for lymphedema garments?

Answer 33

``` acute dvt arterial disease acute infection uncontrolled chf untreated ulcers ```

Question 34

what is a TED hose, 12-20 mmHg used for?

Answer 34

TEDS are for BED | mild edema, but are not medical grade-not medical grade

Question 35

what is compression class 1 (20-30 mmHg) used for in lymphedema treatment?

Answer 35

``` mild lymphedema prevention/recurrence of venous ulcers mild venous insufficiency burn scars dvt prevention ```

Question 36

what is compression class II (30-40 mmHg) used for in lymphedema treatment?

Answer 36

``` chronic venous insufficiency moderate lymphedema management of active venous ulcers moderate and post-traumatic edema varicosities during pregnancy prevention of DVT/post thrombotic syndrome ```

Question 37

when should one wear an elastic compression garment?

Answer 37

daytime only

Question 38

what kind of pressure does a high stretch garment have?

Answer 38

hi resting pressure

Question 39

in lymphedema treatment, how would a patient balance hi stretch and low stretch garment use?

Answer 39

high stretch during day and low bandages/garments at night