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Integ Final > Lymphedema and Swelling Disorders: Manual Lymph Drainage, Bandaging, Garments, and Remedial Exercises > Flashcards

Lymphedema and Swelling Disorders: Manual Lymph Drainage, Bandaging, Garments, and Remedial Exercises Flashcards

1
Q

lymphatic system =

A

cervical lymph nodes
thoracic duct
thymus
axillary lymph nodes
spleen
UE lymphatics
Inguinal lymph nodes
LE lymphatics
pelvic lymph nodes
lumbar lymph nodes
cisterna chyli

mammary gland lymphatics

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2
Q

Lymph vessels absorb interstitial fluid from the skin and subcutaneous tissue➔

A

transport it to the circulatory system

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3
Q

Nutritional fatty acids are absorbed via intestinal lymph called ___

A

chyle

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4
Q

____ are manufactured and stored in lymphatic tissue

A

Lymphocytes (WBC)

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5
Q

Thymus:

A

a lymphoid organ located in the anterior superior mediastinum➔ matures T cells for the immune system

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6
Q

Spleen:

A

largest organ in the lymphatic system, acts primarily as a blood filter, RBCs are recycled in the spleen, WBC and platelets are stored in the spleen➔ located under the rib cage and above the stomach in the left upper quadrant of the abdomen

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7
Q

Thoracic Duct:

A

the largest lymphatic vessel in the human body➔ 1-5 mm diameter, 40 cm long

Located left and anterior to the spine

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8
Q

Thoracic Duct Drains into the ____

A

venous angle which is the Junction of the internal Jugular and subclavian
veins

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9
Q

Cisterna Chyli:

A

a dilated sac at the lower end of the thoracic duct, functions as a temporary reservoir

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10
Q

Lymph Vessels:

A

thin walled system for
Transporting lymph throughout the body
From distal to proximal

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11
Q

Lymph nodes:

A

Part of the immune system

Generally located in the adipose tissue

Palpable sensitive nodes signify infection

Vary in size from 2-30 mm long, oval,
round, kidney shape
600-700 lymph nodes in the body, majority found in the abdomen

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12
Q

Lymph Node Function:

A

Filtering station for noxious matter such as bacteria, toxins and dead cells

Regulate the concentration of protein in the lymph➔ hydrostatic and osmotic pressure controls the balance of water between the lymph nodes and blood vessels

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13
Q

Lymph Nodes arrangement:

A

Arranged in chains

~600-700 -> 100-200 are mesenteric

Size ranges from .2 – 30 mm

Outside: fibrous capsule

Afferent Vessels: entering node

Efferent Vessels: exiting node

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14
Q

Lymph Vessels

A

Capillaries
Pre-collectors
Collectors
Trunks
Ducts

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15
Q

Lymph Vessels:
Different from veins and arteries➔

Localized pump action via movement and muscle contraction➔

A

NO central pump

moves fluid distal to proximal to the subclavian and into the circulatory system

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16
Q

Lymph Capillaries
Do not contain one way valves➔

A

lymph can flow in any direction

One layer, overlapping endothelial cells

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17
Q

exchange across capillary walls:

A

fluid & solutes flows out of capillaries to tissues due to blood pressure
*bulk flow

interstitial fluid flows back into capillaries due to osmosis
*plasma proteins increase osmotic pressure in capillary
*BP < OP

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18
Q

Lymph Capillaries: Important Characteristics

A

Form a plexus throughout the body

Are larger in diameter than blood capillaries

Are able to absorb interstitial fluid as necessary

Have no valves inside the vessel➔ lymph can flow in any direction

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19
Q

Lymph Capillaries: fluid leakage

A

fluid leaks through mini-valves into lymph capillaries

higher pressure on inside closes mini-valves

blood capillaries -> interstitial tissue -> lymph capillaries -> lymph collectors -> lymph trunks -> lymph ducts

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20
Q

Pre-Collectors =

A

Channel the lymph fluid into the larger transporting vessels

Able to absorb fluid and molecules➔ similar to lymph capillaries

Situated vertically in the subcutaneous tissue

Connect lymph capillaries to collectors

Mostly function to move fluid in both directions with few valves

Some areas of smooth muscle and valves

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21
Q

Collectors =

A

Three layer walls➔ similar to veins, however, thinner than veins

Inner layer: endothelial cells and basement membrane

Middle layer: smooth muscle

Outer layer: connective tissue

Contain valves➔ determine direction of lymph fluid flow➔ distal to proximal or toward the nearest regional node bed each valve segment called ‘lymphangion’

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22
Q

Lymphangion Activity

A

sympathetic nervous system innervation of smooth muscle

Rhythmic contractions

Also utilizes skeletal muscle contraction, arterial pulsation, and respiration to move fluid

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23
Q

Trunks

A

Larger than collectors

Primary trunks are formed by the joining of efferent collectors of regional lymph node beds

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24
Q

Features of Lymph Trunks:

A

One way valves

Smooth muscle layer -> contraction

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25
Lymphatic vessel that empties lymph into one of the subclavian veins ->
superior vena cava -> right atrium
26
Right lymphatic duct drains lymph from the ___
right upper limb, right side of thorax and right halves of head and neck
27
Thoracic duct drains lymph into the ___
circulatory system at the left brachiocephalic vein between the left subclavian and left internal jugular vein
28
Lymphatic Ducts Transport ___
1.5-2.5 L/24 hours
29
Thoracic Duct
Largest lymph vessel 40 cm long 2-3 cm wide 20 valves Moves lymph from lower body and left arm to left subclavian vein
30
Right Lymphatic Duct
3 cm long Moves lymph from right upper quadrant to right subclavian vein
31
Definition of Lymphedema
Protein-rich edema that occurs when the lymph load or volume exceeds the lymph transport capacity in any body segment Considered a disorder/disease
32
Lymphatic vessels may be:
Absent or under-developed = Primary Lymphedema Obstructed or damaged = Secondary Lymphedema
33
Pedal edema➔
swelling in bilateral feet and LE due to long periods of sitting or standing➔ causes hypervolumenia
34
Cerebral edema ➔
fluid accumulation on the brain due to abnormal metabolic conditions such as lupus, can also be due to high altitudes
35
Pulmonary edema ➔
left sided heart failure leads to accumulation of fluid on the lungs
36
Polymyositis ➔
inflammatory muscle condition that causes generalized weakness and swelling
37
Musculoskeletal injury ➔
unresolved acute inflammation and edema leads to chronic inflammation and edema
38
Definition of Edema
Visible and palpable excessive accumulation of interstitial fluid; usually detected when volume reaches 30% above normal. Edema is a symptom and not a disease
39
Definition of Lipedema
disorder characterized by massive, bilateral accumulation of fat below the waist and in the legs Enlargement of the lower extremities is often accompanied by leg pain and accumulation of fluid Little is known about the functional changes that lead to fat accumulation and pain in patients (women>>>men) with lipedema.
40
Definition of Cellulitis
potentially serious bacterial skin infection The affected skin appears swollen and red and is typically painful and warm to the touch Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas.
41
tributary zone
each major lymph node grouping recerives lymph from a specific body region
42
watersheds
direction of lymphatic flow of each tributary zone is defined by invisible boundaries
43
anastamoses
areas between zones where vessels physically line up, critical in movement of lymph between adjacent zones during treatment
44
Quadrants or ‘territories’ are only connected to each other through:
a few anastomotic branches – few vessels connecting the territories
45
The only way lymph can move from one territory or zone to the next is through:
the initial lymph vessel network -> lymph capillaries
46
These cross-over areas are called the ‘lymphatic water shed’ areas via ___
anastamoses
47
Grade 0 lymphedema
Normal sensation Normal appearance Patient at risk to develop lymphedema
48
Grade 1 Lymphedema
Abnormal sensation Pitting Reversible with elevation Early intervention needed
49
Grade II Lymphedema
Intermittent ‘heaviness’ Abnormal tissue texture Irreversible with elevation due to fibrosis
50
Grade III Lymphedema
Elephantitis Persistent ‘heaviness’ Grossly abnormal Irreversibly damaged tissue Treatment will help decrease severity of symptoms
51
Edema 1+
Edema that is barely detectable, <2 mm depression, immediate rebound
52
Edema 2+
A slight indentation visible when the skin is depressed, 3-4 mm depression, <15 second rebound
53
Edema 3+
A deeper fingerprint when the skin is depressed, 5-6 mm depression, 10-30 second rebound
54
Edema 4+
Large fingerprint when the skin is depressed, >7 mm depression, >20 second rebound ➔ the limb may be 1.5-2 times normal size
55
Lymph Fluid Movement
Water, protein and small molecules diffuse through the blood capillary walls into the interstitium -> process called filtration -> to nourish the tissues
56
Ultrafiltration dependent on:
hydrostatic pressure in capillary and interstitial space Colloid osmotic pressure gradient of plasma proteins
57
In homeostasis, ‘reabsorption’ occurs when fluid moves:
from blood capillaries, to interstitial tissue, and back into the venule side of capillaries and into the lymph vessels due to higher concentration of plasma proteins
58
Lymph Circulation
blood capillaries lymph capillary initial lymph vessels pre-collectors collectors (pumps) lymph nodes lymphatic ducts subclavian venous system
59
Filtration =
Reabsorption + Lymph Fluid
60
Starling’s Equilibrium:
= 85% Venous Capillaries + 15% Lymph Capillaries
61
Factors Affecting Tissue Fluid Exchange
Total tissue pressure Gravity Ultrafiltration: High BP?? Muscle contraction: what’s the impact Diaphragmatic breathing Intestinal contractions Skin/tissue movement
62
Functions of the Lymph System =
Transports proteins from the bloodstream back to the bloodstream after being filtered by lymph nodes Immunological function -> antigen presented to t cell stimulates B cell production of antibodies Keeps connective tissue in a healthy state
63
Lymphedema
High Protein edema➔ exudate Congestion in the interstitium Visible swelling Chronic inflammation of the tissues ➔ proliferation of fibroblasts Proliferation of fibroblasts = fibrosis
64
Types of Lymphedema
Primary Secondary
65
Primary Lymphedema:
Rare inherited condition due to deficient lymph vessels
66
Secondary Lymphedema:
Acquired lymphatic system deficits Surgery Radiation therapy Trauma Filariasis -> elephantiasis, parasite infection affects 90 million people world-wide -> primarily in tropical regions
67
Lymphedema Prevalence:
250,000 million people worldwide, 5 million people in the United States, estimated 1 in 100,000 people have primary lymphedema
68
Normal healthy lymphatic system = ___ is greater than the ___
transport capacity lymphatic load
69
Lymphatic system insufficiency = ____ is greater than the ___
lymphatic load transport capacity
70
Too much fluid in a normal system ➔
hypervolemia
71
Normal fluid amount in an abnormal or damaged system ➔
primary and/or secondary lymphedema
72
Recommended Treatment for Lymphedema
Complete Decongestive Therapy: Manual Lymph Drainage Bandaging Garments Remedial Exercise
73
MLD: Increases the uptake and transport of lymph fluid➔
compression alone does not create a ‘stretch stimulus’ ➔ which causes peristalsis of lymph capillaries and pre-collectors
74
MLD =
Gentle touch is necessary since the lymph vessels involved in fluid collection sit just beneath the skin – are < one mm in diameter Working or pressure phase ➔ increase external pressure Relaxation phase ➔ negative pressure Stretch in the drainage direction during the working phase Stronger touch is necessary for deeper structures and fibrotic areas
75
Lymphangion contraction is:
~6 per minute at rest and ~20 per minute with activity
76
MLD: Basic Sequence
Neck ➔ Right Duct ➔ Right Subclavian Neck➔ Thoracic Duct ➔ Left Subclavian
77
Contraindications for Manual Lymph Drainage Absolute ➔ Red Flags
Congestive Heart Failure (CHF) Renal failure Acute infection Thrombosis, DVT AAA -> abdomen Severe Arteriosclerosis Surgery
78
Contraindications for Manual Lymph Drainage Relative ➔ Yellow Flags
Malignant or metastatic lymphedema Hyperthyroidism Pregnancy -> abdomen
79
Compression Bandaging Contraindications
DVT➔ May mobilize blood clot Infection➔ May spread infection from local to systemic Cardiac Edema➔ CHF Advanced Arterial Disease➔ May further disturb arterial blood flow Malignancy➔ Cancer related complications Renal Disease➔ Renal related complications
80
Compression Bandaging: Indications
Lymphedema Edema Chronic Venous Insufficiency Post-traumatic edema Post-surgical edema Lipedema
81
Compression Bandaging: Short Stretch bandage
Short stretch lymphedema bandages contain no elastic threads Ace bandages contain elastic threads Short stretch extends by 50%➔ Ace extends by 300%
82
Lymphedema short stretch bandages➔
high working pressure and low resting pressure
83
Working Pressure➔
multilayered bandage does not yield to the forces generated by fluid refilling or by bulging muscles when at work – these internal forces cannot overcome the thick, rigid bandage sheath
84
Resting Pressure➔
the shortening force or constriction generated by an elastic bandage – increased risk of blood circulatory disturbances (tourniquet), soft tissue damage, and neuro problems
85
Desirable fluid movement➔
distal areas to proximal areas
86
This proximal movement of fluid relies on ____
compression gradient created around the involved limb
87
Compression Bandaging: Principles
Low resting pressures High working pressures
88
Lymphedema patients graduate from ___ into ___garments as the limb reaches a decongested state
bandages elastic compression

Integ Final (16 decks)

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