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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
Q

Lymphatic vessel that empties lymph into one of the subclavian veins ->

A

superior vena cava -> right atrium

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26
Q

Right lymphatic duct drains lymph from the ___

A

right upper limb, right side of thorax and right halves of head and neck

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27
Q

Thoracic duct drains lymph into the ___

A

circulatory system at the left brachiocephalic vein between the left subclavian and left internal jugular vein

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28
Q

Lymphatic Ducts Transport ___

A

1.5-2.5 L/24 hours

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29
Q

Thoracic Duct

A

Largest lymph vessel
40 cm long
2-3 cm wide
20 valves

Moves lymph from lower body and left arm to left subclavian vein

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30
Q

Right Lymphatic Duct

A

3 cm long

Moves lymph from right upper quadrant to right subclavian vein

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31
Q

Definition of Lymphedema

A

Protein-rich edema that occurs when the lymph load or volume exceeds the lymph transport capacity in any body segment

Considered a disorder/disease

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32
Q

Lymphatic vessels may be:

A

Absent or under-developed = Primary Lymphedema

Obstructed or damaged = Secondary Lymphedema

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33
Q

Pedal edema➔

A

swelling in bilateral feet and LE due to long periods of sitting or standing➔ causes hypervolumenia

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34
Q

Cerebral edema ➔

A

fluid accumulation on the brain due to abnormal metabolic conditions such as lupus, can also be due to high altitudes

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35
Q

Pulmonary edema ➔

A

left sided heart failure leads to accumulation of fluid on the lungs

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36
Q

Polymyositis ➔

A

inflammatory muscle condition that causes generalized weakness and swelling

37
Q

Musculoskeletal injury ➔

A

unresolved acute inflammation and edema leads to chronic inflammation and edema

38
Q

Definition of Edema

A

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
Q

Definition of Lipedema

A

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
Q

Definition of Cellulitis

A

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
Q

tributary zone

A

each major lymph node grouping recerives lymph from a specific body region

42
Q

watersheds

A

direction of lymphatic flow of each tributary zone is defined by invisible boundaries

43
Q

anastamoses

A

areas between zones where vessels physically line up, critical in movement of lymph between adjacent zones during treatment

44
Q

Quadrants or ‘territories’ are only connected to each other through:

A

a few anastomotic branches – few vessels connecting the territories

45
Q

The only way lymph can move from one territory or zone to the next is through:

A

the initial lymph vessel network -> lymph capillaries

46
Q

These cross-over areas are called the ‘lymphatic water shed’ areas via ___

A

anastamoses

47
Q

Grade 0 lymphedema

A

Normal sensation

Normal appearance

Patient at risk to develop lymphedema

48
Q

Grade 1 Lymphedema

A

Abnormal sensation

Pitting

Reversible with elevation

Early intervention needed

49
Q

Grade II Lymphedema

A

Intermittent ‘heaviness’

Abnormal tissue texture

Irreversible with
elevation due to fibrosis

50
Q

Grade III Lymphedema

A

Elephantitis

Persistent ‘heaviness’

Grossly abnormal

Irreversibly damaged tissue

Treatment will help decrease severity of symptoms

51
Q

Edema 1+

A

Edema that is barely detectable, <2 mm depression, immediate rebound

52
Q

Edema 2+

A

A slight indentation visible when the skin is depressed, 3-4 mm depression, <15 second rebound

53
Q

Edema 3+

A

A deeper fingerprint when the skin is depressed, 5-6 mm depression, 10-30 second rebound

54
Q

Edema 4+

A

Large fingerprint when the skin is depressed,
>7 mm depression, >20 second rebound ➔ the limb may be 1.5-2 times normal size

55
Q

Lymph Fluid Movement

A

Water, protein and small molecules diffuse through the blood capillary walls into the interstitium -> process called filtration -> to nourish the tissues

56
Q

Ultrafiltration dependent on:

A

hydrostatic pressure in capillary and interstitial space

Colloid osmotic pressure gradient of plasma proteins

57
Q

In homeostasis, ‘reabsorption’ occurs when fluid moves:

A

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
Q

Lymph Circulation

A

blood capillaries
lymph capillary
initial lymph vessels
pre-collectors
collectors (pumps)
lymph nodes
lymphatic ducts
subclavian venous system

59
Q

Filtration =

A

Reabsorption + Lymph Fluid

60
Q

Starling’s Equilibrium:

A

= 85% Venous Capillaries + 15% Lymph Capillaries

61
Q

Factors Affecting Tissue Fluid Exchange

A

Total tissue pressure

Gravity

Ultrafiltration: High BP??

Muscle contraction: what’s the impact

Diaphragmatic breathing

Intestinal contractions

Skin/tissue movement

62
Q

Functions of the Lymph System =

A

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
Q

Lymphedema

A

High Protein edema➔ exudate

Congestion in the interstitium

Visible swelling

Chronic inflammation of the tissues ➔ proliferation of fibroblasts

Proliferation of fibroblasts = fibrosis

64
Q

Types of Lymphedema

A

Primary
Secondary

65
Q

Primary Lymphedema:

A

Rare inherited condition due to deficient lymph vessels

66
Q

Secondary Lymphedema:

A

Acquired lymphatic system deficits

Surgery

Radiation therapy

Trauma

Filariasis -> elephantiasis, parasite infection affects 90 million people world-wide -> primarily in tropical regions

67
Q

Lymphedema Prevalence:

A

250,000 million people worldwide, 5 million people in the United States, estimated 1 in 100,000 people have primary lymphedema

68
Q

Normal healthy lymphatic system = ___ is greater than the ___

A

transport capacity

lymphatic load

69
Q

Lymphatic system insufficiency = ____ is greater than the ___

A

lymphatic load

transport capacity

70
Q

Too much fluid in a normal system ➔

A

hypervolemia

71
Q

Normal fluid amount in an abnormal or damaged system ➔

A

primary and/or secondary lymphedema

72
Q

Recommended Treatment for Lymphedema

A

Complete Decongestive Therapy:
Manual Lymph Drainage
Bandaging
Garments
Remedial Exercise

73
Q

MLD: Increases the uptake and transport of lymph fluid➔

A

compression alone does not create a ‘stretch stimulus’ ➔ which causes peristalsis of lymph capillaries and pre-collectors

74
Q

MLD =

A

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
Q

Lymphangion contraction is:

A

~6 per minute at rest and ~20 per minute with activity

76
Q

MLD: Basic Sequence

A

Neck ➔ Right Duct ➔ Right Subclavian

Neck➔ Thoracic Duct ➔ Left Subclavian

77
Q

Contraindications for Manual Lymph Drainage

Absolute ➔ Red Flags

A

Congestive Heart Failure (CHF)

Renal failure
Acute infection
Thrombosis, DVT
AAA -> abdomen
Severe Arteriosclerosis
Surgery

78
Q

Contraindications for Manual Lymph Drainage

Relative ➔ Yellow Flags

A

Malignant or metastatic lymphedema

Hyperthyroidism

Pregnancy -> abdomen

79
Q

Compression Bandaging Contraindications

A

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
Q

Compression Bandaging: Indications

A

Lymphedema
Edema
Chronic Venous Insufficiency
Post-traumatic edema
Post-surgical edema
Lipedema

81
Q

Compression Bandaging: Short Stretch bandage

A

Short stretch lymphedema bandages contain no elastic threads

Ace bandages contain elastic threads

Short stretch extends by 50%➔ Ace extends by 300%

82
Q

Lymphedema short stretch bandages➔

A

high working pressure and low resting pressure

83
Q

Working Pressure➔

A

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
Q

Resting Pressure➔

A

the shortening force or constriction generated by an elastic bandage – increased risk of blood circulatory disturbances (tourniquet), soft tissue damage, and neuro problems

85
Q

Desirable fluid movement➔

A

distal areas to proximal areas

86
Q

This proximal movement of fluid relies on ____

A

compression gradient created around the involved limb

87
Q

Compression Bandaging: Principles

A

Low resting pressures
High working pressures

88
Q

Lymphedema patients graduate from ___ into ___garments as the limb reaches a decongested state

A

bandages

elastic compression

Integ Final (16 decks)

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