Lymphedema--Jen Flashcards

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1
Q

Lymphotomes

A
  • anatomical regions that drain to same area

- left/right and upper/lower

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2
Q

Lymph flows toward:

A
  • nodes from peripheral tissues

- controlled by bicuspid valves of lymphangion

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3
Q

lymphangion

A
  • segment of lymph vessel that contains a bicuspid valve
  • has smooth muscle
  • lined with epithelial cells
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4
Q

Smooth Mm Contraction of lymphangion

A
  • initiatied by pressure increase outside the vessel
  • pumps only 3-4 times per min
  • need skeletal movement to move fluid
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5
Q

lymph vessels empty into:

A

-veins near internal jugular and subclavian veins

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6
Q

How many nodes in body

A

-600

  • 160: head neck
  • 200: digestive system
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7
Q

Ducts/Trunks

A
  • larger lymph vessels

- lumbar trunk and intestinal trunks flow to cisterna chili then to thoracic duct at venous angle

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8
Q

Pressure change by respiration increases____

A

rate of lymph flow into the thoracic duct

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9
Q

Function of Lymph System

A
  • maintain balance of fluids
  • return fluid/substances from interstitium to blood stream
  • differentiate between foreign and self cells
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10
Q

Lymph Fluid Contains

A
  • water
  • proteins
  • cytokines
  • enzymes
  • lymphocytes
  • macrophages
  • –bacteria, fungi, viral, tumor cells
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11
Q

Lymphadema

A
  • abnormal collection of excessive tissue proteins, edema, chronic inflammation and fibrosis
  • lymph load>total capacity
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12
Q

complications of lymphadema

A
  • recurrent infection (cellulitis etc)
  • chylous reflux
  • lymphocutaneous fistulae (weeping) pathways from lymph vessel to surface of skin
  • lymphangiosarcoma
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13
Q

chylous reflux

A

-backflow of intestinal lymph

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14
Q

Lymphangiosarcoma

A

-cancer of lymphatic vessels

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15
Q

Risk Factors

A
  • axillary surgery (any cancer surgery)
  • radiation therapy
  • mastectomy
  • axillary node dissection
  • obese
  • delayed wound healing
  • tumor causing lymphatic obstruction
  • scarring ducts from surgery/radiation
  • intrapelvic/intra-abdominal tumors
  • chronic venous insufficiency
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16
Q

Medical Management

A
  • no meds, no surgery

- PT

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17
Q

Diagnosis

A
  • lymphangiography
  • Lymphoscintigraphy (gold standard)
  • venography/dopplar US
18
Q

PT Tests/Measures

A
  • stemmer’s sign: inability to pinch skin on dorsal hand/foot
  • volumetrics: water displacement
  • Circumferential: use formula to determine volume

-if it resolves with elevation then it’s not lymphadema

19
Q

Staging of Lymphadema

A

stage 1-3

20
Q

Stage 1

A

spontaneously reversible (elevation)

  • pitting edema
  • increased limb girth and heaviness
21
Q

Stage 2

A
  • does not change with elevation
  • spongy tissue feeling
  • fibrotic changes
22
Q

Stage 3

A

-lymphostatic elephantiasis

23
Q

Precautions/Contraindications with lymphedema complicatiosn

A
  • careful techniques (don’t cause genital edema)
  • US
  • Elastic tubular bandage
  • skin irritation
  • infection
  • CHF
  • cognition/communication
  • DVT
24
Q

PT for Lymphadema

A

-Complete Decongestive Therapy (CDT)

25
Q

CDT

A
  • Manual lymphatic drainage (MLD)
  • compression bandaging
  • exercise
  • skin care
  • risk reduction
26
Q

Manual Lymphatic Drainage

A
  • increase movement of lymph & interstitial fluid
  • stretching of skin
  • pressure phase
  • relaxation phase
  • slow: 5-7 reps per area
27
Q

Stretching of skin effects:

A

-effects superficial lymph vessels

28
Q

Pressure Phase promotes:

A

fluid movement in desired direction

29
Q

Relaxation Phase causes:

A

-vacuum due to distention of tissue and leads to refilling of vessels

30
Q

Compression Bandaging

A
  • short stretch, low elastic
  • low resting pressure
  • high working pressure
  • non stretch tubular layer (wick moisture)
  • layered with graduated pressure in limb
31
Q

Compression Garments

A
  • maintain limb size (not reduce it)

- Graded: class 1-4

32
Q

Class 1 Garments

A

-20-30mmHg

33
Q

Class 2 Garments

A
  • 30-40mmHg

- UE

34
Q

Class 3 Garments

A
  • 40-50mmHg

- LE

35
Q

Class 4 garments

A

-60+mmHg

36
Q

Reason of Disuse of Garments

A
  • not fit properly
  • not aesthetically pleasing
  • uncomfortable fabric
  • difficulty to don/doff
  • wrong amount of compression
37
Q

Exercise for Lymphadema

A
  • moderate intensity
  • diaphragmatic breathing
  • muscle pump exercises
38
Q

Muscle Pump Exercises

A
  • ball squeeze
  • elbow flex/ext
  • shoulder flex
  • cervical flex/ext
  • scap retraction
  • ankle pump
  • knee flex/ext
  • hip flex/abd/add
39
Q

Skin Care

A
  • low pH moisturizer (Eucerin, Lindi)
  • keep clean
  • wash garmets
  • clean cuts and cover properly with anti-biotic
  • careful with nail cutting (podiatrist)
40
Q

Risk Reduction

A
  • protect skin
  • avoid insect bites/public pools/burns
  • stay clean
  • exercise
  • avoid increased body temp (hot tub, sauna, steam)
  • minimize limb constriction (jewelry)
  • healthy nutrition
  • hydration
41
Q

Prognosis

A
  • early detection and pt ability to self manage increases prognosis
  • progressive disorder
  • if unmanaged–>elaphantiasis
42
Q

Abdominal/Pelvic Lymphadema

A
  • difficult to manage and bandage

- good results with pelvic floor Mm training and compression garments (spanks)