Lymphedema/lipidema

Question 1

What is lymphedema?

Answer 1

Chronic disorder characterized by excessive accumulation of lymph fluid 2’ mechanical insufficiency of the lymphatic system

Question 2

What is primary lymphedema?

Answer 2

Congenital or hereditary disorder with abnormal lymph node or lymph vessel formation

Question 3

What is secondary lymphedema?

Answer 3

Acquired insult to the lymphatic system. Most commonly seen after surgery for breast or cervical cancer
A. Surgery including lymph node removal
B. Tumors, trauma, or infection involving lymphatic system structures
C. Radiation therapy
D. Chronic venous insufficiency
E. Filariasis (parasitic infection of lymph system)

Question 4

What is Stage 0 of lymphedema?

Answer 4

Latent or preclinical stage
NO CLINICAL EDEMA
Symptomatic: heavy, unusual sensation, pain in limb

Question 5

Stage 1 of lymphedema?

Answer 5

REVERSIBLE
-Visible swelling
-Pitting edema resolves with elevation
-stemmars sign NEGATIVE

Question 6

Stage 2 Lymphedema?

Answer 6

-Spontaneously irreversible
-Increase in swelling
-elevation does not reduce swelling
-Stemmars sign POSITIVE

Question 7

Stage 3 lymphedema?

Answer 7

-elephantitis
-severe non pitting edema, FIBROTIC EDEMA
-hyperkeratosis, papillomas tissue flaps, leaking lymph fistulae, hardening of dermal tissue

Question 8

What is the difference between lipidema and lymphedema?

Answer 8

Lipidema- feet are not affected (stops at ankles) , stemmars sign is not involved and it is bilateral. It is an accumulation of fat deposition rather than lymph fluid
-PINCHING hurts with lipidema and not lymphedema

Question 9

What is stage 1 of lipidema?

Answer 9

Soft skin, regular, nodular change felt on palpation
No color changes, subcutaneous skin is spongy

Question 10

What is stage 2 lipidema?

Answer 10

Subcutaneous nodular and tough
-Large fatty lobules begin to form medial distal and proximal thighs
-Pitting edema and skin changes

Question 11

What is stage 3 lipidema?

Answer 11

MASSIVE fat depositions between hips and knee, rubbery

Question 12

What is lymphadenopathy?

Answer 12

-Enlargement of the lymph nodes, with or without tenderness
-Typically caused by infection
-Localized lymphadenopathy: enlargement of lymph nodes in just one body organ
-Generalized lymphadenopathy: enlargement of lymph nodes in 2 or more body regions
-Lymphadenitis: lymphadenopathy accompanied by signs of inflammation such as redness and tenderness

Question 13

What is lymphangitis?

Answer 13

-An acute bacterial (often streptococcus) or viral infection that spreads throughout the lymphatic system
-Red streaks are often seen in the skin proximal to the infection site

Question 14

How should one perform exercise with lymphedema?

Answer 14

Decongestive exercises work with bandages to compress lymph between the bandage and muscles to move fluid PROXIMALLY
-Walking and cycling program

Question 15

How do you perform complete decongestive therapy?

Answer 15

Manual lymphatic drainage
-Massage- technique requires very low pressure effleurage strokes
-Decongest PROXIMAL SEGMENTS first at the RIGHT lymphatic duct for R UE involvement and the thoracic duct for LUE, LE’s and torso

Question 16

What bandages should you use for lymphedema?

Answer 16

Short stretch
Should be warn 24 HOURS A DAY
-The bandages have low resting and high working pressure

Question 17

What is 1+ on the edema scale?

Answer 17

Mild, Barely perceptible indentation; <1/4 inch pitting

Question 18

What is a 2+ on the edema scale?

Answer 18

Moderate, easily identified depression; returns to normal within 15 seconds; 1/4-1/2 inch pitting

Question 19

What is a 3+ on the edema scale?

Answer 19

Severe, depression takes 15-30 seconds to rebound; 1/2-1 inch pitting

Question 20

What is a 4+ on the edema scale?

Answer 20

Very severe, depression lasts for >30 seconds or more; > 1 inch pitting