Lymphedema Quiz 2 Flashcards
How is lymphedema characterized?
Chronic disease with no cure
Swelling in affected area (normally an extremity)
Swelling occurs due to impaired flow of lymph fluid
What type of tissue does lymphedema primarily affect?
Subcutaneous fatty tissue
What’s the epidemiology of lymphedema?
Patients with breast cancer and radiation (10-40% incidence range)
Why is lymphedema becoming more prevalent?
Patients with cancer living longer
Obesity Rates are rising
Population is aging
What is the purpose of the lymphatic system?
Return fluid and protein from interstitial spaces to the vascular system (has no basement membrane, allows vessels to absorb larger molecules)
What are the 2 functions of the lymphatic system?
Maintain pressure and volume of interstitial fluid and blood by returning excess water and dissolved substances
Assist the immune system at the lymph nodes and other lymphatic tissue with lympocytes and macrophages
How much fluid is absorbed per day?
2-4L
What is lymph fluid consisted of?
Protein Water Fatty Acids Salts White Blood Cells Microorganisms Debris
What does the superficial and deep vessels of the lymphatic system drain?
Superficial - drains skin and subcutaneous tissues
Deep - Drains tissues to the fascia and below (located with major blood vessels, especially veins)
What is the order of vessels in the lymphatic system from smallest to largest?
Capillaries -> Precollectors -> Collectors -> Nodes -> Trunks -> Ducts
Which vessels have valves in the lymphatic system?
Collectors
No valves in precollectors, fluid flows in direction of low pressure
What are some characteristics of acute lymphedema?
Lasts less than 6 months (reversible)
Pitting edema with pressure
Lack of brawny skin changes
What are the risk factors for acute lymphedema?
Surgical drains with leakage of drainage back into surgical site Acute injury to a limb Radiation therapy Infection Phlebitis
What are some characteristics of chronic lymphedema?
Not reversible
Skin Changes likely
What are the the 2 types of chronic lymphedema?
Primary - Idiopathic or Congenital
Secondary - Acquired
Where does primary lymphedema generally involve?
Leg or legs
What are the 3 classifications of primary lymphedema and how old are patients affected?
Congenital =
What is secondary lymphedema most commonly asociated with?
Malignancy and subsequent treatment
What are some ways dysfunction generally occurs at the lymph nodes?
Surgery Radiation Trauma Infection Malignancy Scar Tissue
What happens at stage 0 of lymphedema?
Reversible
Swelling is not evident
Damage to lymphatic function has occurred
May exist for months or years before swelling is detectable
What happens in stage 1 of lymphedema?
Reversible Lymph fluid with high protein content Fluid dissipates after the involved limb is elevated Pitting edema begins distally No palpable fibrosis Negative or borderline Stemmer sign
What are the levels of pitting edema
0+ no pitting edema
1+ Mild pitting edema (2mm depression that dissapears rapidly
2+ Moderate (4mm takes 10-15 seconds to disappear)
3+ Moderately severe (6mm takes more than a minute)
4+ Severe (8mm that lasts for 2 minutes)
What is stage 2 of lymphedema?
Irreversible Pitting edema is present Non-pitting edema develops Limb elevation doesn't reduce edema Tissue fibrosis starts Positive Stemmer sign Skin Thickens Skin has rough cobblestone appearance and texture
What is stage 3 of lymphedema?
Irreversible
Also known as Elephantiasis
Pitting edema NOT present
Increased skin changes
What is the Stemmer’s Sign/Test?
Inability to pinch a skin fold on dorsal aspect at base of 2nd toe (or base of middle finger)
Can you get a false positive with Stemmer’s Sign/Test?
No
What is Lipedema?
Fat deposition in irregular patterns/amounts
Predominately found in legs
Can lead to lymphedema due to tissue congestion
What causes lipedema?
Unknown Female hormones suspected -puberty -Pregnancy -Around time of menopause
Does lipedema respond to compression therapy?
Not really
