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PT in Specific Groups > Lymphoedema > Flashcards

Lymphoedema Flashcards

1
Q

Define lymphoedema (4)

A
  • Chronic swelling of a body part
  • accumulation of fluid/prtn in tissue spaces
  • from congenital malformed lymphatics OR damage to lymph vessels/nodes
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2
Q

What is in lymphoedema (4)

A
  1. Prtn
  2. Cell debris
  3. Fat
  4. Bacteria
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3
Q

Do the lymphatics filter at different layers? And why?

A

Yes, 2 layers

Protect vitals from bacteria/cancer cells/etc

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4
Q

What is the function of the lymphatic system?

A

Collect and transport extra-cellular fluid

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5
Q

What is extra-cellular fluid called when in the lymphatic vessels?

A

Lymph

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6
Q

What do the lymph nodes do? (2)

A

Filter lymph

Immune function role

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7
Q

How much lymph is collected/moved in 24hrs?

A

2-4L normally

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8
Q

What 5 things assist lymph drainage?

A
  1. Intrinsic pumping of lymph vessels (4-5bpm)
  2. Active mm contraction
  3. Passive jt movement
  4. Respiration (pressure changes above/below diaphragm)
  5. Pulsation of adjacent B.vessels
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9
Q

Define primary lymphoedema and the 3 types.

A

Primary (Developmental fault)
- if no other reason, malformed vessels = likely.

Birth-2yo = Ly... congenita
2-35yo = Ly... praecox
>35yo = Ly... tarda
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10
Q

Define secondary lymphoedema (4)

A

Damage sustained later

  1. Lymph node resection/radiotherapy
  2. Obstruction (e.g. tumour)
  3. Infection
  4. Injury
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11
Q

Triggers/aggravating factors (1, 6)

A

Anything increasing lymphatic load OR obstructing/reducing drainage

  1. Infection
  2. Excess body weight
  3. Too little exercise/movement
  4. Heat
  5. Tight clothing, jewellery, bandaging
  6. Air travel with no compression garment
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12
Q

Why would air travel affect lymphoedema?

A
  • Air pressure change

- Stationary

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13
Q

Practical prevention

A

Exercise

  • resistance does not worsen
  • may = less flare ups (self reported
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14
Q

Should an unfit person start intense/repetitive exercise?

A

No, build up gradually

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15
Q

Describe total/simple mastectomy

A

Breast tissue removed including nipple (no lymph nodes removed)

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16
Q

Describe radical mastectomy

A

Breast, chest mm and axilla lymph nodes removed

17
Q

Describe modified radical mastectomy

A

Breast and some lymph nodes removed. NO chest mm taken.

18
Q

Describe partial mastectomy

A

Lump and small amount of breast surrounding is removed.

19
Q

What is a WLE?

A

Wide local excision or Lumpectomy

- remove small diseased area

20
Q

Briefly describe the 3 levels of Axillary dissection

A

L1 - contents between lat dorsi, axillary vein, lateral border of pec minor (lower)

L2. + tissue beneath pec minor (middle)

L3. + resection of pec minor (upper)

21
Q

What is a SNB?

A

Sentinel node biopsy

- remove first lymph nodes that cancer would be likely to spread to

22
Q

What possible morbidities are likely?

A

Reduced ROM

  • Scarring
  • Postural changes
  • Axillary web syndrome/cording

Pain
Arm/breast lymphoedema

23
Q

What surgery affects arm/shoulder morbidity most?

A

Sx involving axilla

24
Q

What 3 things affect lymphoedema risk?

A

Axillary Sx
Other risk factors
Adjuvent Rx

25
Q

What is adjuvent Rx?

A

Combo of Sx, radiotherapy, chemotherapy and hormone therapy.

26
Q

Why hormonal therapy?

A

Block oestrogen receptor positive tumours

27
Q

Relevant side effects of chemo/radio/hormonal

A
  • Oedema
  • Peripheral neuropathy
  • Fibrosis (tighten skin and mm of chest wall)
  • Reduced bone density
28
Q

Lymphoedema interventions

A
  1. Staged exercise prog
  2. Scar Mx
  3. Advice re: activity/exercise return
  4. Edu about lymphoedema risk
29
Q

Symptoms of lymphoedema (3)

A
  • Heavy, aching, sore
  • Burning or I/T shooting pain
  • Tightness
  • P+N
  • Pain moving neck/shoulder
  • Increased skin folds/thickness
30
Q

Signs of lymphoedema

A
  • Obvious oedema
  • Invisible veins
  • Stemmers sign (positive if can’t pick up MCP skin)
31
Q

How to Ax lymphoedema

A

Observe, palpate, measure

32
Q

Objective circumferential measures

A
  • 10cm intervals up the limb

- Do on both limbs for comparison

33
Q

Early lymphoedema Mx advice

A

Exercises
Elevate when able
Avoid static
Refer to lymphoedema PT

34
Q

Rx precautions (5)

A
  • Heat
  • Constriction
  • Vigorous massage
  • Dry needling (infection)
  • Build up exercise/strength gradually
35
Q

Red flags

A

Hx of cancer - recurrence?

36
Q

Treatments for lymphoedema

A
  • Lymphatic drainage massage
  • Exercise
  • Skin care
  • Compression
  • ADL advice
37
Q

Why compression?

A
  • reduced capillary filtration
  • increased uptake of lymphatic collectors
  • increased movement of lymph (with mm and jt move)
38
Q

What should edu include?

A
  • self massage
  • exercise
  • skin care
  • compression garment instructions
  • ADL mods

PT in Specific Groups (5 decks)

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