Random Review LYMPHATICS Flashcards

1
Q

Will lymphedema usually present unilaterally or bilaterally?

A

Unilaterally, on the distal portion of the extremity

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2
Q

What makes Stemmer’s sign positive?

A
  • if the skin on the dorsum of the toes and fingers cannot be lifted, or is difficult to lift, compared to the opposite side
  • accurately diagnoses the presence of lymphedema
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3
Q

When is compression therapy contraindicated for management of edema?

A

in the presence of peripheral arterial disease

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4
Q

Why is manual lymph drainage contraindicated with patients who have congestive heart failure?

A

the heart will not be able to handle the additional fluid and the heart failure will worsen

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5
Q

Primary lymphedema

A

Occurs due to an abnormal development of the lymphatic system

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6
Q

Secondary lymphedema

A

Occurs as a result of some other disease or injury that causes damage to the lymphatic system

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7
Q

Types of insufficiencies that lead to lymphedema

A
  • Dynamic
  • Mechanical
  • Combined
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8
Q

Dynamic lymphatic insufficiency

A
  • Most common
  • Excess lymph in circulation, exceeds transport capacity of the system
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9
Q

What does dynamic lymphatic insufficiency lead to?

A

Pitting edema

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10
Q

Mechanical lymphatic insufficiency

A

Transport capacity of the system is reduced due to damage of the lymph system

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11
Q

What does mechanical lymphatic insufficiency lead to?

A

Protein-rich lymphedema

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12
Q

Combined lymphatic insufficiency

A

Both increase in lymph fluid and decrease in transport capacity

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13
Q

Primary sign of lymphedema

A

Swelling in the extremities

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14
Q

Classification for lymphedema

A
  • Mild
  • Moderate
  • Severe
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15
Q

Mild lymphedema

A

<3 cm difference b/t affected and unaffected limbs

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16
Q

Moderate lymphedema

A

3-5 cm difference b/t the affected and unaffected limbs

17
Q

Severe lymphedema

A

> 5 cm difference b/t the affected and unaffected limbs

18
Q

Stages of lymphedema

A

0-3

19
Q

Stage 0 lymphedema

A
  • AKA latent (preclinical) stage
  • No visible edema
  • Transport of the lymph system has been affected
20
Q

Stage 1 lymphedema

A
  • AKA reversible lymphedema stage
  • Pitting edema is present, increases w/ activity or heat
  • Edema diminishes w/ elevation and rest
21
Q

Stage 2 lymphedema

A
  • AKA spontaneously irreversible lymphedema stage
  • Edema is non-pitting, no change w/ elevation or rest
  • Skin has fibrotic changes, risk of infection increases
  • Positive stemmer’s sign
22
Q

Stage 3 lymphedema

A
  • AKA lymphostatic elephantiasis stage
  • Extensive non-pitting edema
  • Significant fibrotic changes to the skin, papillomas, deep skinfolds, and hyperkeratosis
  • Infection is common at this stage
  • Positive Stemmer’s sign
23
Q

What is regarded as the most sensitive and accurate standard for volume measurement with lymphedema?

A

Water displacement

24
Q

What is CDT with lymphedema treatment?

A

Complete decongestive therapy

25
Q

Phases of CDT

A
  • Phase 1: Intensive acute treatment phase
  • Phase 2: Self-management phase
26
Q

How long does phase 1 of CDT last?

A

4-6 weeks in an outpatient clinic

27
Q

Components of CDT

A
  • Manual lymphatic drainage
  • Compression therapy
  • Exercise
  • Skin care
28
Q

Manual lymphatic drainage for lymphedema

A
  • Move lymph around blockages and into areas it can be drained
  • Target unaffected areas first to prepare for new flow
29
Q

Compression therapy for lymphedema

A
  • Helps maintain reduction in edema obtained through MLD
  • Use short-stretch bandages for lymphedema during phase 1
  • Combo of compression garments (day) and bandages (night) during phase 2
  • Higher pressures in distal regions
30
Q

Exercise for lymphedema

A
  • Uses a “muscle pump” to drive flow
  • Monitor for adverse effects
  • Low impact, aerobic exercise
  • Start with trunk, work proximal to distal
31
Q

Skin care for lymphedema

A
  • Inspect and clean skin each day
  • Soaps and moisturizers should have low/neutral pH to prevent damage
32
Q

Is Milroy disease an example of primary or secondary lymphedema?

A

Primary

33
Q

Recommendations for manual drainage massage w/ lymphedema

A
  • Light stroking to maximize tissue elasticity and fluid movement
  • Repetitive stroking to decrease tissue viscosity
  • Stroking should be in a circular motion
  • Clear proximal congestion first
34
Q

Stage 0 lymphedema AKA

A

latent (preclinical) stage

35
Q

Stage 1 lymphedema AKA

A

reversible lymphedema stage

36
Q

Stage 2 lymphedema AKA

A

spontaneously irreversible lymphedema stage

37
Q

Stage 3 lymphedema AKA

A

lymphostatic elephantiasis stage

38
Q

Which anthropometric measurements should be used w/ patients w/ lymphedema?

A
  • Circumferential measurements (preferred)
  • Volumetric measurements (more accurate)
  • BMI (screen for obesity)
39
Q

Best strategy for circumferential measurements

A

Measure at bony landmarks bilaterally