Unit 2 - Lymphatic System Flashcards
lymphatic system
serves to collect and return excess fluid (“lymph fluid”) that has accumulated in the peripheral tissues back to the right side of the heart via the right and left subclavian veins.
fluid movement in lymphatic system
As fluid (“ultrafiltrate”) moves from the arterial side of the capillary bed to nourish tissues and cells, 90% will be reabsorbed into the venous capillary network, while the other 10% is returned to the circulation via the lymphatic system.
lymph nodes
Lymph nodes are bean-shaped and range in size from a few millimeters to about 1-2 cm in their normal state.
The lymph nodes act as filters, they contain lymphocytes that will collect and destroy bacteria and viruses.
When the body is fighting an infection, lymphocytes multiply rapidly and produce a characteristic swelling of the lymph nodes.
lymph/ducts
Lymph fluid re-enter the circulation as the Right Lymphatic Duct and the Thoracic Duct discharge the lymph into the right and left subclavian veins respectively.
types of lymphedema
Primary (“Idiopathic”)
Secondary
Lymphedema
swelling of the tissues due to accumulation of protein –rich fluid in the extracellular spaces.
Glassy appearance
Peau d’orange
Disappears slowly with elevation (Stage I)
May not disappear with elevation (Stage II, III)
Primary Lymphedema (Idiopathic”) 3 types
Lymphedema Congenita (Connatal)
Lymphedema Praecox
Lymphedema Tarda
primary lymphatic disorders
L. Connatal - (present at birth)
L. Praecox - (adolescence – midlife). Most Common type
L. Tarda – (appears after age 35)
Secondary causes
Surgical destruction of lymph nodes Lymph node blockage Infection Malignancy (Lymphoma) Parasite Obstruction Wucheria Bancrofti
lymphedema stages
Stage I – Pitting edema, reversible with elevation
Stage II – Irreversible edema, nonpitting, clinical fibrosis present, skin changes present in severe type II
Stage III – (Elephantiasis”) severe nonpitting fibrotic edema, atrophic skin changes
Elephantiasis
May be caused by chronic parasitic infection - Wuchereria Bancrofti (“filariasis”) .
Damages lymphatic system and leads to obstruction.
Lymph blockage due to parasitic infection (“filariasis”).
Most common cause of secondary lymphedema worldwide.
Greatest incidence in tropical climates
Carried by mosquitos, the parasitic worm can grow up to 20 cm in length.
PT/OT implications
- Prevent further overload (“lymphedema”) through proper positioning during treatment and avoiding exercises/modalities (“for example heat and ultrasound”) that may increase edema in the affected limb.
- In patients receiving radiation therapy, observe for possible skin changes which may be precursors of lymphedema.
Blistering
Discoloration
Erythema (“redness”) - skin infections
interventions
Manual lymphatic drainage Compression bandaging Exercise (AROM, aerobic, and strengthening) Compression garments Skin care education Compression pumps Pyschological/emotional support
Exercise Guidelines:
Relaxation and deep breathing
Use compression garments on affected limb
Work trunk muscles to clear central lymph reservoirs
Activate muscles in the affected area/limb
Finish session with trunk exercises and deep abdominal breathing to facilitate lymph flow through the thoracic duct
Aerobic exercise - emphasize low impact activities performed at mild to moderate intensities
PRE is OK, progress slowly beginning with light loads and low reps
Be alert for signs of lymph overload
Aching Congested feeling in the limb Discomfort in proximal lymph node area (axilla or inguinal areas) Pain Throbbing Discoloration
