Unit 2_Lymphatic System Pathophysiology Flashcards
What 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 (“ultrafiltrate”) moves from the arterial side of the capillary bed to nourish tissues and cells.
- 90% will be reabsorbed into the venous capillary network
- 10% is returned to the circulation via the lymphatic system
Lymphatic System
What occurs in only one direction due to “one-way valves”?
Lymph Flow
What are bean-shaped nodules?
Size: a few millimeters to 1-2 cm.
Act as filters
- Contain lymphocytes that 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 Nodes
What occurs when 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?
Lymph Drainage
What is known as swelling of the tissues due to accumulation of protein–rich fluid in the extracellular spaces?
Types:
Primary (idiopathic)
Secondary
Lymphedema
What stage of Lymphedema includes abnormal flow? No apparent signs and symptoms.
Stage I
What stage of Lymphedema includes pitting edema, resolves with elevation?
Stage II
What stage of Lymphedema includes irreversible edema, nonpitting, clinical fibrosis present, skin changes present in severe type III (scarring and thickening)?
Stage III
What stage of Lymphedema includes Elephantiasis”, severe nonpitting fibrotic edema, atrophic skin changes?
Stage IV
What occurs when skin has a:
Glassy appearance
OR
Peau d’orange (“orange peel appearance”)?
Swelling:
Disappears slowly with elevation (Stage I, II)
May not disappear with elevation (Stage III, IV)
Lymphedema
What kind of Lymphedema includes:
Lymphedema Connatal - (present at birth)
Lymphedema Praecox - (adolescence – midlife) *Most Common type
Lymphedema Tarda - (appears after age 35)
Primary Lymphedema (idiopathic)
What kind of Lymphedema includes:
Surgical destruction of lymph nodes
- Example: may occur as result of treatment intervention for breast cancer
Lymph node blockage
Infection
Malignancy (Lymphoma)
Parasite Obstruction
“Wuchereria Bancrofti” or “filariasis”
Secondary Lymphedema
What is the 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 in the lymph vessels
Chronic infection damages the lymphatic tissue
Filariasis
What disease is the goal of rehabilitation to 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?
Common component of oncologic rehabilitation:
1. Surgical removal of lymph nodes
2. Radiation therapy
- Lymphedema correlates with skin changes over time
Blistering
Discoloration
Erythema (“redness”)
Lymphedema Rehabilitation
What disease should you observe adjacent areas during treatment to reduce edema, as these adjacent areas may become edematous?
- Example: when providing treatment designed to reduce lymphedema in a leg, observe the ipsilateral buttock and groin regions for signs of lymphedema.
Individuals with lymphedema are at high risk of skin infections which can potentially lead to serious complications, including further compromise in their lymphatic system.
Suspected skin infections (cellulitis) should be referred immediately.
Lymphedema
What are the following specific treatments for:
“Complete Decongestive Therapy”
Manual lymphatic drainage
Compression bandaging
Skin care education
Compression garments
Compression pumps
Psychological/emotional support
Exercise (aerobic, and strengthening)
Lymphedema
What are the following exercise Guidelines for?
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 - low impact activities (mild to moderate intensities)
Progressive Resistance Training is okay.
progress slowly beginning with light loads and low reps
*Aquatic exercise
Water provides compression
Lymphedema
When should you discontinue exercise when dealing with a Lymphedema patient?
Discontinue if increase in edema, pain, or redness
What is a condition where lymph nodes become inflamed due to infection?
Treated by correcting the infection
Lymphadenitis
What is acute inflammation of subcutaneous lymph channels?
Hemolytic streptococci or staphylococci infection due to local abrasion, scrape, or wound.
Red streak may be present (“blood poisoning”).
Treated by oral or/and IV antibiotics
Lymphangitis
What is characterized by a symmetrical swelling of the legs due to subcutaneous adipose tissue deposits?
Caused by hormonal imbalance resulting in fat deposition. (Not obesity)
Not a lymphatic disorder
Occurs almost exclusively in women with family history (20% of cases)
Management involves treating hormonal disturbance and preventing weight gain through nutritional counseling.
Lipoedema
