Week 10 - Lymphatic system disorders Flashcards
What is the role of the lymphatic system?
Transporting fluid and waste product around the body
Immune function
Absorbing dietary fats
What makes up the lymphatic system?
- Lymphoid organs including:
Spleen, thymus, tonsils, bone marrow, appendix, lining of the respiratory and digestive tract and lymph nodes - Lymphatic vessels
Found in all tissues except teeth, bone, cornea and bone marrow.
How many lymph nodes are in the body?
400-700 nodes
What is the role of interstitial fluid?
Brings oxygen and nutrients to cells and waste from these cells enters the interstitial fluid. It is then absorbed by the lymphatics, becoming lymph and is transported to lymph nodes for filtering before returning cleaned to the venous system.
What do lymph nodes do?
Capture and recognise invaders, preventing them from harming the body
What helps lymph move?
Skeletal muscles contracting, blood vessels pulsating.
True or false; Lymph fluid can only go in 1 direction?
True, the vessels have muscle cells and valves so fluid is one directional
What is the process of lymphoedema?
The failure of the lymphatic system
It is an imbalance between capillary filtration into and lymphatic drainage from the interstitial space. The system fails and fluid builds up`
What is lymphoedema?
Oedema or swelling due to accumulation of lymph in tissues
Where can lymphoedema occur?
Limbs, trunk, breast, head, neck and genitals
What causes lymphoedema?
The system doesn’t develop properly (primary lymphoedema)
The system is damaged (secondary lymphoedema)
The system is overloaded (secondary lymphoedema)
What are the 2 types of lymphoedema?
Primary and secondary lymphoedema
Who get’s lymphoedema?
- People whose lymphatic system hasn’t developed properly
- People who have had cancer treatment
- People who have medical conditions, injury or take medication that predisposes them to lymphoedema
- People whose lifestyle increases the lymphatic burden (obesity, sedentary behaviour, poor hygiene)
How does cancer cause lymphoedema?
Lymph nodes may need to be removed
Radiation may damage and scar the lymph nodes
Tumours can grow in and around the nodes and vessels
What type of lymphoedema is most common?
Secondary lymphoedema
What are the 4 stages of lymphoedema?
Stage 0 - Latent
Stage 1 - Reversible
Stage 2 - Irreversible
Stage 3 - Lymphostatic elephantiasis
What are the symptoms of Stage 0?
Swelling is not evident despite impaired lymph transport
What are the symptoms of stage 1?
Early onset, there is an accumulation of tissue fluid that subsides with limb elevation. Oedema may be pitting
What are the symptoms of stage 2?
Limb elevation alone rarely reduces swelling, pitting is manifest with protein rich oedema fluid.
Late stage: May or may not be pitting as tissue fibrosis becomes more evident
What are the symptoms of stage 3?
There is an accumulation of protein rich oedema fluid. Tissue is hard (fibrotic) and pitting is absent. Skin changes including thickening, hyperpigmentation, increased skin folds, fat deposits and warty overgrowths develop.
What are the impacts of lymphoedema if left untreated?
Physical
Psychological
Economical
What are the physical affects of lymphoedema?
Heaviness Aching Discomfort Deterioration in skin health (cellulitis) Wounds Impaired movement Impaired mobility Difficulty fitting in to clothing and footware
What are the psychological affects of lymphoedema?
Reduced quality of life Negative body image Social isolation Impacts work and family life Contributes to increased anxiety and depression
What are the economic impacts of lymphoedema?
Cost of medical appointments
Cost of treatment
Time off work
Cost to the health care system
How is lymphoedema assessed?
Subjective assessment and objective assessment
What are the early signs and symptoms of lymphoedema?
Swelling doesn’t start suddenly
Feeling of swelling, heaviness, stiffness in affected body part
Often worse at the end of the day, hot weather, after inactivity
Tightness or temperature changes to areas across the body
History of infection or skin issues
LYMQOL
Other - meds, Hx, DVT etc
What does objective assessment consider?
Size Shape Symmetry BMI Movement and function Skin assessment Vascular assessment
What do skin assessments are used for LO?
Skin appearance - colour, texture, scars, wounds, circulation
Pitting test
Stemmer’s sign
Pinch test
What is the pitting test?
Firm pressure applied to swelling for 30 second - assess indentation
What is stemmer’s sign?
When you are unable to pinch the skin at base of second toe.
What is the pinch test?
Pinching skin and comparing tissue thickness and texture between limbs
What is Bioimpedence Spectroscopy?
Uses electrical current to measure extracellular fluid
Can detect changes before swelling becomes visible
What are circumferential measures?
Using a tape measure at intervals along limb to compare sides at intervals and monitor changes over time
What is tissue dielectric constant?
A “spot” measure of tissue water content, good for hard to measure places eg breast, face, trunk.
What imaging can be used for LO?
ICG lymphography
Lymphoscintigraphy
Ultrasound
MRI
What are the aims of LO management?
Prevent progression, reduce oedema and maintain gains
What are the principles of LO management?
The key is: to self manage by:
Education Compression Skin care Exercise and Lifestyle Manual Lymphatic drainage
What are the 2 phases of LO management?
Treatment phase
Maintenance phase
Why is exercise beneficial for LO?
Assists lymphatic flow, improves QOL function, reducing cancer treatment side effects
Why do we use compression for LO?
Reduces pooling of fluid
Improves limb size and shape
Lymphatic circulation supported and improved
Improves skin health and reduces risk of infection
Why is skincare important in LO?
To minimise infection and maintain healthy skin
What is manual lymphatic drainage?
Aims to manually move fluid from congested areas to an area of functioning lymph flow.
