Lymphatic System Overview for NPTE Exam Preparation

Lymph

Interstitial fluid that enters the lymphatic system.

Lymphatic Organs

Includes nodes, tonsils, thymus, spleen, and marrow.

Major Lymph Nodes

Includes submaxillary, cervical, axillary, and more.

Flow of Lymph

Transported from capillaries through collecting vessels.

Lymphatic Load

Amount of lymphatic fluid transported by the system.

Transport Capacity

Maximum fluid amount lymphatic system can handle.

Lymphedema

Chronic disorder with abnormal lymph fluid accumulation.

Primary Lymphedema

Congenital or hereditary causes of lymphedema.

Secondary Lymphedema

Result of injury to lymphatic system components.

Pitting Edema

Indentation persists after pressure on swollen tissue.

Brawny Edema

Hard palpation indicates severe interstitial swelling.

Weeping Edema

Severe lymphedema with fluid leakage from sores.

Severity of Lymphedema

Described by changes in skin and subcutaneous tissue.

Venous Insufficiency

Condition affecting lymphatic load and transport capacity.

Lymph Node Removal

Can reduce transport capacity of the lymphatic system.

Adverse Effects

Negative outcomes from lymphatic system dysfunction.

Rehabilitation

Therapeutic interventions for lymphedema management.

Differential Diagnosis

Process of distinguishing lymphedema from other conditions.

Non-Pharma Management

Treatment strategies excluding pharmaceuticals for lymphedema.

Lymphatic Trunks

Major vessels that collect lymph from nodes.

Lymphatic Collecting Ducts

Final pathways for lymph before entering veins.

Subclavian Veins

Where lymphatic fluid is returned to the bloodstream.

Stemmer Sign

Indicates stage II or III lymphedema.

Positive Stemmer Sign

Skin on fingers/toes cannot be pinched.

Stage 0 Lymphedema

No edema, occasional heaviness reported.

Stage I Lymphedema

Soft, pitting edema; reversible with elevation.

Stage II Lymphedema

Fibrosclerotic tissue; non-pitting 'brawny' edema.

Stage III Lymphedema

Severe changes; includes papillomas and infections.

Lymphedema Stages

Progressive stages from latency to elephantiasis.

Edema Grading Scale

Measures severity of edema from 1+ to 4+.

1+ Edema

Mild indentation;

2+ Edema

Moderate indentation; 1/4-to-1/2-inch pitting.

3+ Edema

Severe indentation; 1/2-to-1-inch pitting.

4+ Edema

Very severe indentation; >1 inch pitting.

Lipedema

Bilateral condition affecting lower extremities.

Lipedema Characteristics

Affects proximal areas; spares distal feet.

Lipedema Symptoms

Sensitive skin; bruises easily and is painful.

Brawny Edema

Hard swelling; non-pitting type of edema.

Fibrosclerotic Tissue

Thickened tissue due to chronic lymphedema.

Hyperkeratosis

Thickened skin; common in advanced lymphedema.

Papillomas

Skin growths associated with severe lymphedema.

Clinical Presentation

Signs and symptoms observed during physical examination.

Lymphedema Diagnosis

Identified by positive Stemmer sign and swelling.

Pressure Sensitivity

Lipedema skin is sensitive to touch.

Lymphedema

Unilateral or bilateral swelling, often asymmetric.

Lipedema

Bilateral symmetric swelling, primarily in lower extremities.

Stemmer sign

Positive in lymphedema, negative in lipedema.

Cellulitis

Common complication in lymphedema, rare in lipedema.

Pain on pressure

Absent in lymphedema, present in lipedema.

Distal edema in foot

Present in lymphedema, absent in lipedema.

Girth Measurements

Circumferential limb measurements for comparison.

Volumetric Measurements

Water displacement method for limb volume assessment.

Bioimpedance Measurements

Resistance measurement indicates extracellular fluid levels.

Indirect lymphography

Imaging technique to visualize lymphatic system.

Lymphoscintigraphy

Identifies lymphatic insufficiency during rest and exercise.

MRI/CT

Shows honeycomb patterns in soft tissue.

Ultrasonography

Assesses soft tissue thickening and fibrosis.

Fluorescent microlymphography

Detailed imaging of lymphatic vessels.

Doppler US

Differentiates lymphatic issues from venous insufficiency.

Hard lymph nodes

Indicates potential malignancy, requires physician referral.

Soft lymph nodes

Less concerning, may not require referral.

Radical mastectomy

Can cause secondary lymphedema.

Pre/Post Surgery Assessment Tool

Bioelectric impedance for lymphedema evaluation.

Stage of lymphedema

Positive Stemmer sign indicates early fibrosis.

Bilateral lower extremity edema

Characteristic of lipedema, no pedal edema.

Tender lymph nodes

Palpable and tender nodes indicate possible issues.

Lymphedema

Swelling due to lymphatic system blockage.

Goal of Treatment

Minimize lymphedema or return to latency stage.

Interstitial Pressure

Increased by external forces like compression therapy.

Dynamic Pressure Changes

Altered by breathing or muscle contractions.

Manual Lymphatic Drainage (MLD)

Technique to clear lymphatic congestion.

Proximal to Distal

Order of treatment in MLD technique.

Compression Therapy

Uses bandages to manage lymphedema phases.

Phase I Compression

Active reduction phase using low-stretch bandages.

Low-Stretch Bandages

Provide low resting pressure, high work pressure.

Distal-to-Proximal Direction

Compression applied from extremities towards trunk.

Active ROM Exercises

Range of motion exercises with compression garments.

Skin Care

Prevent skin breakdown and infection in lymphedema.

Stemmer Sign

Positive test indicates lymphedema presence.

Circumferential Measurement

Best method to measure upper arm edema.

Proximal Areas First

Clear trunk and axilla before limbs.

Distal Strokes

MLD strokes directed towards lymph nodes.

Exercise Program

Developed to improve strength and mobility.

Furosemide

Medication for managing fluid retention.

Edema Management

Lymphedema does not decrease with elevation.

Poor Grip Strength

Indicates weakness in affected limb.

Exercise Direction

Upper extremity exercises performed proximal to distal.

High-Stretch Bandages

Not recommended for lymphedema management.