Lymphatics

interstitial fluid

what do lymphatic vessels reabsorb after ECF is reabsorbed by the veins

collecting vessels

trunks

ducts

what is the progression of lymphatic drainage from initial lymphatic vessels to the heart

the subclavian veins then the right atrium

where do lymphatic ducts empty into

circulation

where does the lymphatic system return fluid to

ultrafiltration

what is the process called when fluid leaves the arterial side of the capillary bed

90%

how much of the fluid that nourishes the tissues reenters circulation via reabsorption

capillary hydrostatic pressure

the pressure inside the capillaries that pushes fluid out of the blood vessels into the surrounding tissues

tissue hydrostatic pressure

the pressure of fluid in the surrounding tissues that pushes fluid into the capillary (usually 0 or negative)

capillary osmotic pressure

pressure caused by plasma proteins that pulls fluid back into the capillary

tissue osmotic pressure

pressure caused by plasma proteins in the tissues that cause a net movement of fluid into the tissues

plasma proteins

overall osmotic pressure involves pressure created by...

higher

into

hydrostatic pressure is _______________ at the arterial end compared to the tissues and fluid will flow ______ the tissue space due to a pressure gradient (high in capillary to low in the tissues)

thymus, bone marrow, spleen, tonsils, peyer patches

what are the lymphatic organs

capillaries

skeletal and respiratory muscle contraction

initial lymphatics are located in close proximity to the ________________ and act as force pumps powered by...

pressure

without changes in total tissue ______________ the pumps of the initial lymphatics will not work

in the subcutaneous tissue

where are collecting lymphatics located

valves

collecting lymphatic vessels contain ___________ to prevent backflow

lymphangion

what is the name of the segments in collecting lymphatics between the valves

ANS

what innervates the smooth muscle of the collecting lymphatic system?

distention of the vessel wall

what triggers contraction of the lymphangion

distention

failure

increased pressure can fatigue the vessels leading to vessel _____________

trunks

ducts

lymphatic ___________ in the extremities join the ________ in the trunk

right lymphatic duct (RUQ)

thoracic duct (LUQ)

what is the name of the two thoracic ducts that empty into the subclavian veins

lymph nodes

what does lymph have to flow through before going into central circulation

axilla

right and left thoracic lymphotomes drain into the ipsilateral ____________

superficial inguinal nodes then deep inguinal nodes

right and left abdominal lymphotomes drain into the...

soft and nonpalpable

what do normal and healthy lymph nodes feel like?

lymphadenopathy

what is the name for tender, enlarged lymph nodes?

refer to PCP

what should we do if you feel a swollen lymph node

around the ear, supraclavicular, pectoral region

what are areas that if lymph nodes are enlarged we should be concerned because they usually are not enlarged due infections

lymphangitis

inflammation of a lymphatic vessel

lymphadenitis

inflammation in one or more lymph nodes

lymphedema

an increased amount of lymph fluid in the soft tissues

protein rich

lymphedema is the accumulation of ___________-__________ fluid

safety valve

lymphedema is a failure of the ____________ __________ mechanism

decreased transport capacity of the lymphatic system

increased lymphatic load

what are the causes of lymphedema

primary lymphedema

idiopathic lymphedema present from birth or from a genetic abnormality

secondary lymphedema

acquired lymphedema following surgery, radiation and other injury

aplastic lymphedema

a type of primary lymphedema where parts of the system are missing

hypoplastic lymphedema

a type of primary lymphedema where parts of the system are under developed

hyperplastic lymphedema

a type of primary lymphedema where parts of the system are larger than normal and do not work very well

filariasis (parasitic infection)

worldwide, what is the most common cause of secondary lymphedema

invasive procedures and treatment of cancer

what is the most common cause of secondary lymphedema in the US

stage 0 lymphedema

known as latent lymphedema (no edema is actually present), when transport capacity is reduced and patient reports subjective symptoms of edema

pitting edema that is reversal with elevation, area may e normal size in the morning

what is stage 1 edema

irreversible non pitting edema with scar tissue and fibrosis

what is stage 2 edema

severe non pitting fibrotic edema with atrophic changes

what is stage 3 lymphedema/elephantiasis

mastectomy, axillary lymph node dissection, radiation

what types of procedures increase inscidence for lymphedema

increased BMI (>25)

hand use on the operative side

infection

what other things can increase risk for lymphedema that are not procedures

prospective surveillance model

the process of obtaining baseline measurements, function, and volume on extremities prior to treatment

bed rest, paralysis, prolonged immobility

what activities cause changes in total tissue pressure that leads to edema

stemmer test

what test is characterized by a cutaneous skin fold over the second toe that can be indicative of lymphedema

injury, infection, and increased activity from normal

what types of things can trigger lymphedema

try to find a limb without it (if theres no choice its ok)

what are blood pressure considerations for a limb with lymphedema

manual lymphatic drainage

compression and bandaging

exercise and education

what are some PT interventions for lymphedema

to disperse lymphatic fluids and prevent congestion

what is the purpose of lymphedema treatment

compression garments

what should be worn during exercise in those with lymphedema

cellulitis

what skin conditioned should be monitored for that may look like a rash or sunburn

heat because it increases circulation which will lead to fluid accumulation

what is contradicted with lymphedema, why?

manage

in PT, we cannot fix lymphedema but we can ______________

lipedema

often mixed up with lymphedema but affects both legs with fat deposits on the medial proximal and distal thigh

as fat deposits grow, the skin increases in sensitivity

why is exercise harder for those with lipedema

lifestyle changes and exercise

fatty deposits in lipedema do not respond to...

lymphoscintigraphy

a procedure that injects a radioactive protein dye to the web spaces of the fist and second digits to visualize the movement of the dye throughout the lymphatic origin

circumference, volumetric, perometry, bioimpedence

what are the types of objective measurements for lymphedema

proximal

distal

Manual lymphatic drainage is a gentle treatment that starts _____________ and goes _____________

short stretch because it has low resting pressure and avoids skin ischemia and break down

which type of compression bandaging is best for lymphedema, why?

high resting pressure

what does pressure look like in long stretch compression bandaging

increased

according to Laplace law, skinner parts of the limb will need to have the radius _______________ because pressure a smaller radius can lead to a tourniquet effect

aerobic and resistance exercise

for all stages of lymphedema what types of exercises should be done

proximal

distal

exercises should start _____________ and end ____________

maintaining

compression garments are helpful with ________________ reduction not creating it

mindful of exposure to bacteria and fungus

compression

exercise

what are "lifelong" precautions that are not actually lifelong precautions for clients with lymphedema