Lymphedema
Anatomy & Physiology
Management
Complete Decongestive Therapy
Pathologies
Lymphedema
Lymphedema
Stages & Severity
Differential Dx & Examination
Anatomy & Physiology
Vessel/Smooth Muscle Contraction
Interstitial fluid entering system
Lymph
Accessory Muscle Contraction
Collects waste, assists immune response
Breathing Pressure Changes (diaphragm)
10-20% of intersittial fluid collected
Dermal Mechanism Stimulation
Flow Mechanisms
Nodes, Tonsils, Thymus, Spleen
Lymphatic Organs & Tissues
Physiology Concepts
Lymphatic Loads (amount transported)
Thoracic duct, bone marrow
MALT (Mucosa-associated lymphoid tissue)
Transport Capacity (max amount transported)
Capillaries->Collect-> Nodes (Filter)
Major Lymph Nodes
Lymph flow/Circulation
Cervical, Submaxillary
Trunks->Collecting ducts-> Subclavian Veins-> Venous System
Axillary (Apical, Lateral, Anterior)
R Lymphatic Duct (Ue, Neck, U Trunk)
Inguinal (superficial), Illiac, Mesenteric
Thoracic Duct (all esle)
Popliteal, Cubital, Superclavicular, Parasternal
Pathologies (Lymphedema)
Pitting Edema (Early Stages)
Non-pitting, fibrous (later stage/Brawney)
Definition
Clinical Presentation
Chronic disorder
Heaviness/Fullness in extremity
Abnormal accumulation of lymph fluid (10% increase)
Dermal abnormalities
Increased callulitus/Infection risk
Disturbances of water and protein
+ Stemmer Sign (stage II or III)
Milroy's disease (congenital, Autosomal, B LE)
Most Common
Primary Lymphedema (Congenital/Hereditary)
Secondary Lymphedema (Aquired/Injury)
Lymphedema Praecox (Meige disease)
Causes: CA, Surgery, Radiation
Lymphedema Tarda
Other Causes: Trauma, Fibrosis, Infection, Chronic Venous Insufficency)
Hypoplasia, Hyperplasia, Aplasia
Outside US Causes: Filariases
Lymphedema Stages & Severity
Stage 0
Pitting Edema
Stages
Edema Types by Severity
Stage I
Brawney Edema
Stage II
Weeping Edema
Stage III
Edema Grading
Pitting Scale
Differential Dx & Examination
Lipedemia (Comparison)
Lymph Node Palpation
Normal: soft, non-tender, non-palpable
Tender: inflamation/infection
Fixed, hard, non-tender: malignancy
Diagnostic Tests
Girth Measurements
Examination Measures
Lymphoscintigraphy
Volumetric measurement
Bioimpedance
Doppler Ultrasound
Stemmer sign test
Management -Complete Decongestive Therapy (CDT)
Malignancies
minimize lymphedema
Goal
Renal failure
Return to latency
contraindications (MLD/compression)
acute infection (cellulitus)
Manual lymphatic Drainage
Acute DVT
Phase I (intensive phase)
Multiple layer compression bandaging
Cardiac Edema
skin & nail care
PAD
exercise
MLD
Self MLD
Phase II (Maintenance phase)
Key Components
Compression Therapy
Compression therapy
skin & nail care
exercise
exercise
Lymphedema
Corie Malitz
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Transcript
Lymphedema
Anatomy & Physiology
Management
Complete Decongestive Therapy
Pathologies
Lymphedema
Lymphedema
Stages & Severity
Differential Dx & Examination
Anatomy & Physiology
Vessel/Smooth Muscle Contraction
Interstitial fluid entering system
Lymph
Accessory Muscle Contraction
Collects waste, assists immune response
Breathing Pressure Changes (diaphragm)
10-20% of intersittial fluid collected
Dermal Mechanism Stimulation
Flow Mechanisms
Nodes, Tonsils, Thymus, Spleen
Lymphatic Organs & Tissues
Physiology Concepts
Lymphatic Loads (amount transported)
Thoracic duct, bone marrow
MALT (Mucosa-associated lymphoid tissue)
Transport Capacity (max amount transported)
Capillaries->Collect-> Nodes (Filter)
Major Lymph Nodes
Lymph flow/Circulation
Cervical, Submaxillary
Trunks->Collecting ducts-> Subclavian Veins-> Venous System
Axillary (Apical, Lateral, Anterior)
R Lymphatic Duct (Ue, Neck, U Trunk)
Inguinal (superficial), Illiac, Mesenteric
Thoracic Duct (all esle)
Popliteal, Cubital, Superclavicular, Parasternal
Pathologies (Lymphedema)
Pitting Edema (Early Stages)
Non-pitting, fibrous (later stage/Brawney)
Definition
Clinical Presentation
Chronic disorder
Heaviness/Fullness in extremity
Abnormal accumulation of lymph fluid (10% increase)
Dermal abnormalities
Increased callulitus/Infection risk
Disturbances of water and protein
+ Stemmer Sign (stage II or III)
Milroy's disease (congenital, Autosomal, B LE)
Most Common
Primary Lymphedema (Congenital/Hereditary)
Secondary Lymphedema (Aquired/Injury)
Lymphedema Praecox (Meige disease)
Causes: CA, Surgery, Radiation
Lymphedema Tarda
Other Causes: Trauma, Fibrosis, Infection, Chronic Venous Insufficency)
Hypoplasia, Hyperplasia, Aplasia
Outside US Causes: Filariases
Lymphedema Stages & Severity
Stage 0
Pitting Edema
Stages
Edema Types by Severity
Stage I
Brawney Edema
Stage II
Weeping Edema
Stage III
Edema Grading
Pitting Scale
Differential Dx & Examination
Lipedemia (Comparison)
Lymph Node Palpation
Normal: soft, non-tender, non-palpable
Tender: inflamation/infection
Fixed, hard, non-tender: malignancy
Diagnostic Tests
Girth Measurements
Examination Measures
Lymphoscintigraphy
Volumetric measurement
Bioimpedance
Doppler Ultrasound
Stemmer sign test
Management -Complete Decongestive Therapy (CDT)
Malignancies
minimize lymphedema
Goal
Renal failure
Return to latency
contraindications (MLD/compression)
acute infection (cellulitus)
Manual lymphatic Drainage
Acute DVT
Phase I (intensive phase)
Multiple layer compression bandaging
Cardiac Edema
skin & nail care
PAD
exercise
MLD
Self MLD
Phase II (Maintenance phase)
Key Components
Compression Therapy
Compression therapy
skin & nail care
exercise
exercise