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| Question | Answer |
| The _____________ empty into the right lymphatic duct while the ____________ empty into the left lymphatic duct. | Right: upper R quadrant Left: upper L quadrant and LE. |
| T/F: only the lymphatic capillary reabsorb fluid from interstitial space. | F. Veins also do. |
| Filtration and reabsorption are governed by _________ across a _______ memberane. The three factors affecting edema are: 1. 2. 3. | Starling's law Semi-permeable membrane factors: 1. hydrostatic pressure 2. osmotic pressure 3. capillary permeability |
| Give some systematic pathologies that can cause an increase in venous pressure: 1. cardiovascular 2. body electrolyte 3. venous pathology 4. others | 1. cardiovascular: R ventricular failure, constrictive pericarditis, increased jugular venous pressure 2. body electrolyte: salt and water overload, IV fluid overload 3. venous pathology: venous obstruction, venous reflux, dependent position, DVT 4. others: external compression, pregnancy, pelvic tumor |
| Give some systematic pathologies that can cause a decrease in colloid osmotic pressure: 1. nutrition 2. nephrotic syndrome 3. Liver disease 4. Systemic disease | 1. nutrition: malnutrition, malabsorption, protein loss (due to cirrhosis or renal failure) 2. nephrotic syndrome (proteinuria, hypercholesteremia, hypoalbuminemia) 3. Liver disease: liver failure, inability to synthesize albumin 4. Systemic disease: chronic inflammation, allergic reactions |
| Give some syetemic pathologies that can increase capillary permeability: | 1. breakdown of the endothelial barrier 2. vasodilation (increased capillary pressure) 3. infection/ sepsis/ allergy/ trauma |
| List some medications that may result in peripheral edema | 1. antihypertensive meds 2. calcium channel blockers 3. direct vasodilators 4. beta blockers 5. corticosteroids 6. hormones 7. nonsteroidal anti-inflammatory agents 8. nonselective cox inhibitors |
| Edema that are caused by DVT/ venous insufficiency/ lymphedema/ compartment syndrome/ obstruction of inguinal LN/ trauma/ CRPS -II are usually: | unilateral |
| Edema with systemic cause is usually | bilateral |
| Signs and symptoms of chronic venous insufficiency: 1. swelling in the _______ and ______, especially after extended periods of standing. 2. edema is _____, _____ and _____. 3. legs feeling _______, ____ or _____. 4. pain worsens when ________. 5. new ______ veins. 6. _____-looking skin 7. flaking or itching skin 8. venous ______ ulcers. | 1. swelling in the lower legs and _ankles, especially after extended periods of standing. 2. edema is non-viscous, soft and non-pitting. 3. legs feeling heavy, achy or tired. 4. pain worsens when standing/dependency. 5. new varicose veins. 6. leathery-looking skin 7. flaking or itching skin 8. venous stasis ulcers. |
| Hemosiderin stains is an indicator of ________. | Chronic venous insufficiency |
| Another world for reticular vein is _______ | Telangiectases |
| Subcutaneous tissue fibrosis is called ________. It is a type of _________. It can lead to _________. Typical presentation: | Lipodermatosclerosis. Type of panniculitis. May lead to ulceration. Typical presentation: skin induration, increased pigmentation, swelling, redness, inversed bowling-pin appearance. |
| Primary varicose veins result from an intrinsic genetic defect of ___________. | Collagen synthesis. (increased Type I or decreased Type III) |
| T/F: Varicose vein is always present with valvular dysfunction. | F. May or may not |
| Causes of secondary valvular incompetence: | 1. deep vein obstruction 2. increased venous distensibility 3. post-thrombotic syndrome, DVT, damage to valves |
| What tests can be used for varicose veins? | 1. venous duplex doppler 2. ultrasound |
| Treatment options for varicose veins: | 1. frequent elevation 2. ankle pumps, calf exercise 3. compression garment (20- 30 mmHg is the best, 12 - 18 may benefit) 4. weight management 5. aerobic exercise with garment 6. pool exercise 7. laser therapy |
| Treatment for venous insufficiency that is different from varicose vein: | 1. compression garment should be 20 -30 mmHg or 30 - 40 mmHg. 2. management of HTN and DM 3. patient education 4. wound care |
| What are some management for CVI? | 1. skin care 2. antibiotics 3. medications to prevent blood clots 4. medical management of HTN and DM 5. sclerotherapy 6. endovenous thermal ablation 7. ligation and stripping 8. compression bandages /garments 9. aerobic exercises/ leg exercises 10. stretch 11. weight management |
| What are the differences between lymphedema and lipedema? | Foot is spared in lipedema. |
| T/F: Patient has no fibrosis or dilated lymph vessels in stage 0 lymphedema. | F. may be present. |
| Signs of lymphedema stage 1: | 1. lymphedema disappears with bed rest and elevation. 2. soft, pitting edema 3. no or little fibrosis 4. no tissue changes 5. no Stemmer sign 6. dilated pre-lymphatic channels 7. small number of protein molecules in tissue space |
| Signs of lymphedema stage 2: | 1. edema is protein-rich 2. does not decrease with elevation 3. formation of connective and scar tissue (fibrosis) 4. pitting - non pitting (difficult to pit) 5. positive Stemmer sign 6. hardened edema (difficult to make indentation) |
| Signs of lymphedema stage 3: | 1. protein-rich, with connective and scar tissue formation 2. hardening of the papillomas of skin 3. significant increase in fibrosis (sclerosis) fatty deposit with deep sulci at joints 4. thickening of dermal tissue 5. protein is in ground substance and is interwoven with the collagen fibers (gel rather than solvent) 6. + Stemmer sign 7. firm and difficult to produce pitting |
| Diagnosis of lymphedema: | 1. use exclusion 2. volume assessment (3-4% increase in volume since last visit) 3. Stemmer's sign 4. Imaging (lymphoscintigraphy, MRI, CT, US) 5. Bioelectrical impedance (early stage) |
| Lipedema is a metabolic disease characterized by a significant increase in ___________ from iliac crests to the ankles. | subcutaneous fat. |
| T/F: Hyperplasia is present in lipedema. | T. |
| Swelling usually occurs in the ________ of the day because of the associated _______ edema and the diminished tissue resistance of fatty tissue. | the second half of the day associated with orthostatic edema |
| T/F: Lipedema is associated with decreased capillary ultrafiltration and vessel wall permeability. | F. (increased capillary ultrafiltration) |
| T/F: lipedema is hemorrhage free and non-painful. | F. It has frequent hemorrhage and is painful. |
| List the symptoms of lipedema stage I: | 1. subQ tissue is thickened but not viscous 2. superficial skin is smooth 3. fat tissue is nodular/lumpy 4. tender to palpation |
| Symptoms of lipedema in stage II: | 1. larger nodular 2. 'cotton ball' feeling under dermis 3. increasingly uneven skin surface 4. tender to palpation |
| Symptoms of lipedema in stage III: | 1. increasing fat deposits with severe alteration in normal contours of the body 2. more compact 'cotton ball' and firmer tissue |
| T/F: Lipedema is soft and non-pitting. | T. |
| The best exercise for lipedema patient is _______ | Strengthening and muscle hypertrophy exercises |
| Onset time of lipedema | Puberty |
| How does CHF cause peripheral edema? | inefficient cardiac pump --> increase in hydrostatic pressure --> increase in interstitial fluid volume LV fariluer: pulmonary cappilaries are involved. RV failure: dependent systemic capillaries involved. |
| How does renal failure cause peripheral edema? | decreased filtration --> more fluid in venous system --> increased plasma filtration and decreased reabsorption --> overload of lymphatic system OR damage in glomeruli --> decreased oncotic pressure in blood |
| IF edema is associated with increased BUN, suspect: | CHF, MI, Cancer, urinary tract obstruction |
| If edema is associated with increased creatinin, suspect: | renal dysfunction, hyperthyroidism, CHF, dehydration, urinary tract obstruction |
| If BNP/ CPK are increased, suspect: | MI, CHF |
| Lower level of albumin suggests: It may lead to _____ which results in peripheral leg edema. | Liver disease (cirrhosis/ liver failure). May lead to low plasma oncotic pressure |
| Lab values indicating liver dysfunction include: | 1. increased bilirubin level (anemia, CHF, liver disease) 2. decreased albumin level |
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