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Sheri B.Feldscher OT, CHT 3/9/2015 1 Sheri B.Feldscher OT, CHT 3/9/2015 EDEMA MANAGEMENT Anatomy and Physiology Sheri B. Feldscher OT, CHT Lymphatic System Functions of Lymphatic System . Scavenger system . Immune function Removes excess fluid, debris, By protecting the body from and other materials from the disease and infection tissue spaces Via production, maintenance, and . Alternate pathway to the distribution of lymphocytes heart . Responsible for returning proteins that have For substances too large to be accumulated in the interstitial disposed of through the venous system spaces back into the venous system https://www.studyblue.co www.dynamicwellnesssolution . Restoring balance m/notes/note/n/lymphatic‐ s.org/lymphsystem.html system/deck/5249093 Fluid Transport Through Blood Capillaries Definitions . Net capillary filtration pressure is the balance of pressure between: . Lymph Fluid collected from Capillary (hydrostatic) pressure tissues Moves fluid from capillary outward through the membrane Flows via lymphatic Pressure is greater at arterial than venous end vessels through lymph Results in fluid filtering out at arterial end and being reabsorbed at nodes and drains into the venous end of blood capillaries venous system Interstitial fluid pressure Forces fluid inward through the capillary membrane when (+) and . Interstitium outward when (‐) Interstitial fluid colloid osmotic pressure The spaces between cells Pressure created by dissolved proteins causing osmosis of fluid Interstitial fluid is the fluid http://thessgiatro.gr/index.php/topics/scie If high will cause osmosis of fluid outward through the membrane between cells derived by ntific‐article/item/1885‐ filtration from the Plasma colloid osmotic pressure capillaries Pressure created by dissolved proteins causing osmosis of fluid Draws fluid inward through the membrane 1 Sheri B.Feldscher OT, CHT 3/9/2015 Fluid Transport Through Blood Capillaries Mechanism of Edema After injury the inflammatory response changes the permeability of the microvessels . When net filtration pressure Allowing plasma proteins to leak into interstitial spaces rises excessively They are too large to permeate the venous system Too much fluid is moved The role of the lymphatic system is to dispose of matter outward into the interstitial too large for venous system spaces for the lymphatics to If damaged or overloaded (dynamic insuffiency) manage Ability to dispose of these larger plasma proteins is hindered If lymphatic load exceeds the If these proteins remain in the interstitium transport capacity Colloid osmotic pressure increases and draws more fluid into extracellular edema will result http://lymph.weebly.com/lymphati c‐system.html the interstitial space Edema Lymphatic Tissue Drainage System . Can only occur if the . 3 levels of structures lymphatic system has failed Lymphatic capillaries Collector lymphatics . By DDfiitiefinition NdNodes . Accumulation of excess fluid in the intercellular spaces in the body Lymphatic capillaries Lymphatic capillaries . Beginning of the lymphatic . Consists of single layer of system overlapping endothelial cells that have connector filaments . Found in the dermis at the anchoring them to surrounding CT dermal‐epidermal junction Forms flap like junctions that open forming a flat 2 dimensional when local interstitial pressure continuous network over changes When open, fluid flows in changing the entire body internal pressure from low to high, Quizlet.com Except the CNS and cornea causing junctions to close Enables vessels to stay open even http://www.nature.com/nri/journal/v4/ under high tissue pressure n1/fig_tab/nri1258_F2.html Fluid is unable to flow out 2 Sheri B.Feldscher OT, CHT 3/9/2015 Lymph Precollectors and Collectors Lymph Precollectors and Collectors . Lymphatic loads are . Segments between 2 valves in a collector are called lymph reabsorbed by the lymph angions capillaries and flow into The contraction of smooth larger lymph vessels muscle in each angion generates propulsive force of called precollectors which lymph flow along the lymph drain into collectors vessel Collectors have valves At rest lymph angions pump http://royalsocietypublishing.org/conte spaced every 6‐20 mm 6‐10x/min With muscle contraction from nt/9/69/601 Prevent the backflow of lymph http://fau.pearlashes.com/a exercise they can pump 10x natomy/Chapter%2035/Cha that amount pter%2035.htm Lymph Nodes Trunk Lymphotomes . Divided into 4 lymphatic quadrants . Propulsion directs the (drainage territories) lymph fluid into regional L and R Upper Quadrant‐Thoracic Lymphotomes Extend from anterior midline to vertebral and central lymph nodes column on L and R sides of upper trunk to be filtered Lyypmph drains from superficial to deeper vessels that connect to nodes Nodes consist of a Between lymphotomes are watershed areas complex of sinuses that where normal drainage is away from the perform immunologic watershed toward the nodes There are superficial collateral vessels across functions watershed areas http://www.cyberound http://howshealth.com/lymph‐node‐cancer/ Ultimately empties into * With lymph congestion they provide s.com/cmecontent/art alternative pathway to uncongested lymph 137.html?pf=yes the venous system vessels L and R Lower Quadrant‐ Abdominal Lymphotomes Drainage Areas for Lymphatic Duct Drainage Areas for Thoracic Duct . UE drain mainly into . Both LE, both abdominal axillary nodes lymphotomes, L thoracic . Lymph from R thoracic lymphotome and L side of lyypmphotome, RUE and head drain into the R side of head drain Thoracic Duct into trunks that empty Largest lymphatic vessel in into R Lymphatic Duct the body extending from L2 Duct empties into R toT4 http://www.lymphedemablog.com/wp Subclavian Vein and into http://www.tabers.co http://quizlet.com/5502405/ Thoracic Duct empties into ‐content/uploads/2011/09/venous‐ m/tabersonline/repvi anatomy‐ch‐23‐lymphatic‐ angle.jpg the Superior Vena Cava ew?type=539‐ flash‐cards the venous system at the of the heart 22&name=D31 juncture of the Subclavian and Jugular Veins 3 Sheri B.Feldscher OT, CHT 3/9/2015 Lymphatic Therapies . Types Complete Decongestive Therapy Manual Lymph Drainage Lyypmphatic therapies Manual Edema Mobilization . Overall Theory To remove plasma proteins from edematous areas by stimulating the lymphatic system Enables these proteins to leave the interstitial spaces and enter lymphatic structures By ridding the interstitial spaces of these hydrophilic proteins, subacute and chronic edema decreases Complete Decongestive Therapy Manual Lymphatic Drainage . 2 phase non‐invasive intervention for lymphedema . Specialized manual technique based on physiologic Benefits principles of lymph flow and lymph vessel emptying Open collateral lymphatic drainage pathways . Affects lymph system by moving lymph fluid around Increased pumping by deep lymphatic pathways blocked areas toward collateral vessels, Reduction and breakdown of fibrotic tissue anastomoses, and unildinvolved lhlymph node regions Phases . Benefits Phase I (intensive) Increases lymph angiomotoricity (pulse) Increases volume of transported lymph fluid Involves MLD, bandaging, use of compression garments Increasing pressure in lymph collector vessels Phase II (self mgt) Improving lymph transport capacity Pt wears compression garment during day; bandaging at night, exercise, and self MLD Potentially increasing arterial blood flow Manual Edema Mobilization Differences . A lymphatic stimulation technique used for Manual Edema Mobilization Manual Lymphatic Drainage recalcitrant sub acute or chronic limb/ hand edema in the orthopedic population . Designed for orthopedic . Originally intended for patients with subacute and . Basic Premise individuals w lymphedema chronic edema . Insufficient Lymphatic Diaphragmatic breathing, light skin‐traction massage, . Lymphatic system is intact System and exercise help stimulate the lymphatic system High plasma protein By changing interstitial pressure which enables the Temporarily overloaded edema associated with proteins to leave the interstitial spaces and enter Treatments are shorter and mechanical obstruction lymphatic structures typically involve moving Treatments are longer By ridding the interstitial spaces of these proteins the less fluid and more involved edema decreases Large amounts of fluid may need to be rerouted . Key point: throughout the body Lymphatic system is intact but temporarily overloaded 4 Sheri B.Feldscher OT, CHT 3/9/2015 Critical Points Lymphedema . High plasma protein edema associated with a mechanical obstruction or insufficiency of All edema is not the same the lymphatic system . Lymphatic system is unable to clear the interstitial tissues . Most distinguishing feature is resultant high content plasma proteins in the interstitial fluid . Over time can lead to fibrosis http://www.agoracosmopolitan.com Stroke Edema Edema from Kidney or Liver Disease Caused by decreased Simple pitting edema plasma proteins in Perpetuated by the loss the interstitium of motor function Pitting edema (muscle pump) Eventually can become gel‐like and then fibrotic Contraindication Edema from Cardiac Conditions Inflammatory Edema Acute (0‐72 hours) . Increased venous and Inflammatory phase of wound healing capillary pressures Initial flooding of damaged tissue area Bilateral pitting edema with electrolytes and water around ankles/feet Edema is liquid, soft, and easy to mobilize Contraindication These low‐protein substances readily http://en.wikipedia.org/wiki/Acute
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