2Objective Identify form and function of circulatory and lymph systems Describe various factors that affect the movement of fluidDescribe difference between edema and lymphedemaDescribe stages of lymphedemaDescribe types of lymphedemaDescribe lymphedema treatmentDescribe Referral process
3Anatomy of circulatory system 3 structural elementsHeartBlood cells-RBC, WBC, plateletsPlasma – water, salts, proteins, vitamins, minerals, hormones, dissolved gases, toxins, medications, and fatsBlood vesselsArteries, veins, and blood capillaries
4Anatomy of Lymphatic system 3 structural componentsLymph vesselsTrunks, collectors, precollectors, and lymph capillariesLymphatic tissuesLymph nodes ( ), spleen, and thymusLymph fluidProteins, WBC, Medications, toxins, fats, water, bacteria
5Lymph capillaries > Collectors> Nodes>Lymph Vessels>Venous angle Originate close to BCClosed tubes in the interstitial spaces of sub endothelial layers of the skinLarger than BCMore permeableAnchoring filaments that connect to skinFlat endothelial cells, arranged in a single layer, overlap
6Lymph Collectors Are larger vessels than LC Valves that contract Propel lymph into lymph nodes
7What does the Lymph system Do? Basically a scavenger system that removes proteins, excess fluid, debris, and other matter from the interstitial spaces….
8Factors affect fluid movement DiffusionOsmosis/osmotic pressureColloid osmosis/ colloid osmotic pressureFiltration and reabsorptionDiffusion- Molecules moving in a solution so as to equalize there are several factors that can speed up or slow down this processtemperature, concentration gradient (larger the difference the faster the diffusion rate, size of molecules, surface area, diffusion distance the shorter the distance the more effecitve diffusion. Clinically 1 cm of swelling increaases the diffusion distance by 100xs.Osmosis- diffusion of water mol across a selective permeable membrane from a place of higher water concentration to a place of lower. Cell membranes in the body are generally permeable to water and water in and out of cells will be the same. Some times a concentration difference for water may develop across a membrane. In the case of lymphedema yOu have have a high protein concentration within the interstital tissue ( why because the main function of the lymph system is to remove protein, if I doesn’t work because of sx or cancer, scar tissue… then the protein doesn’t get removed). If protein doesn’t get removed Protein attracts water which brings more fluid volume to already congested area which goes back to increasing the diffusion distance…. The only way to overcome this Pressure ( focethe water back into the cells or BC is to apply compressionFiltration and absorption –Filtration depends on a pressure gradient between both sides of the membrane and always moves from high area to low. In the blood capillary the colloid osmotic pressure is 29mmhg, in the interstitium it is 25, this causes filtration.At the venous capillary, the blood cap is 14 mmHG which is lower the the Colloid osmotic pressure of the intersititum which facilitates reabsorbption.
9Physiology of lymphatic system Passive edema protectionPressures ^ in BC> pressure ^ in interstitial fluid> ^ reabsorption rateActive edema protectionSafety factor:Increase permeability of Lymph CapillariesIncrease contraction frequency of Lymph collectorsLymph systems way of kicking into high speed to deal with additional fluid what ever the cause is.
10Edema or Lymphedema? Dynamic insufficiency Lymphatic load > Transport capacity of an intact functioning lymph systemCHF, CVI (stage I or II), immobility, hypoproteineima, pregnancyEdema is a swelling caused by the accumulation of abnormally large amounts of fluid in the intercellular spaces of the bodyTreat withElevationCompressionExerciseIf dynamic insufficienty is present over long periods of time beasue of the tissue damage (cells not getting the nutrition they need) you can have 2ndary damage to lytmph collectors which will lead to a Mechanical insufficiency
11Lymphedema Mechanical insufficency Reduction of transport capacity due to damage of insufficient lymph systemSurgery, radiation, chronic inflammation, paralysis, Primary lymphedemaLymphedema is high protein edemaTo treatCDT- Complex decongestive therapyBecause the lymph system can’t remove protein as it is compromised the result is a high protein intersititum. Chronic inflammation- The stagnation of watrer, protein, and other wast products in the intersititum causes tissue damage (decreased circulation, lack of 02 and nutrients). The protein rich swelling increases the diffusion distance and thus reduces the ability of the bodys defense mechanisms prone to infections
12Lymphedema or Edema? Combined insufficiency Lymph transport is compromisedCompounded with a sx or trauma
13Stages of Lymphedema Stage 0 Stage I Stage II Stage III Transport capacity is subnormal yet sufficientStage IPitting edema that recedes over night, 0 skin changesStage IIFibrosis, cellulitis, pitting difficult to induce, woundsStage IIIFibrosis, papillomas, cysts, fistuals, hyperkeratosis, recurrent cellulitis, wounds
14Types of Lymphedema Primary Secondary Born with insufficient or compromised lymph systemSecondaryDue to know insultCancer, surgery, venolymphedema, obesity induced lymphedema, CHF induced
15CDT in Home Health4-6 weeks, although treatment set up upon individual needEnsure pt is a good candidateEducation Disease processBandageTher ExMLDGarmentsPumpsLymphedema will not go away unless you manage.
16CDT BenefitsIndividual comprehensive treatment with focus on education to work towards independence with maintenence programIncorporate functionCan fit into shoesAmbulates much easier with smaller legsDecreased risk of infectionHeal wounds
17Home Health Benefits Great support staff In home assessment SN, PT, OT, MSW, AidesIn home assessmentReadily available to caregivers
18Refer to Home HealthPhysical therapy to Eval and treat (Bilateral LE) lymphedemaSend prescription to Home HealthPhoneFaxDemographics