Fluid And Edema

Question 1

What are LOL fats?

Answer 1

• small monoglycerides and free fatty acids

- long chain fatty acids and reformed triglycerides

Question 2

What are LOL cells?

Answer 2

• circulating B and T lymphocytes
• macrophages
• dendritic cells (veiled cells)
• other WBC’s
• dead and dying cells
• mutated cells
• cell fragments (including RBC’s)

Question 3

What is LOL water?

Answer 3

• 95% lymph
• slightly alkaline 7.4
• clear and colourless
  - milky is lipids present

Question 4

What are the three fluid dynamics?

Answer 4

• filtration - blood pressure - into tissues - one way
• diffusion - needs concentration gradient
• osmosis

Question 5

What is the starling hypothesis?

Answer 5

BP + C/OTP C/OBP + TP

Question 6

At what end is colloid osmotic tissue pressure?

Answer 6

Arterial end

Increased blood pressure so increased filtration

Question 7

At what end is colloid osmotic blood pressure?

Answer 7

• venous end

- decreased blood pressure so decreased filtration and possible reabsorption

Question 8

What is active hyperaemia?

Answer 8

Sphincter open increases blood flow and results in increased filtrate

Eg - massage, exercise, blushing, heat, cellulitis

Question 9

What is passive hyperaemia?

Answer 9

Blood accumulation in capillaries due to reflux or stasis. Does not affect sphincter

Eg - CVI, thrombosis, chronic venous insufficency

Question 10

What is ultra filtrate?

Answer 10

At blood capillary fluid is forced out into the pericapillary tissue through a fine filter by blood pressure, which exceeds the colloid-osmotic pressure of plasma proteins

Question 11

What are the two classifications of lymphedema?

Answer 11

Functional and organic

Question 12

What is functional lymphedema?

Answer 12

Problem with lymph vessel function

Skeletal muscle paralysis
- stroke, para/quadriplegic, post polio

Can be valve incompetence - long term venous stasis

Spasm of smooth muscle in collector - inflammation

Question 13

What is organic lymphedema?

Answer 13

Damaged pathways or nodes - irreversible

Lymph node dissection

Radiotherapy

Trauma

Filariasis

Question 14

What is primary lymphodema?

Answer 14

Deficiencies in formation of vessels or nodes

Congenital

High protein edema

Forms - hypoplasia, aplasia, hyperplasia

Question 15

What is secondary edema,

Answer 15

Event of disease process resulting in damage or impairment of LVS

High protein edema

Question 16

What do primary and secondary edema have in common?

Answer 16

Both high protein

Question 17

What is lymphedema?

Answer 17

Mechanical insufficiency

• lowered transport capacity
• problem in the LVS - damaged, absent
• accumulation of protein rich fluid in the CT

Question 18

What are the four characteristics of primary lymphedema?

Answer 18

1. Begins distal and progresses proximally
2. Commonly in one or both legs
3. Usually pain free
4. Progress can be slow

Question 19

What is secondary lymphedema?

Answer 19

Disease process - not ore existing

Can be organic or functional

Organic - irreversible, damage to structure

Functional - reversible, changes in function

Question 20

What is characteristic of secondary lymphedema?

Answer 20

Begins proximal and progresses distally

Question 21

What is stemmer sign?

Answer 21

Determines if swelling in distal extremities

Ability to lift skin on the proximal phalange of the digits

Informative not diagnostic (cause)

A positive is if cannot lift skin

Question 22

What is the kibik - stemmer sign?

Answer 22

Also determines swelling in distal extremity

Ability to lift skin over MCP’s or MTP’s

Positive - cannot lift skin

Gives information not diagnosis

Question 23

Stages

What is the latent stage?

Answer 23

Sub clinical (stage 0)

No visible edema - safety factors still working

Slow accumulation of fluid and proteins

Question 24

What is stage 1?

Answer 24

Reversible (disappears with bed rest)

Soft, pitting, protein rich fluid

Question 25

What is stage 2?

Answer 25

Irreversible Hard, strong pressure required to cause pitting or no pitting, fibrosis, increased volume and adiopse tissue

Question 26

What is stage 3?

Answer 26

Called elephatiasis Fibrosis, pachydermia, hyprkeratosis, papillomatosis, Pain may be present Lymph, blood vessels and nerve sheaths can become fibrotic and sclerotic

Question 27

What are the three possibly complications from stage 3?

Answer 27

Lymphocele - mass containing lymph with no endothelial lining Lymph cysts - extension of cutaneous lymph vessels / cyst is cavity with endothelial lining Lymph fistula - caused by increased pressure in cutaneous lymph vessels - opens surface of skin Erysipelas/cellulitis - aggressive infection - due to reduced immune defense - development of secondary tumours or relapses due to chronic lymph stasis

Question 28

What are the two other classifications of lymphedema and their characteristics

Answer 28

Acute - less than 3 months, may spontaneously resolve, cancer patients after surgery or radiology Chronic - more than 3 months, does not spontaneously resolve - influx of inflammatory cells - dendritic, mast, plasma cells and lymphocytes - increase in microcirculation - growth of new CT - fibre and fat

Question 29

What is lipedema?

Answer 29

Disorder of subcutaneous fat metabolism and distribution Women only 10-15% of pop Most common is lower limbs Chronic and progressive Familial Soft pliable skin, tender and cool to touch, always bilateral and symmetrical, whole limb and bruises easily

Question 30

What are treatment options for lipodema,

Answer 30

Early - compression garment with physical activity Mid - massage and sometimes compression Late - CDT Others - liposuction, infared therapy, laser

Question 31

What is dynamic edema?

Answer 31

Lymph system working normally or at max capacity. Too much fluid in spaces Low protein edema - may lead to lymphedema High volume of LOL - high BP, thrombus, chf

Question 32

Define post ischaemic edeme...

Answer 32

Surgery performed in blood free manner - edema develops when area is re supplied with blood. Cause is usually tissue damage.

Question 33

Define exudate

Answer 33

Appearance of protein rich fluid from vessels during inflammation

Question 34

Define transudate?

Answer 34

Low protein, usually clear, serous fluid not appearing during inflammation but with local or general congestion, increased capillary permeability

Question 35

Define induration...

Answer 35

Definite or diffuse hardening or thickening of a tissue or organ due to reactive hyperplasia of ct - after inflammation

Question 36

What are the 4 properties of loose connective tissue?

Answer 36

Recoil ability (elastin and collagen) Thixotrophy Inertia mass - fixed state until acted upon, at least 15 mins in area to affect Transit stretch - distance and time it takes for nutrition to tissue and waste to capillary

Question 37

What are the effects on smooth muscle?

Answer 37

Blood vessels - elderly, raynauds, diabetes, (vasomotion) Lymph vessels - increase transport capacity Digestive tract - constipation

Question 38

Effects on the nervous system?

Answer 38

Analgesic effects - stimulation of mechanoreceptors inhibits pain pathways (gate theory) trauma, migraines, headaches, neuralgia, OA, CRPS, phantom pain Sympathicolytic effects - calming - palliative care, recuperation, stress, sleep disorders, fibromyalgia

Question 39

Effects on immune system

Answer 39

Immunological - increased lymph flow MAY affect immunological processes - chronic inflammation, wound healing - ulcers, arthritic conditions

Question 40

How does it effect drainage?

Answer 40

Affects circumferential and longitudinal muscles of lymphangion Affects a chain on angions Increased pumping and filling of angions Collectors stimulated, fluid displaced, easier for pre collectors to empty into collectors At blood vessels - removal of tissue proteins, MLD acts like tissue pressure Into initial lymphatics Emptying of proximal vessels, movement of skin - post surgical edema, chromic inflammation, hematoma, skin conditions