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Lymphatics > Fluid And Edema > Flashcards

Fluid And Edema Flashcards

1
Q

What are LOL fats?

A
  • small monoglycerides and free fatty acids

- long chain fatty acids and reformed triglycerides

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2
Q

What are LOL cells?

A
  • circulating B and T lymphocytes
  • macrophages
  • dendritic cells (veiled cells)
  • other WBC’s
  • dead and dying cells
  • mutated cells
  • cell fragments (including RBC’s)
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3
Q

What is LOL water?

A
  • 95% lymph
  • slightly alkaline 7.4
  • clear and colourless
    - milky is lipids present
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4
Q

What are the three fluid dynamics?

A
  • filtration - blood pressure - into tissues - one way
  • diffusion - needs concentration gradient
  • osmosis
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5
Q

What is the starling hypothesis?

A

BP + C/OTP C/OBP + TP

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6
Q

At what end is colloid osmotic tissue pressure?

A

Arterial end

Increased blood pressure so increased filtration

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7
Q

At what end is colloid osmotic blood pressure?

A
  • venous end

- decreased blood pressure so decreased filtration and possible reabsorption

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8
Q

What is active hyperaemia?

A

Sphincter open increases blood flow and results in increased filtrate

Eg - massage, exercise, blushing, heat, cellulitis

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9
Q

What is passive hyperaemia?

A

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

Eg - CVI, thrombosis, chronic venous insufficency

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10
Q

What is ultra filtrate?

A

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

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11
Q

What are the two classifications of lymphedema?

A

Functional and organic

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12
Q

What is functional lymphedema?

A

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

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13
Q

What is organic lymphedema?

A

Damaged pathways or nodes - irreversible

Lymph node dissection

Radiotherapy

Trauma

Filariasis

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14
Q

What is primary lymphodema?

A

Deficiencies in formation of vessels or nodes

Congenital

High protein edema

Forms - hypoplasia, aplasia, hyperplasia

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15
Q

What is secondary edema,

A

Event of disease process resulting in damage or impairment of LVS

High protein edema

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16
Q

What do primary and secondary edema have in common?

A

Both high protein

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17
Q

What is lymphedema?

A

Mechanical insufficiency

  • lowered transport capacity
  • problem in the LVS - damaged, absent
  • accumulation of protein rich fluid in the CT
18
Q

What are the four characteristics of primary lymphedema?

A
  1. Begins distal and progresses proximally
  2. Commonly in one or both legs
  3. Usually pain free
  4. Progress can be slow
19
Q

What is secondary lymphedema?

A

Disease process - not ore existing

Can be organic or functional

Organic - irreversible, damage to structure

Functional - reversible, changes in function

20
Q

What is characteristic of secondary lymphedema?

A

Begins proximal and progresses distally

21
Q

What is stemmer sign?

A

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

22
Q

What is the kibik - stemmer sign?

A

Also determines swelling in distal extremity

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

Positive - cannot lift skin

Gives information not diagnosis

23
Q

Stages

What is the latent stage?

A

Sub clinical (stage 0)

No visible edema - safety factors still working

Slow accumulation of fluid and proteins

24
Q

What is stage 1?

A

Reversible (disappears with bed rest)

Soft, pitting, protein rich fluid

25
Q

What is stage 2?

A

Irreversible

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

26
Q

What is stage 3?

A

Called elephatiasis

Fibrosis, pachydermia, hyprkeratosis, papillomatosis,

Pain may be present

Lymph, blood vessels and nerve sheaths can become fibrotic and sclerotic

27
Q

What are the three possibly complications from stage 3?

A

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

28
Q

What are the two other classifications of lymphedema and their characteristics

A

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

29
Q

What is lipedema?

A

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

30
Q

What are treatment options for lipodema,

A

Early - compression garment with physical activity

Mid - massage and sometimes compression

Late - CDT

Others - liposuction, infared therapy, laser

31
Q

What is dynamic edema?

A

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

32
Q

Define post ischaemic edeme…

A

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

Cause is usually tissue damage.

33
Q

Define exudate

A

Appearance of protein rich fluid from vessels during inflammation

34
Q

Define transudate?

A

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

35
Q

Define induration…

A

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

36
Q

What are the 4 properties of loose connective tissue?

A

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

37
Q

What are the effects on smooth muscle?

A

Blood vessels - elderly, raynauds, diabetes, (vasomotion)

Lymph vessels - increase transport capacity

Digestive tract - constipation

38
Q

Effects on the nervous system?

A

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

39
Q

Effects on immune system

A

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

40
Q

How does it effect drainage?

A

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

Lymphatics (3 decks)

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