Lecture 5b Flashcards
7 Qs to think about when managing oedema
- Patient and therapist must share clear view of:
1. what caused the oedema?
2. when did it commence?
3. how did it become chronic, or how to prevent this from occurring?
4. what course and severity do we expect of the oedema?
5. how can we treat it and how effective will this be?
6. how do we implement this into the patient’s everyday life and roles?
7. what will be the barriers and facilitators of the oedema control?
What systems cause oedema?
problems with LYMPHATIC & VENOUS
Venous system function
- Returns blood to heart for reoxygenation and recirculation
Limitation of the venous system
Unable to filter large protein molecules from capillaries - that’s why we need the lymphatic system
Lymphatic system function
- Accessory route for 10% of interstitial fluid to return to heart
- Allows return of plasma proteins that are easily absorbed into lymphatic capillaries
- Flow of fluid through lymph nodes, with macrophage and lymphocyte activity
- Transport of absorbed fat from digestive tract
What is the main difference between arteries, veins and lymphatics (in terms of structure)
How much smooth muscle is in the walls
Arteries, veins & lymphatic vessel structure
- Arteries: round, thick walls (high pressure - elastic & contractile
- Veins: flattened, thin walls (decreased smooth muscle, elasticity; larger diameter
- Lymphatics: similar to veins but more fragile
Why does oedema occur?
- Abnormal accumulation of interstitial fluid
- Disturbance in the normal balance between hydrostatic and osmotic pressure forces at capillary level
- Valve incompetence (if capillary wall stretches, valves won’t touch - cause backflow)
Physiological effects of oedema
- Increased tissue space
- Impaired tissue function
- Reduction in exchange of materials
- Metabolic and functional tissue changes
- Blood and lymphatic vessels function
- Valve function
Clinical effects of oedema
- Swelling
- Pain & discomfort (skin stretching, nerve compression, heaviness)
- Increased risk of infection and cellulitis
- Reduced wound healing
Which swelling his higher in protein (venous or lymphatic)
LYMPHATIC - if not working, there is a high amount of protein in the tissue
Which swelling increases your chances of infection and cellulitis?
Lymphatic
Causes of oedema
- Congenital malformation of lymphatic vessels or veins (e.g. Klippel Trenaunay Weber Syndrome)
- Damage to lymphatic system (e.g. secondary lymphoedema)
- DVT
- Chronic venous disease
- Venous ulcers
2 types of oedema
- Dependency oedema (not activating muscle pump)
- post-neurological deficit
- elderly - Persistent oedema
- post-trauma
- post-surgery
- pain symptoms
- palliative
Assessment of oedema (process)
- Establish diagnosis (is this lymphatic or venous?)
- Referral or medical request
- Test results
- Medical history (DVT, surgical Hx, trauma Hx, medications, comorbidities
- Patient interview
- Physical examination
