View
218
Download
0
Category
Preview:
Citation preview
Acknowledgements / Affiliations Animations and Movie clips
Prof. Neil Piller, Flinders University: Vital Essence CD
Affiliations Dr. Vodder School International:
director and senior instructor
BCLA: Advisory Board
Canadian Lymphedema Framework: Advisory Board
Lymphedema Association of Ontario: Advisory Board
BCLA conference 6/25/11 R. Harris
Physiology behind Lymphedema Overview:
Normal fluid movement in the tissues
How fluid accumulates
What types of problems can arise
Why lymphedema occurs
How lymphedema progresses
BCLA conference 6/25/11 R. Harris
Normal fluid movement Lymph vessel system responsible for removal from
tissues of:
fluid
proteins
cell debris
waste matter
pathogens
(bacteria and viruses)
BCLA conference 6/25/11 R. Harris
Normal fluid movement• Fluid leaving blood capillaries is mostly taken up by lymph vessels
BCLA conference 6/25/11 R. Harris
Courtesy: Flinders University, Vital Essence CD
Normal fluid movement Balance in tissues
J.R. Levick: Revision of the Starling Principle: new views of tissue fluid balance. J. Physiol. 553.3 (2004) p.704.
BCLA conference 6/25/11 R. Harris
How fluid accumulates in lymphedema
•Normal amount of fluids leaving blood capillaries•Problem in lymph system•Fluid levels rise in tissues
BCLA conference 6/25/11 R. Harris
Courtesy: Flinders University, Vital Essence CD
What types of problems can arise? With reference to lymphedema:
Mechanical insufficiency of the lymph vessel system
Primary: chronic edema caused by a developmental abnormality of the lymphatic system.
Secondary: acute or chronic edema caused by obstruction, damage, trauma, inflammation
BCLA conference 6/25/11 R. Harris
Types of lymphedema Primary lymphedema:
Born with insufficiency of lymph vessels
Insufficient lymph vessels to manage normal amount of fluid being produced in tissues
Edema can develop years later or soon after birth
BCLA conference 6/25/11 R. Harris
Types of lymphedema Primary lymphedema:
Milroy’s (10%), hereditary, manifests at birth typically in feet and lower legs. Thought to be a functional impairment of lymph vessels rather than aplasia or absence of lymph vessels (F. Connell: ILF conference 2011).
BCLA conference 6/25/11 R. Harris
Types of lymphedema Primary lymphedema:
Meige’s (90%): sporadic, generalised lymphatic dysplasia (abnormal growth). Edema typically occurs in puberty or later.
BCLA conference 6/25/11 R. Harris
Types of lymphedema Secondary lymphedema:
Insufficient lymph vessels to manage normal amount of fluid being produced in tissues
An acquired cause (e.g. surgery, radiation, trauma, malignancy)
BCLA conference 6/25/11 R. Harris
Types of lymphedema Secondary lymphedema:
Acute: e.g. immediately after surgery or trauma lasting up to 6 months (Weissleder)
Chronic: can develop months or years after damage to lymph vessel system
BCLA conference 6/25/11 R. Harris
Courtesy: Flinders University, Vital Essence CD
Why does lymphedema occur?Summary
Normal amount of fluid entering tissues from blood capillaries
Either too few or abnormal lymphatics to take away fluid resulting in primary lymphedema
Damage, inflammation or blockage of lymph vessels resulting in secondary lymphedema
BCLA conference 6/25/11 R. Harris
How lymphedema progresses Latent Phase
Problems with lymph vessels but able to handle amount of fluid being produced
Decreased capacity of lymph vessels
No visible edema
BCLA conference 6/25/11 R. Harris
How lymphedema progresses Stage One
Problems with lymph vessels and not able to take away enough fluids in tissues
Transport capacity exceeded
Accumulation of proteins in tissues
Visible edema, reversible
BCLA conference 6/25/11 R. Harris
How lymphedema progresses Stage Two
As in Stage One but not reversible on elevation
Fibres laid down in tissues
Chronic inflammatory processes
BCLA conference 6/25/11 R. Harris
Courtesy: Flinders University, Vital Essence CD
How lymphedema progresses Stage Three
As in Stage Two
Thickened, hard skin
Fibrosis of remaining lymph vessels, blood vessels and nerves
BCLA conference 6/25/11 R. Harris
Recommended