Robert Harris Senior instructor Dr. Vodder School - International

Transcription

1 Robert Harris Senior instructor Dr. Vodder School - International

2 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

3 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

4 Normal fluid movement Lymph vessel system responsible for removal from tissues of: fluid proteins cell debris waste matter pathogens (bacteria and viruses)

5 Normal fluid movement Fluid leaving blood capillaries is mostly taken up by lymph vessels Courtesy: Flinders University, Vital Essence CD

6 Normal fluid movement Balance in tissues J.R. Levick: Revision of the Starling Principle: new views of tissue fluid balance. J. Physiol (2004) p.704.

7 How fluid accumulates in lymphedema Courtesy: Flinders University, Vital Essence CD Normal amount of fluids leaving blood capillaries Problem in lymph system Fluid levels rise in tissues

8 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

9 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

10 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).

11 Types of lymphedema Primary lymphedema: Meige s (90%): sporadic, generalised lymphatic dysplasia (abnormal growth). Edema typically occurs in puberty or later.

12 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)

13 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 Courtesy: Flinders University, Vital Essence CD

14 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

15 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

16 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

17 How lymphedema progresses Stage Two As in Stage One but not reversible on elevation Fibres laid down in tissues Chronic inflammatory processes Courtesy: Flinders University, Vital Essence CD

18 How lymphedema progresses Stage Three As in Stage Two Thickened, hard skin Fibrosis of remaining lymph vessels, blood vessels and nerves

19 Conclusion Lymph vessel system removes normal fluids from tissues Mechanical problem with lymph vessels results in impaired drainage Accumulating fluids and proteins results in progressive severity of lymphedema Early intervention to prevent progression!