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    Input4 Insufficiency 2012-03-05 PDF

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    silkofos
    This document discusses the physiology and pathophysiology of the lymph vessel system. It explains key terms like ultrafiltrate, gross filtrate, and lymphatic load. It describes Starling's equilibrium, which governs fluid filtration between blood vessels and tissues. The lymph vessel system can become insufficient dynamically due to high filtration loads or mechanically due to structural issues. Mechanical insufficiency leads to lymphedema, where proteins accumulate in tissues due to insufficient lymph drainage. Chronic lymphedema can progress to lymphostasis and fibrosis as macrophages and cytokines are activated. The document contrasts edemas caused by acute inflammation versus chronic lymphedema.

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    Input4 Insufficiency 2012-03-05 PDF

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    silkofos
    56 views14 pages
    This document discusses the physiology and pathophysiology of the lymph vessel system. It explains key terms like ultrafiltrate, gross filtrate, and lymphatic load. It describes Starling's equilibrium, which governs fluid filtration between blood vessels and tissues. The lymph vessel system can become insufficient dynamically due to high filtration loads or mechanically due to structural issues. Mechanical insufficiency leads to lymphedema, where proteins accumulate in tissues due to insufficient lymph drainage. Chronic lymphedema can progress to lymphostasis and fibrosis as macrophages and cytokines are activated. The document contrasts edemas caused by acute inflammation versus chronic lymphedema.

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    Input4 Insufficiency 2012-03-05.pdf

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    This document discusses the physiology and pathophysiology of the lymph vessel system. It explains key terms like ultrafiltrate, gross filtrate, and lymphatic load. It describes Starling's equilibrium, which governs fluid filtration between blood vessels and tissues. The lymph vessel system can become insufficient dynamically due to high filtration loads or mechanically due to structural issues. Mechanical insufficiency leads to lymphedema, where proteins accumulate in tissues due to insufficient lymph drainage. Chronic lymphedema can progress to lymphostasis and fibrosis as macrophages and cytokines are activated. The document contrasts edemas caused by acute inflammation versus chronic lymphedema.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    56 views14 pages

    Input4 Insufficiency 2012-03-05 PDF

    Uploaded by

    silkofos
    This document discusses the physiology and pathophysiology of the lymph vessel system. It explains key terms like ultrafiltrate, gross filtrate, and lymphatic load. It describes Starling's equilibrium, which governs fluid filtration between blood vessels and tissues. The lymph vessel system can become insufficient dynamically due to high filtration loads or mechanically due to structural issues. Mechanical insufficiency leads to lymphedema, where proteins accumulate in tissues due to insufficient lymph drainage. Chronic lymphedema can progress to lymphostasis and fibrosis as macrophages and cytokines are activated. The document contrasts edemas caused by acute inflammation versus chronic lymphedema.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 14

    Complex Decongestive Physiotherapy

    Physiology and Pathophysiology of the lymph vessel


    system
    Lymphology

    • Sufficiency, insufficiency of the lymph vessel


    system
    • Protein-rich (high protein) edema
    • Clinical stages / complications of lymph edema
    Terms

    • Ultra filtrate
    small-molecular solution
    • Gross filtrate
    total fluid filtered (ultrafiltered) by blood capillaries
    • Net filtrate / lymphatic load of water
    the remaining fraction of approx. 10 to 20 % of fluid
    filtered by (nonrenal) blood capillaries into interstitial
    space that is not reabsorbed by venous system, but is
    returned to blood circulation by lymphatic system
    • Lymphatic loads
    protein, cells and particles, water, fatty acids
    Starling‘s equilibrium

    BCPart/ven:
    Blood Capillary Pressure

    COPPL:
    Colloid Osmotic Pressure

    (Zutter, 2005)
    Starling‘s equilibrium

    ID = Interstitial Fluid Pressure

    BKD = Blood Capillary Pressure

    KODI = Colloid Osmotic


    Pressure (Interstitial tissue)

    KODP = Colloid Osmotic


    Pressure (Plasma)

    (Földi & Kubik, 2002)


    Sufficieny of lymph vessel system:
    At rest

    (Földi & Kubik, 2002)

    TK: Transportkapazität = Transport Capacity


    LZV: Lymphzeitvolumen = Lymph Time Volume
    LL: Lymphatic Load FR: Functional Reserve
    Sufficieny of lymph vessel system:
    Safety Factor

    (Földi & Kubik, 2002)


    Insufficiency of lymph vessel system
    Dynamic insufficiency (high-volume insufficiency)

    (Földi & Kubik, 2002)


    Insufficiency of lymph vessel system
    Mechanical insufficiency (low-volume insufficiency)

    (Földi & Kubik, 2002)


    Insufficiency of lymph vessel system
    Combined insufficiency / „safety valve insufficieny“

    (Földi & Kubik, 2002)


    The Edema

    • Edema (= symptom):
    Swelling produced by increase of fluid in
    intercellular tissue space.
    Visible and palpable, that is clinically apparent
    • Lymphedema (high protein edema):
    In mechanical insufficiency proteins leave
    blood capillary vessels normally, but are not
    sufficiently reabsorbed by lymph vessels
    (= diagnosis)
    Lymphostasis

    Stoppage of the flow of lymph fluid:


     Proteins remain in interstitial space
     Proteins are ingested by macrophages
     Macrophages release cytocines (interleukin 1)
     Cytocines activate fibroblasts
     Tissue proliferation
     Lymphostatic fibrosis
    Edema in an acute inflammatory process
    Blood capillaries: Blood capillaries + postcapillary veins:
    Capillary pressure  Permeability for plasma proteins (contraction of endothelium
      cells)
    Ultrafiltration  Proteins in intercellular tissue space 
     
    Safety factor (if lymphvessels are not damaged by trauma)

    Dynamic insufficiency

    Lymphangiospasm (overloading of lymph vessels)
    +
    Lymphangitis (inflammation encroaches upon lymph vessels)

    Safety valve insufficiency
      Source: Földi, 1999 und handout
    Manuelle Gelenksdrainage by J.Winter
    High-protein edema
    Sources:

    Földi M., Kubik S. (2002) Lehrbuch der Lymphologie. 4th. and 5th.
    Ed. München, Jena: Urban & Fischer Verlag
    Zutter J.E. (2005) Lymphedema Management. Thieme

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