The Lymphatic System
Lymphatic System
Key functions:
• Immune defense
• Transports and drains excess fluids, proteins, and cellular
debris
• Maintenance of proper fluid levels in the blood capillaries
• Facilitates optimal fluid balance
Anatomy and Physiology
Lymphatic System
• One-way system
• “Lymph”
• Tissues and organs:
Lymphatic Vessels
• Initial lymph vessel
• Lymph Precollectors
• Lymph Collectors
• Lymphatic Trunks
Lymph Nodes
Approximately 600 to 700 lymph
nodes in the body
Functions:
• Filter harmful materials
• Immunity
• Concentrate lymph as it
enters the lymph node
Lymph vessels are thinner, smaller, and are
more likely to collapse than veins
Lymph flows
Vessel contraction
Accessory ms contraction
Pressure changes during breathing
Dermal mechanical stimulation
Starling Law of Capillaries
• Describes how fluid leaves and enters the
semipermeable blood capillaries and
interstitium
• OSMOSIS
-net diffusion of water/solvent across a
semipermeable membrane such as the blood
capillary wall
1. PLASMA HYDROSTATIC PRESSURE
> pressure on the capillaries that is higher on the arterial - fluid leaves
capillary and enter the interstitium (filtration)
>Venous= lower pressure so fluid leaves interstitium to go to capillary
(reabsorption)
2. PLASMA COLLOIDAL OSMOTIC PRESSURE
> pressure caused by proteins in the capillaries that attracts water and
pull it inside (reabsorption)
3. INTERSTITIAL FLUID HYDROSTATIC PRESSURE
> pressure in the interstitium that may be:
a. positive - capillary reabsorption (higher pressure in interstitium)
b. negative - capillary filtration (lower pressure sa interstitium)
4. INTERSTITIAL COLLOIDAL OSMOTIC PRESSURE
> pressure caused by proteins present in the interstitium that attracts
water to the interstitium
Amount of fluid filtered each day:
How much is reabsorbed back in into the blood
capillary?
How much is taken up by the lymphatic system
and returned to the venous system?
Blood comes down to the arteries down to the extremities branches into
narrower arteries to - arterioles to capillaries because it has to send
nutrients and oxygen to interstitial spaces to feed the tissues and it has to
be reabsorbed by the capillaries to bring blood back to the vein but 90%
only goes backs to the vein the other 10% of blood in the capillaries will
be collected by the Lymphatic system (Lymph fluid) to be returned to
venous system.
• Transport Capacity
• maximum ability of the lymphatic system to
transport lymph
• Lymphatic Load
• amount of lymph that is transported by the
lymphatic system
Conditions
Lymphatic System Insufficiencies
• Dynamic
• Mechanical
• Combined
Dynamic Insufficiency
Lymphatic Load exceeds Transport Capacity
Associated conditions:
CHF, CVI (stages I and II), immobility, hypoproteinemia, and pregnancy
Mechanical Insufficiency
Lymphatic Load exceeds the IMPAIRED
Transport Capacity
Associated condition: Lymphedema
Combined Insufficiency
Transport Capacity is reduced and Lymphatic
Load is abnormally high
Associated Condition: Lymphedema
Lymphedema
Accumulation of protein-
rich edema in the
interstitium
• Increased interstitial
colloidal osmotic
pressure
Lymphedema
PRIMARY lymphedema
Hypoplasia-
incomplete development of lymph
vessels; MC FORM
Hyperplasia-
enlarged diameter of lymph vessels
resulting in malfunction of valves
Aplasia-
absence of lymph vessels
• Milroy's disease
• Meige's disease
• Lymphedema Praecox
• Lymphedema Tarda
Primary Lymphedema
Secondary Lymphedema
- May be secondary to:
Surgery, radiation, trauma, tumor growth, infection, CVI, and artificial
(self-induced) lymphedema
Lymphatic disorders
1. Primary Lymphedema
-Lymph node/ vessel hypoplasia
-Congenital/ developmental disorder
-Milroy’s disease- AD causing bilateral LE
2. Secondary lymphedema (MC)
-Caused by injury or disruption of the lymphatic
system
-Blocked, dissected, fibrosed, altered, damaged
- Filariasis- nematode worm larvae
Lymphedema
Major Characteristics:
• Nonpitting edema
• (+) Stemmer’s sign
Lipedema
• Gradual and progressive symmetrical
accumulation of fat in the subcutaneous
tissue, typically seen in the buttocks and lower
extremities
Stages of Lipedema
Manifestation
Stage 1
Stage 2
Clinical Feature Lipedema Lymphedema
Almost exclusively in
Gender Women > Men
women
Family Hx Common Rare
Unilateral, or bilateral,
Bilateral LE (rarely UE) with one leg affected
Distribution
symmetric involvement more severely
(asymmetric)
Cellulitis Rare Common
Pain on pressure Present Absent
Easy brusing Present Absent
Distal edema in the
Absent Present
foot
Stemmer Sign Negative Positive
Lipolymphedema
• Combination form of lipedema and
lymphedema
• On average, occurs 17 years after the initial
onset of lipedema in patients who do not
receive proper treatment
Other disorders of the Lymphatic
System
LYMPHANGITIS
-Inflammation of the lymph
vessels
LYMPHADENITIS
Inflammation of the lymph nodes
LYMPHADENOPATHY
-Enlargement of the lymph nodes
Management
Medications
• Diuretics
• Benzopyrenes (Coumarin and Flavonoids)
- degrade the high levels of protein found in lymphedema
• Naturally-occurring Benzopyrenes
-bioflavonoids, horse chestnut, grapeseed extract
Surgery
• Debulking
removal of excess skin and subcutaneous tissue
• Liposuction
removal of suprafascial fatty tissue
Intermittent Pneumatic Compression
Conservative Methods
Phase I -
• Manual lymphatic drainage
• Compressions
initially - bandages;
later on - compression garment pag nag-plateau na
• Exercise (in bandages)
• Meticulous skincare
✓ Short stretch bandages
Low resting, high working pressure
Conservative Methods
Manual Lymph Drainage
• gentle manual treatment technique that causes
increased lymph flow into desired areas and
around blockages
Conservative Methods
External Compression
• Phase I - BANDAGES
• Phase II - COMPRESSION GARMENTS and
BANDAGES
Conservative Methods
Short-stretch Compression Bandage
MLD contraindications
Acute infection (cellulitis)
Acute DVT
Malignancies
Renal failure
Cardiac Edema
Compression therapy contraindications
PAD (ABI <0.8)
Conservative Methods
Exercise
Two major benefits:
1. To support or improve lymphatic function
2. To enhance overall functional mobility
Exercise
• Start with cardiovascular low-impact activities
• Simple exercise modifications
• Avoid eccentric exercises to avoid DOMS
• Focus on smooth, rhythmic, concentric activities
with light resistance
Meticulous Skin Care
Protein-rich fluid provides
ideal conditions for
bacterial and fungal
infections in the skin and
nails
MC: Streptococcus bacteria
THANK YOU :)