Lymphoedema Lymphorrhea Lymph Fluid

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Lymphoedema Lymphorrhea Lymph Fluid

Postby patoco » Sun Jun 11, 2006 8:41 pm

Lymphoedema Lymphorrhea

Interstial Fluids, Lymph Fluid

Our Home Page: Lymphedema People

http://www.lymphedemapeople.com/

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Definition of Lymphorrhea

Lymphorrhea is the light amber colored fluid that drains from open skin areas (wounds) on a lymphodemous limb. It is not normal plasma, but is a protein-rich substance that can lead to serious complications for the lymphedema patient. The composition of lymphorrhea is approximately 1.0=5.5 g/ml of protein.

Causes of Lymphorrhea

The cause of lymphorrhea drainage is any open area or break in the skin of the lymphoedemous limb. Any opening, no matter how small will cause this fluid to weep or drain. Insect bites, cuts, abrasions, cracks in the skin from dryness, wounds of any type become a source for leakage of this fluid.

Lymphorrhea Complications

There are two serious complications that arise from lymphorrhea.

The fluid is a natural "food-source" for bacteria. The open draining wound becomes what is referred to as an entry foci for bacteria. This leads to cellulitis, lymphangitis or erysipelas.

Lymphorrhea is highly caustic to the skin tissue that it come into contact with. Untreated wounds with this drainage can very quickly become large gaping areas that may eventually lead to the need for skin grafts.

For further information on lymphorrhea and wounds associated with lymphedema see our Wounds section.

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Lymphorrhea - What Is It

Lymphorrhea is an escape of lymph from a cut, torn, or burst blood vessel onto the surface of the skin. Lymph is a milky fluid that contains proteins, fats, and white blood cells (which help the body fight off diseases). Blood vessels are tube shaped structures that carry blood to and from the heart. Lymphorrhea is also known as lymphorrhagia. Lymphorrhea comes from the Greek word "lympha" meaning "spring water," and the Greek word "rhoia" meaning "a flow." Put the words together and you have "a flow (of) spring water."

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This article is taken from the Winter 2002 issue of LymphLine

Lymphorrhea

By LSN Trustee and Nursing Advisor, Denise Hardy

What is Lymphorrhea?

Lymphorrhea is the leakage, or weeping, of lymph fluid through the skin surface. Large beads of fluid appear on the skin and trickle from the affected areas.

Causes of Lymphorrhea

May be the result of lacerations, abrasions, or trauma of the altered dry skin of longstanding edema e.g. graze/cut
It may result from the rupture (bursting) of lymphangiomas (described more fully below)

It may also occur in a sudden or acute edema (swelling) where the shiny, taut skin has stretched so rapidly that it splits, forming a leak.

Lymphorrhea - the complications it causes

The skin feels very cold, wet and uncomfortable. The fluid can soak through dressings which may need changing many times a day to cope with the large amounts of leakage The fluid can collect in shoes/slippers… clothing and bed linen can become soaked and require frequent changes

Lymphorrhea will increase the risk of cellulitis - the break in the skin acts as an entry for bacteria. Infection will cause further problems (pain/inflammation/flu-like symptoms and increased amounts of fluid leakage)

If left to leak and dressings are not regularly changed the lymph (being an excellent culture medium) may grow bacteria causing odor and discoloration

Lymphorrhea may cause social difficulties and embarrassment.

Lymphorrhea not uncommonly affects the genital area and may be difficult to distinguish from urinary incontinence.

Treatment of Lymphorrhea

In order to stop the fluid leaking, a series of steps are essential.
Your Lymph edema nurse/therapist or other nurse involved in your care should be able to help you with these steps following a full assessment of the cause of the leakage:

The area around the 'leak' needs to be cleaned carefully to ensure the risk of infection is reduced.

An emollient (moisturizing cream/lotion) should be applied to the skin to improve the condition and protect it (by acting as a barrier) against further skin breakdown.

A non-adherent (non sticky), absorbent, (e.g. Allevyn/Cutinova/lyofoam) sterile dressing should be applied to the leaking area to prevent further trauma to the skin - and to absorb the leakage.

Pressure should be applied. For example a limb should be supported with appropriate bandaging e.g. Multi Layer Lymph edema Bandaging (MLLB) with short stretch compression bandages. This normally stops the flow of leakage within 24-48 hours. Bandages may have to be replaced frequently during this period of time to remove wet bandages/ dressings and to prevent further skin breakdown. MLLB should continue until the skin condition has improved enough to wear your stockings/sleeve again.

At rest, the affected limb should be elevated to reduce the effects of gravity.

Once the leakage has stopped, and the skin condition has improved, your usual compression garment should once again be applied. The garment will keep the swelling to a minimum and prevent any further 'leaks' appearing.

http://www.lymphoedema.org/lsn/lsn140.htm#TOP

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Prevention of Lymphorrhea by Means of Fibrin Glue after Axillary Lymphadenectomy in Breast Cancer: Prospective Randomized Trial

F.N. Gillya, Y. Françoisa,b, A.C. Sayag-Beaujardb,c, O. Glehenb, A. Brachetb, J. Vignala,b

a Department of Surgery, Centre Hospitalo-Universitaire Lyon-Sud, Pierre-Bénite,
b Laboratoire Recherche Oncologie, Université Lyon-1, Oullins, and
c Department of Anesthesiology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.

Prof. F.N. Gilly MD
Department of Surgery, CHLS
F-69495, Lyon Pierre-Bénite Cedex (France)
Tel. +33 4 78 86 13 75, Fax +33 4 78 86 33 43
E-Mail francogi@uheim.univ-lyon1.fr

http://content.karger.com/ProdukteDB/pr ... kelNr=8611

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Composition of Lymph Fluid and Interstitial Fluid

ORIGIN and COMPOSITION of LYMPH

Each cell in the body of a multicellular organism is somewhat specialized and cannot survive independant from other cells. Because a cell is dependant on other cells it can only survive in a specific enviroment (milieu). This internal environment, also called cell milieu, is a thin layer of fluid, namely the tissue fluid or interstitial fluid which envelopes and bathes the living cells of the body.

Tissue fluid is basically blood plasma with a great reduced protein content, because the plasma proteins are too large to diffuse through the capillary walls. Like blood plasms, tissue fluid is a pale, straw-coloured tissue. Tissue is the medium in which the cells live. It therefore plays an important role in homeostasis, i.e. it helps to maintain a constant environment in which the cell can live. In order for the cells to remain alive and healthy, the tissue fluid must remain in a stable condition, i.e. it must receive a constant supply of oxygen and food, and the waste products must be removed from it.

Mammals have a special transport system made up of branching vessels that return fluids and their contents from the tissues to the blood. These vesels are known as lymph vessels. All the vessels together constitute the lymphatic system, which include lymph veins and lymph capillaries. The lymph capillaries are distributed throughout most of the body (except the nervous system). The lymph capillaries are closed at one end.

http://www.botany.uwc.ac.za/SCI_ED/grad ... origin.htm

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Composition of interstitial fluid

N Fogh-Andersen, BM Altura, BT Altura and O Siggaard-Andersen
Department of Clinical Chemistry, Herlev Hospital, Denmark.

In several previous experiments to determine the composition of interstitial fluid, the results varied depending on the collecting technique, and the electrolyte concentrations differed from those of a hypothetical ultrafiltrate of plasma. In our approach, since a change of position from standing to supine is accompanied by hemodilution with interstitial fluid, we used the changes in hematocrit and composition of plasma in 20 subjects before and after lying down to calculate the composition of added interstitial fluid. The estimated protein concentration was 20.6 g/L, and the concentrations of total calcium and magnesium were low, in accord with a lower concentration of protein- bound calcium and magnesium. The activity of free cations was also lower, in agreement with a Donnan equilibrium potential of 1 mV across the endothelium. The concentration of leukocytes and platelets decreased according to the hemodilution, implying no escape or mobilization of these elements.

http://www.clinchem.org/cgi/content/abstract/41/10/1522

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Fluid Physiology

2.1.3 Intracellular Fluid

The Intracellular Fluid is composed of at least 1014 separate tiny cellular packages. The concept of a single united "compartment" called intracellular fluid is clearly artificial. The ICF compartment is really a "virtual compartment" considered as the sum of this huge number of discontinuous small collections. How can the term ‘intracellular fluid’ be used as though it was a single body of fluid? The reason is that though not united physically, the collections have extremely important unifying similarities which make the ICF concept of practical usefulness in physiology. In particular, similarities of location, composition and behaviour:

Location: The distinction between ICF and ECF is clear and is easy to understand: they are separated by the cell membranes.
Composition: Intracellular fluids are high in potassium and magnesium and low in sodium and chloride ions.

Behaviour: Intracellular fluids behave similarly to tonicity changes in the ECF.

Because of this physiological usefulness, it is convenient to talk of an idealised ICF as though it were a single real entity. The use of this convention allows predictions to be made about what will happen with various interventions and within limits these are physiologically meaningful.

2.1.4 Extracellular Fluid

A similar argument applies to the Extracellular Fluid. The ECF is divided into several smaller compartments (eg plasma, Interstitial fluid, fluid of bone and dense connective tissue and transcellular fluid). These compartments are distinguished by different locations and different kinetic characteristics. The ECF compositional similarity is in some ways, the opposite of that for the ICF (ie low in potassium & magnesium and high in sodium and chloride).

Interstitial fluid (ISF) consists of all the bits of fluid which lie in the interstices of all body tissues. This is also a ‘virtual’ fluid (ie it exists in many separate small bits but is spoken about as though it was a pool of fluid of uniform composition in the one location). The ISF bathes all the cells in the body and is the link between the ICF and the intravascular compartment. Oxygen, nutrients, wastes and chemical messengers all pass through the ISF. ISF has the compositional characteristics of ECF (as mentioned above) but in addition it is distinguished by its usually low protein concentration (in comparison to plasma). Lymph is considered as a part of the ISF. The lymphatic system returns protein and excess ISF to the circulation. Lymph is more easily obtained for analysis than other parts of the ISF.

Plasma is the only major fluid compartment that exists as a real fluid collection all in one location. It differs from ISF in its much higher protein content and its high bulk flow (transport function). Blood contains suspended red and white cells so plasma has been called the ‘interstitial fluid of the blood’. The fluid compartment called the blood volume is interesting in that it is a composite compartment containing ECF (plasma) and ICF (red cell water).

The fluid of bone & dense connective tissue is significant because it contains about 15% of the total body water. This fluid is mobilised only very slowly and this lessens its importance when considering the effects of acute fluid interventions.

Transcellular fluid is a small compartment that represents all those body fluids which are formed from the transport activities of cells. It is contained within epithelial lined spaces. It includes CSF, GIT fluids, bladder urine, aqueous humour and joint fluid. It is important because of the specialised functions involved. The fluid fluxes involved with GIT fluids can be quite significant. The electrolyte composition of the various transcellular fluids are quite dissimilar and typical values or ranges for some of these fluids are listed in the Table.

The total body water is divided into compartments and useful physiological insight and some measure of clinical predictability can be gained from this approach even though most of these fluid compartments do not exist as discrete real fluid collections.

http://www.qldanaesthesia.com/FluidBook/FL2_1.htm

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The concentration of protein-compounds in interstitial tissue of patients with chronic critical limb ischaemia and oedema.
Anvar MD, Khiabani HZ, Lande K, Kroese AJ, Stranden E.

Departments of Vascular Diagnosis and Research, Aker Hospital, University of Oslo, Norway. m.d.anvar@ioks.uio.no

BACKGROUND: Many of chronic critical limb ischaemia (CLI) patients have distal leg and foot oedema. Previous electronmicroscopic studies have shown that chronic severe ischaemia may cause hypoxic damage of the capillary endothelium, including morphological changes i.e. multiplicated/thickened basal lamina, and formation of interendothelial gaps. To assess the functional consequences of these morphologic derangements, where proteins can leak through, we investigated the composition of the interstitial fluid in oedematous ischaemic limbs. PATIENTS AND METHODS: Nine female and 3 male patients with a mean age of 79 +/- 7.9 years were included. All had unilateral CLI and peripheral pitting oedema. Leg and foot volume was measured with water displacement volumetry. Blister suction technique was used to collect subcutaneous interstitial fluid. The concentration of albumin, transferrin, immunoglobulin G and alpha 2-macroglobulin in plasma and blister fluid was measured by immunoturbidimetry. Nine patients, 8 women and 1 man with a mean age of 83 +/- 5.5 years with a proximal femur fracture served as an age-matched control group. RESULTS: The mean concentration of albumin in blister fluid was significantly lower in the patients, whereas the mean concentration of alpha 2-macroglobulin in blister fluid did not differ between patients and controls. Mean ratio between concentrations in blister and serum of albumin, transferrin and immunoglobulin G in the limbs with CLI and oedema were significantly lower than respective values in the control group. However, there was no significant difference in the ratio of alpha 2-macroglobulin between these groups. CONCLUSION: A higher transcapillary concentration gradient for proteins in CLI limbs signifies an increase in the net osmotic pressure gradient across the capillary wall, which may be a potential oedema limiting factor.

PMID: 11284084 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr

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Subcutaneous interstitial fluid pressure and arm volume in lymphoedema.

Bates DO, Levick JR, Mortimer PS.

Department of Physiological Medicine, St. George's Hospital Medical School, London, United Kingdom.

Interstitial fluid pressures were measured by the wick in needle method in the swollen and normal arms of 38 patients with lymphoedema resulting from treatment for breast cancer. The mean increase in arm volume, calculated from sequential circumferential measurements, was 33% (range 0.25 to 85.9). Subcutis interstitial fluid pressure in the swollen arm (2.0 cmH2O range -4.5 cmH2O to 6.8 cmH2O) was significantly greater (p < 0.001) than in the contralateral, non-swollen arm (-2.6 cmH2O range -11 cmH2O to 0 cmH2O). Interstitial fluid pressure in the oedematous arm did not correlate with the duration of the swelling (1-324 months), but did correlate with the increase in volume relative to the normal arm (r = 0.38, p < 0.05), the slope ('apparent compliance') being 28 ml.dl-1.cmH2O-1. The pressure-volume curve was less steep than the classic curve for acute oedema of dog limbs (Guyton, 1965). Vascular pressures were normal. The interstitial fluid pressures were not as high as those reported for lymphoedema of the lower extremity (mean 17.9 mmHg, Christensen et al., 1985). Nevertheless, the rise in interstitial fluid pressure by an average of 4.6 cmH2O constitutes a force opposing further microvascular fluid filtration and perhaps promoting fluid drainage out of the arm.

PMID: 1459796 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/quer ... =iconabstr
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