If the evening to discover in his legs swelling, usually pain and swelling of the lower limbs in the morning disappear, but if it does not, or is not fully, you should think and begin a serious examination, during which theIt can be identified lymphostasis lower extremities.According to statistics, the disease affects about 10% of people in the world.
little about the lymphatic system
clear link cardiovascular and lymphatic networks, as the latter is part of the blood.The lymphatic system is represented by a network of blood vessels, are located throughout the body and which circulates lymph.Lymph is formed during the filtration of blood plasma, that is, the liquid penetrates into the extracellular space, and from there, together with the coarse proteins interstitial space enters the lymph capillaries and then into the lymphatic network where there is a "clean" the lymph (lymph node), and then poured intothe circulatory system in the area of the lower divisions of the neck.
lymphatic system has its "duties»:
- with the help of tissue fluid is evacuated from the interstitial space (the prevention of edema);
- with proteins interstitial space through the subclavian vein transports tissue fluid back into the blood stream;
- participates in the transfer of fat from the small intestine into the blood;
- synthesizes lymphocytes, which are part of the protective mechanism of the organism;
- filters lymph node tissue fluid and it removes toxins, micro-organisms, tumor cells, foreign substances;
- involved in the formation of antibodies.
The lymphatic system consists of lymph capillaries, vessels, components, shafts and ducts.Any damage to the lymphatic pathways (sticking, blockage or overgrowth) a free outflow of lymph fluid from tissues is broken, resulting in edema, later turning into lymphostasis.
limfostazom lower limb: definition
pathological condition in which increases swelling of tissues involved in the field (in this case the lower limbs), called limfostazom feet or lymphedema (lymphedema).The disease is caused by violation of the outflow of fluid through the lymph vessels, which leads to its stagnation in the tissue space and edema.Among patients with peripheral vascular pathology 3 - 7% are people with limfostazom feet.
There are primary and secondary lymphostasis feet.And if the primary lymphostasis lower limbs has an innate character, the secondary develops during life under the influence of any precipitating factors.In turn, the secondary lymphostasis divided into juvenile (occurs between 15 and 30 years old) and adult (developing after 30 years).
Primary lymphostasis lower limbs has the following causes of:
- diameter of the lymph vessels is very small;
- limfootvodyaschih insufficient number of ways;
- anomaly of lymphatic vessels (imperforate, obliteration, doubling);
- amniotic constriction, which lead to scar formation, compressing blood vessels;
- genetic predisposition to the underdevelopment of the lymphatic system;
- congenital lymphatic tumor formation.
Secondary lymphostasis caused by various diseases that lead to stagnation of lymph and edema of the lower extremities:
- damage lymphatic pathways as a consequence of lower limb injuries (fractures, dislocations, surgery);
- formation of scarring and damage limfososudov as a result of burns, radiation exposure;
- failure of the cardiovascular system;
- chronic venous insufficiency (after suffering a thrombosis);
- benign and malignant tumors of the lymphatic system;
- inflammation leg skin (erysipelas);
- parasitic infections (eg, the introduction in the filarial limfososudy violates the lymph that causes wuchereriasis - elephantiasis);
- hypoalbuminemia (protein deficiency);
- surgery in the thoracic cavity and cells (including mastectomy);
- renal pathology;
- removal of lymph nodes;
- prolonged bed rest or immobility of the legs.
Symptoms lymphostasis feet
limfostazom feet in its development passes through three stages, with different manifestations:
The initial phase of the disease called mild or reversible swelling called lymphedema.Edema / swelling of the feet when lymphostasis appears in the ankle area, at the base of the fingers and between the metatarsal bones of the foot from the rear.Typically, a similar phenomenon occurs in the evening and / or after physical exertion.The skin over the swollen place pale, easily going to fold at a palpation.Proliferation of connective tissue is not present, and he is painless and quite mild edema.After sleeping or resting the foot / feet quickly bounce back.
This stage is characterized by the irreversible swelling of the lower limbs and is called fibredemy.Phase irreversible swelling occurs slowly, until a few years and shows the growth of connective tissue.Edema "rise" up, it becomes dense enough, and the skin is stretched over him and thickens, collect it in the crease becomes impossible.Edema is permanent, does not disappear alone and is accompanied by pain or a feeling of heaviness during exercise.
At this stage of the lower limb begins to deform, foot circumference is significantly increased, and long distance leads to cramps in the calf muscles and joints of the foot.Skin becoming cyanotic shade, compacted (hyperkeratosis), you may receive the warty protuberances.Complications of this stage are the wounds and ulcers of the skin in places of constant friction (contact with clothes, skin folds), they become inflamed and constantly oozing lymph.The difference diameters healthy and sore feet can reach 50 cm.
This is the final and most severe phase of the disease.At this stage of the disease called elephantiasis or elephantiasis (elephantiasis).It is characterized by a significant growth of the connective tissue under the edema, the skin becomes very thick and coarse, "like an elephant", stretched and streaked blue.The affected limb strongly increased in size, lost its contours and soft tissue develops fibrosis and cystic changes.Leg becomes similar to an elephant and completely loses its function.Complications of the third stage are: the development of osteoarthritis, contractures, eczema, trophic ulcers and non-healing erysipelas.
addition to local manifestations lymphostasis lower extremities occur, and common symptoms:
- general weakness;
- pain in the head;
- tongue coated with white bloom;
- loss of attention and concentration difficulties it;
- weight gain, obesity;
- joint pain.
After careful anamnesis and complaints, vascular surgeon (vascular surgeon, or phlebologist lymphology) conducts inspection of the lower extremities and appoint additional methods of inspection:
Refers to the X-ray examination methods.It consists in the introduction of time (between 1 and 2 toes) of the foot 1 - 2 cubic lymphotropic dye, and then between the metatarsal bones (1 and 2) produce a transverse incision approximately 2 cm, wherein the visible blue stained limfososudy.In any of the blood vessels visible radiopaque substance is injected, and take pictures.
lymphography to determine the number of vessels, their shape and continuity, connection and spare collateral vessels, wall permeability limfososuda.If there is a uniform filling of the vessel contrast with the stored diameter of its diameter along the entire length, then talk about maintaining patency and damage to the contractile apparatus.
- In primary lymphostasis marked hypoplasia of vessels
- In secondary disturbed the course of vessels, modified forms, filling the skin and spread the network contrast substance into the subcutaneous tissue (extravasation).
This method of radioisotope diagnosis (in the subcutaneous tissue isotope injected substance, where it enters the limfoset, then a special gamma camera images are produced).The method allows the observation of the state of the lymphatic system in the dynamics and determine the nature of lymph: collateral, trunk or diffuse, as well as full lymphostasis assess patency, tortuosity and their state of the valves.
Doplerografija vessels of the lower extremities
or duplex scanning of vessels - vascular ultrasound with Doppler effect (allows to differentiate venous and lymphatic edema).
- pelvic ultrasound - identification of inflammatory diseases or tumors that disrupt the lymphatic flow.
- Biochemical and CBC - definition of blood proteins, hepatic enzymes, revealing signs of inflammation, and more.
- General urinalysis - to exclude renal disease.
- Heart Study - appointed by ultrasound, ECG to detect cardiac / heart disease exclusion.
When lymphostasis lower extremities necessarily being treated.Moreover, the sooner it is started, the better the chances of success.Treatment of the disease is a complex task, which combines many techniques (health food, massage, medication, etc.), and aims to improve lymphatic drainage of the lower limbs.
all conservative treatments are used by only 1 stage of the disease (phase of lymphedema), when there began the structural changes of the skin and connective tissue.How to treat lymphostasis, depends on the cause, he was summoned.The first step is (if possible) to eliminate the causative factor (eg, in the presence of pelvic tumor, compressing limfososudy shown its removal).General recommendations for patients with this pathology:
- strictly forbidden to visit the bath, sauna or sunbathing (thermal effect contributes to the expansion of blood vessels, including the lymph, which impairs blood circulation and lymph flow in the legs);
- not wear shoes with heels or with lacing (heel increases the burden on the feet and lymph worsens and lacing pulls the soft tissue and blood vessels, in their passing, which also negatively affects the disease);
- avoid heavy lifting and static loads (prolonged standing or sitting);
- handle even minor skin damage (including bites) antiseptic solutions;
- stop wearing tight underwear and tight clothes (first, helps squeezing limfososudov, and, secondly, the skin friction at the contact with clothing provokes the formation of trophic disorders);
- can not sit, especially long legs crossed (by the way, women's favorite position), as this situation makes it difficult to lymph - and blood flow in the legs and pelvic organs;
- prohibited to walk barefoot outside the home (a high probability of damage to the skin and stop the formation of long non-healing ulcers);
- while taking a bath to use special oil (Balneum Plus), and after water treatment to wipe feet skin creams and lotions without perfumes and preservatives that not only cleans the skin, but also softens the skin and restores the protective barrier;
- use powder (talc, baby powder) with a strong sweating of the feet, reducing perspiration and the risk of venous disorders;
- timely and accurately cut toenails;
- during kneading massage techniques to eliminate.
Dietetic therapy at lymphostasis
The first treatment of the disease should begin with correct nutrition is especially true for patients with obesity.Diet for lymphostasis seeks to limit the consumption of salt (sodium chloride causes fluid retention in the tissues and swelling) and spicy food (caused thirst and increase fluid intake).
number of free liquid should be at least, but no more than 2 liters per day (tea and coffee substitute herbal teas, fruit drinks without sugar, fruit drinks), eliminate carbonated beverages.Also it is necessary to limit simple carbohydrates (bread, pastries, confectionery, sweets, etc.), which contributes to a raise extra kilos, replacing them with complex (bread from wheat flour or bran cereal with water or diluted milk: millet, barley, corn).
Increase consumption of vegetables and fruit (you can bake, braise, but do not fry), to give preference to fresh vegetable salad, dressed with vegetable oil.Restrict intake of animal fat (about 10 g. Per day) as well as saturated (animal) fats in large numbers difficult lymph.A vegetable oils in the diet should be less than 20 grams.daily.In addition, excess animal fat triggers the development of atherosclerosis, which exacerbates the lymphostasis.
also in nutrition should be a sufficient number of proteins of plant and animal origin, it is necessary for the formation of antibodies and enhance immunity.From animal fats to give preference to dairy products, sea- and offal.Sources of vegetable protein - buckwheat, legumes and nuts.
Compression treatment and kinesitherapy
Compression therapy is squeezing the skin and subcutaneous tissue sore feet so that the pressure force increases from the foot to the leg and thigh.The patient is recommended during the day as much as possible to keep the affected foot in the raised position, and at night underlay under her pillow or cushion (creating angle 45%).
Compression carried elastic bandaging of the lower limb, and wearing elastic stockings.Overlay elastic bandage held in the morning, not getting out of bed, since each finger, and then moving on foot and then on the lower leg and thigh.At night, leg come off (see. The choice of compression underwear for varicose).
also applies pneumocompression method with the help of special devices, which is a sequential mechanical compression of the legs with a certain pressure.To do this, the affected leg is put on a special pneumatic boots, into which air is blown in the direction of the foot to the thigh.In the course relies 10 - 14 procedures.After each session held light gymnastic exercises.
Kinesiotherapy - is holding a lymphatic drainage massage and perform physical therapy exercises.Massage at lymphostasis leg supports lymph flow, "kicks" from the swollen lymph tissue, stimulates phagocytosis by macrophages, enhances the work of lymph capillary pump.Also with the help of massage destroyed krupnomolekulyarnyh substances that interfere with normal lymph flow.
Lymphatic Drainage Massage is performed by specialists and is contraindicated in skin sore feet trophic disorders, thrombosis of the veins and the presence of tumors and diseases of the internal organs.Allowed and conduct self-massage (in the early stages).In home massage it is recommended to carry out after taking a warm bath, and after application to the skin of the feet a special cream.
In the first 3 - 5 minutes are made circular stroking movements (it is important to remember that massage is performed in the course of lymph flow, ie from the top of the foot), and then carried out the friction of movement and pressing pat and end the session.Duration of massage is 15 minutes.Recommended courses for 14 days with 1 - 2 week break.After the massage session should make 10 easy jumping on his toes 15 times or stretch on his toes.
Physiotherapy (physical therapy) is carried out twice a day, for 5 - 10 minutes and includes the following exercise (on a hard surface):
- horizontally to perform a "bicycle" as sick and healthy foot;
- raise the affected leg up (without bending) and to carry out its circular motion;
- in sitting flexion and extension of toes;