18 Lymphatic System Flashcards

1
Q

How does the lymphatic system work in relation to the venous system?

A

Collects 3 litres per day of interstitial fluid and returns it to the venous system

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2
Q

State the names of the fluid and vessels of the lymphatic system.

A
  • Fluid – lymph
  • Vessels – lymphatics
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3
Q

Identify the cells of the lymphatic system

A
  • Lymphocytes: B cells, T cells and NK cells (natural killer)
  • Supporting cells: follicular dendritic cells and macrophages
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4
Q

Identify the organs of the lymphatic system

A
  • Lymph nodes
  • Thymus
  • Spleen
  • Appendix
  • Tonsils
  • Payer’s patches
  • (small masses of lymphatic tissue found throughout the ileum region of the small intestine)*
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5
Q

What 3 factors help to propel lymph along?

A
    • Skeletal muscle movement
    • Pressure changes in the thorax during breathing
    • Pulsations of adjacent arteries
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6
Q

Describe the arrangement of lymphatic vessels in the body

A
  • Lymphatics tend to lie adjacent to arteries and veins
  • Lymphatics are arranged into superficial and deep (lymph flows superficial–>deep)
  • Large vessels (ducts and trunks) eg in abdomen contain smooth muscle
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7
Q

In which region of the body are there no lymphatics?

A

The Central Nervous System

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8
Q

What are the functions of lymph nodes?

A
  • Serve as filters for lymph: traps antigen, processes antigen and presents processed antigen to T cells (contain APCs)
  • Contains macrophages, B cells and T cells which work to produce an inflammatory response (macrophages) then an immune response (B & T cells)
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9
Q

Approximately how many lymph nodes are there in the human body?

A

600-700

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10
Q

Describe the structure of a lymph node (general terms).

A

Shaped like kidney, mainly= CT fibre

  • Afferent lymphatics that enter via the convex surface
  • Efferent lymphatics that leave via the hilum
  • Feeding artery that leaves via the hilum
  • Draining vein that leaves via the hilum
  • Follicles=nodules containing immune dendritic cells
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11
Q

How do lymphocytes enter lymph nodes?

A
  • Enter via the feeding artery
  • Leave via the efferent lymphatics
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12
Q

Account for possible causes of lymphadenopathy

A
    • Infection as germinal centres in lymph nodes fill with lymphocytes
    • Lymphoma as cancer metastasises to afferent lymphatics
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13
Q

Lymph nodes contain professional antigen presenting cells (APCs).

What is the role of such cells?

A

APCs are specially equipped with immunostimulatory receptors to acquire and present antigens which allows for enhanced activation of T cells

(B cells don’t require APCs to recognise antigens)

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14
Q

What is the structure, function and location of follicular dendritic cells (found in lymphoid tissue)?

A
  • Structure: contain antigen-antibody complexes adhere to its dendritic processes
  • Function: cause proliferation of B cells, in particular, memory B cells
  • Location: found in germinal centres
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15
Q

Outline the humoral response (in terms of immunity).

A

- Humoral immunity is B lymphocyte mediated

  • It involves B lymphocytes which transform into plasma cells that synthesise and secrete a specific antibody
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16
Q

What is cell-mediated immunity?

A

Cell-mediated immunity is when T cells need antigen presenting cells (macrophages, B lymphocytes) to recognise antigens

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17
Q

Outline the structure, function and location of the thymus gland

A
  • Structure: fully formed and functional at birth, involutes after puberty and ends up being mostly fat
  • Function: maturation of bone marrow derived stem cells into immunocompetent T cells (thymic cell education)
  • Location: found in superior mediastinum
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18
Q

What are the functions of the spleen?

(The spleen is the largest lymphatic organ and has a very rich blood supply.)

A
  • IMMUNE:
      • Antigen presentation
      • Activation and proliferation of B and T lymphocytes= Production of antibodies
  • HAEMOPOIETIC
      • Removal + destruction of old, damaged erythrocytes/platelets
    • RBC storage
    • Iron retrieval from haemoglobin
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19
Q

Discuss the implications of a splenectomy (2)

A
    • Splenectomy increases the risk of infection by encapsulated bacteria e.g. the meningococcus and malaria
    • Splenectomy increases the risk of DVT and pulmonary embolism
20
Q

Which organs/structures perform the spleen’s functions after a splenectomy?

A

Liver and bone marrow take over the removal & destruction of old RBCs

21
Q

Distinguish between the lymph node and spleen response to infection.

A
  • Lymph nodes enlarge in response to local infection
  • Spleen enlarges in response to systemic infection e.g. glandular fever, malaria, septicaemia
22
Q

What is phagocytosis?

A

Phagocytosis is a specific form of endocytosis by which cells internalise solid matter, including microbial pathogens

23
Q

What is opsonisation?

A

Opsonisation is the molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have stronger interactions with cell surface receptors on phagocytes and NK cells

24
Q

What effect does opsonisation have?

A
  • With the antigen coated in opsonins, binding to immune cells is greatly enhanced
  • Opsonisation also mediates phagocytosis via signal cascades from cell surface receptors
25
Q

What is oedema?

A

Oedema is an accumulation of an excessive amount of watery fluid in cells, tissues or serous cavities

26
Q

What is lymphoedema?

A

Lymphoedema is swelling (especially in subcutaneous tissues) due to obstruction of lymphatic vessels or lymph nodes and the accumulation of large amounts of lymph in the affected region

27
Q

Describe the appearance of lymphoedema

A

Lymphoedema is non-pitting oedema due to the build-up of lymph and protein in the interstitial space

28
Q

How does oedema change with position?

A
  • If someone is standing up, oedema often appears first at the ankles (gravity)
  • If someone is lying down/sitting in bed, the oedema is expected to appear in the sacral region
29
Q

Outline how fluid flows from the capillaries back to the veins via the lymphatics.

A
30
Q

Which of the structures shown below is a lymphatic vessel and which is a small vein?

A
31
Q

Describe the structure of a lymphatic capillary.

A
  • Low pressure system w./ valves
32
Q

Name some main areas where there are lymph nodes. (3) (clinically important)

A
  • Neck (cervical)
  • Groin (inguinal)
  • Armpit (axillae)
33
Q

Fill in the missing labels:

A
34
Q

Where are follicular dendritic cells found and what is their function?

A
  1. In germinal centres
  2. Cause proliferation of B cells- as antigen antibody complexes adhere to them- can retain antigen for a month
35
Q

Where is the spleen located and what is it’s structure (in general terms)?

A

Location: Inferior to diaphragm, posterior to stomach

Structure: Similar to lymph node BUT White pulp and Red pulp

36
Q

Why is a ruptured spleen usually removed?

A

Risk of death by exsanguination (loss of blood)

37
Q

Where can the tonsils be found?

A

Oropharynx and nasopharynx

38
Q

What is the structure and function of the tonsils?

A

Nodules- reside inferior to surface invaginations

Prevent pathogen ingress:

  • Surface epithelia- numerous microfold cells
39
Q

Outline the location, structure and function of the Appendix (Veniform).

A
  1. LOCATION Inferior&attched to ascending colon
  2. STRUCTURE Nodules reside inferior to surface invaginations- many microfold cells
  3. FUNCTION prevent pathogen ingress
40
Q

Outline the Location, Structure and Function of Payer’s patches?

A

LOCATION: inferior and attched to ileum

STRUCTURE: nodules= on inferior surface of domes
FUNCTION: Prevent pathogen ingress through digestion

41
Q

What are the functions of the lymphatic system?(4)

A
  1. Fluid balance-return interstitial fluid to circulation
  2. Transport- fats and fat-soulble vitamins- from digestive system to venous circulation
  3. Defence against invading pathogens-nodes filter out organisms/cancer cells
  4. Storage and destruction- aged erythrocytes (spleen
42
Q

What is a ‘sentinel lymph node’?

A

First lymph node to which cancer cells are most likely to spread from a primary tumor eg breast cancer

43
Q

Outline the relationship between sentinel lymph nodes and the prevention of a secondary tumour.

A
44
Q

How is lymphodema treated? (4)

A
  1. Compression hosiery
  2. Specialised massage
  3. Skincare
  4. Exercises
45
Q

What are the primary causes of lymphodema? (3)

A
46
Q

What are the secondary causes of lymphodema? (4)

A
  1. Surgery- node involvement
  2. Radiotherapy- nodal fibrosis
  3. Autoimmune- rheumatoid arthritis
  4. Infections- cellulitis (vessel obstruction)