4: Lymphatics Flashcards
3 components of lymph system
- Lymph fluid
- Lymph vessels
- Organized lymph tissues/organs
Lymphatic development in embryo
Begins during week 5, significant presence by week 20
When does lymphoid tissue stop increasing?
Around 6-9 years old
Substances found in lymph fluid
- Substances that leak out of arteries, like proteins and electrolytes
- Immune cells
- Foreign Ags, bacteria, and viruses
- Clotting factors
- Chylomicrons
Four tissues that do not have lymph vessels
- Epidermis
- Endomysium of muscle
- Cartilage
- Bone marrow
Superficial vs deep LNs
Superficial: within subq tissue
Deep: beneath fascia, muscle, and organs
Virchow’s node
Left supraclavicular node -> indicated intrathoracic or abdominal cancer
Epitrochlear nodes
In elbow region, indicate secondary syphilis
Three tonsils and their locations
- Palatine: lateral pharynx
- Lingual: posterior 1/3 of tongue
- Pharyngeal: adenoids at nasopharyngeal border
Normal interstitial fluid pressure (Pif)
-6.3mmHg (negative pressure system
What happens if interstitial fluid pressure reaches above 0 mmHg
Lymph caps collapse and flow ceases -> increased hydrostatic pressure, decreased plasma colloid osmotic pressure, increased cap permeability
What two forces help lymph move through large vessels
- Muscle contractions
2. Breathing
What happens with each breath in terms of lymph movement (2 things)
- Increased negative intrathoracic pressure pulls fluid centrally
- Direct force on cisterna chyli, pushes fluid superiorly
Sympathetics effect on lymph valves
Increased symps -> tighter valves -> decreased lymph flow into venous system
Sympathetics effect on lymph smooth muscle
Increased symps -> decreased peristalsis -> lymph congestion
What happens with a buildup of interstitial fluid?
Edema!
Four things edema causes
- Increased arterial pressure
- Increased venous pressure
- Decreased plasma osmotic pressure
- Increased capillary permeability
Effects of increased arterial vs venous pressure
Arterial: HTN, increased blood volume
Venous: CHF, valvular disease, venous obstruction, dysfunctional valves
What does decreased plasma osmotic pressure cause?
Cirrhosis, protein malnutrition, DM
Local effect of edema compression on structures
Vascular: decreased delivery of O2, nutrients, meds, hormones
Neuronal: decreased sensation, pain, or parasthesia
Edema and clearing tissues
Edema causes decreased waste and pathogen clearance
Indications for lymphatic OMT
- Lymph congestion / edema
- Mild CHF
- URI or lower RI
- Asthma or COPD
- Sprains or strains
- Acute SD
- Pregnancy
Four absolute contraindications for lymphatic OMT
- Anuria: kidneys needed to process extra fluids
- Necrotizing fasciitis
- Pt unable to tolerate tx
- Pt refuses tx
Some relative contraindications for lymphatic OMT
- Inability to tolerate excessive preload in CHF
- COPD
- Acute asthma exacerbation
- Untreated coagulopathy
- Cancer (unsure if it could spread it)
- Osseous fracture
- Bacterial or chronic infection
- diseased organ
- Pregnancy (dont do uterus or abd work)
- Circulatory disorders
Four transverse restrictors in the body
- Tentorium cerebelli
- Thoracic inlet
- Thoracolumbar diaphragm
- Pelvic diaphragm
Path of lymph through the body
- Terminal lymphatics
- Collecting vessels
- Afferent vessels
- LN
- Efferent vessels
- Lymphatic trunks
- Cysterna chyli
8 Thoracic duct + right lymphatic duct
What forms collecting vessels?
Lymphangions - chains of SM units with 2-3 leaflet bicuspid valves
Level of cisterna chyli
L1-2
