8. Acquired and Genetic Disorders of the Lymphatic Vascular System Flashcards
Lymphatic System Function
• Drainage of interstitial fluid from body tissues and return to bloodstream
• ____ and ____ immune response
– ____ (B, T, and NK cells)
– ____ cells (monocytes, macrophages, neutrophils, etc)
humoral
cell-mediated
lymphocytes
supporting cells
Lymphatic System Structure • Closely associated with the \_\_\_\_ system • \_\_\_\_ to prevent backflow (like veins) • Components: – Lymph nodes – Lymphatic vessels – Lymph
cardiovascular
valves
Lymph Composition • \_\_\_\_ cells • \_\_\_\_ proteins • Extra interstitial fluid • Can also transport \_\_\_\_ cancer cells
Named for lympha, the Roman deity of ____
• Metastatic cancer can also travel via \_\_\_\_
white blood
large
metastic
fresh water
blood
Lymphoid Structures in H&N
• Lymphoid structures within the oral cavity ○ Waldeyer's ring § \_\_\_\_ tonsils § \_\_\_\_ airways
asymmetric
compromised
Lymphatic System Disorders
• ____
– Abnormal collection of interstitial fluid & fibroadipose tissue
• ____
– Abnormal lymph node enlargement
• Lymphoma and metastatic cancers
lymphedema
lymphadenopathy
Lymphedema Overview
- Primary lymphedema: lymphedema due to ____ etiologies
- Secondary lymphedema: lymphedema ____ to acquired conditions
• Secondary ○ \_\_\_\_, cancer, infection, etc. • Malformation in drainage in one of the fingers ○ Primary lymphedema ○ Resolve by surgery
congenital/inherited
secondary
surgical
Primary Lymphedema
• Primarily affects the ____ extremities, but may be found ____ the body
• May progress ____ or resolve ____ throughout development
• Classified by ____ at onset
lower throughout slowly spontaneously age
Malformations of Vessels
• Abnormality resulting in ____ of interstitial fluid
○ Lymphatic malformation
[NOTES]
accumulation
Primary Lymphedema
• Clinical presentation reflects area affected, for example:
Tongue, mouth, trachea
____, ____, speech disturbance, difficult ____
Orbits
____, diplopia
Bone
Bone ____ or overgrowth
Skin
____, pain, swelling
Chest
____, wheezing, ____
dyspnea
dysphagia
feeding
proptosis
hypertrophy
cellulitis
chest pain/pressure
dyspnea
Primary Lymphedema
• Lymphatic Malformations
– Rare ____ deformities of the lymphatic system due to abnormal development of the lymphatic vasculature
• Drainage in the lower extremities, resulting in \_\_\_\_ swelling • Cystic hygroma ○ \_\_\_\_ that can be resected
congenital
unilateral
cystic structure
Primary Lymphedema
May occur as part of a syndrome including ____ syndrome
• \_\_\_\_ of X • Presents in \_\_\_\_ • Webbing of the \_\_\_\_ ○ Primary lymphedema • \_\_\_\_ corrected
turner monosomy females neck surgically
Secondary Lymphedema
• Etiologies include ____, trauma, ____, inflammatory disorders, cancer and cancer treatments
* More \_\_\_\_ * Primary lymphedemas are rare
infection
burns
common
Secondary Lymphedema
SVC Syndrome
- Obstruction of the superior vena cava (SVC) due to thrombosis or compression by pathologic process in adjacent structure
- Associated with ____ and ____ etiologies
- Symptoms include ____ and marked interstitial ____ of the head and neck• Swelling of neck and face; shortness of breath; lungs, coughs, shortness of breath and dysphagia
• Large ____ mass
○ Lymphoma
○ Tumors from ____
○ ____ tumors
• Compression of vessels that drain HN region
• Can also be caused by thrombosis (bloot clot)
○ No smooth flow: area is prone to thrombosis
• Blood clot and compression results in significant swelling
benign
malignant
dysphagia
lymphedema
medistinal
thymus
germ cell
Secondary Lymphedema
Post-surgical Lymphedema
- Most common etiology is ____ lymph node dissection for ____ cancer
- Also seen in patients following ____ and/or radiation• ____ lymph node biopsy
○ Dye injected in area of tumor, and see where it’s draining (radioactive dye)
○ Ultimately resecting the lymph node where the drain is flowing
○ Complication: ____
§ If axillary lymph nodes are all removed: significant swelling
• Compression sleeves allows lymph to recirculation
• OT lymph massages
• Life-long complication
• Treating the lymphedemic arm is ____ (where the dissection was)
○ Do not use the arm for drawing ____, etc
• ____ can mimic the phenotype of lymphedema
○ ____swelling
axillary
breast
chemotherapy
sentinel lymphedema limited blood thrombosis (DVD) unilateral
____ Lymphedema
Lymphatic Filariasis (Elephantiasis)
• ____infection of lymphatics and subcutaneous tissue by filarial worms transmitted by ____
• Can cause disfiguring swelling resulting in pain, disability, and social stigma
• Epidemiology: Over 140 million people infected worldwide
• Common in \_\_\_\_ countries
secondary
parasitic
mosquitoes
tropical
____ Lymphedema
Obesity
• Would be \_\_\_\_
secondary
bilateral
Lymphadenopathy Overview
• ____: widespread lymph node enlargement
• ____: lymph node enlargement in one region
generalized
localized
Lymphadenopathy
• Etiologies include ____, autoimmune conditions (e.g. ____), drug side effects, and ____
• Of note, lymphadenopathy may be ____ or entirely ____
infections
sarcoidosis
cancer
painful
asymptomatic
Lymphadenopathy
• A “normal” lymph node is about ____ cm – about the size of a fingernail, or pea
– May be slightly larger in ____
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adolescents
