Chapter 13 - Lymphatics

Question 1

What drains into the R thoracic duct?

Answer 1

R head and neck
R arm
Heart
Lungs (except L upper lobe)

Question 2

Where does the Left (major) duct drain into the venous system?

Answer 2

Junction of L subclavian and L internal jugular

Question 3

What is the thoracic duct?

At what level does it turn around and go down?

Answer 3

The lymphatic duct that comes up from the thorax and drains into the left (major) lymphatic duct

C7

Question 4

Describe the path of the thoracic duct

Answer 4

Cisterna chyli (L2) –> aortic hiatus (T12) –> neck

Question 5

Extrinsic forces on the lymphatic flow

Answer 5

OMT
Exercise
Contraction of muscles
Pulsation of adjacent arteries
Respiratory movement (negative pressure)

Question 6

Intrinsic forces on lymphatic flow

Answer 6

Smooth muscle contraction (SNS)

Interstitial fluid pressure

Question 7

Factors that cause interstitial pressure to increase above 0 mmHg such that the lymphatic capillaries collapse (4)

All 4 result in what?

Answer 7

• Systemic HTN
• Cirrhosis
• Hypoalbuminemia (starvation, kidney damage)
• Toxins (rattlesnake poison)

Increased fluid flow into the interstitium from the blood capillaries

Question 8

Thoracic pump - function

Answer 8

Increase rib cage motion

Mobilize lymphatic fluid

Question 9

Pedal pump - function

Answer 9

Encourage lymphatic movement, especially in CHILD

Question 10

Basic treatment protocol for lymphatics (4)

Answer 10

1. Thoracic inlet
2. Rib raising or paraspinal inhibition
3. Redome the thoracoabdominal diaphragm
4. Lymphatic pump techniques

Question 11

Relative contraindications to lymphatic treatment (4)

Answer 11

Osseous fractures
Bacterial infections w/ FEVER
Abscess or localized infection
Carcinomas (especially late)