Chapter 7: Lymphatic System Flashcards
Lymphatic System
Inspect the visible nodes and surrounding area for:
Edema
Erythema
Red streaks
Palpate the superficial lymph nodes and compare side to side for:
Size
Consistency
Mobility
Discrete borders or matting
Tenderness
Warmth
LS Anatomy and Physiology
Lymphatic system consists of:
Lymph fluid/collecting ducts
Lymph nodes
Spleen
Thymus
Tonsils and adenoids
Peyer patches
Lymph tissue located in multiple body systems, including the mucosa of the stomach, appendix, bone marrow, and lungs
Lymphatic drainage pathways
half of right head, right shoulder, right arm, half of A&P trunk is drained via the right lymphatic duct, which is formed by the union of three vessels: right jugular trunk, right subclavian trunk, and right bronchomediastinal trunk. Lymph from the remainder of the body enters the venous system by way of the thoracic duct.
immune system
Function
Protects body from antigenic substances
Removes damaged cells
Partial barrier to malignant cell maturation
When it functions well, the individual is immunocompetent.
Tissue rejection of transplanted organs
When it fails, immunoincompetence can lead to a variety of illnesses:
Allergic
Immunodeficient
Autoimmune
Immunologic and Metabolic Processes
Movement of lymph fluid within cardiovascular system
Filtration of fluid
Production of lymphocytes
Production of antibodies
Phagocytosis
Absorption of fat and fat-soluble substances
Pathway for spread of malignancy
Lymph
Composition
Clear fluid
Mostly white blood cells (WBCs)
Mostly lymphocytes
Occasional red blood cells (RBCs)
Proteins
Drainage
Moves from bloodstream to interstitial spaces -No built-in pumping mechanism
Collected by tubules/ducts
Carried to lymph nodes
Moved to venous system -Subclavian veins
Closed but porous circulation
Lymph Nodes
Discrete structures surrounded by a capsule composed of connective tissue and a few elastic fibrils
Usually occur in groups
Located superficially and deep in body
Superficial nodes accessible to inspection and palpation
Lymphocytes
Central to body response to antigens
B lymphocytes produce antibodies.
T lymphocytes have important role in controlling immune responses brought about by B lymphocytes.
Increased presence in blood indicates systemic response to most viral and some bacterial infections.
Thymus
Located in the superior mediastinum, extending upward into the lower neck
Primary function in infancy and childhood
Little or no demonstrated function in adulthood
Essential to the development of the protective immune function
Site for T-cell production
Spleen, Tonsils, and Adenoids
Spleen
Highly vascular organ composed of white and red pulps
Destroys old red blood cells, produces antibodies, stores red blood cells, filters microorganisms from blood
Tonsils
Composed of lymphoid tissue
Adenoids
Pharyngeal tonsils
Tonsils and adenoids defend against inhaled and intranasal antigens
Peyer Patches
Small, raised areas of lymph tissue on the mucosa of the small intestine
Consist of many clustered lymphoid nodules
Immune surveillance of the intestinal tract
Facilitate immune response when pathogenic microorganisms are detected
Infants and Children
Antibody production is immature at birth.
Thymus is at its largest relative to the rest of the body shortly after birth and persists through the first year.
Tonsils are larger in early childhood.
Lymph node distribution is same as in adults.
Lymphatic tissue is normally very reactive in childhood leading to shotty lymph nodes, big tonsils, and adenoids.
Lymphatic system gradually reaches adult competency after the age 7 to 9 years.
Pregnant Patients and Older Adults
Pregnant patients
Pregnancy is a state of altered immune function.
Pregnancy can lead to temporary remission of autoimmune/inflammatory diseases.
Older adults
Number of lymph nodes may diminish.
Size of lymph nodes may decrease.
Some of the lymphoid structures are lost.
Nodes of older patients are more likely to be fibrotic and fatty -Impaired ability to resist infection
History of Present Illness
Enlarged node(s)
Character (should be firm and mobile)
Associated local symptoms
Associated systemic symptoms
Predisposing factors
Medications
Swelling of extremity
Unilateral or bilateral, intermittent or constant, duration
Predisposing factors
Associated symptoms
Efforts at treatment and effect
Past Medical History
Blood transfusions, use of blood products
Chronic illness
Surgery
Recurrent infections
Autoimmune disorders
Allergies
PMH Family
Malignancy
Anemia
Recent infectious diseases
Tuberculosis
Immune disorders
Hemophilia
PMH Personal and social history
Travel, especially to Asia, Africa, Western Pacific, India, Philippines
Use of recreational drugs, especially injected
Sexual history (risk factors for HIV exposure)
Infants and Children
Recurrent infections
Present or recent infections or trauma distal to nodes
Poor growth, failure to thrive
Fever
Joint pain
Loss of interest in play or eating
Immunization history
Maternal HIV infection
Pregnant Patients and Older Adults
Pregnant patients
Weeks of gestation
Exposure to infections
Presence of pets in household -Exposure to cat feces or litter
Immunization status
Older adults
Presence of an autoimmune disease
Present or recent infection or trauma distal to nodes
Delayed healing
Immunization status
Inspection and Palpation
Disorders of the lymph system have three physical signs:
Enlarged lymph nodes (lymphadenopathy)
Red streaks on the overlying skin (lymphangitis)
Lymphedema
Inspection
Lymph nodes
Edema
Erythema
Red streaks
Skin lesions
Palpation lymph nodes
Detect and note
Enlargement
Consistency
Mobility
Tenderness
Size
Warmth
Node characteristics
Hard=malignancy
Tender=inflammatory process
Nodes do not pulsate; arteries do
Palpable supraclavicular node on left (Virchow node)=thoracic/abdominal malignancy
Rapid enlargement=malignancy
Slow enlargement=benign process
Head sequence for LN
Occipital nodes at skull base
Postauricular nodes over mastoid
Preauricular nodes in front of ear
Parotid/tonsillar nodes at mandible angle
Submandibular nodes between angle and tip of mandible
Submental nodes behind mandible tip
LN neck sequence
Superficial cervical nodes at sternocleidomastoid
Posterior cervical nodes along anterior trapezius
Cervical nodes deep to sternocleidomastoid
Supraclavicular areas in angle of clavicle and sternocleidomastoid
other lymph areas
Axillae
Epitrochlear lymph nodes
Inguinal and popliteal lymph nodes
Spleen
Infants and Children exam
Technique of examination is similar for all ages.
Enlarged lymph nodes are common.
Shotty (firm and mobile) lymph nodes are common.
Enlarged tonsils common, not necessarily abnormal until after age 7 years
Supraclavicular lymph nodes are always worrisome for malignancy.
Acute lymphangitis
Inflammation of one or more lymphatic vessels
Causes red streaking from infection site toward heart
Acute suppurative lymphadenitis
Infection and inflammation of a lymph node
May affect a single or localized group of nodes
Lymphedema
Edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
Lymphangioma/cystic hygroma
Congenital malformation of dilated lymphatics
Lymphatic filariasis (elephantiasis)
Massive accumulation of lymphedema throughout the body
Most common cause of secondary lymphedema worldwide
Epstein-Barr virus mononucleosis
Infectious mononucleosis
Non-Hodgkin lymphoma (NHL)
Malignant neoplasm of the lymphatic system and the reticuloendothelial tissues
Hodgkin disease
Malignant lymphoma
Toxoplasmosis
Zoonosis, caused by the parasite Toxoplasma gondii
Roseola infantum (HHV-6)
Infection by human herpes virus-6
Herpes simplex (HSV)
Infection by human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2)
Cat scratch disease
Common causes of subacute or chronic lymphadenitis in children
HIVAIDS
Dysfunction of cell-mediated immunity
Serum sickness (type III hypersensitivity reaction)
Immune complex disease
Latex allergy type IV dermatitis
Delayed hypersensitivity
Latex allergy type I reaction
True allergic reaction caused by protein antibodies
Which is the function of the thymus in early life?
Protect immune function
Drain lymph from the chest
Destroy old white blood cells
Filter white blood cells
ANS: A
Rationale: In early life, the thymus is essential to the development of the protective immune function.
Which organ does NOT have lymphatic vessels?
Brain
Intestine
Bone marrow
Lungs
ANS: A
Rationale: Lymphatic tissues are found abundantly throughout the body except in two places: the placenta and the brain (central nervous system).
Small, clustered lymphoid nodules that are raised areas of lymph tissue are called:
Adenoids
Thymus
Peyer patches
Spleen
ANS: C
Peyer patches are small, raised areas of tissue on the surface of the small intestine and consist of many clustered lymphoid nodules.
Enlarged, painful lymph nodes, firm and tender, with mild edema, caused by group A beta-hemolytic streptococci is:
Acute suppurative lymphadenitis
Lymphatic filariasis
Lymphangioma
Lymphedema
ANS: A
Rationale: Infection and inflammation of the lymph node from group A beta-hemolytic streptococci can cause enlarged, painful lymph nodes. This is referred to as acute suppurative lymphadenitis.
