Day 1 Flashcards
Global swelling indicates
Kidney, heart, and liver problems
What is the main purpose of the lymphatic system?
Drain substances that cannot be drained/reabsorbed by the blood system.
What are commonalities between circulatory and lymphatic systems?
- Protect the body from infection and disease
- Superficial & deep organ systems
- Leukocytes
- Blood plasma
- Serum proteins
- Common pathway to heart
Circulatory and lymphatic system differences
- No central pump (lymphatic system is innervated by sympathetic part of ANS)
- Lymph transport is interrupted by lymph nodes
What is edema?
- Accumulation of water in tissues
- Symptom
- Caused by dynamic insuffancy of lymphatic system
What is lymphedema?
- Amnormal accumulation of water and protein
- Disease process
- Mechanical insuffancy of lymphatic system
What are lymphatic loads made of?
Water
Protein
Cells
Long-chain fatty acids (Fat)
How many liters are returned to venous system via the thoracic duct in 24 hours
2-4 Liters
It is the responsibility of the lymphatic system to remove what from the tissue spaces?
Proteins
What can not be absorbed by the blood vessels of the small intestines?
Long-chain fatty acids
Lymphatic loads/cell fragments include
- All cells that become free in the interstitial space
- Hematoma contents, RBC, WBC, CA cells, bacteria, viruses, and tattoo ink (90-95%)
- Inhaled spores
- Cell fragments too large to be reabsorbed by venous capillaries
If mechanical insuffancy is not treated what happens?
Lymphedema continues to progress
Initial lymph capillaries are where
Plexus
Lymph collectors are located where?
Suprafascial fatty tissue
Each lymph capillary endothelial cells is connected to surrounding interstitial tissue via what
Anchoring filaments
Locations of perforating precollectors
Parasternal
Paravertebral
Intercostal
Purpose of lymphatic collectors
Transport lymph to regional lymphatic nodes and lymphatic trunks
Which part of the nervous system innervated the smooth muscles?
Sympathetic portion of the autonomic nervous system (ANS)
3 main regional lymph nodes
Axillary, inguinal, and cervical
What makes up the femoral lymph node borders (femoral triangle)?
Inguinal ligament, sartorius muscle, and gracilis muscle
How many inguinal lymph nodes are there?
6-12
What skin areas drain to inguinal lymph nodes?
Legs
Lower body quadrants
External genitalia of men and women (penis and scrotum or external labia)
Where are axillary lymph nodes located
Between pectoralis and latissimus dorsi
How many axillary lymph nodes are there?
12(10)-24
Where is the upper horizontal watershed?
Sternal notch - clavicle - acromion - spine of scapula - between c7/t2
Where is the lower horizontal watershed?
Umbilicus - lower boarder of ribs - to t12
Where is the sagittal watershed?
Midline dividing body from L to R - vertex to the perineum
What are intra-territorial anastomosis
Connections between collectors within the same territory
What are inter-territorial anastomoses
Anastomoses where the collector’s origins directly align with each other at the watersheds
How many collectors for every anastomoses?
7-10
What are the 6 anastomoses?
AAA: Anterior Axillo-axillary AII: anterior inter inguinal AI or IA: right or left axillo-inguinal or inguinal-axillary (only on front side) PAA: posterior Axillo-axillary PII: posterior inter inguinal
Where is the cisterna chyli
Anterior to vertebrae T11-L2
What makes up the venous angle (R or L)?
Internal jugular and subclavian veins
The lymph from lumbar trunks feeds into what?
Cisterna chyli
How much lymph goes through the R lymphatic duct in 24 hours
300ml (soda can)
What drains into L venous angle?
Lower extremities, bil lower quadrants, external genitalia, L upper quadrant, LUE, L side face/head/neck
What drains into the R venous angle?
R upper quadrant, RUE, R face/head/neck
What are the boarders of deep cervical lymph nodes/lateral cervical triangle
Anterior boarder: SCM
Posterior boarder: upper trapezius
Inferior boarder: clavicle
Where does the upper extremity have a bottle neck?
Antecubital fossa
What lymph nodes do the upper extremity drain into?
Axillary and supraclavicular lymph nodes
Ventro-medial bundle is where?
15 collectors;
Drains plantar surface of feet, 1/2 medial sole, dorsum of foot, lower leg, bottlenecks behind medial femoral condyle, and increases to run to inguinal lymph nodes
Dorsi-lateral bundle is where?
1/2 sole of foot, heel, and narrow strip following Achilles to popliteal fossa
What options do you have to re-route lymph?
Utilize lymph collectors in affected area, plexus, lymphatic vasa-vasorum, anastomoses, deep lymph vessels
What are the general effects of MLD?
Increase lymph production Increase lymphangiomotorocity Increase in venous return Reverse of lymph flow Soothing Analgesic
What are neck contraindications (absolute)?
Carotid endoarterectomy Hyperthyroidism/thyroid problems Carotid-sinus syndrome History of CVA Cardiac arrhythmia
