Day One - Anatomy Flashcards

1
Q

What is the most common cause of Ly in the US?

A

breast cancer surgery

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2
Q

What does lymphatic load consist of?

A

Water
Proteins
Cells
Fat (long chain fatty acids)

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3
Q

What are characteristics of proteins?

A

macromolecues
hydrophilic - attract water
too large to be reabsorbed by blood capillaries

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4
Q

What are characteristics of long chain fatty acids?

A

> 16 carbon atoms
re-synthesized by body into chylomicrons
cannot be absorbed by the blood vessels (too large)

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5
Q

Where are chylomicrons absorbed?

A

in the digestive system

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6
Q

What are characteristics of short chain fatty acids?

A

< 16 carbon atoms

reabsorbed by venous blood capillaries of the small intestine

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7
Q

All cells that become free in the interstitial space will become…

A

lymphatic load

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8
Q

What percentage of lymphatic load is water?

A

96%

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9
Q

True or false: Most lymphedema cases involve the deep LS

A

False - most involve the superficial LS

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10
Q

What is the start of the lymphatic system?

A

initial lymph capillaries

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11
Q

Initial lymph capillaries cover the entire body surface to form the…

A

initial lymph vessel plexus

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12
Q

What are some characteristics of lymphatic collectors?

A
  • have well developed muscular walls
  • located in the superficial fatty tissue
  • are suprafascial
  • can regenerate/repair
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13
Q

What is the purpose of lymphatic collectors?

A

transport lymph to regional lymph nodes and lymphatic trunks

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14
Q

Which part of the nervous system innervates the smooth muscles?

A

sympathetic portion of the ANS

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15
Q

The inherent contraction of a lymphangion is _________ per minute. With MLD, the contraction can increase to ________ per minute.

A

10-12

60

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16
Q

What are the 3 groups of regional lymph nodes?

A
  • axillary
  • inguinal
  • cervical
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17
Q

Inguinal lymph nodes are located in the…

A

medial femoral triangle

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18
Q

What form the borders of the medial femoral triangle?

A
  • inguinal ligament (superior)
  • gracilis (medial)
  • sartorius (lateral)
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19
Q

What are the skin drainage areas of the inguinal lymph nodes?

A
  • legs
  • lower body quadrants
  • external genitalia
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20
Q

What is the inguinal lymph node pathway?

A

perforate fascia below inguinal ligament –> pelvic lymph nodes –>
lumbar lymph nodes –> lumbar trunks –> cysterna chyli –> thoracic duct –> left venous angle

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21
Q

Where are the bulk of the axillary lymph nodes located?

A

between the pectoralis and latissimus dorsi muscles

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22
Q

The efferent vessels from the axillary lymph nodes converge to form the…

A

subclavian trunk

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23
Q

What skin areas do the axillary lymph nodes drain?

A
  • upper quadrants

- upper extremities

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24
Q

Describe the pathway of lymph fluid to the left venous angle.

A

LEs to inguinal lnn — under inguinal ligament to the pelvic lnn — lumbar lnn — (R) and (L) lumbar trunks — gastrointestinal trunk — cisterna chyli —thoracic duct — left venous angle

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25
What do the lumbar trunks drain?
- lower extremities - lower body quadrants - external genitalia
26
What forms the cysterna chyli?
- both lumbar trunks (R and L) | - gastrointestinal trunk
27
What are characteristics of the thoracic duct?
- originates together with the cysterna chyli - represents the largest lymph trunk in the body - perforates the diaphragm with aorta - empties into the (L) venous angle
28
What is the left venous angle composed of?
- left internal jugular vein | - left subclavian vein
29
The thoracic duct empties approximately ___ of the total body lymph fluid into the left venous angle.
3/4
30
The right lymphatic duct is formed by the confluence of which trunks?
- right jugular - supraclavicular - subclavian - parasternal
31
The jugular trunk is formed by the...
efferent vessels from the internal jugular nodes
32
The internal jugular nodes empty the...
Ipsilateral head and neck
33
The supraclavicular trunk is formed by...
efferent lymph vessels of supraclavicular lymph nodes
34
The supraclavicular lymph nodes drain the
- head and neck - shoulder region - parts of the mammary gland
35
The subclavian trunk drains the...
lymph originating from the axillary lymph nodes
36
The axillary lymph nodes are responsible for draining...
- upper extremities - upper quadrants (ant and post) - majority of the mammary gland - shoulder region
37
The parasternal trunk drains...
- part of the mammary gland - parts of the pleura - diaphragm - liver - pericardium - striated musculature in chest and abdominal areas
38
Where are the axillary lymph nodes located?
- axilla (apex) - pectoralis minor (anterior border) - subscapularis (posterior border)
39
What are the five groups of axillary nerves?
- anterior (pectoral) group - posterior (subscapular) group - central group - lateral (infraclavicular) group - apical group
40
The efferent vessels from the axillary lymph nodes converge to form the...
subclavian trunk
41
Axillary lymph nodes drain the...
- upper quadrants | - upper extremities
42
Watersheds represent linear areas that separate _________.
territories
43
Name the watersheds.
- upper horizontal - sagittal/median - low horizontal/transverse - gluteal
44
True or false: Lymph collectors usually cross watersheds.
False
45
What are characteristics of lymphatic territories?
- made up of several collectors that run adjacent to each other - are responsible for draining the same body area - run towards the same group of regional lymph nodes
46
Territories of the trunk are called...
quadrants
47
Upper quadrants (territories of the trunk) drain into the...
axillary lymph nodes
48
Lower quadrants (territories of the trunk) drain into the...
inguinal lymph nodes
49
Lymph above the upper horizontal watershed drains into the...
cervical lymph nodes
50
On the extremities, lymphatic territories are called...
bundles
51
Define intra-territorial anastomoses.
Collectors within the same territory that anastomise/communicate.
52
Define inter-territorial anastomoses.
Connections between collectors of two adjacent territories. Occur where collector's origins directly align with each other at the watersheds.
53
What are the main inter-territorial anastomoses?
- AAA - anterior axillo-axillary anastomosis - AII - anterior inter-inguinal anastomosis - AI (or IA) - axillo-inguinal (or inguinal-axillary) - PAA - posterior axillo-axillary anastomosis - PII - posterior inter-inguinal anastomosis
54
Describe the pathway of lymph fluid to the left venous angle.
from LEs to inguinal lnn --> from inguinal lnn, dive under the inguinal lig to pelvic lnn (now part of deep LS) --> lumbar lnn --> lumbar trunks (GI trunk may join here - side road) --> cisterna chyli --> thoracic duct --> left venous angle
55
Where is the cisterna chyli located?
anterior to T11-L2
56
What is the "end of the track" (or terminus) of the lymphatic system?
(R) or (L) venous angles
57
The venous angles occur at the junction of what veins?
- internal jugular | - subclavian
58
The lumbar trunks are responsible for draining...
- LEs - lower body quadrants - external genitalia
59
The lumbar trunks and GI trunk converge to form the...
cisterna chyli
60
What form the borders of the parasternal trunk?
- anterior border of intercostal spaces | - parallel to mammary artery
61
Efferent vessels pass via the parasternal trunk to the...
venous angle
62
Skin areas that drain into the left venous angle include...
- LEs - both lower quadrants - external genitalia - (L) upper quadrant (ant and post) - LUE - (L) side of head/face/shoulder
63
The (L) venous angle drains ~ ______ in a 24 hour period.
2-4 L
64
Skin areas that drain into the (R) venous angle include...
- (R) upper quadrant (ant and post) - RUE - (R) head/face/shoulder
65
The (R) venous angle drains ______ in a 24 hour period.
300 mL (soda can)
66
Where are the deep cervical lymph nodes located?
lateral cervical triangle
67
What are the borders of the lateral cervical triangle?
- SCM (anterior) - upper trapezius (posterior) - clavicle (inferior)
68
The jugular chain of deep cervical lnn are located near the...
SCM muscle
69
The accessory chain of the deep cervical lnn is located near the...
upper trapezius muscles
70
The supraclavicular chain of deep cervical lymph nodes is located near the...
clavicle
71
What composes the peri-cervical lymphatic circle?
- occipital lnn - retro-auricular lnn - pre-auricular (parotid) lnn - submandibular lnn - submental lnn
72
Where are the occipital lnn located?
between the splenius capitis and skull
73
What do the occipital lymph nodes drain?
- posterior scalp - muscles and ligaments - skin of upper neck - facets of C1-3
74
Where are the retro-auricular lymph nodes located?
on the mastoid process
75
The retro-auricular lymph nodes drain...
- parietal scalp | - skin of posterior ear
76
Where are the pre-auricular (parotid) lymph nodes located?
embedded in parotid gland
77
The pre-auricular (parotid) lymph nodes drain...
- forehead - upper lid - lateral part of lower lid - skin of anterior ear
78
Where are the submandibular lymph nodes located?
- embedded in salivary glands | - posterior to mandible
79
The submandibular lymph nodes drain the...
- medial portion of lower eye lid - cheek - nose - upper and lower lip - sinuses - gums
80
What do the submental lymph nodes drain?
- middle of lower lip | - chin
81
Name the territories (bundles) of the hand.
- radial - ulnar - mesothenar - descending
82
Name the territories (bundles) of the forearm.
- radial - median - ulnar
83
All lymph collectors of the forearm converge and decrease in number at the...
antecubital fossa "bottleneck"
84
The medial upper arm territory is a continuation of the ________ that run directly to the _______.
bottleneck collectors | axillary lymph nodes
85
The medial upper arm territory is located between the _______ and _______ muscles.
biceps | triceps
86
The lateral upper arm territory drains into the _______ and ______ lymph nodes.
axillary (infraclavicular) | supraclavicular
87
The Mascagni-Sappy (MS) Pathway - cephalic bundle is important because...
explains why some people do not develop lymphedema
88
The MS pathway of the arm is present in _____ percentage of the population?
16%
89
The MS pathway is the direct connection of what bundles of the UE?
- radial forearm bundle | - lateral upper arm bundle
90
The MS pathway terminates at the...
supra or infra clavicular lymph nodes
91
Name the lower extremity bundles.
- ventro-medial bundle | - dorso-lateral bundle
92
What is the primary LE bundle for transport of lymph fluid out of the LE?
ventro-medial bundle
93
What does the ventro-medial bundle drain?
- plantar surface of the feet (met heads to distal toes) - 1/2 medial sole of foot - dorsum of foot - lower leg - lower leg to bottleneck at medial femoral condyle to inguinal lnn
94
What does the dorso-lateral bundle of the LE drain?
- lateral malleolus - 1/2 sole of foot (plantar surface - lateral) - heel area - narrow strip following achilles tendon, along calf to popliteal fossa
95
Where do the mammary glands drain?
- 3/4 into axillary nodes | - 1/4 into parasternal nodes (are not removed in breast CA sx)
96
What drains the intercostal spaces?
- para-sternal lnn - drain anterior intercostal spaces | - para-vertebral lnn - drain posterior intercostal spaces
97
Where do external genitalia of men and women drain?
- inguinal lnn
98
Where do pelvic organs drain?
- pelvic lnn
99
Which lymph vaso-vasorum do we use, clinically?
- femoral vein | - cephalic vein
100
Where is the femoral lymph vaso-vasorum located?
- medial to the sartorius
101
Where is the cephalic lymph vaso-vasorum located?
- in delto-pectoral groove
102
What can be activated to re-route lymph?
- utilize existing lymph collectors in affected area - plexus - lymph vaso-vasorum - anastomoses - deep lymph vessels (create suction effect from superficial to deep) - exercise - stretches lymph vessels/increases lymphangiomotoricity
103
What are the general effects of MLD?
- increase in lymph production by opening lymph capillaries - increase lymphangiomotoricity by stimulating smooth mm - reverse of lymph flow through anastomoses towards healthy side - increase in venous return - soothing - analgesic effect
104
What are the absolute contraindications for neck MLD?
- carotid endoarterectomy - medicated thyroid dysfunction - carotid-sinus syndrome - history of CVA or multiple TIA - cardiac arrhythmia
105
True or False. Age > 60 is an absolute contraindication to neck MLD.
False. It is a relative contra-indication.