Lecture 3: Lymphatic Lecture Flashcards
What are the three anatomic components of the lymphatic system?
Lymph fluid
Lymphatic vessels
Lymphatic organs
What are lymphatic organs or tissues?
Spleen Liver Thymus Tonsils Appendix Visceral lymphoid tissue Lymph nodes
What is the physiologic function of the lymphatic system?
Plays a major role in homeostatic mechanisms of: Immune system Digestive system Fluid balance Waste
What is embryological layer do most lymph tissue arise from?
What are the exceptions?
Mesoderm
Thymus and part of tonsils from endoderm
What is the role of lymphatic function?
Maintain fluid balance
Tissue cleaning/purification
Defense
Nutrition
How does the lymph fluid purify and cleanse the body?
Cleanses extracellular spaces
-gets rid of toxins, bacteria, waste products, etc
Where does lymph fluid travel to from the vessel?
What is the function of this structure?
Travels to lymph node, which acts as a purifying filter
Describe lymph nodes.
Contains high concentrations of immune cells to combat toxins, bacteria, waste products, etc from lymph fluid
How does the lymphatic system play a role in fat absorption?
Chylomicrons travel via lacteals into larger lymph vessels, thoracic duct, and eventually venous system
What tissues do not have lymph tissue?
Epidermis
Endomysium of muscle
Cartilage
Bone marrow
In what direction do lymph travels?
- Collecting vessels
- Afferent lymph vessels
- Lymph nodes
- Efferent vessels
- Lymphatic trunks
- Thoracic duct or right lymphatic duct
- Venous system
Where does lymph formation begin?
Interstitial space of tissues w/ initial lymphatics
- lined by leaky endothelium
- coalesce into collecting vessels
What are collecting vessels primarily made up of?
Lymphangions: chains of muscular units possessing a bicuspid valve
Where are superficial lymph nodes found?
Within subcutaneous tissue
Ex: cervical, axillary, and inguinal
Where are deep lymph nodes found?
Beneath fascia, muscle, and organs
What is the pathway of lymph through a lymph node?
- Afferent lymphatics
- Subscapular space
- Outer cortex: rich in B cells
- Deep cortex: rich in T cells
- Medullary sinus: rich in B cells
- Efferent lymphatics
From where does the lumbar lymphatic trunk drain?
Lower limbs and pelvic organs
From where does the intestinal lymphatic trunk drain?
Abdominal viscera
From where does the bronchomediastinal lymphatic trunk drain?
Portions of thorax
From where do the subclavian lymphatic trunk drain?
Upper limbs
From where do the jugular lymphatic trunk drain?
Portions of neck and head
What is cisterna chyli?
Drains lymphatic trunks of lower body and gives rise to thoracic duct
-Level of L1/L2
What is the function of the thoracic duct?
Receives all drainage from the body except right upper portion
What does the right lymphatic duct drain?
Right head/neck Right UE Right thorax Heart Lungs (except LUL)
What is Virchow’s node?
left-sided supraclavicular lymph node
Where is the spleen?
Beneath ribs 9-11 on the left
What is the function of the spleen?
Destroys damaged/deformed RBC
Synthesizes immunoglobulins
Clear bacteria
Where is the liver?
Right Upper Quadrant of abdominal area
What is the lymphatic function of the liver?
Half of lymph formed
Clears bacteria
Where is the thymus?
Anterior mediastinum
What is the function of the thymus?
Maturation site for T-cells in children
Where are the tonsils?
Palatine: lateral pharynx
Lingual: posterior portion of tongue
Pharyngeal: adenoids at nasopharyngeal border
What is the function of tonsils?
Helps build immunity early in life
Where is the appendix?
Proximal end of large intestine
What is the function of appendix?
Part of gut-associated lymphoid tissue (GALT)
What is GALT?
Lymphoid tissue which works in the immune system to protect the body from invasion in the gut
What is the normal interstitial fluid pressure of lymph vessels?
-6.3 mmHg (negative)
What happens if interstitial fluid pressure of lymph vessels is positive?
Lymph capillaries collapse and flow stops
How does increased sympathetic tone effect lymph nodes?
Tighter valves, meaning less flow into venous system
How does increased sympathetic tone effect lymphatic smooth vessels?
Less peristalsis and more lymphatic congestion
What is a major symptom of a poorly functioning lymphatic system?
Edema
What are some systematic effects of edema?
- Decreased delivery of oxygen, nutrients, hormones, etc
- Decreased sensation and pain
- Shortness of breath*
- Decreased tissue waste removal
- Decreased pathogen clearance and immunity
What is the goal of OMT when treating lymphatic system?
Balanced, well-functioning system (no edema)
- Remove any impediments
- Enhance respiratory-circulatory homeostasis
- Augment flow of lymph and immune system elements
- Help decongest local tissues
What are some indications for lymphatic OMT?
Lymphatic congestion (edema) Minor CHF Upper/lower respiratory infections Asthma COPD Sprains/strains Pregnancy
What are absolution contraindications of lymphatic OMT?
Anuria: Failure of the kidneys to produce urine
Necrotizing fasciitis
Patient cannot tolerate or refused treatment
What are relative contraindications of lymphatic OMT?
Inability to tolerate excessive preload COPD Acute asthma exacerbation Unstable cardiac conditions Untreated coagulopathies or patients on anticoagulants Cancer Osseous fracture Bacterial or chronic infections Diseased organ Pregnancy Circulatory disorders
What are the principles of diagnosis from a lymphatic approach?
- Evaluate risk-benefit ratio
- Evaluate fascial patterns of Zink
- Evaluate diaphragms/fascia
- Evaluate for somatic dysfunction
- Evaluate tissue congestion
What is a compensatory pattern?
Main: L/R/L/R
R/L/R/L
What are some transverse restrictors?
Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar Diaphragm
Pelvic Diaphragm
What must you always do when performing lymphatic OMT?
Thoracic inlet
