Lecture 5 LOs Flashcards
Describe the components of the lymphatic system
-Organized lymph tissue-spleen-location?
- Located between ribs 9, 10, and 11th ribs on the left side
- Between left hemi-diaphragm and peritoneal cavity
Describe the components of the lymphatic system
-Organized lymph tissue-spleen-movement of the diaphragm is important for?
Movement of the diaphragm is important for the homeostatic movement of splenic fluids
Describe the components of the lymphatic system
-Organized lymph tissue-spleen-Functions?
- Destroys deformed/damaged RBCs
- Synthesizes immunoglobulins
- Clearance site for:
- Antigens, microorganisms, and poorly organized bacteria
Describe the components of the lymphatic system
-Organized lymph tissue-liver?
- Half of the body’s lymph is formed here
- Pressure sensitive organ
- Affected by the muscular action of the thoraco-abdominal diaphragm
- The liver is the “gate-keeper” of the shared hepato-biliary-pancreatic venous and lymphatic region
- Also clears bacteria
Describe the components of the lymphatic system
-Organized lymph tissue-thymus-location?
- Located in the superior mediastinum
- Anterior to great vessels
- Extends into the neck
Describe the components of the lymphatic system
-Organized lymph tissue-thymus-when is it largest?
- Largest in infants (age 2)
- After puberty-involutes
- Adults-replaced by fatty tissue
Describe the components of the lymphatic system
-Organized lymph tissue-thymus-function?
- Provide cells involved in maturation of immune system
- Processing site T cells
- Little or no function in adult
Describe the components of the lymphatic system
-Organized lymph tissue-tonsils?
- Multiple areas in ring formation in posterior oropharynx
- Palatine-lateral pharynx
- Lingual-posterior 1/3rd of tongue
- Pharyngeal-adenoids at nasopharyngeal border
Describe the components of the lymphatic system
-Organized lymph tissue-tonsils-function?
- Provide cells to influence and build immunity early in life
- Non-essential to adult immune function
Describe the components of the lymphatic system
-Organized lymph tissue-appendix?
- Located at the medial surface of the cecum
- Exact function unknown
- Presume it offers support to immune system
Describe the components of the lymphatic system
- Organized lymph tissue-Visceral lymphoid tissue-GI:
- 2 components?
- Location of each component?
- Peyer’s patches-distal ilium
- Lacteals-lymphatic capillaries in each villi in small bowel
- Fats enter circulation via GI system
Describe the components of the lymphatic system
-Organized lymph tissue-Visceral lymphoid tissue-pulmonary-function?
-Aids filtration of toxins from lungs
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes?
- MOST HIGHLY ORGANIZED LYMPH TISSUE
- Dispersed along the course of lymph vessels
- Primary purpose is for filtration of lymph
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes-Two types?
- Superficial
- Deep
Describe the components of the lymphatic system
- Organized lymph tissue-Lymph nodes-superficial-location?
- Receive?
- Follows subcutaneously with superficial veins
- Receive (lymph?) from skin/deep tissues off upper and lower extremities/head and neck
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes-superficial-drain into 3 main groups of nodes (from extremities into the core)?
- Cervical
- Axillary
- Inguinal
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes-superficial-cervical drains?
head/supraclavicular and upper extremity extremity drain to jugular nodes
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes-superficial-axillary drains?
Infraclavicular to umbilicus, drain to axillary nodes and then to subclavian
Describe the components of the lymphatic system
-Organized lymph tissue-Lymph nodes-superficial-inguinal drains?
Caudal to umbilicus drain to inguinal nodes and then lumbar
Superficial LNs in head/neck?
Submental, Virchow’s
Superficial LNs in abdomen?
Cisterna chyli, celiac
Superficial LNs in upper extremity?
Deltopectoral, axillary, cubital
Superficial LNs in lower extremity?
superficial inguinal, popliteal
Deep LNs-general location?
Beneath fascia and muscles, follows deep veins
Describe the components of the lymphatic system
-Lymph channels/collecting duct-Perfuses all tissues of the body except?
- CNS (although new research indicates it does have lymph vessels)
- Epidermis (includes hair and nails)
- Endomysium of muscles and cartilage
- Bone marrow
- Selected portions off peripheral nerves
- Exceptions still possess direct diffusion
Lymph channels/collecting duct
-Where do they run?
They follow the course of deep and superficial veins
Describe the components of the lymphatic system
-Lymph fluid?
-Substance that leaks out of arterial capillaries, into the interstitium and into single-cell lymphatic vessels
Describe the components of the lymphatic system
-Lymph fluid components?
-Proteins, salts, fats, lymphocytes (primary cell), clotting factors, large particles (bacteria, viruses)
Structure of the lymphatic system?
- Unidirectional fluid flow in channels
- Flow controlled by one-way valves
- Channels/nodes surround major organs and vasculature
- Unite with thoracic duct or right lymphatic duct
Location of some important nodes
-Why is the location of these nodes important?
Because we can easily access these nodes and treat them with OMT
Locations of some important nodes
-Tip?
When evaluating any swollen LNs, look for any cuts, bites etc in the area:
-Could tip you off to a local reaction vs a systemic issue
Locations of some important nodes
-Virchow’s node?
Located in the supraclavicular region on the left side, it is associated with any intra-abdominal or thoracic carcinoma/cancer
Lymph drainage-thoracic duct
- Size?
- Location?
- Largest lymph vessel
- Lies against vertebral column between aorta and azygous vein
- At the level of T4 moves left of midline and connects to the junction of the subclavian and left brachiocephalic veins
Lymph drainage
-Thoracic duct-Drains?
- Left side of head and neck
- Left arm
- Left side of thorax
- Left and right LOWER body
- Viscera of thoracic
Lymph drainage
-Cisterna chyli
- Dilation of distal thoracic duct
- Anterior to L1-2 and posterior to right crura of diaphragm
Lymph drainage
-Right lymphatic duct drains?
- Right head and neck
- Right arm
- Right chest
Lymph drainage
-Right lymphatic duct connects to?
-The right lymphatic duct connects to the venous system at the jugular-subclavian junction
Lymph drainage-Common characteristics of both vessels?
- Each duct has one-way valves preventing backflow into lymphatic system
- Larger vessels have smooth muscle
- Under sympathetic control
- Stress increases sympathetic tone which causes tissue congestion
Name the functions of the lymphatic system
- Fluid balance
- Purification and cleansing
- Defense
- Nutrition
Describe the functions of the lymphatic system
-Fluid balance?
- 50% of plasma proteins re-enter system via lymph
- This system can absorb some excess fluid from pleura, peritoneum, pericardium, and joints (excess of 3L/24hrs)
- Large proteins can enter lymphatic system
- Aids in homeostasis in fluid in fluid overload situation
Describe the functions of the lymphatic system
-Purification and cleansing?
- Lymph fluid bathes all organs
- This cleanses extracellular spaces of particulate matter, exudate, and bacteria
- Fluid is delivered to the the node
- Node acts as a purifying filter for removal
Describe the functions of the lymphatic system
-Defense?
- Lymph fluid brings toxins, bacteria, viruses, into contact with lymphatic system
- How acquired immunity begins
- Free flowing of lymph is necessary for good immune function
Describe the functions of the lymphatic system
-Nutrition?
- Lymph returns proteins back to vascular system
- Proteins bind to nutrients
- Fats are absorbed via lymph system
Describe the mechanics of lymph flow
-Interstitial fluid pressure-Normal=?
-6.3
Describe the mechanics of lymph flow
- Interstitial fluid pressure-increase in pressure will result in?
- Efficiency ceiling=?
- Above the efficiency ceiling?
- An increase in pressure will result in an increase in flow
- Efficiency ceiling=0 mmHg
- Above the efficiency ceiling (0 mmHg) will collapse the vessels and obstruct flow
Describe the mechanics of lymph flow
-Interstitial fluid pressure-increased by?
- Increased arterial capillary pressure (HTN)
- Decreased plasma colloidal osmotic pressure (hepatic cirrhosis)
- Increased interstitial fluid protein (starvation/plasma hypoalbuminemia)
- Increased capillary permeability (toxins = rattlesnake poisoning)
Lymphatic pump
-Intrinsic pump-Distension of larger vessels triggers?
- Distension of larger vessels triggers constriction of smooth muscle
- Pumps fluid to next segment (one-way valves)
Lymphatic pump
-Intrinsic pump-smaller vessels?
-Endothelial cells have contractile fibers that respond to distension
Lymphatic pump
-Intrinsic pump?
- The contraction causes causes pressure gradients to help move fluid
- For example, the aortic pulse can act on the lymphatic ducts and help the lymph move through
Lymphatic pump
-Extrinsic pump?
- Direct pressure on vessels moves lymph
- Internally exerted pressure will increase flow
- Thoracic diaphragm
- Pelvic diaphragm
Lymphatic pump
-Extrinsic pump-Thoracic diaphragm?
- Crura acts on cisterna chyli
- Respiration produces pressure gradients between thorax and abdomen
- Pressure gradients and one-way valves pull lymph toward venous circulation
Lymphatic pump
-Extrinsic pump-pelvic diaphragm?
- Synchronous with the abdominal diaphragm
- Movement of interstitial fluids from pelvis
Lymphatic pump-Extrinsic pump
-Important in several situations?
- Dysmennorrhea
- Preparation for labor and delivery
- Prostate irritation in benign prostatic hypertrophy and other prostate problems
Describe the consequences of a poorly functioning lymphatic system
-Edema-build up of interstitial fluid
Describe the consequences of a poorly functioning lymphatic system
- Effects of edema?
- Chronic states?
- Compression of lymph vessels and neurovascular structures
- Tissue congestion
- Fluid stasis changes pH of tissue/organ
- Chronic states have fibroblasts leaving fibrotic structures
- Decreased delivery of nutrients
- Decreased bioavailability of drugs and hormones
Describe the consequences of a poorly functioning lymphatic system
-Fluid stasis changes pH of tissue/organ resulting in?
-Altered function
Describe the consequences of a poorly functioning lymphatic system
-Chronic states have fibroblasts leaving fibrotic structures-what is this called?
-Fibrotic contractures
Describe the consequences of a poorly functioning lymphatic system
-Results from?
- Too much fluid flowing into interstitium
- Too little fluid flowing into the interstitium
- Increase of interstitial pressure causes collapse of lymph capillaries
Describe the consequences of a poorly functioning lymphatic system
- Results from too much fluid flowing into interstitium
- Examples?
- High venous pressure conditions:
- Congestive heart failure, incompetent heart valves, venous obstruction, gravitational effects
Describe the consequences of a poorly functioning lymphatic system
- Results from too little fluid flowing out of the interstitium
- Examples?
- Conditions that decrease osmotic pressure gradients:
- Starvation, cirrhosis of liver, abnormal protein metabolism
Describe the consequences of a poorly functioning lymphatic system
- Results from increase of interstitial pressure causes collapse of lymph capillaries
- What does this cause?
- Further interstitial congestion and edema
- Dilation of vessels spreads endothelial cells
- Stops intrinsic pump
Describe the principles of OMT for the lymphatic system
-Goal?
- To have a balanced, well-functioning lymphatic system in which no edema occurs
- Goal of lymphatic OMT is to mobilize lymph
Describe the principles of OMT for the lymphatic system
-General-what type of system is the lymphatic system?
The lymphatic system is a passive system
Describe the principles of OMT for the lymphatic system
* **-Where do you start treatment?***
- What major structures are here?
- What is the purpose of starting here?
- It is CRITICAL to start at the level of the thoracic duct-thoracic inlet
- The junction of the duct and the left subclavian/brachiocephalic vein
- Release fascial restrictions that may impede lymph flow into venous system
Describe the principles of OMT for the lymphatic system
-Treatment sequence?
- In general, you start from the drain (centrally) and work your way out distally (peripherally, i.e. unclog the sink)
- Always return centrally to the thoracic duct-thoracic inlet
Describe the principles of OMT for the lymphatic system
-Areas of treatment (1-5)?
- Area 1-thoracic
- Area 2-abdomen
- Area 3-upper extremity
- Area 4-lower extremity
- Area 5-head and neck
Describe the principles of OMT for the lymphatic system
-Sequence of treatment in a total body lymphatic treatment?
- Thoracic inlet
- Area 1-thoracic
- Area 2-abdomen
- Areas 3 and 4-arms then legs or legs then arms depending on which is the most needy of lymphatic treatment
- THORACIC INLET-ALWAYS RETURN TO THE THORACIC DUCT TO RE-TREAT
Describe the contraindications of lymphatic treatments
- Early carcinoma/metastatic cancer
- Osseous fracture
- Acute bacterial infection with temp > 102 degrees F
- Acute hepatitis
- Infectious mononucleosis
- Circulatory disorders
- Coagulopathies
- Anuria
Describe the contraindications of lymphatic treatments
-Acute bacterial infection with temp > 102 degrees F
- Antibiotics should be implemented first to reduce the chance of causing septic spread
- Certain skin/fascia infections like necrotizing fasciitis
Describe the contraindications of lymphatic treatments
-Circulatory disorders-examples?
Venous obstruction, embolisms hemorrhage
Describe the contraindications of lymphatic treatments
-Coagulopathies
For those on anti-coagulants
Describe the contraindications of lymphatic treatments
-Anuria
Patient is not producing urine-needs dialysis
Describe the contraindications of lymphatic treatments
-Some techniques cannot be done if?
Some techniques (thoracic/abdominal pump, doming the diaphragm, etc) cannot be done if the patient cannot lay supine due to fluid overload (like in a congestive heart failure patient)
