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OS Exam 2 > Lecture 5 LOs > Flashcards

Lecture 5 LOs Flashcards

1
Q

Describe the components of the lymphatic system

-Organized lymph tissue-spleen-location?

A
  • Located between ribs 9, 10, and 11th ribs on the left side

- Between left hemi-diaphragm and peritoneal cavity

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2
Q

Describe the components of the lymphatic system

-Organized lymph tissue-spleen-movement of the diaphragm is important for?

A

Movement of the diaphragm is important for the homeostatic movement of splenic fluids

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3
Q

Describe the components of the lymphatic system

-Organized lymph tissue-spleen-Functions?

A
  • Destroys deformed/damaged RBCs
  • Synthesizes immunoglobulins
  • Clearance site for:
    • Antigens, microorganisms, and poorly organized bacteria
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4
Q

Describe the components of the lymphatic system

-Organized lymph tissue-liver?

A
  • 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
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5
Q

Describe the components of the lymphatic system

-Organized lymph tissue-thymus-location?

A
  • Located in the superior mediastinum
  • Anterior to great vessels
  • Extends into the neck
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6
Q

Describe the components of the lymphatic system

-Organized lymph tissue-thymus-when is it largest?

A
  • Largest in infants (age 2)
  • After puberty-involutes
  • Adults-replaced by fatty tissue
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7
Q

Describe the components of the lymphatic system

-Organized lymph tissue-thymus-function?

A
  • Provide cells involved in maturation of immune system
  • Processing site T cells
  • Little or no function in adult
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8
Q

Describe the components of the lymphatic system

-Organized lymph tissue-tonsils?

A
  • Multiple areas in ring formation in posterior oropharynx
  • Palatine-lateral pharynx
  • Lingual-posterior 1/3rd of tongue
  • Pharyngeal-adenoids at nasopharyngeal border
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9
Q

Describe the components of the lymphatic system

-Organized lymph tissue-tonsils-function?

A
  • Provide cells to influence and build immunity early in life
  • Non-essential to adult immune function
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10
Q

Describe the components of the lymphatic system

-Organized lymph tissue-appendix?

A
  • Located at the medial surface of the cecum
  • Exact function unknown
  • Presume it offers support to immune system
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11
Q

Describe the components of the lymphatic system

  • Organized lymph tissue-Visceral lymphoid tissue-GI:
    • 2 components?
    • Location of each component?
A
  • Peyer’s patches-distal ilium
  • Lacteals-lymphatic capillaries in each villi in small bowel
  • Fats enter circulation via GI system
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12
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Visceral lymphoid tissue-pulmonary-function?

A

-Aids filtration of toxins from lungs

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13
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Lymph nodes?

A
  • MOST HIGHLY ORGANIZED LYMPH TISSUE
  • Dispersed along the course of lymph vessels
  • Primary purpose is for filtration of lymph
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14
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Lymph nodes-Two types?

A
  • Superficial

- Deep

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15
Q

Describe the components of the lymphatic system

  • Organized lymph tissue-Lymph nodes-superficial-location?
    - Receive?
A
  • Follows subcutaneously with superficial veins

- Receive (lymph?) from skin/deep tissues off upper and lower extremities/head and neck

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16
Q

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)?

A
  • Cervical
  • Axillary
  • Inguinal
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17
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Lymph nodes-superficial-cervical drains?

A

head/supraclavicular and upper extremity extremity drain to jugular nodes

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18
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Lymph nodes-superficial-axillary drains?

A

Infraclavicular to umbilicus, drain to axillary nodes and then to subclavian

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19
Q

Describe the components of the lymphatic system

-Organized lymph tissue-Lymph nodes-superficial-inguinal drains?

A

Caudal to umbilicus drain to inguinal nodes and then lumbar

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20
Q

Superficial LNs in head/neck?

A

Submental, Virchow’s

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21
Q

Superficial LNs in abdomen?

A

Cisterna chyli, celiac

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22
Q

Superficial LNs in upper extremity?

A

Deltopectoral, axillary, cubital

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23
Q

Superficial LNs in lower extremity?

A

superficial inguinal, popliteal

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24
Q

Deep LNs-general location?

A

Beneath fascia and muscles, follows deep veins

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25
Q

Describe the components of the lymphatic system

-Lymph channels/collecting duct-Perfuses all tissues of the body except?

A
  • 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
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26
Q

Lymph channels/collecting duct

-Where do they run?

A

They follow the course of deep and superficial veins

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27
Q

Describe the components of the lymphatic system

-Lymph fluid?

A

-Substance that leaks out of arterial capillaries, into the interstitium and into single-cell lymphatic vessels

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28
Q

Describe the components of the lymphatic system

-Lymph fluid components?

A

-Proteins, salts, fats, lymphocytes (primary cell), clotting factors, large particles (bacteria, viruses)

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29
Q

Structure of the lymphatic system?

A
  • 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
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30
Q

Location of some important nodes

-Why is the location of these nodes important?

A

Because we can easily access these nodes and treat them with OMT

31
Q

Locations of some important nodes

-Tip?

A

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

32
Q

Locations of some important nodes

-Virchow’s node?

A

Located in the supraclavicular region on the left side, it is associated with any intra-abdominal or thoracic carcinoma/cancer

33
Q

Lymph drainage-thoracic duct

  • Size?
  • Location?
A
  • 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
34
Q

Lymph drainage

-Thoracic duct-Drains?

A
  • Left side of head and neck
  • Left arm
  • Left side of thorax
  • Left and right LOWER body
  • Viscera of thoracic
35
Q

Lymph drainage

-Cisterna chyli

A
  • Dilation of distal thoracic duct

- Anterior to L1-2 and posterior to right crura of diaphragm

36
Q

Lymph drainage

-Right lymphatic duct drains?

A
  • Right head and neck
  • Right arm
  • Right chest
37
Q

Lymph drainage

-Right lymphatic duct connects to?

A

-The right lymphatic duct connects to the venous system at the jugular-subclavian junction

38
Q

Lymph drainage-Common characteristics of both vessels?

A
  • 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
39
Q

Name the functions of the lymphatic system

A
  • Fluid balance
  • Purification and cleansing
  • Defense
  • Nutrition
40
Q

Describe the functions of the lymphatic system

-Fluid balance?

A
  • 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
41
Q

Describe the functions of the lymphatic system

-Purification and cleansing?

A
  • 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
42
Q

Describe the functions of the lymphatic system

-Defense?

A
  • 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
43
Q

Describe the functions of the lymphatic system

-Nutrition?

A
  • Lymph returns proteins back to vascular system
  • Proteins bind to nutrients
    • Fats are absorbed via lymph system
44
Q

Describe the mechanics of lymph flow

-Interstitial fluid pressure-Normal=?

A

-6.3

45
Q

Describe the mechanics of lymph flow

  • Interstitial fluid pressure-increase in pressure will result in?
    • Efficiency ceiling=?
    • Above the efficiency ceiling?
A
  • 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
46
Q

Describe the mechanics of lymph flow

-Interstitial fluid pressure-increased by?

A
  • 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)
47
Q

Lymphatic pump

-Intrinsic pump-Distension of larger vessels triggers?

A
  • Distension of larger vessels triggers constriction of smooth muscle
    • Pumps fluid to next segment (one-way valves)
48
Q

Lymphatic pump

-Intrinsic pump-smaller vessels?

A

-Endothelial cells have contractile fibers that respond to distension

49
Q

Lymphatic pump

-Intrinsic pump?

A
  • 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
50
Q

Lymphatic pump

-Extrinsic pump?

A
  • Direct pressure on vessels moves lymph
  • Internally exerted pressure will increase flow
  • Thoracic diaphragm
  • Pelvic diaphragm
51
Q

Lymphatic pump

-Extrinsic pump-Thoracic diaphragm?

A
  • Crura acts on cisterna chyli
  • Respiration produces pressure gradients between thorax and abdomen
  • Pressure gradients and one-way valves pull lymph toward venous circulation
52
Q

Lymphatic pump

-Extrinsic pump-pelvic diaphragm?

A
  • Synchronous with the abdominal diaphragm

- Movement of interstitial fluids from pelvis

53
Q

Lymphatic pump-Extrinsic pump

-Important in several situations?

A
  • Dysmennorrhea
  • Preparation for labor and delivery
  • Prostate irritation in benign prostatic hypertrophy and other prostate problems
54
Q

Describe the consequences of a poorly functioning lymphatic system

A

-Edema-build up of interstitial fluid

55
Q

Describe the consequences of a poorly functioning lymphatic system

- Effects of edema?
    - Chronic states?
A
  • 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
56
Q

Describe the consequences of a poorly functioning lymphatic system
-Fluid stasis changes pH of tissue/organ resulting in?

A

-Altered function

57
Q

Describe the consequences of a poorly functioning lymphatic system
-Chronic states have fibroblasts leaving fibrotic structures-what is this called?

A

-Fibrotic contractures

58
Q

Describe the consequences of a poorly functioning lymphatic system
-Results from?

A
  • Too much fluid flowing into interstitium
  • Too little fluid flowing into the interstitium
  • Increase of interstitial pressure causes collapse of lymph capillaries
59
Q

Describe the consequences of a poorly functioning lymphatic system

- Results from too much fluid flowing into interstitium
     - Examples?
A
  • High venous pressure conditions:

- Congestive heart failure, incompetent heart valves, venous obstruction, gravitational effects

60
Q

Describe the consequences of a poorly functioning lymphatic system

- Results from too little fluid flowing out of the interstitium
     - Examples?
A
  • Conditions that decrease osmotic pressure gradients:

- Starvation, cirrhosis of liver, abnormal protein metabolism

61
Q

Describe the consequences of a poorly functioning lymphatic system

- Results from increase of interstitial pressure causes collapse of lymph capillaries
    - What does this cause?
A
  • Further interstitial congestion and edema
    • Dilation of vessels spreads endothelial cells
    • Stops intrinsic pump
62
Q

Describe the principles of OMT for the lymphatic system

-Goal?

A
  • To have a balanced, well-functioning lymphatic system in which no edema occurs
  • Goal of lymphatic OMT is to mobilize lymph
63
Q

Describe the principles of OMT for the lymphatic system

-General-what type of system is the lymphatic system?

A

The lymphatic system is a passive system

64
Q

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?
A
  • 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
65
Q

Describe the principles of OMT for the lymphatic system

-Treatment sequence?

A
  • 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
66
Q

Describe the principles of OMT for the lymphatic system

-Areas of treatment (1-5)?

A
  • Area 1-thoracic
  • Area 2-abdomen
  • Area 3-upper extremity
  • Area 4-lower extremity
  • Area 5-head and neck
67
Q

Describe the principles of OMT for the lymphatic system

-Sequence of treatment in a total body lymphatic treatment?

A
  • 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
68
Q

Describe the contraindications of lymphatic treatments

A
  • Early carcinoma/metastatic cancer
  • Osseous fracture
  • Acute bacterial infection with temp > 102 degrees F
  • Acute hepatitis
  • Infectious mononucleosis
  • Circulatory disorders
  • Coagulopathies
  • Anuria
69
Q

Describe the contraindications of lymphatic treatments

-Acute bacterial infection with temp > 102 degrees F

A
  • Antibiotics should be implemented first to reduce the chance of causing septic spread
  • Certain skin/fascia infections like necrotizing fasciitis
70
Q

Describe the contraindications of lymphatic treatments

-Circulatory disorders-examples?

A

Venous obstruction, embolisms hemorrhage

71
Q

Describe the contraindications of lymphatic treatments

-Coagulopathies

A

For those on anti-coagulants

72
Q

Describe the contraindications of lymphatic treatments

-Anuria

A

Patient is not producing urine-needs dialysis

73
Q

Describe the contraindications of lymphatic treatments

-Some techniques cannot be done if?

A

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)

OS Exam 2 (1 decks)

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