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ECOS II Midterm > Lympathics > Flashcards

Lympathics Flashcards

1
Q

What are the three components of the lymphatic system?

A

Lymph fluid, vessels and organized lymphatic tissues/organs (spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue, LNs)

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2
Q

What is the physiologic function of the lymphatic system?

A

Major role in numerous homeostatic mechanisms of the body

Immune, digestive, fluid balance, waste

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3
Q

Describe lymphatic development

A

Begins during 5th week of gestation

Significant presence by 20 weeks

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4
Q

Describe lymphoid tissue during development

A

Immature at birth
Increases until 6-9 years
At puberty immune system matures but lymphoid tissues slowly degrees until 15-16 years

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5
Q

What is the function of the lymphatic system?

A

Maintain fluid balance, tissue cleansing/purification defense and nutrition

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6
Q

Describe fluid balance

A

30 L of fluid move from capillaries to interstitial space each day
90% to venules; 10% to lymphatic system
1/2 of diffused plasma proteins re-enter system via lymph

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7
Q

When fluid overload occurs the lymphatic system helps prevent tissue damage by doing what?

A

Clearing the excess

Second/third spacing

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8
Q

Describe purification and cleansing

A

Lymph fluid bathes organs
Cleanses extracellular spaces of particulate matter, toxins, bacteria, cellular waste products and post injury biochemical by products
Fluid then travels via lymphatic vessels -> LN (acts as purifying filter)

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9
Q

Describe the defense function

A

Lymph fluid brings toxins, bacteria and viruses into contact with the organized lymph tissue (LNs)
Contain high concentrations of immune cells, Ag processing and presentation, maturation of the immune cells -> immunity
Free flow of lymph necessary for appropriate immune function

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10
Q

Describe the nutrition function of lymph

A

Fat absorption via chylomicrons
Too big to cross capillary intercellular junctions
Travel via lacteals -> larger lymph vessels -> thoracic duct -> venous system
Returns proteins to vasculature
Proteins then bind nutrients

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11
Q

What is lymph fluid?

A

Substances that leak out of the arterial capillaries into the interstitium get taken up by the lymphatic capillaries (fluids, proteins, electrolytes, and cells)
Immune cells, foreign Ags, bacteria and viruses, clotting factors, chylomicrons post prandial

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12
Q

Which tissues do not have lymphatic vessels?

A

Epidermis (including hair and nails), endomysium of muscle, cartilage and bone marrow

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13
Q

What is the pathway of lymphatic vessels?

A

Terminal lymphatics -> collecting vessels -> afferent lymph vessels -> LNs -> efferent lymph vessels -> lymphatic trunks -> thoracic or right lymphatic duct -> venous system

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14
Q

What are terminal lymphatics?

A

Lymph formation begins in the interstitial space of tissues with initial lymphatics/terminal lymphatic/lymph capillaries
Lined by leaky endothelium anchored to ECM by small filaments
-endothelial cells overlap creating one way valves; lack smooth muscle walls
Terminal lymphatic coalesce into collecting vessels

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15
Q

What are collecting vessels?

A

Consists primarily of chains of muscular units called lymphangions which posses two leaflet bicuspid valves (lymphatic hearts)
Contract regularly throughout the lymphatic system and moving lymph in peristaltic waves
Contain smooth muscle

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16
Q

Describe LNs

A

Dispersed along the course of lymph vessels
Two types - superficial (within subcutaneous tissue) or deep (beneath fascia, muscles, organs)
Function: filtration of lymph fluid, maturation of lymphocytes and phagocytosis of bacteria/cellular debris

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17
Q

What is the path of lymph flow through a LN?

A

Afferent lymphatic -> subscapular space -> outer cortex (B cells)-> deep cortex (T cells) -> medullary sinus -> efferent lymphatics

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18
Q

What are the 5 lymphatic trunks?

A

Lumbar, intestinal, bronchomediastinal, subclavian and jugular

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19
Q

What do lumbar trunks drain?

A

Lymph from lower limbs and pelvic organs

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20
Q

What do intestinal trunks drain?

A

Abdominal viscera

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21
Q

What do bronchomediastinal trunks drain?

A

Portions of thorax

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22
Q

What does the subclavian trunk drain?

A

Upper limbs

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23
Q

What does the jugular trunk drain?

A

Portions of neck and head

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24
Q

What are cisterna chyli?

A

Located at level of L1-2
Drains lymphatic trunks of the lower body
Gives rise to thoracic duct

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25
Describe the thoracic duct
Origin: cisterna chyli as a dilation at L1-2 level Termination: pierces Sibson’s fascia at superior inlet, U turns to empty into L subclavian and L internal jugular veins
26
What is the function of the thoracic duct?
Master lymph vessel and drains L head and neck, LUE, L thorax/abdomen, everything inferior to umbilicus, receives from lumbar lymphatics
27
Describe the right lymphatic duct
Origin: from the junction of R jugular and subclavian trunks (and occasionally the bronchomediastinal trunk) Termination: empties at R subclavian/R internal jugular venous junction
28
What does the right lymphatic duct drain?
R head/neck, RUE, R thorax, heart and lungs (except LUL)
29
Describe locating/evaluating LNs
Size/shape/consistency/tenderness/mobility/color/warmth
30
Describe Virchow’s node
L supraclavicular | Indicates intra-thoracic or abdominal cancer
31
What do swollen epitrochlear nodes indicate?
Secondary syphilis
32
Describe the spleen
Beneath ribs 9-11 on the left Normally not palpable Largest single mass of lymphoid tissue Pressure-sensitive (movement of diaphragm drives splenic fluid movement)
33
What are the functions of the spleen?
Destroy damaged/deformed RBCs Synthesize immunoglobulins Clear bacteria
34
Describe the liver
``` RUQ; palpable at R costal margin Pressure sensitive (movement of the diaphragm is important for the homeostatic movement of hepatic fluids) ```
35
What is the lymphatic function of the liver?
Half of body’s lymph is formed here Clears bacteria Gate keeper of the shared hepato-biliary-pancreatic venous and lymphatic drainage
36
Describe the thymus
Located at anterior mediastinum | Development: large in infancy and size peaks at 2 y/o; after puberty involuted and replaced by fatty tissues
37
What is the function of the thymus?
Maturation site for T cells | Little or no function in adult
38
Describe the tonsils
3 types and all located in posterior oropharynx Palatine (lateral pharynx) Lingual (posterior 1/3 tongue) Pharyngeal (adenoids at nasopharyngeal border) Most are not visible until 6-9 m/o; remain enlarged through childhood
39
What is the function of the tonsils?
Provide cells to influence and build immunity early in life | Non essential to adult immune function
40
Describe the appendix
At the proximal end of the cecum (LI) Contains lymphoid pulp (lymphoid tissue atrophies with age) Part of the GALT
41
What is GALT?
GI associated lymphoid tissue Peyer’s patches in the ileum Lacteals in the SI Pulmonary lymphoid tissue scattered, filters toxins from lungs
42
Describe interstitial fluid pressure (Pif)
Normally -6.3 mmHg (negative pressure system) Pressure >0 mmHg = lymphatic capillaries collapse, flow ceases Causes include increased hydrostatic pressure, decreased plasma colloid osmotic pressure, increased capillary permeability Smooth muscle contraction within walls of large lymph vessels -> pressure gradients -> peristalsis
43
Describe direct diaphragmatic pressure in the thoracic diaphragm
With each breath contraction increases the negative intrathoracic pressure which pulls fluid centrally Also exerts a direct force on the cisterna chyli pushing fluid superiorly
44
Describe direct diaphragmatic pressure in the pelvic diaphragm
Synchronous with thoracic diaphragm Helps move fluids from the lower extremities and pelvic to the thoracic duct May be dysfunctional in dysmenorrhea, endometriosis, post labor and delivery, BPH, etc
45
Describe the sympathetic NS effects on lymph valves
Increased sympathetic tone —> tighter valves —> decreased lymph flow into the venous system
46
Describe the SNS effects on lymphatic smooth muscle
Increased sympathetic tone —> decreased peristalsis —> lymphatic congestion
47
What are the consequences of a poorly functioning lymphatic system?
Edema Buildup of interstitial fluid (poor lymphatic flow, imbalance of Starling forces) Increased edema —> continued increased interstitial pressure —> lymphatic vessels collapse —> more edema
48
What can cause increased arterial pressure?
HTN, drugs, increased blood volume
49
What can cause increased venous pressure?
CHF, valvular disease, venous obstruction, dysfunctional venous valves
50
What can cause decreased plasma osmotic pressure?
Cirrhosis, protein malnutrition (Kwashiorkor), DM
51
What can cause increased capillary permeability?
Infection, rattlesnake bite, trauma
52
What are the effects of edema?
Compression of local structures -vascular (decreased delivery of O2, nutrients, meds or hormones) -neuronal (decreased sensation, pain, or paresthesia) -SOB if pulmonary; decreased LOC if cerebal) Decreased tissue waste removal (i.e. lactic acid; pH of tissues chain goes and leads to pain) Decreased pathogen clearance and immunity Chronic states -> fibroblast recruitment and activation
53
What is lymphatic OMT?
A diverse group of techniques designed to remove impediments to lymphatic circulation and promote and augment flow of interstitial fluid and lymph
54
What is the purpose of lymphatic OMT?
To improve the functional capacity of the lymphatic system Including the maintenance of body fluid balance purification and cleansing of tissues, enhancement of immune responses Improve tissue nutrition
55
What are the goals of lymphatic OMT?
Balanced well functioning system in which no edema occurs Remove impediments to lymphatic flow Enhance mechanisms involved in respiratory circulatory homeostasis Extrinsically augment the flow of the lymph and other immune system elements Further mobilize lymphatic fluids from local tissues that need decongestant
56
What are the indications for lymphatic OMT?
Lymphatic congestion, manifested as edema, mild CHF, upper or lower respiratory infections, asthma, COPD, ligamentous sprains or muscular strains, acute somatic dysfunction or pregnancy Chronic conditions should be approached with caution
57
What are the absolute contraindications for lymphatic OMT?
Anuria (need kidneys functioning to process the extra fluid return) Necrotizing fasciitis (in the tx area) Pt unable to tolerate tx Pt refuses tx
58
What are the relative contraindications for lymphatic OMT?
Inability to tolerance excessive preload in CHF pt, COPD (thoracic pump with activation), acute asthma exacerbation, unstable cardiac conditions, untreated coagulopathies or pts on anticoagulants, cancer, fracture or crushed tissue, bacterial infections, chronic infections, diseased organ, pregnancy, circulatory disorders
59
What is the risk to benefit ratio?
Clinical judgment must be used in employing lymphatic techniques with particular attention to the pt’s diagnosis, clinical condition, and medical therapy These factors influence choice of the appropriate technique, dose, duration and frequency of Tx
60
What are the principles of diagnosis from a lymphatic approach?
1. Evaluate risk benefit ratio 2. Evaluate fascial patterns of Zink (which describe fascial restriction patterns that causes restriction to lymphatic flow) 3. Evaluate diaphragms/fascia including thoracic inlet for restrictions that may limit lymph drainage 4. Evaluate for SD affecting any motion that would normally enhance lymph flow 5. Evaluate tissue congestion (excess fluid in the interstitial tissues)
61
What is a compensatory pattern?
L/R/L/R | 80% of healthy people
62
What is a uncommon compensatory pattern?
20% of healthy people | R/L/R/L
63
What are uncompensated patterns?
Usually symptomatic and a trauma is unusually involved | Ex. R/R/R/R
64
What are the transverse restrictors?
Tentorium cerebelli, thoracic inlet, thoracolumbar diaphragm, pelvic diaphragm
65
What are the transition zones of the spine?
OA, C1, C2 C7, T1 T12, L1 L5, sacrum
66
What is the sequence of generalized lymphatic tx?
1. Open pathways to remove restrictions to flow (transverse myofascial restrictors - thoracic inlet, myofascial restrictors, broad fluid movement) 2. Maximize diaphragmatic functions (abdominal and pelvic diaphragms) 3. Increase pressure differentials or transmit motion (fluid pumps) 4. Mobilize target tissue fluids (localized to specific somatic dysfunctions)

ECOS II Midterm (10 decks)

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