Lymph

Question 1

When does lymphatic development begin?

Answer 1

5th week

Question 2

What tissues form from the mesoderm?

Answer 2

lymphatic vessels, lymph nodes, spleen, and myeloid tissue

Question 3

What tissue forms from the endoderm?

Answer 3

thymus and parts of the tonsils

Question 4

What is the general timeline of lymphoid tissue maturation?

Answer 4

Lymphoid tissue is immature at birth and increases until puberty.

Lymphoid tissue regresses with age making it difficult to even fight off a a fever

Question 5

What are the 3 components of the lymphatic system?

Answer 5

1. organized lymphatic tissues/organs (spleen, tonsils, liver, thymus, appendix, visceral lymphoid tissue, lymph nodes)
2. Lymph fluid
3. Lymph vessels

Question 6

What are the physiological functions of the lymph system?

Answer 6

Immunity, Digestion, Fluid balance, Waste

Question 7

Spleen: Where is it located? What is its function? What other important characteristics are there?

Answer 7

Beneath ribs 9-11 on the left side (next to stomach)

Destroy damaged/deformed RBCs, Synthesize immunoglobulins, clear bacteria

Largest single mass of lymphoid tissue; is pressure sensitive (diaphragm movement)

Question 8

Liver: Location? Lymphatic function? Other Characteristics?

Answer 8

Right upper quadrant, right costal margin

Half of body’s lymph formed in liver, clears bacteria, “gate-keeper” of shared hepato-biliary-pancreatic venous and lymphatic drainage.

Pressure sensitive (diaphragm movement)

Question 9

Thymus: Location? Lymphatic function? Other Characteristics?

Answer 9

Anterior mediastinum

Maturation site for T cells, little to no function in adults

Large in infancy (peaks at 2 y-o), after puberty replaced by fat

Question 10

Tonsils: Location? Lymphatic function? Other Characteristics?

Answer 10

3 types: all in posterior oropharynx

• Palatine - lateral pharynx (traditional tonsil)
• Lingual - posterior 1/3 of tongue
• Pharyngeal - adenoids at nasopharyngeal border

Provide cells to influence and build immunity early in life, nonessential to adult immune function

Most are not visible until 6-9 months, remain enlarged through childhood

Question 11

Appendix: Location? Lymphatic function? Other Characteristics?

Answer 11

Proximal end of the large intestine

Part of gut-associated lymphoid tissue

Contains lymphoid pulp, lymphoid tissue atrophies with age

Question 12

What are the two forms of Visceral Lymphoid Tissue?

Answer 12

Gastrointestinal Associated Lymphoid TIssue

Pulmonary lymphoid Tissue

Question 13

What is the function of pulmonary lymphoid tissue?

Answer 13

It is scattered throughout the lungs and removes toxins from the tissue

Question 14

What is the function of Gastrointestinal Associated Lymphoid Tissue?

Answer 14

Carries large Chylomicrons from the GI tract through Lacteals (lymphatic capillaries) to the thoracic duct, then to the venous system because they are too large to enter the circulatory capillaries in the GI tract

Peyers Patches in the ileum protect against pathogenic bacteria in the gut

Question 15

How are lymphatic vessels organized?

Answer 15

Lymphatic capillaries -> collecting lymphatics -> afferent lymphatics -> efferent lymphatics -> thoracic duct OR right lymphatic duct -> venous system

Question 16

How does lymph flow through a lymph node?

Answer 16

Afferent lymphatics -> subscapular space -> outer cortex -> deep cortex -> medullary sinus -> efferent lymphatics

Question 17

What tissues does the thoracic duct drain and where does it empty the lymph fluid?

Answer 17

Generally drains the entire left side and everything umbilicus and down.

Left head/neck, left upper extremity, left thorax/abdomen, everything below umbilicus, lumbar lymphatics

Empties into left subclavian vein/internal jugular junction

Question 18

What tissues does the right lymphatic duct drain and where does it empty the lymph fluid?

Answer 18

Generally drains the right side of the body above the umbilicus

Right head/neck, Right upper extremity, right thorax, heart, lungs (except left upper lobe)

Question 19

How do sympathetics affect lymphatics?

Answer 19

SNS causes valves to “tighten” which decreases lymph flow to veinous system

SNS also causes a decrease in peristalsis causing lymph congestion

Question 20

What are the absolute contraindications for lymphatic treatments?

Answer 20

Anuria: failure of kidneys to produce urine. Need kidneys functioning to process the extra fluid return

Necrotizing Fasciitis: flesh eating disease. Contraindication only in affected area

Patient unable to tolerate treatment

Patient refuses treatment

Question 21

What are the relative contraindications?

Answer 21

• Inability to tolerate excessive preload (CHF)
• COPD
• Acute asthma exacerbation
• Unstable cardiac onditions
• Untreated coagulopathies or Pts on anti-coagulants
• Cancer
• Bone fracture (area involved)
• Bacterial infection
• Chronic infection
• Diseased organ
• Pregnancy
• Circulatory disorders

Question 22

What is the common compensatory pattern?

Answer 22

LRLR (80% healthy people)

Question 23

What us the uncommon compensatory pattern?

Answer 23

RLRL (20% of healthy people)

Question 24

What are the uncompensated patterns?

Answer 24

LLLL, LRRL, RRLL, etc

Usually symptomatic, usually trauma is invovled

Question 25

Where are the transition zones of the spine?

Answer 25

OA, C1, C2
C7, T1
T12,L1
L5, sacrum

Question 26

What are the transverse restrictors?

Answer 26

Tentorium Cerebelli (neck)
Thoracic Inlet
Thoracolumbar diaphragm
Pelvic Diaphragm