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Clinical Medicine II > Lymph Anatomy & Physiology > Flashcards

Lymph Anatomy & Physiology Flashcards

1
Q

3 main functions of the lymphatic system

A
  • lymphatic circulation
  • immune system
  • fat/fatty acid digestion
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2
Q

Lymph circulatory system

A
  • one way drainage
  • transport proteins that are too large to re-enter venous capillaries
  • loose junctions btw endothelial cells encourages gapping
  • tiny filaments that anchor lymph vessels to surrounding connective tissue
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3
Q

Immune support lymph organs (B and T lymphocytes and macrophages)

A
  • lymph vessels and nodes
  • thymus gland
  • bone marrow
  • spleen
  • tonsils
  • bowel/mucous membranes
  • appendix
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4
Q

Major lymph node collection sites

A
  • colon
  • axilla
  • neck
  • inguinal region
  • bronchial region
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5
Q

Lymph node functions

A
  • antigen presentation
  • immune cell recognition
  • phagocytosis
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6
Q

Lymph node sequence of events

A
  • antigen enters lymph node through lymph vessel
  • triggers inflammation and causes lymphocytes & macrophages to multiply in the lymph node causing swelling
  • phagocytosis begins
  • inflammation & increased WBCs cause lymph fluid to thicken
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7
Q

Direction of flow in lymphatic circulation

A
  • lymphatic capillaries
  • lymph nodes
  • lymph trunks
  • lymph ducts
  • internal jugular/subclavian veins (right lymphatic duct enter R subclavian vein and left thoracic duct enter L subclavian vein)
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8
Q

What areas does the right lymphatic duct drain in the body

A
  • right UE
  • right side of trunk
  • right side of face
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9
Q

Describe lymph vessels

A
  • located superficially in the skin, subcutaneous, and deep fascia
    -parallel the venous system
  • thinner walls, more valves, & contain lymph nodes at designated points
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10
Q

3 layers of lymph vessels

A
  • Intima: one layer of endothelial cells
  • Media: smooth muscles
  • Adventitia: collagen
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11
Q

What is lymph flow controlled by

A
  • tissue pressure
  • circulatory system is controlled by a central pump
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12
Q

What is lymph flow facilitated by

A
  • intermittent skeletal muscle activity
  • lymphangion vessel contractions
  • an extensive system of one way valves
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13
Q

Lymphangions

A
  • region btw valves
  • smooth muscle stretch reflexes sensing when it fills with lymph fluid
  • contracts 6-12 times at rest and increases 10 fold with aerobic activity
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14
Q

Other physiological pressures that influence lymph flow

A
  • arterial pulsations
  • postural changes
  • respiratory pressure changes
  • scar tissue
  • body mass/skin folds
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15
Q

Transport capacity

A
  • amount of lymph volume that can be transported in a given period of time
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16
Q

Contraction regulation

A
  • sympathetic NS regulates contraction in the lymphangion
  • pain and stress can decrease the activity of the lymph flow in the lymphangion
17
Q

High output failure

A
  • lymphatic load is too great to transport the fluid from the interstitium
  • caused by anything that causes swelling (ex. an injury)
18
Q

Low output failure

A
  • lymphatic system has difficulty transporting a minimal amount of high protein fluid from the interstitium due to damage in the lymph vessels or lymph nodes
19
Q

Combined insufficiency

A
  • combination of a high output failure & a low output failure
  • high output failure due to infection, trauma, or surgery
  • low output failure due to previous injury to lymph vessels or modes (ex. radiation therapy)
20
Q

Lymphedema

A
  • low output failure
  • consists of protein rich fluid & low grade inflammation with reactive fibrosis as a result of altered/damaged lymph transport capacity
21
Q

What is the only diagnostic imaging to diagnose lymphedema

A
  • lymphoscintigraphy
22
Q

Congenital abnormality of development of the lymphatics

A
  • hypoplasia: reduced # of lymph collectors & decreased diameter of lymph vessels
  • hyperplasia: increased # of collectors
  • aplasia: absence of lymph system components
  • kinmoth syndrome: inguinal lymph node fibrosis
23
Q

Milroy disease, lymphedema praecox, and lymphedema tarda

A
  • Milroy: observed at birth due to gene mutation
  • Praecox: developed before 35
  • Tarda: developed after age 35
24
Q

Prevalence for primary lymphedema

A
  • females 2x more than males
  • LE 3x more than UE
  • Bilateral 2x more than unilateral
25
Q

Secondary lymphedema

A
  • damage to an otherwise normal lymphatic system
26
Q

Risk factors for secondary lymphedema

A
  • invasive procedures
  • regional lymph node dissection
  • radiation therapy
  • scar tissue
  • burns
  • skin folds
27
Q

Symptoms of lymphedema

A
  • tightness/heaviness/discomfort in the area
  • not usually painful
  • swelling & decrease in skin mobility
  • loss of strength or flexibility in a limb
  • variations in skin temperature and/or color
28
Q

Lipedema

A
  • painful “fluid in the fat” disorder
  • feet are not involved
29
Q

Stewart-Treves syndrome

A
  • rare angiosarcoma that develops in people with long standing lymphedema
  • usually people have a history of breast cancer that was treated with radical mastectomy
30
Q

Stage 0/Latent lymphedema

A
  • lymph transport is impaired but there is no clinical evidence of swelling
  • may last months to years
  • symptoms of progression from stage 0 to stage 1: sensation of heaviness, fatigue, ache, or pain in the limb at risk
31
Q

Stage 1 lymphedema

A
  • chronic inflammatory response to the excessive protein in the interstitium
  • pittting on pressure
  • reverses with elevation
  • progression from stage 1 to stage 2: subcutaneous tissues begin to fibrose due to protein buildup
32
Q

Stage 2 lymphedema

A
  • non-pitting
  • does not reduce on elevation of the limb
  • clinical fibrosis is present: skin is thick & rigid
  • clear, sticky lymph fluid may ooze from pores
33
Q

Stage 3 lymphedema/lymphostatic elephantiasis

A
  • severe non-pitting
  • large lobular folds
  • fibrotic edema with atrophic skin changes such as thickened, leathery, keratitis skin, skin folds with tissue flaps, papillomas (warty like overgrowth)
34
Q

Volume differences for functional severity

A
  • Minimal: < 3cm difference and < 20% increase in limb volume
  • Moderate: 3-5cm difference and 20-40% increase in volume
  • Severe: > 5cm difference, positive Stemmers sign, and > 40% increase in volume

Clinical Medicine II (21 decks)

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