lymphatic Flashcards

1
Q

lymphatic system, open or closed

A
  • open (moves one direction, tissues -> blood)
  • slower flow than CV system (no pumping, relies on CV)
  • Lymph vessels have valves that keep fluid moving in one direction (also travels from high to low pressure)
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2
Q

function

A
  • conserving fluid and plasma that leak from capillaries, defends body against disease as part of immune system and absorbing lipids from intestinal tract.
  • movement of lymph fluid within the cardiovascular system (maint. Of fluid balance…without drainage, fluid would build up in interstitial spaces because more fluid leaves capillaries than veins can absorb)
  • filtration of fluid before it is returned to BS, filtering out substances that could be harmful to body and filtering out microorganisms from the blood
  • phagocytosis: in LNs
  • production of lymphocytes within the LNs, tonsils, adenoids, spleen and BM
  • production of antibodies
  • absorption of fat and fat soluble substances from the intestinal tract
  • undesirable role: one pathway for spread of malignancy

– production of lymphocytes & antibodies
– phagocytosis
– absorption of fat and fat soluble substances in the gut
– movement of lymph fluid / drainage of interstitial space
– manufacture of blood when marrow is stressed

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3
Q

lymph

A

contains WBCs, usually lymphocytes (on occasion RBCs)

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4
Q

primary organs

A
  • where lymphocytes are produced

- bone marrow and thymus

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5
Q

secondary organs

A
  • where lymphocytes come in contact with antigens and mature into effector cells (things we are exposed to – allergens or antigens)
  • tonsils/adenoids
  • spleen
  • lymph nodes
  • peyers patches
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6
Q

bone marrow

A

-B lymphocytes (produce antibodies and area characterized by various arrangements of immunoglobulin’s on their surface

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7
Q

thymus

A
  • thymus large in children and small in adults normally
  • T lymphocytes: derived from marrow, flow to thymus
  • thymus: superior mediastinum, extending up into lower neck
  • child: primary site for production of T lymphocytes (cells responsible for cell mediated immunity reactions and the controlling agent for the humoral response generated by B lymphocytes)
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8
Q

tonsils/adenoids

A
  • palatine tonsils = tonsils, rest are adenoids
  • made of lymphoid tissue(follicles and crypts covered by mucous membranes)
  • defensive responses to inhaled and intranasal antigens are activated in these tissues
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9
Q

spleen

A
  • left UQ, highly vascular organ
  • white pulp: made of lymphatic nodules and diffuse lymphatic tissue
  • red pulp: venous sinusoids
  • destroys old RBCs, produces antibodies, storing RBCs, filtering microorganisms from the blood
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10
Q

lymph nodes

A
  • surrounded by capsule composed of connective tissue (usually in groups of nodes) -> storage of concentrated lymphocytes (fluid filters through each node, exposing circulation antigens to the waiting lymphocytes)
  • usually less than 1 cm
  • superficial nodes: in subcutaneous connective tissues
  • deeper nodes: lie beneath fascia of muscles within the various body cavities
  • filtrate and phago, aid in maturation of lymphocytes and monocytes
  • lymphocytes: arise from LNs, tonsils, adenoids, spleen (primarily produced by BM
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11
Q

peyer patches

A
  • small, raised areas of lymph tissue on mucosa of small intestine; made of many clustered lymphoid nodules
  • important to immune surveillance in intestinal tract (facilitate an immune response when pathogenic microorganisms are detected)
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12
Q

humoral immunity

A

involved antibodies produced by B cells

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13
Q

cellular immunity

A

involving attacks on invaders by cells themselves

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14
Q

B cell lifespan

A

short

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15
Q

T cell lifespan

A

long

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16
Q

what does an increase in lymphocytes in blood mean

A

-mostly systemic response to viral infection (some bacterial infections)

17
Q

virchow node

A
  • L supraclavicular node:
  • (VERY IMPORTANT in assessment of cancer because of L drainage area… specifically indicates abd or L thoracic malignancy)
18
Q

is everything supplied by lymph tissue?

A

yes except brain and placenta

19
Q

lymphatic drainage basics (capillaries and node itself)

A
  • Pathway starts with highest pressure (pressure gradually decreases)
  • *Blood capillaries–>Lymph from interstitial space–>Lymph Cap–>Lymph Veins–>Lymph Ducts–>Large circulatory veins
  • Flow through node:
  • *Interstitium–>Afferent lymphatic–>Capsule–>Cortex–>Medulla–>Efferent lymphatic–>either blood OR secondary lymphoid organs
20
Q

Right drainage area

A

R lymphatic (trunk) duct–>R subclavian vein (drains right upper body)

21
Q

Left drainage area

A

Thoracic duct–>L subclavian vein (rest of body)

22
Q

what happens if lymph volume increases?

A

flows faster in response to mountain capillary pressure, greater perm of capillary walls of cardiovascular system, increased bodily or metabolic activity, and mechanical compression.

23
Q

what happens if lymph volume decreases?

A

mechanical obstruction will slow or stop the movement of lymph, dilating system (if obstructed, lymph may diffuse into the vascular system or collateral connecting channels may develop)

24
Q

assessing drainage

A

-Screening exam includes superficial lymph nodes and spleen
-Multiple locations of lymphadenopathy may indicate systemic inflammatory, infectious, or malignancy processes (TB, CA)
-Normal nodes may not be palpable
-Nodes enlarged from prior inflammation may be palpable and may or may not be significant
*Red streaking is lymph-related!
- Inspect above lymph nodes for:
o Color
o Erythema
o Enlargement
o Masses
-Certain nodes correspond to certain areas of the body, so it’s important to examine nodes that may be related to dz process
• Children under 12 years of age may have “shotty” facial, cervical and inguinal lymph nodes

25
Q

epitrochlear node location

A

area of elbow proximal and anterior to medial epicondyle fossa

26
Q

functions of spleen

A

· Filter, destroy and recycle old red blood cells
· Produce antibodies
· Store red blood cells
· Filter microorganisms from the blood

27
Q

where to percuss spleen

A
  • dullness between 6th – 10th ribs. If it is larger, may indicate an enlarged spleen, however a full stomach may also mimic this.
  • Another way to assess spleen enlargement it to percuss the lowest intercostal space; this should be tympanic with expiration/inspiration; If tympany changes to dullness the spleen may be enlarged. When palpating the spleen, if it is felt, it is enlarged.
28
Q

lymphadenopathy

A
  • swollen or enlarged lymph nodes- due to infectious, autoimmune or malignant disease.
  • Localized- in 1 place due to local infection.
  • Drainage pattern of lymph allows knowledge of region of infected.
  • Generalized- due to systemic infection.
  • Very few disease processes cross all lymph groups- systemic inflammatory, infectious or malignant process
29
Q

lymphedema

A

-Edematous swelling due to excess lymph fluid in tissues - due to obstruction in lymph vessels/ nodes. caused by inadequate lymph drainage. Non-pitting Often Iatrogenic Stage 0-3

30
Q

lympadenitis

A

-infection and inflammation of lymph node(s).May result in skin breakdown and ulcerations on overlying tissue- bulboes ID- edematous, erythematous tissues. Node firm, nontender, inflammation without warmth

31
Q

lymphangitis

A

Actue: inflammation of one or more lymph vessel due to infectious agent. ID- red streaks appears like “blood poisoning” following ducts and blood vessels, indurated & palpable.

32
Q

what to note on lymph exam

A

· Location
· Size (in centimeters)
· Shape (should be round)
· Color (red = inflammation, note degree of discoloration)
· Temperature (whether its warm or not – possible inflammation)
· Consistency (hard, fluctuant, stony hard, matted are all common in cancer)
· Tenderness (any unusual increase in vascularity heat or pulsations)
· Mobility/fixation to surrounding tissue
· Discretness/margins (should be able to feel all the way around)

33
Q

what to document for spleen

A

· Size
· Dullness vs tympany and where anatomically they occur (ex: AAL – anterior axillary line)
· Palpable – if yes map and record the size using anatomic landmarks