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Threats and Defence > Lymphatic system > Flashcards

Lymphatic system Flashcards

1
Q

What is the purpose of the lymphatic system?

A

it is a system of vessels and lymphoid organs that drain tissue fluid from the extracellular compartment
- low pressure system as no driving force

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2
Q

Where is the lymphatic system absent?

A

immune-priviledged organs:

  • CNS
  • eyeball
  • inner ear
  • cartilage
  • bone
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3
Q

What is the widest distributed tissue in the body?

A

Interstitial fluid

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4
Q

What are the key functional factors of the lymphatic system?

A

Helps capillaries return plasma proteins that leak into extracellular fluid back to circulation

Helps transport cellular debris that does not use the circulatory system

Essential for immunological functions of the body

Absorbs/ transports fats from the digestive system

Plays a major role in fluid balance of the body

Plays a major part in the determination of cell volume

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5
Q

What are the key clinical factors of the lymphatic system?

A

Major consituent of the immune system

It is a conduit for the spread of:

  • infections
  • malignancies
  • can be a site of primary tumours

Blockage leads to lymphoedema

Primary site for infections

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6
Q

What is lymph?

A

Transudative fluid
Transparent and yellowish in appearance
Alkaline in nature

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7
Q

How is lymph formed?

A

formed when blood plasma leaves capillaries of the circulatory system passing into the extracellular compartment
- 9/10 of plasma returns in venous system
- 1/10 returns via lymphatic system
Bathes cells of the body

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8
Q

What is “chyle”?

A

lymph produced by the small intestine - absorbed fat

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9
Q

What is the composition of lymph?

A 
Composed from water as a solvent and solutes 
H20 makes up 96% of its volume 
Solutes 
- proteins 
- lipids 
- glucose 
- electrolytes 
- cells - mainly lymphocytes
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10
Q

At rest, how much lymph is produced per day?

A

3-4 litres

  • flows at a rate of 120ml/hour
  • 100 ml flow through thoracic duct
  • 20 ml flow through right lymphatic duct
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11
Q

What is the network of lymph channels?

A

Microscopic lymphatic capillaries to
lymphatic vessels to
collecting trunks to
ducts

It all drains back into the subclavian vein

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12
Q

What are the lymph organs?

A 
Bone marrow
Spleen 
Thymus gland 
Lymph nodes 
Tonsils
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13
Q

In a normal young adult how many lymph nodes are there?

A

400-450 lymph nodes
- on average 2/3s of lymph nodes are found in the abdomen

  • head and neck: 60-70
  • arms and superficial thorax: 40
  • legs: 30
  • thorax: 100
  • abdomen and pelvis: 230
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14
Q

What is the structure of a lymph node?

A

Kidney or bean-shaped
Variable in size - range from tiny to 2.5cm in diameter
Lymph enters through afferent channels, percolates through sinuses and exits via efferent channels

They are inhabited by phagocytes and macrophages that clean up lymph

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15
Q

What are the 2 separate drainage systems?

A

Drainage of lymph in superficial structures (skin) - follow venous drainage and drain into deep lymph vessels
Drainage of lymph in deep structures (visceral organs) - tend to accompany arteries - likely use muscular pump to maintain flow

Drainage from these 2 systems drains differently

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16
Q

What are the 2 lymphatic ducts ?

A

right lymphatic duct
thoracic duct
- separated by the midline

17
Q

What does the right lymphatic duct receive?

A

Drains lymph from the right upper quadrant of the body

  • right side of head
  • right side of neck
  • right side of thorax
  • right upper limb

enters venous system via the right venous angle (coming together of right internal jugular and right subclavian vein)

18
Q

What does the thoracic duct receive?

A

Much larger
Drains lymph from the rest of the body that is not drained by the right lymphatic duct

Enters the venous system via the left venous angle (union of internal jugular vein and subclavian vein)

19
Q

How do tumours lead to clinical presenting symptoms via lymphatic system?

A

Local invasion of tissues in which the primary growth arises
Infiltration of tissues adjacent to the site of the primary growth
Spread to tissues that are remote to the site of the primary growth

20
Q

What are the general principles of infiltration of local tissues?

A

Cancerous growth might be contained locally to produce clinical signs arising from disruption of the local tissue alone

The growth may infiltrate tissues adjacent to the site of the primary growth through physical pressure of the growth

21
Q

What are the general principles of spreading to remote sites?

A

Growth might breakdown the integrity of the structures and barriers to spread remotely

Clinical signs arising from complications of the growth may be due to:

  • disruption of the site of the primary growth
  • disruption of the primary site of the growth plus secondary sites not associated with the site of the primary growth
  • disruption of secondary sites not associated with the site of the primary growth
22
Q

What are the general principles of benign tumours?

A

Cell of a particular organ/tissue transform to replicate uncontrollably
Cancerous cells grow and divide to multiply
Such cancerous cells may:
- start to secrete factors that are detectable through diagnostics - chemical factors - can disrupt normal functioning
- new growth: - eventually reaches a size that is detectable and impairs normal functioning

cancerous cells may remain in the site of the primary growth

growths do not spread beyond the primary site

23
Q

What are the general principles of metastatic tumours?

A

Cells of a particular organ/tissue transform to become cancerous
Cancerous cells grow and divide to multiply
Such cancerous cells may:
- start to secrete factors that are detectable through diagnostics - chemical factors - can disrupt normal functioning
- new growth: - eventually reaches a size that is detectable and impairs normal functioning

Such cancerous cells have the ability to secrete chemical signals that lead to spread of the growth to remote organs or trigger new cancerous growths in remote organs

Spread by metastasis

24
Q

What are the routes of metastatic spread of cancers?

A
  • invasion of tissues by general spread after breakdown of basement membranes of cells of primary growth
  • invasion of tissues through fascial or neuro-vascular planes
  • spread via arterial system
  • spread via lymphatic system - direct invasion through lymph nodes
25
Q

How does breast cancer begin?

A

begins as single (or more) cells which have lost normal regulation of differentiation and proliferation but remain confined within the basement membrane of the duct or lobule

26
Q

How does breast cancer start spreading?

A

As cells continue to double, at some point they invade through the basement membrane of the duct or lobule and ultimately metastasize to distant organs

27
Q

What % of breast cancer diagnoses show lymph node metastases?

A

60%

28
Q

Where do lateral lesions tend to metastasise to?

A

axillary and supraclavicular nodes

29
Q

Where do medial lesions tend to metastasise to?

A

Internal mammary and mediastinal lymph nodes as well as supraclavicular nodes

30
Q

Where do most lymph vessels of the breast drain into?

A

Lymph nodes under the arm (axillary nodes)
Lymph nodes around the collar bone (supraclavicular and infraclavicular nodes)
Lymph nodes inside chest, near breast bone (internal mammary lymph nodes)

31
Q

What is the Halsted theory of the spread of breast cancer?

A
  • suggests that breast cancer originates in the breast, eventually spreads to the local skin and/or lymph nodes and then ultimately affects distant organs
    Theory maintains that local/regional lymph nodes serve as a barrier to the spread
    The implication of this theory is that more intensive local therapy should lead to an increased rate of cures
32
Q

What is the most site of recurrent breast cancer?

A

chest wall, the regional lymph nodes and/or bone

Liver, lungs and CNS are less common sites of recurrence

Threats and Defence (10 decks)

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