Lymphatic System: Danto Flashcards
KCU started in
1916
first described lymphatics as a system
1653: Olaf Rudbeck
(Sweden)
Date: _____ emphasized that diagnosis of the fascia and treatment of the lymphatic system was vital for maintaining health and treating disease
•1874: A. T. Still
______________ (date) published Applied Anatomy of the Lymphatics
1922: Frederic Millard, D.O.,
Lymphatic development begins _______ and is of significant prescense by _________
during 5th week of gestation
signficant prescene by 20 weeks
Where is lymphatic system derived from?
Mesoderm,
but thymus and part of tonsils are endoderm
Lymphatic development
Lymphoid tissue is immature @ birth and increases UNTIL puberty when immine system continues to mature, by lymphoid tissue regresses and levels off
immune system in geriatrics
delines and patients may not mount a fever
3 components of lymphatic system
- organized lymphatic tissue and organs (spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue, lymph nodes)
- Fluid
- vessels
Fx of lymphatic system
Maintain homeostasis (immune, digestive, fluid balance and waste)
Spleen
Location:
Characteristics:
Functions:
Spleen
Location: L side, below ribs 9-11
Characteristics: spleen is the largest mass of tissue and sensitive to pressure
Functions: destroy damaged/ deformed RBC, make Ig’s, clear bacteria
Moving the diapragm does what?
drives splenic fluid
drives hepatic fluid
LIVER
Location:
Characteristics:
Functions:
Location: RUQ, can palpate at the R costal margin
Characteristics: pressure sensitive
Functions: forms half of bodies lymph, clears bacteria, gatekeeper of hepatobiliary pancreatic venous and lymphatic drainage
Thymus
Location:
Characteristics:
Fx:
Loccated: anterior mediastinum
Characteristics–> large in infancy and peaks at 2yo. After puberty, it is replaced by fatty tissue
Fx: makes T cells in kids and little /no fx in adults
Tonsils
Location:
Characteristics:
Fx:
Location: located in posterior oropharynx: palatine (lateral pharynx-traditional), lingual (posteiror 1/3), pharyngeal (adenoids at nasopharyngeal border)
Characteristics: most are not visible 6-9 monthes, remains englarged through childhook
Fx: allows cells to build immunity early in life, not needed
Appendix
Location
Characterists
Fx
Location–> proximal end of cecum (LI)
Characteristics- has lymphoid pulp; dies with age
Fx- part of the gut-assx lymphoid tissue (GALT)
Visceral lymphoid tissue (gastrointestinal assx lymphoid tissue :GALT))
peyers path, lacteals (lymphatic capillaries of small bowel)
What is lymph fluid?
•Substances that leak out of the arterial capillaries into the interstitiumget taken up by the lymphatic capillaries like fluids, proteins, electrolytes, and cells
•30 L of fluid move from capillaries to interstitial space each day
–90% to capillaries; 10% to lymphatic system
–½ of diffused plasma proteins re-enter system via lymph
•When fluid overload occurs, lymphatic system helps prevent tissue damage by clearing the excess
–“Second/third spacing”
35%-60% of the drainage through the thoracic associated with _________
RESPIRATION
•“pump” effectof the diaphragmatic crura onthe cysternachyli
•Junctures areunder sympathetic control
Restrictions of lymphatic flow must be first drained through the _______________
the assx terminal area
Where does lymph go?
Lymph bathes all tissues.
Some tissue that does not have lymphatic vessels, but uses diffusion are the [epidermis, endomysium, catilage, bone marrow]
Lymph channels begin as what?
Blind endothelial tubes or capillaries made up of 1 layer of leaky squamous epithelium made up of anchoring filaments.
What is the flow of lymphatics?
Lymphatic capillaries–> collecting lymphatics–> afferent lymphatic vessels–> efferent lymphatic vessels–> thoracic duct or R lymphatic duct–> venous system
lymphatics run with veins
Extracellular fluid is sucked in by _____-level of negative pressure
LOW
lymphatic collectors
chains of muscular units called lymphangions, which have 2-leaflet bicuspid valves. they contract and move lymph in peristaltic waves
path of lymph flow through a lymph node
–> afferent lymphatic –> subscapular space–> outer CTX –> deep CTX–> medullary sinus –> efferent lymphatics via the hilum
lymph nodes
-LN ar the most highly organized lymphoid tissue in lymph cessesl. There is superficial and deep.
Fx of lymph nodes
filtration of lymph fliud,
maturation of lymphocytes,
phagocytoze bacteria and debris
What is the master lymph vessel?
THORACIC DUCT
Drains L side of upper body,
& belly button down
-origin at the cisterna chyli
track of thoracic duct
Originates at the cisterna chyli as a dilation of vessel around L1-2
pierces Sibson’s fascia, makes a U turn to empty into L subclavian/IJ veins
R lymphatic duct
drains the RU body (inc heart and lungs)
4 lymphatic fxs
- maintain fluid balance
- tissue cleansing and purification
- defense
- nutrition
4 lymphatic fxs
- maintain fluid balance
- clean and purify tissue–> baths organs and cleans excellular spaces of particles and byproducts. Lymph then goes from vessel–> node
- defense
- nutrition- lymph absorbs fat via chylomicrons and returns proteins to vsaculature
What type of tissue fluid enders lymph vessel
tissue fluid wilth cell wasts products
___ flow of lymph is necessary for approp immune fx
What causes peristalsis in lymph vessels
SM contraction in large lymph vessels–> pressure gradients –> peristalsis
Machanisms of flow include what
- Interstitial fluid pressure
- Direct diagphragmatic pressure
- Symphatic NS
Thoracic diapgram - direct diaphragmatic pressure
Contraction increases the negative intrathoracic pressure and pulls the fluid centrally and superiorly by exerting a direct force on cisterna chyli
Pelvic diaphragm- direct diaphragmatic pressure
helps move fluid from LE and pelvis –> thoracic duct.
SNS effects lymph valves.
Increasing sympathic tone does what?
tighter valves–> decrease lymph flow
SNS effects lymphatic smooth muscle
–> decrease peristalsis–> causing congestion of lymb
OMT to tx _________ improves lymphatic fx
OMT to address hypersympatheticonia lymphatic function.
Now what happens when the flow is sufficiently inhibited, or the lymph system is poorly functioning???
EDEMA!- imbalance of starling forces
- increase arterial pressure, venous pressure
- decrease plasma oncotic pressure
- increase permability of capillaries
Effects of edema
- Compresses local structures
- decreases removal of tissue waste
- decreases pathogen clearance and immunity
- chronic states can lead to fibroblast recruitment and activation (causing scar contraction!)
Def of lymphatic OMT
diverse techniques desgined to remove impediments to lymphatic circulation and promote and augment the flow of ISF and lymph
Lymphatic OMT purpose
infprove functional capacity of lymphatic system: including maintenance of body fluid, purification and cleaning, enhance immune response, improve tissue nutrition
Indications for lymphatic oMT
- edema, tissue congestion, lymphatic stasis
- infection
- inflammation
chronic conditions should be gentler and shorter, but more FREQUENT
Contraindicaitions
Clinical judgment
Absolute contraindications
- Anuria–> kidneys NEED to fx so process extra fluid
- Necrotixing fasciatis
- Patient cant tolerate tx or refuses
Relative contraindications
- Splenomegaly/Hepatitis–
- If the problem is CHF is the pump isn’t working as well, causing fluid backup. Do we want to put more fluid into the pump system??
- Osseous fx
- COPD
- acute asthsma exacerbation
- untreated coagulapathies or patiens on anticoagulants
- cancer
Pricinples of dx from a lymphatics approach
- Look at risk-benefit ration
- Evaulate fascial patterns of Zink
- Evaulate diaphragms and fascia
- Loof for SD
- Look for tissue congestion (excess fluid in ISF)
Common compensaroy pattern (80% of people)
L, R L R
Uncommon compensaroy pattern (20% of people)
RLRL
symptomatic and trauma is involved
Transition zones of spine
- OA, C1 and C2
- C7 and T1
- T12 and L1
- L5 and sacrum
Transverse restrictors
1. tentorium cerebelli
2. thoracic inlet
3. thoracolumbar diaphragm
4. pelvic diaphragm
Evaluate for Lymphatic Congestion
Where do we feel?
The regional collection sites where lymph collects prior to drainage into the thoracic duct
Sequence of Tx for Lymphatics
- Open path and remove restriction to flow via the transverse myofascial restrictors
- Maximize diaphragmatic functions (abdominal and pelvic diaphram)
- Increase pressure differentials or trasmit motion via fluid pumps
- Mobilize targeted tissue fluids
Zink’s compensatory patterns
•Look at the 4 functional diaphragms to move lymph.
Dysfunction of these may impede the flow of lymph
Assess: cranial cervical joint, cervicothoracic joint, thoracolumbar junction, lumbosacral
vertebra assx with thoracic inlet
T1-4
•The lymphatic system is particularly vulnerable to fascial dysfunction in the region of the ___________
superior thoracic inlet
•Initialdraining of the lymphatic system must always be done through __________
terminal areas
