Lymphatics Flashcards
Describe a lymph node in an unhealthy patient (cancer)
Size is larger
shape: irregular
Consistancy: hard or irregular
Large and tender = infection (fast process)
Large and nontender = lymphoma (slower process)
Fixed mobility
Color of skin: red = infection; pale = other
Warmth: warm = infection; cool = other
Edema is at the periphery/distal
Skin lesions/ rash present
What are the locations of nodes in the head area? state any abnormalities
Occipital: below occipital ridge - drains post scalp
Pre-post auricular: peace sign - abnormal otitis externa
Superficial parotid on top of angle of mandible
retropharyngeal (tonsillar)
Submandibular/submental is jaw angle down to mentum: abnormal look for things in mouth (leukoplakia, abscess, gingivitis)
Where are the lymph nodes in the neck region?
Anterior cervical - anterior border of SCM = ant cervical chain drains face and anterior neck
Posterior border of SCM = posterior cervical chain drains occipital and back of pharynx (throat)
Where are the lymph nodes in the clavicular region?
Supra/infra clavicular - above and below
Virchoow’s (enlarged due to metastasis) - supraclavicular on L side = intra-abdominal cancer b/c abdomen drains to deep visceral - cisterna chilli-> thoracic duct -> Virchow
Where are the lymph nodes in the inguinal region?
Superior/inferior inguinal- find ASIS and move medial and inferior - inferior in femoral triangle (can frog leg to open up femoral triangle)
Where are the lymph nodes in the axillary region?
Apex: top of diamond Anterior axillary: front Central/medial (rib): bottom Posterior: back Lateral (along upper surface of arm: above apex
where are the lymph nodes in the epitrochlear region? If enlarged what can that indicate?
Superior/posterior to medial humeral epicondyle - symphilis
Treatment zone 1?
Thoracic inlet down tot thoracoabdominal diaphragm
Treatment zone 2?
Abdominal diaphragm down to pelvic diaphragm
Treatment zone 3?
Upper extremities
Treatment zone 4?
Lower extremities
Treatment zone 5?
Head and neck
What is the goal of lymphatic treatment and what is the proper order?
move lymph centrally
Always start with opening thoracic inlet then zones 1 and 2. Work central to peripheral in zones - but peripheral to central when treating a specific zone. Treat 3 and 4 in either order; treat whatever is worse first. Tx the inlet again at the end
Name 4 abnormal findings of a LN
Large, irregular, hard, red, tender/painful, fixed waarm
Where does abdominal cancer drain to and where is this spot located?
Virchow’s node in the left supraclavicular space
What position do you put your patient to examine the inguinal nodes?
Supine with frog leg position
How should every lymph tx begin and end?
Opening the thoracic inlet
What are the zones of treatment? does it matter which order you treat them in? if so, what is it?
- Thoracic
- Abdominal
- Upper extremity
- Lower extremity
- Head and neck
- thoracic inlet
What are the contraindication for lymph tx?
Relative contraindications: metastatic cancer, osseous fracture, acute bacterial infection w/T > 102*F and w/o antibiotic coverage, some serious skin/fascial infections, acute heptatis, infectious mononucleosis, venous obstruction, embolism, hemorrhage, coagulopathies, no urin production
Or body position intolerance
The lymphatic system transports _____ from digestive system blood
fats
Why do lymphatics have to assist the body in removing interstitial fluids and plasma proteins?
It accumulates due to metabolism; inflammation; infection; trauma; or system dysfunction
Describe the function and location of the spleen?
Located beneath ribs 9, 10, and 11 on the left between left hemi-diaphragm and peritoneal cavity
Function is to destroy deformed/damaged RBCs
synthesizes immunoglobulins
Clearance site for: antigens, micro-organisms, poorly organized bacteria
What is important for the homeostatic movement of splenic fluids?
Movement of the diaphragm
Where is half of body’s lymph formed?
Liver
The liver is the “gate-keeper” of what?
the shared hepato-biliary-pancreatic venous and lymphatic region and also clears bacteria
The liver is a pressure sensitive organ, affected by what?
Muscular action of the thoraco-abdominal diaphragm
Where is the thymus located?
Superior mediastinum
Anterior to great vessels
Extends into the neck
Describe the thymus from infant to adult
Large in infant (greatest at 2)
After puberty - involutes
Adult - replaced by fatty tissue
What is the function of the thymus?
Provide cells involved in maturation of the immune system
Processing site for T-lymphocytes
Little or no function in adult
What are tonsils and what is their function?
Multiple areas in ring formation in posterior oropharynx
Function to provide cells to influence and build immunity early in life
Nonessential to adult immune function
Where are palatine, lingual, pharyngeal tonsils?
Palatine - lateral pharynx
Lingual - posterior 1/3 of tongue
Pharyngeal - adenoids at nasopharyngeal border
Describe the appendix
Located at medial surface of the cecum
exact function unknown
Presume it offers support to immune system
How is the respiratory system a visceral lymphoid tissue?
It aides in filtration of toxins from lungs
In the GI system, what immune visceral lymphoid tissues can be found in the distal ilium and in small bowel?
Peyer’s patches - distal ilium
Lacteals - lymphatic capillaries in each villi in small bowel
What is the most highly organized lymphoid tissue and its main purpose?
Lymph nodes
Primary purpose is for filtration of lymph
What are the to types of lymph nodes?
Superficial - follows subcutaneously with superficial veins; receive from skin/deep tissues of upper and lower extremities/ head and neck
Deep - beneath fascia and muscles, follows deep veins
What do superficial nodes drain into?
three main groups of nodes (from the extremities into the core)
- Cervical - head/supraclavicular and upper extremity drain to jugular nodes
- axillary - infraclavicular to umbilicus, drain to axillary nodes and then subclavian
- inguinal - caudal to umbilicus drain to inguinal nodes and then lumbar
Describe a lymph node in a healthy patient
Pea sized round spongy no tenderness movable color of skin is unchanged from baseline normal temperature no edema
The lymph channels/ducts perfuse all tissues of the body except….
CNS* Epidermis (include hair and nails) Endomysium of muscles and cartilage Bone marrow Selected portions of peripheral nerves exceptions still possess direct diffusion *New research says CNS has lymph vessels
Describe the structure of lymph nodes
Unidirectional fluid flow in channels
Flow controlled by one-way valves
Channels/nodes surround major organs and vasculature
Unite with thoracic duct or right lymphatic duct
The right range area includes what?
25% of the body - half the head, neck and the right arm, right chest
Right lymphatic channel - connects to the venous system at the jugular-subclavian junction
What is the largest lymph vessel?
thoracic duct and it lies against to vertebral column between aorta and azygous vein
The thoracic duct connects to what?
At level of T4 it moves left of midline and connects to the junction of the left subclavian and left brachiocephalic veins
What does the thoracic duct drain?
left side of head and neck, left arm, left side of thorax, left and RIGHT lower body, viscera of thoracic
What is the dilation of distal thoracic duct called and where is it located?
cisterna chyli
Anterior to L1-2 and posterior to right crura of diaphragm
Describe larger lymphatic vessels
One-way valves preventing backflow
Smooth muscle
Sympathetic control
Stress increases sympathetic tone which decreases decongestion of tissues
What is lymph fluid?
substance that leaks out of arterial capillaries, into the interstitium, and into single-cell lymphatic vessels
What are the components of lymph fluid?
proteins, salts, fats, primary cell - lymphocytes, clotting factors, large particles such as bacteria and viruses
Describe fluid balance
50% of plasma proteins re-enter system via lymph
the the system can absorb some excess fluid from pleura, peritoneum, pericardium, and joints (excess of 3 L/24 hours)
Large proteins can enter lymphatic system
Aids in homeostasis in fluid overload situation
Describe purification and cleansing by the lymphatic system
lymph fluid baths all organs
This cleanses extracellular space of particulate matter, exudate and bacteria
Fluid then delivered to node
How does the lymphatic system act as defense for the body
Lymph fluid brings toxins, bacteria, viruses into contact with lymphatic system - acquired immunity
Free flowing of lymph necessary for good immune function
Describe nutrition in the lymphatic system
Lymph returns proteins back to vascular system
Proteins bind to nutrients
Fats absorbed via lymph system
What is normal interstitial fluid pressure and at what point will the vessels collapse?
normal = -6.3 mmHg
Increase in pressure will increase flow
Efficiency ceiling at 0 mmHg
Above 0 = collapse vessels and obstruct flow
What can increase interstitial fluid pressure?
Increased arterial capillary pressure (HTN)
Decreased plasma colloidal osmotic pressure (hepatic cirrhosis)
Increased interstitial fluid protein (starvation/plasma hypoalbuminemia)
Increased capillary permeability (toxins = rattlesnake poisoning)
Describe the intrinsic pump
Distention of larger vessels trigger constriction of smooth muscle - pumps fluid to next segment
Smaller vessels - endothelial cells have contractile fibers that respond to distention
Contraction causes pressure gradients to move fluid
Describe extrinsic pump
Direct pressure on vessels moves lymph
What is the thoracic diaphragm?
thoracic diaphragm: crura acts on cisterna chyli, respiration produces pressure gradients between thorax and abdomen, pressure gradients and one-way valves pull lymph towards venous circulation
What is the pelvic diaphragm?
Synchronous with abdominal diaphragm
Movement of interstitial fluids from pelvis
important in several situations: dysmenorrhea, preparation for labor and delivery, prostrate irritation in benign prostatic hypertrophy and other prostate problems
Edema in lymphatic system can be a result of…
too much fluid flowing into interstitium
ex. high venous pressure conditions: CHF, incompetent heart valves, venous obstructions, gravitation al effects
Too little fluid flowing out of interstitium
ex: conditions that decrease osmotic pressure gradients: starvation, cirrhosis of liver, abnormal protein metabolism
What happens if there is an increase of interstitial pressure and the lymph capillaries collapse?
More interstitial congestion and edema
Dilation of vessels spreads endothelial cells
stops intrinsic pump
What are the effects of edema?
compression of lymph vessels
Tissue congestion
Fluid stasis changes pH of tissue/organ
Chronic - fibroblasts causing contractures/fibrosis
Decreased delivery of nutrients
Decreased bioavailability of drugs and hormones
Lymphatic system is a _________ system
passive
