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OSI Test 2 > Lymphatics > Flashcards

Lymphatics Flashcards

1
Q

Describe a lymph node in an unhealthy patient (cancer)

A

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

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2
Q

What are the locations of nodes in the head area? state any abnormalities

A

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)

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3
Q

Where are the lymph nodes in the neck region?

A

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)

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4
Q

Where are the lymph nodes in the clavicular region?

A

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

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5
Q

Where are the lymph nodes in the inguinal region?

A

Superior/inferior inguinal- find ASIS and move medial and inferior - inferior in femoral triangle (can frog leg to open up femoral triangle)

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6
Q

Where are the lymph nodes in the axillary region?

A 
Apex: top of diamond
Anterior axillary: front
Central/medial (rib): bottom
Posterior: back
Lateral (along upper surface of arm: above apex
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7
Q

where are the lymph nodes in the epitrochlear region? If enlarged what can that indicate?

A

Superior/posterior to medial humeral epicondyle - symphilis

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8
Q

Treatment zone 1?

A

Thoracic inlet down tot thoracoabdominal diaphragm

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9
Q

Treatment zone 2?

A

Abdominal diaphragm down to pelvic diaphragm

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10
Q

Treatment zone 3?

A

Upper extremities

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11
Q

Treatment zone 4?

A

Lower extremities

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12
Q

Treatment zone 5?

A

Head and neck

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13
Q

What is the goal of lymphatic treatment and what is the proper order?

A

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

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14
Q

Name 4 abnormal findings of a LN

A

Large, irregular, hard, red, tender/painful, fixed waarm

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15
Q

Where does abdominal cancer drain to and where is this spot located?

A

Virchow’s node in the left supraclavicular space

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16
Q

What position do you put your patient to examine the inguinal nodes?

A

Supine with frog leg position

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17
Q

How should every lymph tx begin and end?

A

Opening the thoracic inlet

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18
Q

What are the zones of treatment? does it matter which order you treat them in? if so, what is it?

A
  1. Thoracic
  2. Abdominal
  3. Upper extremity
  4. Lower extremity
  5. Head and neck
  6. thoracic inlet
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19
Q

What are the contraindication for lymph tx?

A

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

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20
Q

The lymphatic system transports _____ from digestive system blood

A

fats

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21
Q

Why do lymphatics have to assist the body in removing interstitial fluids and plasma proteins?

A

It accumulates due to metabolism; inflammation; infection; trauma; or system dysfunction

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22
Q

Describe the function and location of the spleen?

A

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

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23
Q

What is important for the homeostatic movement of splenic fluids?

A

Movement of the diaphragm

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24
Q

Where is half of body’s lymph formed?

A

Liver

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25
Q

The liver is the “gate-keeper” of what?

A

the shared hepato-biliary-pancreatic venous and lymphatic region and also clears bacteria

26
Q

The liver is a pressure sensitive organ, affected by what?

A

Muscular action of the thoraco-abdominal diaphragm

27
Q

Where is the thymus located?

A

Superior mediastinum
Anterior to great vessels
Extends into the neck

28
Q

Describe the thymus from infant to adult

A

Large in infant (greatest at 2)
After puberty - involutes
Adult - replaced by fatty tissue

29
Q

What is the function of the thymus?

A

Provide cells involved in maturation of the immune system
Processing site for T-lymphocytes
Little or no function in adult

30
Q

What are tonsils and what is their function?

A

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

31
Q

Where are palatine, lingual, pharyngeal tonsils?

A

Palatine - lateral pharynx
Lingual - posterior 1/3 of tongue
Pharyngeal - adenoids at nasopharyngeal border

32
Q

Describe the appendix

A

Located at medial surface of the cecum
exact function unknown
Presume it offers support to immune system

33
Q

How is the respiratory system a visceral lymphoid tissue?

A

It aides in filtration of toxins from lungs

34
Q

In the GI system, what immune visceral lymphoid tissues can be found in the distal ilium and in small bowel?

A

Peyer’s patches - distal ilium

Lacteals - lymphatic capillaries in each villi in small bowel

35
Q

What is the most highly organized lymphoid tissue and its main purpose?

A

Lymph nodes

Primary purpose is for filtration of lymph

36
Q

What are the to types of lymph nodes?

A

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

37
Q

What do superficial nodes drain into?

A

three main groups of nodes (from the extremities into the core)

  1. Cervical - head/supraclavicular and upper extremity drain to jugular nodes
  2. axillary - infraclavicular to umbilicus, drain to axillary nodes and then subclavian
  3. inguinal - caudal to umbilicus drain to inguinal nodes and then lumbar
38
Q

Describe a lymph node in a healthy patient

A 
Pea sized
round
spongy
no tenderness
movable
color of skin is unchanged from baseline
normal temperature
no edema
39
Q

The lymph channels/ducts perfuse all tissues of the body except….

A 
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
40
Q

Describe the structure of lymph nodes

A

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

41
Q

The right range area includes what?

A

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

42
Q

What is the largest lymph vessel?

A

thoracic duct and it lies against to vertebral column between aorta and azygous vein

43
Q

The thoracic duct connects to what?

A

At level of T4 it moves left of midline and connects to the junction of the left subclavian and left brachiocephalic veins

44
Q

What does the thoracic duct drain?

A

left side of head and neck, left arm, left side of thorax, left and RIGHT lower body, viscera of thoracic

45
Q

What is the dilation of distal thoracic duct called and where is it located?

A

cisterna chyli

Anterior to L1-2 and posterior to right crura of diaphragm

46
Q

Describe larger lymphatic vessels

A

One-way valves preventing backflow
Smooth muscle
Sympathetic control
Stress increases sympathetic tone which decreases decongestion of tissues

47
Q

What is lymph fluid?

A

substance that leaks out of arterial capillaries, into the interstitium, and into single-cell lymphatic vessels

48
Q

What are the components of lymph fluid?

A

proteins, salts, fats, primary cell - lymphocytes, clotting factors, large particles such as bacteria and viruses

49
Q

Describe fluid balance

A

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

50
Q

Describe purification and cleansing by the lymphatic system

A

lymph fluid baths all organs
This cleanses extracellular space of particulate matter, exudate and bacteria
Fluid then delivered to node

51
Q

How does the lymphatic system act as defense for the body

A

Lymph fluid brings toxins, bacteria, viruses into contact with lymphatic system - acquired immunity
Free flowing of lymph necessary for good immune function

52
Q

Describe nutrition in the lymphatic system

A

Lymph returns proteins back to vascular system
Proteins bind to nutrients
Fats absorbed via lymph system

53
Q

What is normal interstitial fluid pressure and at what point will the vessels collapse?

A

normal = -6.3 mmHg
Increase in pressure will increase flow
Efficiency ceiling at 0 mmHg
Above 0 = collapse vessels and obstruct flow

54
Q

What can increase interstitial fluid pressure?

A

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)

55
Q

Describe the intrinsic pump

A

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

56
Q

Describe extrinsic pump

A

Direct pressure on vessels moves lymph

57
Q

What is the thoracic diaphragm?

A

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

58
Q

What is the pelvic diaphragm?

A

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

59
Q

Edema in lymphatic system can be a result of…

A

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

60
Q

What happens if there is an increase of interstitial pressure and the lymph capillaries collapse?

A

More interstitial congestion and edema
Dilation of vessels spreads endothelial cells
stops intrinsic pump

61
Q

What are the effects of edema?

A

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

62
Q

Lymphatic system is a _________ system

A

passive

OSI Test 2 (5 decks)

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