Lymphatics

Question 1

Right lymphatic duct

Answer 1

right upper extremity, right hemicranium, heart and lobes of the lung except left upper lobe

drains into right brachiocephalic v.

transverses Sibson’s fascia of thoracic inlet once

Question 2

Left lymphatic duct

Answer 2

lymph from remainder of body

drains junction of the left internal jugular and subclavian v.

Question 3

Thoracic duct

Answer 3

18 inches

from cisterna chyli below diaphragm (L2) through aortic hiatus (T12) into neck for about 3 cm before draining into left (major) duct

Valves - semilunar

Question 4

Composition of Lymph

Answer 4

aa, glycerol, glucose, long chain fats, chylomicrons, cholesterol, clotting factors

Lymphocytes

cleanse body of immune complexes, bacteria, viruses, salts, 50% plasma proteins

Question 5

Innervation of lymphatics

Answer 5

sympathetic –> constrict lymphatic capillaries

Cisterna chyli innervated by T12
Thoracic duct innervated by intercostal nerves

Question 6

Extrinsic forces influencing lymph movement

Answer 6

OMT
exercise
contraction of muscles
pulsation of adjacent arteries
respiratory movement to increase negative intrathoracic pressure

Question 7

Intrinsic forces influencing lymph movement

Answer 7

sm.m. contraction

interstitial fluid pressure

Question 8

Factors allowing ECF to enter lymphatics

Answer 8

increased arterial capillary pressure
decreased plasma colloid osmotic pressure
increased protein in interstitium
increased capillary permiability

Question 9

Factors increasing interstitial pressure above 0mmHg

Answer 9

systemic HTN
cirrhosis - decreased plasma protein synthesis
hypoalbuminemia assoc w/ starvation
Toxins - rattlesnake

Question 10

Areas of lymphatic dysfunction

Answer 10

Fullness and bogginess in:

Supraclavicular - congestion of head and neck (sinusitis)

Posterior axillary fold - arm

Epigastric area - chest/abdomen congestion (cirrhosis)

Inguinal area - LE infection

Popliteal area - leg congestion (thrombophlebitis)

Achilles tendon - ankle/foot inj

Question 11

Areas of dysfunction leading to lymphatic congestion

Answer 11

Tense pelvic diaphragm - levator ani and coccygeus

Restricted thoracic cage motion

Viscerosomatic tissue texture changes (Chapman’s)

Paravertebral muscle spasm -> flat diaphragm

Torsioned throacic inlet

Cranial base strain - tentorium cerebelli

Question 12

basic sequence of lymphatic treatments

Answer 12

1. thoracic inlet SD
2. rib raising or paraspinal inhibition
3. redome thoracoabdominal diaphragm
4. apply lympathic pump techniques

Question 13

Relative contraindications of lympathic treatment

Answer 13

osseous fractures
bacterial infections with temp over 102
Abscess or localized infection
carcinoma - advanced stage