Lymphatics Flashcards

1
Q

Who first described the lymphatics system and when?

A

Olaf Rudbeck (Sweden) in 1653

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2
Q

When did AT Still emphasize that diagnosis of the fascia and treatment of the lymphatic system was vital for maintaining health and treating disease?

A

1874

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3
Q

Who and when was Applied Anatomy of the Lymphatics published?

A

1922: Frederic Millard DO

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4
Q

When does lymphatic development begin? Significant?

A

5th week of gestation; 20 weeks

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5
Q

From which structures do lymphatic structures arise?

A

Mesoderm - lymph vessels, lymph nodes, spleen, myeloid tissue
Endoderm - thymus and parts of tonsils

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6
Q

When does lymphoid tissue increase until?

A

puberty

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7
Q

What happens to the immune system in geriatrics?

A

declines, may not mount a fever

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8
Q

What are the anatomic components of the lymph system?

A

tissues/organs: spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue, lymph nodes
lymph fluid
lymphatic vessels

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9
Q

What are the physiological functions of the lymphatic system?

A

immune
digestive - nutrition
fluid imbalance
waste

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10
Q

Spleen: location, characteristics, function

A

location: beneath ribs 9-11 on left, next to diaphragm
normally not palpable
characteristics: largest single mass of lymphoid tissue, fluid movement driven by diaphragm movement
functions: destroy damaged/deformed RBCs, synthesize Igs, clear bacteria

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11
Q

Liver: location, characteristics, function

A

location: RUQ; palpable at R costal margin
characteristics: movement of diaphragm important for movement of fluids
function: half body’s lymph formed here, clears bacteria, “gate keeper” of shared hepato-billary pancreatic venous and lymphatic drainage

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12
Q

Thymus: location, characteristics, function

A

location: anterior mediastinum
characteristics: large in infancy and peaks at 2 yo, involutes after puberty and replaced by fatty tissue
function: maturation of t cells, little or no function in adults

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13
Q

Tonsils: location, characteristics, function

A

location: 3 types in posterior oropharynx: palantine (lateral pharynx), lingual (posterior 1/3 tongue), and pharyngeal (adenoids at nasopharyngeal border)
characteristics: not visible until 6-9 mo, remain enlarged through childhood
function: provide cells to influence and build immunity early in life, nonessential to adult immune function

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14
Q

Appendix: location, characteristics, function

A

location: proximal end of the cecum (large intestine)
characteristics: contains lymphoid pulp, atrophies with age
function: part of GALT

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15
Q

What are examples of GALT?

A

Peyer’s patches (ileum), lacteals (lymphatic capillaries of small bowel), appendix (cecum)

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16
Q

What is lymph fluid and what is is made of?

A

Substances that leak out of the arterial capillaries into the interstitium get taken up by lymphatic capillaries;
immune cells, foreign antigens, bacteria and viruses, clotting factors, chylomicrons post-prandial

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17
Q

How much fluid moves from capillaries to interstitial space each day? to where?

A

30 L; 90% to capillaries, 10% to lymphatic system

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18
Q

What does the lymphatic system help prevent?

A

third spacing

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19
Q

How much drainage through the thoracic duct is associated with respiration?

A

35-60%

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20
Q

What tissues do not have lymphatic vessels?

A

epidermis, endomysium, cartilage, bone marrow

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21
Q

What do the lymph channels begin as? What are they composed of?

A

The lymph channels begin as blind endothelial tubes or capillaries composed of a single layer of leaky squamous epithelium that is supported by anchoring filaments.

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22
Q

What are the path of the lymphatic vessels?

A

lymphatic capillaries, collecting lymphatics, afferent, efferent, thoracic duct or R lymphatic duct, venous system

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23
Q

What are lymphagions?

A

chains of muscular units that possess two-leaflet bicuspid valves that contract regularly throughout the system and move lymph along in peristaltic waves

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24
Q

What is the afferent lymphatics?

A

channel that delivers lymph to the node from the peripheral tissues on the side opposite the hilum

25
Q

What is the subcapsular space of a lymph node?

A

a meshwork of reticular fibers, macrophages, and dendritic cells where afferent vessels deliver lymph

26
Q

What is the outer cortex of a lymph node?

A

rich in B cells that sit within germinal centers that resemble those of lymphoid nodules

27
Q

What is the deep cortex of a lymph node?

A

contains lymph sinuses dominated by T cells

28
Q

What is the medullary sinus of a lymph node?

A

located at core, region rich in B cells and plasma cells

29
Q

What is the efferent lymphatics of a lymph node?

A

channel through which the lymph collected from the medullary sinus exits at the hilum

30
Q

Where are superficial lymph nodes? examples?

Where are the deep lymph nodes?

A

within the subcutaneous tissue: cervical axillary, inguinal

deep: beneath fascia, muscle, organs

31
Q

What are the functions of lymph nodes?

A

filtration of lymph fluid, maturation of lymphocytes, phagocytosis of bacteria and cellular debris

32
Q

What do you look for when evaluating lymph nodes?

A

size, shape, consistency, tenderness, mobility, color, warmth

33
Q

Where is Virchow’s node?

A

left supra-clavicular (intra-thoracic/abd CA)

34
Q

What do epitrochlear nodes indicate?

A

secondary syphilis

35
Q

What does the thoracic duct drain?

A

Left head/neck, LUE, L thorax/abdomen, below the umbilicus

36
Q

Where is the origin and termination of the thoracic duct?

A

origin: cisterna chyli as a dilation at L1-2 level
termination: pierces Sibson’s fascia at superior inlet, U-turns to empty into left subclavicular/IJ veins

37
Q

What is the origin and termination of the right lymphatic duct? What does it drain?

A

origin: junction of right jugular and subclavian trunks and occasionally the bronchomediastinal trunk
termination: R subclavian/IJ venous junction
drains: R head/neck, RUE, R thorax, heart, lungs (except LUL)

38
Q

Describe the lymphatic drainage of the pelvic organs

A

superficial inguinal –> deep inguinal –> lacunar –> external iliac –> common iliac
visceral pelvic –> internal iliac –> common iliac

common iliac –> right lumbar, intermediate lumbar, or left lumbar –> (right/left lumbar trunk) –> cisterna chyli –> thoracic duct

39
Q

How does the lymph system purify and cleanse?

A

bathes organse, cleanses ECF spaces of particulate matter, toxins, bacteria, cellular waste products, and post injury biochemical byproducts
node acts as filter

40
Q

How doe the lymph system defend?

A

lymph fluid brings toxins, bacteria, and viruses in contact with organized lymph tissue with high concentrations of immune cells for antigen processing and presentation, allows free flow of lymph

41
Q

How does the lymph system function in nutrition?

A

fat absorption via chylomicrons that are too big to cross capillary intercellular junctions travel via lacteals to venous system
returns proteins to vasculature to bind nutrients

42
Q

What is the normal interstitial fluid pressure (Pif)

A

-6.3 mmHg (negative pressure)

43
Q

What are causes of positive pressure in lymph system?

A

increased hydrostatic pressure, decreased colloid osmotic pressure, increased capillary permeability

44
Q

Does the SNS increase or decrease lymph flow?

A

decrease

45
Q

What are the consequences of poorly functioning lymphatic system?

A

EDEMA, buildup of interstitial fluid, increased arterial pressure: HTN drugs increased blood volume, increased venous pressure: CHF valvular dz venous obstruction, decreased plasma osmotic pressure: cirrhosis protien malnutrition (Kwarshiokor) DM, increased capillary permeability: infection snake bite trauma

46
Q

What are the effects of edema?

A

compression of local structures:
vascular - decreased delivery of O2, nutrients, meds, hormones.
neuronal: decreased sensation, pain, or paresthesia
pulmonary: SOB
cerebral: LOC

decreased tissue waste removal: pH changes

decreased pathogen clearance and immunity

chronic states: fibrosis/contractures

47
Q

What is lymphatic OMT?

A

a diverse group of techniques designed to remove impediments to lymphatic circulation and promote and augment the flow of interstitial fluid and lymph

48
Q

What are indications of lymphatic OMT?

A
  1. edema, tissue congestion, lymphatic stasis
  2. infection
  3. inflammation
    * approach chronic conditions with gentler techniques, shorter, but more frequent
49
Q

What are contraindications to lymphatic treatments?

A

clinical judgement with attention to diagnosis, clinical condition, and medical therapy influencing choice, dose, duration, and frequency

50
Q

what are absolute contraindications to lymphatic OMT?

A

anuria, necrotizing fasciitis in the treatment area, pt unable to tolerate, pt refuses

51
Q

What are relative contraindications for lymphatic OMT?

A

inability to tolerate excessive preload, COPD for thoracic pump, acute asthma exacerbation, unstable cardiac conditions, untreated coagulopathies or patients on anticoagulants, cancer, osseous fracture, bacterial infections, chronic infections, diseased organs, pregnancy, circulatory disorders

52
Q

What are the principles of diagnosis from a lymphatics approach?

A
  1. evaluate risk-benefit ratio
  2. evaluate fascial patterns of Zink
  3. evaluate diaphragms/fascia including thoracic inlet for restrictions that may limit lymphatic drainage
  4. evaluate for SD
  5. evaluate tissue congestion
53
Q

Compensatory patterns

A

80% LRLR

20% RLRL

54
Q

What are the transition zones of the spine for Zink patterns?

A

OA, C1, C2
C7, T1
T12, L1
L5, sacrum

55
Q

What are the transverse restrictors?

A

tentorium cerebelli
thoracic inlet
thoracolumbar diaphragm
pelvic diaphragm

56
Q

What are the OMT treatments to evaluate diaphragms/fascia?

A
  1. Thoracic inlet MFR (always 1st)
  2. Doming of the diaphragm (2nd for lymphatic problems inferior to the diaphragm)
  3. Suboccipital release by kneading or inhibition (2nd for HEENT lymphatic problems)
  4. Ischiorectal fossa release (3rd for lymphatic problems in the lower extremities)
57
Q

Where do we feel to evaluate for lymphatic congestion?

A
  1. supraclavicular space (head and neck)
  2. epigastric region (abdomen and chest)
  3. posterior axillary fold (arm)
  4. inguinal region (lower extremity)
  5. popliteal region (leg)
  6. achilles region (ankle and foot)
58
Q

What is the sequence of treatment for lymphatics?

A
  1. open pathways to remove restriction to flow
  2. maximize diaphragmatic functions (abdomen and pelvic diaphragms)
  3. increase pressure differentials or transmit motion (fluid pumps)
  4. mobilize targeted tissue fluids (localized to specific somatic dysfunctions)