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OS Exam 2 > Lymphatics > Flashcards

Lymphatics Flashcards

1
Q

Embryology

A

Mesoderm: Lymphatic vessels, LN, the spleen, myeloid tissues

Endoderm: thymus and parts of the tonsils

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2
Q

Physiological Function

A

Major role in numerous homeostatic mechanisms of the body: Immune, digestive, fluid balance, waste

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3
Q

Spleen

A

Location: beneath ribs 9-11 on the left, abuts diaphragm

Characteristics: Largest single mass of lymphoid tissue, pressure-sensitive-movement of the diaphragm drives splenic fluid movement

Function: Destroy damaged and deformed RBC, synthesize Igs, clear bacteria

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4
Q

Liver

A

Location: RUQ; palpable at R costal margin

Characteristics is pressure sensitive like the spleen

Function: half of the body’s lymph is formed, clears bacteria, gate-keeper of the hepatobiliary-pancreatic venous and lymph drainage

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5
Q

Thymus

A

Location: Anterior mediastinum

Characteristics: Development, larger in infacy and size peaks at 2 y/o. After puberty involutes, replaced by fatty tissue

Function: Site of maturation of T cells

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6
Q

Tonsils

A

Location: 3 types all located in the posterior oropharynx

  • Palatine-lateral pharynx
  • Lingual-Posterior 1/3 of tongue
  • Pharyngeal-Adenoids at nasophyangeal border

Characteristics: Most are not visible until 6-9 months of age, remain enlarged thru childhood

Function: Provide cells to influence and build immunity early in life, nonessential to adult immune function

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7
Q

Appendix

A

Location: Proximal end of the cecum

Characteristics: Contains lymphoid pulp

Function: Part of the GALT

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8
Q

Visceral Lymphoid Tissue

A

GALT:
Peyer’s patches-ileum
Lacteals-Lymphatic capillaries of small bowel

Pulmonary lymphoid tissue scattered, filters toxins from lungs

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9
Q

Lymph FLuid

A

Substances that leak out of the arterial capillaries into the interstitium get taken up by lymphatic capillaries
-Fluids, proteins, electrolytes, and cells

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10
Q

Fluid Balance

A

30 L of fluid move from capillaries to interstitial space each day
-90% to capillaries and 10% to lymphatic system

When fluid overload occurs, lymphatic system helps prevent tissue dps by clearing the excess

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11
Q

OMT and Lymphatic Drainage

A

35-60% of the drainage thru the thoracic duct is associated with respiration
-Pump effect of the diaphragmatic crura on the cystena chyli

Restrictions of lymphatic flow must be first drained thru the associated terminal area

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12
Q

Normal Lymph Flow

A

Lymph channels begin a blind endothelial tubes or capillaries compose d of a single layer of leaky squamous epithelium that is supported by anchoring filaments

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13
Q

Lymph Vessel Anatomy

A

Lymphatic capillaries–>collecting lymphatics–>afferent lymphatic vessels–>efferent lymphatic vessels–>thoracic duct or R lymphatic duct–>venous system

Run with veins
ECF is sucked in by the low level negative pressure

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14
Q

Lymphatic Collectors

A

Consist of primarily of chain of muscular units called lymphangions

Possess two-leaflet bicuspid valves

Work like pacemakers, contracting regularly throughout the lymphatic system and moving lymph in peristaltic waves

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15
Q

Path of Lymph Flow thru a LN

A

Afferent lymphatics–>Subscapsular Space–>Outer cortex–>Deep Cortex–>Medullary sinus–>Efferent Lymphatics

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16
Q

Lymph Nodes

A

Most highly organized lymphoid tissue, dispersed along the course of lymph vessels

Types: superficial and deep

Function: Filtration of lymph fluid, maturation of lymphocytes, phagocytosis of bacterial and cellular debris

17
Q

Virchow’s Node

A

L supra-clavicular, GI cancer

18
Q

Epitrochlear Nodes

A

Secondary syphilis

19
Q

Thoracic duct

A

Master lymph vessel: drains L head/neck, LUE, L thorax/abs, Everything umbilicus down

Origin at cisterna chyli (Distal dilation at L1-2, receives lumbar lymphatics)

Pierces Sibons facscia at superior inlet, U-turns to empty into L subclav/IJ veins

20
Q

Right Lymphatic Duct

A

Origin: From the junction of R jugular and subclavian trunks (and occasionally the bronchomediastinal trunk)
Termination: Empties at R subclav/IJ venous junction

Function: Drains R head/neck, RUE, R thorax

21
Q

Purification and Cleansing

A

Lymph fluid bathes organs

Cleanses extracellular spaces of particulate matter, toxins, bacteria, cellular waste, and post-injury biochemical by-products.

Nodes act as filters

22
Q

Defense

A

Lymph fluid brings toxins, bacteria, and viruses into contact with the organized lymph tissues

  • High concentrations of immune cells
  • APCs and maturation of immune cells

Free flow of lymph fluid is necessary

23
Q

Nutrition

A

Fat absorption via chylomicrons
-Too big to cross capillary intercellular junctions, travel via lacteals->larger lymph vessels->thoracic duct->venous system

Returns proteins to the vasculature

24
Q

SNS Effects Lymph Valves

A

Increased sympathetic tone–>Tighter valves–>Decreased lymph flow into the venous system

25
Q

SNS Effects Lymphatic Smooth Muscle

A

Increased sympathetic tone–>Decreased peristalsis–> Lymphatic congestion

26
Q

Effects of Edema

A

Compression of local structures (vascular, neuronal, SOB, LOC)

Decreased tissue waste removal
Decreased pathogen clearance and immunity
Chronic states–>Fibroblast recruitment and activation

27
Q

Indications for Lymphatics OMT

A 
Edema 
Tissue Congestion 
Lymphatic statsis 
Infection 
Inflammation
28
Q

Absolute Contraindications for Lymphatic OMT

A

Anuria
Necrotizing fasciitis
Patient unable to tolerate treatment
Patient refuses treatment

29
Q

Relative Contraindications of Lymphatic OMT

A 
COPD
Acute asthma exacerbation
Unstable cardiac conditions 
Coagulopathies
Osseous fracture
Bacterial infections
Chronic Infections
Diseased organs
Pregnancy 
Circulatory disorders
Cancer
30
Q

Principles of Dx for Lymphatics approach

A

1) Evaluate risk-benefit ratio
2) Evaluate fascial patterns of Zink
3) Evaluate diaphragms/fascia
4) Evaluate SD
5) Evaluate tissue congestion

31
Q

Common Compensatory

A

80% of healthy people

L/R/L/R

32
Q

Uncommon Compensatory

A

20% of healthy people

R/L/R/L

33
Q

Uncompensated Patterns

A

Usually symptomatic, and trauma involved

34
Q

Transverse Restrictors

A

Tentorium Cerebelli
Thoracic Inlet
Diaphragm
Pelvic Diaphragm

35
Q

Sequence of Treatment

A

1) Open pathways to remove restriction to flow
2) Maximize diaphragmatic functions
3) Increase pressure differentials or transmit motion
4) Mobilize targeted tissue fluids

36
Q

Infected LN

A

Swollen, soft, painful

37
Q

Malignancy in LN

A

Swollen, hard, non-painful, fixed

OS Exam 2 (4 decks)

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