Lymphatics Flashcards
Indications for Lymphatic treatment
Acute SD Sprains/strains Edema/Tissue congestion Lymphatic or venous stasis Pregnancy Infection Inflammation
Absolute Contraindications for lymphatic treatment
Anuria
Necrotizing fasciits
Relative Contraindications for lymphatic treatment
Malignancy
Fracture/Dislocation
Certain infections (mono, abscess, chronic osteomyelitis)
Certain circulatory disorders (venous obstructions, embolism, hemorrhage, patients on anticoagulants)
Zink’s Compensated patterns
Alternating may contribute to Lymphatic flow
RLRL or LRLR
(non alternating may contribute to lymphatic congestion)
How to perform Zink “Warmth provocative test” and why
Evaluate thoracic, rib, sternal, cranial, C2, and Sacrum
Warmer areas may be a site of SD
What do you feel for when palpating lymph nodes?
Normal pea size Round/regular shape Spongy consistency Nontender Mobile Overlying skin is baseline
Regional Lymph Node collecting sites
Supraclavicular space Epigastric region Posterior axillary fold Inguinal region Popliteal space Achilles region
What are the 4 principles of Lymphatic treatment?
- Open pathways to remove restriction to flow
- Maximize Diaphragmatic fxns
- Increase pressure differentials or transmit motion
- Mobilize targeted fluid tissue
What lymphatic treatment do you use to open pathways and remove restriction to flow?
Thoracic Inlet MFR
Can also use anterior/posterior axillary fold techniques or popliteal fossa release
What lymphatic treatment do you use to maximize diaphragmatic functions?
Doming the Diaphragm
Ischiorectal Fossa Release/Doming the Pelvic Diaphragm
What lymphatic treatment do you use to increase pressure differentials or transmit motion?
Pectoral traction Rib raising Thoracic pump Abdominal pump Sacral rocking Pedal pump
Where can you perform abdominal pump?
Spleen
Liver
What lymphatic treatment can you use to mobilize targeted tissue fluids?
Tapotement Effleurage and Petrissage Anterior Cervical Arches Release Cervical Stroking Cervical Chain Drainage Submandibular drainage Mandibular drainage/Galbreath Auricular drainage
Lymphatic tissues/Organs
Spleen Liver Thymus Tonsils Appendix Visceral lymphoid tissue Lymph nodes
3 anatomic components of the Lymphatic system
Organized tissues/Organs
Lymph fluid
Lymph vessels
Physiologic fxn of Lymph
Immune
Digestive
Fluid Balance
Waste
Fxn of the spleen
Destroy damaged/deformed RBCs
Synthesize Igs
Clear bacteria
Location of the spleen
Beneath ribs 9-11 on the L
Not palpable
Characteristics of the spleen
Largest single mass of lymphoid tissue
Pressure sensitive - movement of the diaphragm drives splenic fluid movement
Location of the liver
RUQ
Palpable at R costal margin
Characteristics of the Liver
Pressure sensitive - movement of the diaphragm is important for the homeostatic movement of hepatic fluids
Lymphatic fxn of the Liver
Forms half the body’s lymph
Clears bacteria
Gate-keeper of shared hepatobiliary-pancreatic venous and lymphatic drainage
Location of the Thymus
Anterior mediastinum
Characteristics of the Thymus
Development of T cells, important in childhood, replaced by fatty tissue after puberty
Fxn of the Thymus
Maturation site for T cells
Little to no fxn in adults
3 locations of the tonsils
All located in posterior oropharynx
- Palatine - lateral pharynx
- Lingual - Posterior 1/3 of the tongue
- Pharyngeal - Adenoids at nasopharyngeal border
Characteristics of the tonsils
Most not visible until 6-9 months
Remain enlarged through childhood
Fxn of the tonsils
Provide cells to influence and build immunity early in life
Nonessential to adult immune fxn
Appendix location
At the proximal end of the cecum in the LI
Characteristics of the appendix
Contains lymphoid pulp
Lymphoid tissue atrophies with age
Fxn
Part of GALT
Visceral Lymphatic Tissue is also known as ___
GALT
Where are Peyer’s Patches located?
Ileum
GALT contains lacteals, which perform what function?
Lymphatic capillaries of small bowel that transport large chylomicrons into the lymphatic system -> thoracic duct -> Venous system
What comprises lymph fluid?
Fluids, proteins, electrolytes Immune cells Foreign antigens Bacteria and viruses Clotting factors Chylomicrons post-prandial
How much fluid moves from capillaries to interstitial space each day?
30L
90% to capillaries, 10% to lymph
What is 2nd/3rd spacing?
When fluid overload occurs, lymphatic system helps prevent tissue damage by clearing the excess
How much of the diffused plasma proteins re-enter the system via lymph?
1/2
35-60% of drainage through thoracic duct is associated with ____
Respiration
Restrictions of lymphatic flow must first be drained through the associated ___
Terminal area
Tissues that do not have lymphatic vessels but use direct diffusion
Epidermis
Endymysium
Cartilage
Bone marrow
Lymph channels begin as _____ composed of a single layer of _____ epithelium supported by _____
Blind endothelial tubes
Leaky squamous
Anchoring filaments
Describe the flow of lymph
Lymph capillaries => collecting lymphatics => afferent lymphatic vessels => Efferent lymphatic vessels => Thoracic duct or R lymphatic duct => Venous system
The lymph collectors consist primarily of chains of muscular units called ____
Lymphangions
Possess 2 leaf bicuspid valves
Similar to veins
Path of lymph flow through a lymph node
Afferent lymphatics => Subcapsular space => Outer cortex => Deep Cortex => Medullary sinus => Efferent Lymphatics
Most highly organized lymphoid tissue?
Lymph nodes
Where are superficial lymph nodes?
Within subcutaneous tissue
Cervical, axillary, inguinal
Where are deep lymph nodes?
Beneath fascia
Muscle, organs
Where is Virchow’s Node and what does it indicate?
L supraclavicular
Intra-thoracic/Abdominal CA
What do Epitrochlear nodes indicate?
Secondary syphilis
What does the Thoracic duct drain?
L head/neck
LUE
L thorax/abdomen
Everything umbilicus down
What lymph structures come from mesoderm?
Lymphatic vessels
Lymph nodes
Spleen
Myeloid tissue
What lymph structures come from endoderm?
Thymus
Tonsils
Where does the thoracic duct originate?
Cisterna Chyli
What structure pierces Sibson’s fascia at the superior inlet?
Thoracic duct
Where does the thoracic duct empty into?
L subclavian/IJ veins
Right lymphatic duct origin
Junction of R jugular and subclavian trunks
Occasional bronchomediastinal trunk
Termination of R lymphatic duct
R subclavian/IJ venous jxn
R lymphatic duct fxn
Drains R head/neck, RUE, R thorax
Lymph cleaning fxn
Cleans extracell spaces of toxins, cellular waste, bacteria
Lymph defense fxn
Lymph fluid contains high concentrations of immune cells and brings toxins, bacteria, and viruses into contact with organized lymph tissue
Lymph nutrition fxn
Fat absorption via chylomicrons
Travels via lacteals => larger lymph vessels => thoracic duct => Venous system
How does the SNS affect lymph valves?
Iincreased SNS => increased sympathetic tone => tighter valves => decreased lymph flow into venous system
How does the SNS affect Lymphatic smooth muscle?
Increased sympathetic tone => decreased peristalsis => lymphatic congestion
Causes of edema?
Increased interstitial fluid
Increased arterial pressure - HTN, drugs, increased blood volume
Increased venous pressure - CHF, valvular dx, venous obstruction, dysfunctional venous valves
Decrease plasma osmotic pressure - Cirrhosis, protein malnutrition
Effects of Edema
Compression of local structures
Decreased tissue waste removal
Decreased pathogen clearance and immunity
Chronic state will increase fibroblast recruitment and activation
Principles of Diagnosis from a Lymphatic approach
- Evaluate risk-benefit ratio
- Evaluate fascial patterns of Zink
- Evaluate diaphragms/fascia
- Evaluate for SD
- Evaluate tissue congestion
Common Compensatory pattern
LRLR
80% of people
Uncommon Compensatory pattern
RLRL
20% of healthy people
Transition zones of the spine
OA, C1
C2, C7, T1
T12, L1
L5, Sacrum
Transverse restrictors of the spine
Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar diaphragm
Pelvic Diaphragm
