Lymphatics Flashcards
when did olaf rudbeck first describe lymphatics as a system
1653
when did AT still emphasize that diagnosis of fascia and tx of lymphatic system was vital
1874 :)
when did frederick millard publish applied anatomy of the lymphatics
1922
what two germ layers does the lymphatic system come from
endoderm and mesoderm
the mesoderm leads to
lymphatic vessels
lymph nodes
spleen
myeloid tissue
the endoderm leads to
thymus
parts of tonsils
spleen function
pressure-sensitive –> movement of diaphgram drives splenic fluid movement
- destroy damaged RBC
- synthesize Igs
- clear bacteria
what is the “gate-keeper” of the shared hepato-bliary-pancreatic venous and lymphatic drainage
the liver
tonsils:
- palatine
- lingual
- pharyngeal
palatine: traditional tonsils
lingual: posterior 1/3 of tongue
pharyngeal: adenoids at nasopharyngeal border
examples of GALT
- appendix
- peyer’s patches
- lacteals
how much of the 30 L of fluid moving from the capillaries to the interstitial space each day is to the lymphatics
10%
second-third spacing
when fluid overload occurs and the lymphatic system clears the excess into the interstitial space
35-50% of the drainage through the thoracic duct is associated with
respiration
the lymph channels are made of what histological layer
leaky squamous epithelium
list the flow of lymph from lymphatic capillaries to the venous system
lymph capillaries –> collecting lymph –> afferent –> efferent –> thoracic duct/R lymph duct –> venous system
lymphangions
the “lymphatic hearts” that contract regularly to move lymph in peristaltic waves
- lymphangiomotoricity
when do you inspect lymph nodes for infection and when for malignancy
swollen, soft, painful –> infection
swollen, hard, non-painful –> malignancy
virchow’s node
left supraclavicular node indicative of intrathoracic/abdominal cancer
epitrochlear nodes
indicative of secondary syphilis
jugulodigastric area/node
1st node to get swollen in infections and can be chronically swollen
what does the thoracic duct drain
left head/neck
LUE
L thorax/abdomen
everything umbilicus down
origin and termination of the thoracic duct
O: at cisterna chyli around L1-L2
T: sibson’s fascia at superior inlet and u-turns to empty into left subclavian/IJ veins
what does the right lymphatic duct drain
right head/neck RUE R thorax heart lungs
origin and termination of right lymphatic duct
O: junction of R jugular and subclavian trunks
T: right subclavian/IJ venous junction
how does lymphatics help with fat absorption
chylomicrons travel lacteals–>large lymp vessels–>thoracic duct–>venous system
causes for interstitial fluid pressures >0
increased hydrostatic pressure
decreased plasma colloid osmotic pressure
increased capillary permeability
effect of SNS on lymph flow
increased SNS decreases lymph flow which increases lymph congestion
A diverse group of techniques designed to remove impediments to lymphatic circulation and promote and augment the flow of interstitial fluid and lymph.
lymphatic OMT definition
indications for lymphatic OMT
- edema, tissue congestion, lymphatic stasis
- infection
- inflammation
also:
- acute SD
- sprains/strains
- pregnancy
absolute contraindications for lymphatic OMT
- anuria
- necrotizing fasciitis
- pt cannot tolerate
- pt refuses
some relative contraindications for lymphatic OMT
CHF, COPD, acute asthma exacerbation, anticoagulation, cancer, bacterial infections w/ risk of dissemination, embolism
4 transition zones of the spine
OA, C1 (tenrorium cerebelli)
C7, T1 (thoracic inlet)
T12-L1 (thoracolumbar diaphragm)
L5-sacrum (pelvic diaphragm)
if you have a lymphatic problem in the lower extremity, what is the order of diaphragm evaluations
- thoracic inlet MFR
- doming the diaphragm
- ischiorectal fossa release
if you have an HEENT lymphatic problem, how do you evaluate
- thoracic inlet MFR
2. suboccipital release
where do you feel for lymphatic congestion
- supraclavicular space (head/neck)
- epigastric region (abd and chest)
- posterior axillary fold (arm)
- inguinal region (LE)
- popliteal space (leg)
- achilles region (foot/ankle)
sequence of treatment
- open pathways to remove restriction of flow
- maximize diaphragmatic functions
- increase pressure differentials or transmit motion (fluid pumps)
- mobilize targeted tissue fluids
where to evaluate for Zink “warmth provocative test”
thoracic rib sternal cranial C2 sacrum
normal:
- size
- consistency
- tenderness
- mobility
- pea-sized
- spongy
- non-tender
- mobile
in pectoral traction when do you pull
on inhalation
what is considered flexion and extension at the sacrum
flexion: sacral base is anterior (exhalation)
extension: sacral apex is anterior (inhalation)
when do you apply pressure in rib raising (seated/supine) if using respirations
inhalation
