Lymphatics

Question 1

when did olaf rudbeck first describe lymphatics as a system

Answer 1

1653

Question 2

when did AT still emphasize that diagnosis of fascia and tx of lymphatic system was vital

Answer 2

1874 :)

Question 3

when did frederick millard publish applied anatomy of the lymphatics

Answer 3

1922

Question 4

what two germ layers does the lymphatic system come from

Answer 4

endoderm and mesoderm

Question 5

the mesoderm leads to

Answer 5

lymphatic vessels
lymph nodes
spleen
myeloid tissue

Question 6

the endoderm leads to

Answer 6

thymus

parts of tonsils

Question 7

spleen function

Answer 7

pressure-sensitive –> movement of diaphgram drives splenic fluid movement

• destroy damaged RBC
• synthesize Igs
• clear bacteria

Question 8

what is the “gate-keeper” of the shared hepato-bliary-pancreatic venous and lymphatic drainage

Answer 8

the liver

Question 9

tonsils:

• palatine
• lingual
• pharyngeal

Answer 9

palatine: traditional tonsils
lingual: posterior 1/3 of tongue
pharyngeal: adenoids at nasopharyngeal border

Question 10

examples of GALT

Answer 10

• appendix
• peyer’s patches
• lacteals

Question 11

how much of the 30 L of fluid moving from the capillaries to the interstitial space each day is to the lymphatics

Answer 11

10%

Question 12

second-third spacing

Answer 12

when fluid overload occurs and the lymphatic system clears the excess into the interstitial space

Question 13

35-50% of the drainage through the thoracic duct is associated with

Answer 13

respiration

Question 14

the lymph channels are made of what histological layer

Answer 14

leaky squamous epithelium

Question 15

list the flow of lymph from lymphatic capillaries to the venous system

Answer 15

lymph capillaries –> collecting lymph –> afferent –> efferent –> thoracic duct/R lymph duct –> venous system

Question 16

lymphangions

Answer 16

the “lymphatic hearts” that contract regularly to move lymph in peristaltic waves
- lymphangiomotoricity

Question 17

when do you inspect lymph nodes for infection and when for malignancy

Answer 17

swollen, soft, painful –> infection

swollen, hard, non-painful –> malignancy

Question 18

virchow’s node

Answer 18

left supraclavicular node indicative of intrathoracic/abdominal cancer

Question 19

epitrochlear nodes

Answer 19

indicative of secondary syphilis

Question 20

jugulodigastric area/node

Answer 20

1st node to get swollen in infections and can be chronically swollen

Question 21

what does the thoracic duct drain

Answer 21

left head/neck
LUE
L thorax/abdomen
everything umbilicus down

Question 22

origin and termination of the thoracic duct

Answer 22

O: at cisterna chyli around L1-L2
T: sibson’s fascia at superior inlet and u-turns to empty into left subclavian/IJ veins

Question 23

what does the right lymphatic duct drain

Answer 23

right head/neck
RUE
R thorax
heart
lungs

Question 24

origin and termination of right lymphatic duct

Answer 24

O: junction of R jugular and subclavian trunks
T: right subclavian/IJ venous junction

Question 25

how does lymphatics help with fat absorption

Answer 25

chylomicrons travel lacteals–>large lymp vessels–>thoracic duct–>venous system

Question 26

causes for interstitial fluid pressures >0

Answer 26

increased hydrostatic pressure
decreased plasma colloid osmotic pressure
increased capillary permeability

Question 27

effect of SNS on lymph flow

Answer 27

increased SNS decreases lymph flow which increases lymph congestion

Question 28

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

Answer 28

lymphatic OMT definition

Question 29

indications for lymphatic OMT

Answer 29

1. edema, tissue congestion, lymphatic stasis
2. infection
3. inflammation
   also:
   - acute SD
   - sprains/strains
   - pregnancy

Question 30

absolute contraindications for lymphatic OMT

Answer 30

• anuria
• necrotizing fasciitis
• pt cannot tolerate
• pt refuses

Question 31

some relative contraindications for lymphatic OMT

Answer 31

CHF, COPD, acute asthma exacerbation, anticoagulation, cancer, bacterial infections w/ risk of dissemination, embolism

Question 32

4 transition zones of the spine

Answer 32

OA, C1 (tenrorium cerebelli)
C7, T1 (thoracic inlet)
T12-L1 (thoracolumbar diaphragm)
L5-sacrum (pelvic diaphragm)

Question 33

if you have a lymphatic problem in the lower extremity, what is the order of diaphragm evaluations

Answer 33

1. thoracic inlet MFR
2. doming the diaphragm
3. ischiorectal fossa release

Question 34

if you have an HEENT lymphatic problem, how do you evaluate

Answer 34

1. thoracic inlet MFR

2. suboccipital release

Question 35

where do you feel for lymphatic congestion

Answer 35

1. supraclavicular space (head/neck)
2. epigastric region (abd and chest)
3. posterior axillary fold (arm)
4. inguinal region (LE)
5. popliteal space (leg)
6. achilles region (foot/ankle)

Question 36

sequence of treatment

Answer 36

1. open pathways to remove restriction of flow
2. maximize diaphragmatic functions
3. increase pressure differentials or transmit motion (fluid pumps)
4. mobilize targeted tissue fluids

Question 37

where to evaluate for Zink “warmth provocative test”

Answer 37

thoracic
rib
sternal
cranial
C2
sacrum

Question 38

normal:

• size
• consistency
• tenderness
• mobility

Answer 38

• pea-sized
• spongy
• non-tender
• mobile

Question 39

in pectoral traction when do you pull

Answer 39

on inhalation

Question 40

what is considered flexion and extension at the sacrum

Answer 40

flexion: sacral base is anterior (exhalation)
extension: sacral apex is anterior (inhalation)

Question 41

when do you apply pressure in rib raising (seated/supine) if using respirations

Answer 41

inhalation