Lymphatics

Question 1

What year did Olaf Rudbeck first describe lymphatics as a system?

Answer 1

1653

Question 2

What did AT Still do in 1874?

Answer 2

Emphasized that diagnosis of the fascia and treatment of the lymphatic system was vital for maintaining health and treating disease

Question 3

What did the faculty in Kirksville do in 1898?

Answer 3

Faculty used skiagraphy (early form of x-ray) to research the distribution of the vascular and lymphatic systems

Question 4

What did Frederic Millard do in 1922?

Answer 4

Published “Applied Anatomy of the Lymphatics”

Question 5

What is considered lymphatic tissues/organs?

Answer 5

Spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue, lymph nodes

Question 6

What is the function of the lymphatic system?

Answer 6

Major role in numerous homeostatic mechanisms of the body, including immune, digestive, fluid balance, and waste

Question 7

When does the lymphatic system begin to develop embryologically?

Answer 7

5th week

Question 8

What parts of the lymphatic system come from mesoderm? Endoderm?

Answer 8

Mesoderm: lymphatic vessels, lymph nodes, spleen, myeloid tissue

Endoderm: thymus and parts of the tonsils

Question 9

When does the lymphoid tissue mature?

Answer 9

At puberty, but then slowly regresses until age 15-16 before it becomes stable throughout the adult lifespan

Question 10

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

Answer 10

30 Liters; 90% to capillaries and 10% to lymphatic system; 1/2 of diffused plasma proteins re-enter system via lymph

Question 11

Where does lymph go?

Answer 11

Tissues that do NOT have lymphatic vessels; epidermis (including hair and nails), endomysium of muscle, cartilage, and bone marrow

Question 12

What is the path of lymph through the lymphatic vessels?

Answer 12

Terminal lymphatics -> collecting vessels -> afferent lymph vessels -> lymph nodes -> efferent lymph vessels -> lymphatic trunks -> thoracic duct or right lymphatic duct -> venous system

Question 13

What are lymphangions?

Answer 13

Muscular units with bicuspid valves that contract regularly throughout the lymphatic system and moving lymph in peristaltic waves

Question 14

What are afferent or prenodal vessels?

Answer 14

Collecting vessels prior to lymph node

Question 15

What are efferent or postnodal vessels?

Answer 15

Collecting vessels draining the lymph node

Question 16

What is the function of lymph nodes?

Answer 16

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

Question 17

What does the lumbar lymphatic trunk drain?

Answer 17

Drains lymph from lower limbs and pelvic organs

Question 18

What does the intestinal lymphatic trunk drain?

Answer 18

Drains abdominal viscera

Question 19

What does the bronchomediastinal trunk drain?

Answer 19

Drains portions of thorax

Question 20

What does the subclavian trunk drain?

Answer 20

Drains upper limbs

Question 21

What does the jugular trunk drain?

Answer 21

Drains portions of neck and head

Question 22

What is located at the level of L1-L2?

Answer 22

Cisterna chyli; gives rise to thoracic duct and drains lymphatic trunks of lower body

Question 23

Where does the thoracic duct drain to?

Answer 23

Left subclavian and left jugular veins

Question 24

Where does the right lymphatic duct drain to?

Answer 24

Empties at right subclavian and right internal jugular venous junction

Question 25

What is Virchow’s Node? What is it associated with?

Answer 25

Left supra-clavicular lymph node; intra-thoracic/abdominal cancer

Question 26

What are the Epitrochlear Nodes? What are they associated with?

Answer 26

Lymph nodes around the elbow trochlea; associated with secondary syphilis

Question 27

Where is the spleen located? What are its functions? Where is it palpable if something is wrong?

Answer 27

Beneath ribs 9-11 on the left next to diaphragm, normally not palpable; destroys damaged/deformed RBCs, synthesize immunoglobulins, clear bacteria; can be palpable near umbilicus if something is wrong

Question 28

Where is the liver located? What are its functions? Where is it palpable?

Answer 28

RUQ; palpable at right costal margin; forms half of the body’s lymph, clears bacteria, and is the “gate-keeper” of the shared hepato-biliary-pancreatic venous and lymphatic drainage

Question 29

What is the relationship between the thoracic and pelvic diaphragms?

Answer 29

Movements should be synchronized to help move fluids from the lower extremities and pelvis to the thoracic duct

Question 30

What are the indications for lymphatic OMT?

Answer 30

Lymphatic congestion manifested as edema, mild CHF, upper/lower respiratory infections, asthma, COPD, ligamentous sprains or muscular strains, acute somatic dysfunction, pregnancy

Question 31

What are the absolute contraindications for lymphatic OMT?

Answer 31

Anuria, necrotizing fasciitis

Question 32

What are the relative contraindications for lymphatic OMT?

Answer 32

COPD (specifically thoracic pump), inability to tolerate excessive preload in CHF patients, acute asthma exacerbation, unstable cardiac conditions, cancer, osseous fracture, bacterial infections, chronic infections, diseased organ, circulatory disorders

Question 33

What are transverse restrictors for the lymphatic system?

Answer 33

Tentorium cerebelli, thoracic inlet, thoracolumbar diaphragm, and pelvic diaphragm

Question 34

What are the transition zones of the spine?

Answer 34

OA/C1/C2, C7/T1, T12/L1, and L5/Sacrum

Question 35

What is the sequence of treatment for lymphatic OMT?

Answer 35

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

Question 36

What are the common and uncommon compensatory patterns?

Answer 36

Common: L/R/L/R

Uncommon: R/L/R/L

Question 37

What are the uncompensated patterns?

Answer 37

Examples: L/L/L/L, R/L/L/R, R/R/R/R, L/R/R/L