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REAL OS 1 final > Lymphatics > Flashcards

Lymphatics Flashcards

1
Q

Indications for Lymphatic treatment

A 
Acute SD
Sprains/strains
Edema/Tissue congestion
Lymphatic or venous stasis
Pregnancy
Infection
Inflammation
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2
Q

Absolute Contraindications for lymphatic treatment

A

Anuria

Necrotizing fasciits

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3
Q

Relative Contraindications for lymphatic treatment

A

Malignancy
Fracture/Dislocation
Certain infections (mono, abscess, chronic osteomyelitis)
Certain circulatory disorders (venous obstructions, embolism, hemorrhage, patients on anticoagulants)

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4
Q

Zink’s Compensated patterns

A

Alternating may contribute to Lymphatic flow
RLRL or LRLR

(non alternating may contribute to lymphatic congestion)

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5
Q

How to perform Zink “Warmth provocative test” and why

A

Evaluate thoracic, rib, sternal, cranial, C2, and Sacrum

Warmer areas may be a site of SD

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6
Q

What do you feel for when palpating lymph nodes?

A 
Normal pea size
Round/regular shape
Spongy consistency
Nontender
Mobile
Overlying skin is baseline
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7
Q

Regional Lymph Node collecting sites

A 
Supraclavicular space
Epigastric region
Posterior axillary fold
Inguinal region
Popliteal space
Achilles region
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8
Q

What are the 4 principles of Lymphatic treatment?

A
  1. Open pathways to remove restriction to flow
  2. Maximize Diaphragmatic fxns
  3. Increase pressure differentials or transmit motion
  4. Mobilize targeted fluid tissue
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9
Q

What lymphatic treatment do you use to open pathways and remove restriction to flow?

A

Thoracic Inlet MFR

Can also use anterior/posterior axillary fold techniques or popliteal fossa release

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10
Q

What lymphatic treatment do you use to maximize diaphragmatic functions?

A

Doming the Diaphragm

Ischiorectal Fossa Release/Doming the Pelvic Diaphragm

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11
Q

What lymphatic treatment do you use to increase pressure differentials or transmit motion?

A 
Pectoral traction
Rib raising
Thoracic pump
Abdominal pump
Sacral rocking
Pedal pump
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12
Q

Where can you perform abdominal pump?

A

Spleen

Liver

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13
Q

What lymphatic treatment can you use to mobilize targeted tissue fluids?

A 
Tapotement
Effleurage and Petrissage
Anterior Cervical Arches Release
Cervical Stroking
Cervical Chain Drainage
Submandibular drainage
Mandibular drainage/Galbreath
Auricular drainage
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14
Q

Lymphatic tissues/Organs

A 
Spleen
Liver
Thymus
Tonsils
Appendix
Visceral lymphoid tissue
Lymph nodes
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15
Q

3 anatomic components of the Lymphatic system

A

Organized tissues/Organs
Lymph fluid
Lymph vessels

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16
Q

Physiologic fxn of Lymph

A

Immune
Digestive
Fluid Balance
Waste

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17
Q

Fxn of the spleen

A

Destroy damaged/deformed RBCs
Synthesize Igs
Clear bacteria

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18
Q

Location of the spleen

A

Beneath ribs 9-11 on the L

Not palpable

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19
Q

Characteristics of the spleen

A

Largest single mass of lymphoid tissue

Pressure sensitive - movement of the diaphragm drives splenic fluid movement

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20
Q

Location of the liver

A

RUQ

Palpable at R costal margin

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21
Q

Characteristics of the Liver

A

Pressure sensitive - movement of the diaphragm is important for the homeostatic movement of hepatic fluids

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22
Q

Lymphatic fxn of the Liver

A

Forms half the body’s lymph
Clears bacteria
Gate-keeper of shared hepatobiliary-pancreatic venous and lymphatic drainage

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23
Q

Location of the Thymus

A

Anterior mediastinum

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24
Q

Characteristics of the Thymus

A

Development of T cells, important in childhood, replaced by fatty tissue after puberty

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25
Fxn of the Thymus
Maturation site for T cells | Little to no fxn in adults
26
3 locations of the tonsils
All located in posterior oropharynx 1. Palatine - lateral pharynx 2. Lingual - Posterior 1/3 of the tongue 3. Pharyngeal - Adenoids at nasopharyngeal border
27
Characteristics of the tonsils
Most not visible until 6-9 months | Remain enlarged through childhood
28
Fxn of the tonsils
Provide cells to influence and build immunity early in life | Nonessential to adult immune fxn
29
Appendix location
At the proximal end of the cecum in the LI
30
Characteristics of the appendix
Contains lymphoid pulp | Lymphoid tissue atrophies with age
31
Fxn
Part of GALT
32
Visceral Lymphatic Tissue is also known as ___
GALT
33
Where are Peyer's Patches located?
Ileum
34
GALT contains lacteals, which perform what function?
Lymphatic capillaries of small bowel that transport large chylomicrons into the lymphatic system -> thoracic duct -> Venous system
35
What comprises lymph fluid?
``` Fluids, proteins, electrolytes Immune cells Foreign antigens Bacteria and viruses Clotting factors Chylomicrons post-prandial ```
36
How much fluid moves from capillaries to interstitial space each day?
30L | 90% to capillaries, 10% to lymph
37
What is 2nd/3rd spacing?
When fluid overload occurs, lymphatic system helps prevent tissue damage by clearing the excess
38
How much of the diffused plasma proteins re-enter the system via lymph?
1/2
39
35-60% of drainage through thoracic duct is associated with ____
Respiration
40
Restrictions of lymphatic flow must first be drained through the associated ___
Terminal area
41
Tissues that do not have lymphatic vessels but use direct diffusion
Epidermis Endymysium Cartilage Bone marrow
42
Lymph channels begin as _____ composed of a single layer of _____ epithelium supported by _____
Blind endothelial tubes Leaky squamous Anchoring filaments
43
Describe the flow of lymph
Lymph capillaries => collecting lymphatics => afferent lymphatic vessels => Efferent lymphatic vessels => Thoracic duct or R lymphatic duct => Venous system
44
The lymph collectors consist primarily of chains of muscular units called ____
Lymphangions Possess 2 leaf bicuspid valves Similar to veins
45
Path of lymph flow through a lymph node
Afferent lymphatics => Subcapsular space => Outer cortex => Deep Cortex => Medullary sinus => Efferent Lymphatics
46
Most highly organized lymphoid tissue?
Lymph nodes
47
Where are superficial lymph nodes?
Within subcutaneous tissue | Cervical, axillary, inguinal
48
Where are deep lymph nodes?
Beneath fascia | Muscle, organs
49
Where is Virchow's Node and what does it indicate?
L supraclavicular Intra-thoracic/Abdominal CA
50
What do Epitrochlear nodes indicate?
Secondary syphilis
51
What does the Thoracic duct drain?
L head/neck LUE L thorax/abdomen Everything umbilicus down
52
What lymph structures come from mesoderm?
Lymphatic vessels Lymph nodes Spleen Myeloid tissue
53
What lymph structures come from endoderm?
Thymus | Tonsils
54
Where does the thoracic duct originate?
Cisterna Chyli
55
What structure pierces Sibson's fascia at the superior inlet?
Thoracic duct
56
Where does the thoracic duct empty into?
L subclavian/IJ veins
57
Right lymphatic duct origin
Junction of R jugular and subclavian trunks | Occasional bronchomediastinal trunk
58
Termination of R lymphatic duct
R subclavian/IJ venous jxn
59
R lymphatic duct fxn
Drains R head/neck, RUE, R thorax
60
Lymph cleaning fxn
Cleans extracell spaces of toxins, cellular waste, bacteria
61
Lymph defense fxn
Lymph fluid contains high concentrations of immune cells and brings toxins, bacteria, and viruses into contact with organized lymph tissue
62
Lymph nutrition fxn
Fat absorption via chylomicrons | Travels via lacteals => larger lymph vessels => thoracic duct => Venous system
63
How does the SNS affect lymph valves?
Iincreased SNS => increased sympathetic tone => tighter valves => decreased lymph flow into venous system
64
How does the SNS affect Lymphatic smooth muscle?
Increased sympathetic tone => decreased peristalsis => lymphatic congestion
65
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
66
Effects of Edema
Compression of local structures Decreased tissue waste removal Decreased pathogen clearance and immunity Chronic state will increase fibroblast recruitment and activation
67
Principles of Diagnosis from a Lymphatic approach
1. Evaluate risk-benefit ratio 2. Evaluate fascial patterns of Zink 3. Evaluate diaphragms/fascia 4. Evaluate for SD 5. Evaluate tissue congestion
68
Common Compensatory pattern
LRLR | 80% of people
69
Uncommon Compensatory pattern
RLRL | 20% of healthy people
70
Transition zones of the spine
OA, C1 C2, C7, T1 T12, L1 L5, Sacrum
71
Transverse restrictors of the spine
Tentorium Cerebelli Thoracic Inlet Thoracolumbar diaphragm Pelvic Diaphragm

REAL OS 1 final (9 decks)

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