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OS1 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
Q

Fxn of the Thymus

A

Maturation site for T cells

Little to no fxn in adults

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26
Q

3 locations of the tonsils

A

All located in posterior oropharynx

  1. Palatine - lateral pharynx
  2. Lingual - Posterior 1/3 of the tongue
  3. Pharyngeal - Adenoids at nasopharyngeal border
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27
Q

Characteristics of the tonsils

A

Most not visible until 6-9 months

Remain enlarged through childhood

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28
Q

Fxn of the tonsils

A

Provide cells to influence and build immunity early in life

Nonessential to adult immune fxn

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29
Q

Appendix location

A

At the proximal end of the cecum in the LI

30
Q

Characteristics of the appendix

A

Contains lymphoid pulp

Lymphoid tissue atrophies with age

31
Q

Fxn

A

Part of GALT

32
Q

Visceral Lymphatic Tissue is also known as ___

A

GALT

33
Q

Where are Peyer’s Patches located?

A

Ileum

34
Q

GALT contains lacteals, which perform what function?

A

Lymphatic capillaries of small bowel that transport large chylomicrons into the lymphatic system -> thoracic duct -> Venous system

35
Q

What comprises lymph fluid?

A 
Fluids, proteins, electrolytes
Immune cells
Foreign antigens
Bacteria and viruses
Clotting factors
Chylomicrons post-prandial
36
Q

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

A

30L

90% to capillaries, 10% to lymph

37
Q

What is 2nd/3rd spacing?

A

When fluid overload occurs, lymphatic system helps prevent tissue damage by clearing the excess

38
Q

How much of the diffused plasma proteins re-enter the system via lymph?

A

1/2

39
Q

35-60% of drainage through thoracic duct is associated with ____

A

Respiration

40
Q

Restrictions of lymphatic flow must first be drained through the associated ___

A

Terminal area

41
Q

Tissues that do not have lymphatic vessels but use direct diffusion

A

Epidermis
Endymysium
Cartilage
Bone marrow

42
Q

Lymph channels begin as _____ composed of a single layer of _____ epithelium supported by _____

A

Blind endothelial tubes
Leaky squamous
Anchoring filaments

43
Q

Describe the flow of lymph

A

Lymph capillaries => collecting lymphatics => afferent lymphatic vessels => lymph nodes => Efferent lymphatic vessels => Thoracic duct or R lymphatic duct => Venous system

44
Q

The lymph collectors consist primarily of chains of muscular units called ____

A

Lymphangions

Possess 2 leaf bicuspid valves
Similar to veins

45
Q

Path of lymph flow through a lymph node

A

Afferent lymphatics => Subcapsular space => Outer cortex => Deep Cortex => Medullary sinus => Efferent Lymphatics

46
Q

Most highly organized lymphoid tissue?

A

Lymph nodes

47
Q

Where are superficial lymph nodes?

A

Within subcutaneous tissue

Cervical, axillary, inguinal

48
Q

Where are deep lymph nodes?

A

Beneath fascia

Muscle, organs

49
Q

Where is Virchow’s Node and what does it indicate?

A

L supraclavicular

Intra-thoracic/Abdominal CA

50
Q

What do Epitrochlear nodes indicate?

A

Secondary syphilis

51
Q

What does the Thoracic duct drain?

A

L head/neck
LUE
L thorax/abdomen
Everything umbilicus down

52
Q

What lymph structures come from mesoderm?

A

Lymphatic vessels
Lymph nodes
Spleen
Myeloid tissue

53
Q

What lymph structures come from endoderm?

A

Thymus

Tonsils

54
Q

Where does the thoracic duct originate?

A

Cisterna Chyli

55
Q

What structure pierces Sibson’s fascia at the superior inlet?

A

Thoracic duct

56
Q

Where does the thoracic duct empty into?

A

L subclavian/IJ veins

57
Q

Right lymphatic duct origin

A

Junction of R jugular and subclavian trunks

Occasional bronchomediastinal trunk

58
Q

Termination of R lymphatic duct

A

R subclavian/IJ venous jxn

59
Q

R lymphatic duct fxn

A

Drains R head/neck, RUE, R thorax

60
Q

Lymph cleaning fxn

A

Cleans extracell spaces of toxins, cellular waste, bacteria

61
Q

Lymph defense fxn

A

Lymph fluid contains high concentrations of immune cells and brings toxins, bacteria, and viruses into contact with organized lymph tissue

62
Q

Lymph nutrition fxn

A

Fat absorption via chylomicrons

Travels via lacteals => larger lymph vessels => thoracic duct => Venous system

63
Q

How does the SNS affect lymph valves?

A

Iincreased SNS => increased sympathetic tone => tighter valves => decreased lymph flow into venous system

64
Q

How does the SNS affect Lymphatic smooth muscle?

A

Increased sympathetic tone => decreased peristalsis => lymphatic congestion

65
Q

Causes of edema?

A

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
Q

Effects of Edema

A

Compression of local structures
Decreased tissue waste removal
Decreased pathogen clearance and immunity
Chronic state will increase fibroblast recruitment and activation

67
Q

Principles of Diagnosis from a Lymphatic approach

A
  1. Evaluate risk-benefit ratio
  2. Evaluate fascial patterns of Zink
  3. Evaluate diaphragms/fascia
  4. Evaluate for SD
  5. Evaluate tissue congestion
68
Q

Common Compensatory pattern

A

LRLR

80% of people

69
Q

Uncommon Compensatory pattern

A

RLRL

20% of healthy people

70
Q

Transition zones of the spine

A

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

71
Q

Transverse restrictors of the spine

A

Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar diaphragm
Pelvic Diaphragm

OS1 Final (12 decks)

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