Lymphatics Flashcards
Lymphatic System: 3 Anatomic Components
- Lymph Fluid
- Lymphatic Vessels
- Organized lymphatic tissues/organs
–Spleen, Liver, Thymus, Tonsils, Appendix, Visceral lymphoid tissue, Lymph nodes
Lymphatic Development Embryology - beginning and significant presence?
–Begins during 5th week of gestation
–Significant presence by 20 weeks
Why is breast feeding recommended?
Development of lymphoid tissue - immature at birth
lymphoid tissue develops until ____ years.
Increases until 6-9 years
–At puberty, immune system matures, but lymphoid tissues slowly regress until 15-16 years
Lymphatic System Functions (4)
- Maintain Fluid Balance
- Tissue Cleansing/Purification
- Defense
- Nutrition
__ L of fluid move from capillaries to interstitial space each day
30 L of fluid move from capillaries to interstitial space each day
- –90% to veinules; 10% to lymphatic system*
- –½ of diffused plasma proteins re-enter system via lymph*
What are chylomicrons, what is function, how do they move?
chylomicrons - packaged form of fats
function: Fat absorption
movement: Too big to cross capillary intercellular junctions
* Travel via lacteals to larger lymph vessels to thoracic duct to venous system*
What substances make up lymph fluid?
•Substances that leak out of the arterial capillaries into the interstitium get taken up by the lymphatic capillaries
(Fluids, proteins, electrolytes, and cells)
- Immune cells
- Foreign antigens
- Bacteria and viruses
- Clotting factors
- Chylomicrons post-prandial
Tissues that do NOT have lymphatic vessels:
–Epidermis (including hair and nails)
–Endomysium of muscle
–Cartilage
–Bone marrow
Lymphatic Vessels PATH
Terminal lymphatics > collecting vessels > afferent lymph vessels > lymph node(s) > efferent lymph vessels > lymphatic trunks > thoracic duct or right lymphatic duct > venous system
Collecting Vessels consist of chains of…
Consist primarily of chains of muscular units called “lymphangions,” which possess two-leaflet bicuspid valves
–“Lymphatic hearts”
–Contracting regularly throughout the lymphatic system and moving lymph in peristaltic waves
Afferent or prenodal vessels
collecting vessels prior to lymph node
Efferent or postnodal vessels
collecting vessels draining the lymph node
Most highly organized lymphoid tissue
Lymph Nodes : Dispersed along the course of lymph vessels
Types of lymph nodes:
Superficial – within the subcutaneous tissue
Ex. – cervical, axillary, and inguinal
Deep – beneath fascia, muscle, organs
Function of lymph nodes:
–Filtration of lymph fluid
–Maturation of lymphocytes
–Phagocytosis of bacteria and cellular debris
Path of lymph flow through a lymph node:
Afferent Lymphatics > subcapsular space (reticular fibers, macrophages, DC) > outer cortex (B cells) > deep cortex (T cells) > medullary sinus (B cells and plasma cells) > efferent lymphatics (exit at hilum)
What are the 5 Lymphatic Trunks?
- Lumbar – drain lymph from lower limbs and pelvic organs
- Intestinal – drains abdominal viscera
- Bronchomediastinal – drains portions of thorax
- Subclavian – drains upper limbs
- Jugular – drains portions of neck and head
Location of Cisterna Chyli:
Located at the level of L1-2
list areas that the Thoracic Duct drains
Master lymph vessel and drains
–L head/neck
–L UE
–L thorax/abdomen
–Everything inferior to umbilicus
–Receives from lumbar lymphatics
List areas the Right Lymphatic Duct drains
Drains:
–R head/neck
–RUE
–R thorax
–Heart
–Lungs (except LUL)
Virchow’s Node
L supra-clavicular
indicative of Intra-thoracic/abdominal cancer
Epitrochlear Nodes
indicative of secondary syphilis
Spleen location:
Spleen
•Location: Beneath ribs 9-11 on the left; abuts diaphragm –Normally NOT palpable
Spleen Characteristics:
•Characteristics:
–Largest single mass of lymphoid tissue
–Pressure-sensitive: Movement of diaphragm drives splenic fluid movement
Spleen Functions:
•Functions:
–Destroy damaged/deformed RBCs
–Synthesize immunoglobulin
–Clear bacteria
Liver Location
Location: RUQ; palpable at R costal margin
Liver Characteristics:
Characteristics:–Pressure sensitive (like spleen), ∴ movement of the diaphragm is important for the homeostatic movement of hepatic fluids
Liver (lymphatic) Functions
Lymphatic Function:
–Half of the body’s lymph is formed here
–Clears bacteria
–“Gate-keeper” of the shared hepato-biliary-pancreatic venous and lymphatic drainage
Thymus location
Location: anterior mediastinum
Thymus characteristics
Characteristics: Development: Large in infancy and size peaks at 2 y/o. After puberty involutes, replaced by fatty tissue
Thymus function
Function:
–Maturation site for T-cells
–Little or no fn in adult
Tonsils location
Location: 3 types – all located in posterior oropharynx
–Palatine – lateral pharynx (traditional “tonsils”)
–Lingual – posterior 1/3 of tongue
–Pharyngeal – adenoids at nasopharyngeal border
Tonsils Characteristics
Characteristics: Most are not visible until 6-9 m/o, remain enlarged through childhood
Tonsils Function
Function:–Provide cells to influence and build immunity early in life
–Nonessential to adult immune function
Appendix location
Location: at the proximal end of the cecum (Lg intestine)
Appendix characteristics
Characteristics: Contains lymphoid pulp–Lymphoid tissue atrophies with age
Appendix function
Function: part of the gut-associated lymphoid tissue (GALT)
Gastrointestinal Assoc. Lymphoid Tissue: examples, classification
EX
–Peyer’s patches – ileum
–Lacteals – small bowel
Visceral Lymphoid Tissue
Explain the Thoracic Diaphragm in Mechanisms of Flow
With each breath, contraction ↑ the negative intrathoracic pressure, pulls fluid centrally
Also exerts a direct force on the cisterna chyli, pushing fluid superiorly
Explain how the pelvic diaphragm affects mechanisms of lymph flow
- Synchronous with thoracic diaphragm
- Helps move fluids from the lower extremities and pelvis to the thoracic duct
- May be dysfunctional in dysmenorrhea, endometriosis, post labor and delivery, BPH, etc.
How does SNS effect Lymph valves? Lymphatic smooth muscle?
SNS Effects Lymph Valves •↑sympathetic tone > tighter valves > ↓lymph flow into the venous system
SNS Effects Lymphatic Smooth Muscle •↑sympathetic tone > ↓peristalsis > lymphatic congestion
Absolute Contraindications for Lymphatic OMT
- Anuria– need kidneys functioning to process the extra fluid return
- Necrotizing fasciitis – in the treatment area
- Patient unable to tolerate treatment
- Patient refuses treatment
Principles of Diagnosis from a Lymphatics Approach (5 steps)
- Evaluate risk-benefit ratio
- Evaluate fascial patterns of Zink
- Evaluate diaphragms/fascia, including thoracic inlet for restrictions that may limit lymphatic drainage.
- Evaluate for somatic dysfunction affecting any motion that would normally enhance lymphatic flow.
- Evaluate tissue congestion.
Fascial patterns of Zink
describe fascial restrictions patterns that cause restriction of lymphatic flow
Compensatory Patterns & Un-Compensated Patterns
Sequence of Generalized Lymphatic Treatment
- Open pathways to remove restriction to flow –Transverse myofascial restrictors: thoracic inlet, myofascial restrictors, broad fluid movement
- Maximize diaphragmatic functions (abdominal & pelvic diaphragms)
- Increase pressure differentials or transmit motion (fluid pumps)
- Mobilize targeted tissue fluids (localized to specific somatic dysfunctions)
