lymphatics lect/lab

Question 1

5 models of osteopathic patient care

Answer 1

1. biomechanical-structural
2. respiratory-circulatory
3. metabolic-nutritional
4. neurologic ANS-CNS-PNS
5. behavioral-psychosocial

Question 2

biomechanical-structural

Answer 2

assess patient for a structural impediment

Question 3

respiratory-circulatory

Answer 3

respiratory & circulatory components of the homeostatic response

Question 4

neurological

Answer 4

abberancies or impairments of neural function

Question 5

metabolic-nutritional

Answer 5

balance between energy production, distribution, and expenditure

Question 6

behavioral-biopsychosocial

Answer 6

assess mental, emotional, & spiritual state of being as well as personal lifestyle choices

Question 7

role of lymphatic system

Answer 7

• to remove fluid, particulates, extravasated proteins from the interstitium
  -maintain osmotic balance b/n extracellular, intracellular & intravascular fluids

Question 8

tissues without a blood supply

Answer 8

cartilage
lens & cornea of the eye
epidermis
inner portion of walls of large BVs

Question 9

terminal lymphatic vessels

Answer 9

-endothelial lined cul de sacs anchored into surrounding ECM by small anchoring filaments
-lack smooth muscle walls

Question 10

path of lymph flow

Answer 10

1. afferent/prenodal vessels
2. efferent / postnodal vessels
3. lymphatic trunks
4. L thoracic duct or R lymphatic duct

Question 11

what is not a factor that contributes to lymph flow?

Answer 11

a hydrostatic gradient from capillary bed to terminal lymphatics

Question 12

LE drainage

Answer 12

LEs & abdominopelvic cavity –> cisterna chyli –> thoracic duct

• superficial = to proximal nodes at inguinal area
• deep = into popliteal space & exits b/n heads of hamstrings

Question 13

UE drainage

Answer 13

• superficial = follows subQ routes to proximal nodes at the axilla
  -deep = follows major neurovascular structures

Question 14

deep cervical nodes

Answer 14

terminal pathway for all drainage of the head & neck

Question 15

classic model of brain lymph drainage

Answer 15

from brain CSF acts as lymphatic fluid, is formed in choroid plexus & drained through arachnoid granulations

Question 16

glymphatic system

Answer 16

clearance of waste products from the brain
-combined activity of water channels at glial cells

1. CSF into brain via periarterial spaces, exchanges with ISF, through extracellular space to collect within perivenous spaces

Question 17

heart drainage

Answer 17

endo to myo to epicardial
-heart drainae enters R thoracic duct
-pericardium drains into thoracic duct

Question 18

pulmonary lymph

Answer 18

drains out of the lungs at the hilum into the tracheobronchial nodes & into both the R lymphatic trunk & thoracic duct

Question 19

gut lymphatics

Answer 19

• have lacteals to absorb fat (chyle)
• join iliac & preaortic nodes en route to cisterna chyli & thoracic duct
• celiac drainage uses this route

Question 20

anterior & superior bladder drainage

Answer 20

hypogastric nodes

Question 21

middle bladder drainage

Answer 21

external iliac trunks

Question 22

posterior & inferior bladder drainage

Answer 22

common iliac trunks

Question 23

major functions of lymphatic system

Answer 23

1. maintain fluid balance
2. purification/cleansing of tissue
3. immune system defense
4. nutrition

Question 24

OA zone has ___ junction & ___ transverse diaphragm

Answer 24

junction = craniocervical
diaphragm = tentorium cerebelli

Question 25

cervico-thoracic zone has ___ junction & ___ transverse diaphragm

Answer 25

cervicothoracic junction thoracic inlets/outlets = diaphragm

Question 26

thoraco lumbar zone has ___?

Answer 26

thoracolumbar junction respiratory diaphragm

Question 27

lumbo sacral zone has ___?

Answer 27

lumbosacral junction pelvic diaphragm

Question 28

3 classifications of fascial patterning

Answer 28

1. ideal = no apparent preferences, but is rarely seen clinically 2. compensated = rotational bias in one transition zone accompanied by an opposite fascial rotation in next zone 3. uncompensated = rotational pattern didn't alternate & is thought to be less healthy

Question 29

sites of terminal lymphatic drainage dysfunction

Answer 29

1. supraclavicular space 2. posterior axillary fold "arm" 3. epigastric area "abd & chest" 4. inguinal area "LE" 5. popliteal space "leg" 6. achilles tendon "ankle & foot"

Question 30

direction of lymphatic tx

Answer 30

treat segmentally from proximal to distal while augmenting flow in distal to proximal direction within each segment

Question 31

diaphragm doming

Answer 31

1. wrap hands around diaphragm, thumbs along lateral costal margin 2. apply superior & medial compression force 3. take several slow & full breaths 4. as they exhale induced firm compression 5. hold compression as they inhale again 6. repeat 2-3 breaths then reassess

Question 32

thoracic inlet MFR "steering wheel"

Answer 32

1. contact across sternoclavicular junction & ribs 1-2 while posterior contacting T1-2 with thumbs (choke them) 2. slight compression to engage Sibson's fascia 3. induce motion in ant-post, med-lat, rotational planes until position achieved 4. hold 20-60 seconds until creep indicates release of tension then reassess

Question 33

UE lymphatic sequence

Answer 33

1. ant & post axillary fold release - pincer grasp 2. antecubital fossa release - grasp with bilat thumbs & spread laterally 3. carpal tunnel release - same as above

Question 34

LE lymphatic sequence

Answer 34

1. inguinal ligament - palpate perpendicularly & apply compression 2. popliteal fossa - fingers of bilat hands engage & spread 3. achilles tendon - compression force with fingers & thumb just anteiror to achilles tendon and hold

Question 35

pedal pump / dalrymple pump

Answer 35

1. palms over plantar aspect of toes 2. DF feet 3. induce rhythmic motion toward pt head, 2 compressions/sec (see motion throughout body) 3. continue for 30 secs - 2 mins 4. go back to neutral & reassess

Question 36

thoracic / miller pump

Answer 36

1. palms inf to clavicles 2. inhale & exhale deeply - while you introduce rhythmic post/inf motion at 2 compressions/sec 3. induce for 30 secs - 2 mins