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OS > Lymphatics Lecture > Flashcards

Lymphatics Lecture Flashcards

1
Q

What did Olaf Rudbeck do and in what year?

A

First described lymphatics as a system in 1653

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2
Q

What did AT Still document about lymphatics and in what year?

A

In 1874, emphasized that diagnosis of fascia & treatment of lymphatic system was vital for maintaining health & treating disease

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3
Q

What is important about 1898?

A

Faculty in Kirksville used early form of X-ray to research the distribution of vascular & lymphatic system

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4
Q

What did Frederic Millard do and in what year?

A

in 1922, published “Applied Anatomy of the Lymphatics”

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5
Q

3 anatomical components of lymphatic system

A

Lymph fluid
Lymphatic vessels
Organized lymphatic tissues/organs

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6
Q

Physiologic function of lymphatic system

A

Major role in numerous homeostatic mechanisms of body (immune, digestive, fluid balance, waste)

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7
Q

Why is it important to maintain homeostasis?

A

To maintain health (balance of all systems to prevent disease)

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8
Q

Embryological development of lymphatics

A

In week 5

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

Endoderm: thymus & parts of tonsils

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9
Q

Function of lymphatic system

A

Maintain fluid balance
Tissue cleansing/purification
Defense
Nutrition

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10
Q

Fluid balance

A

30L of fluid moves from capillaries to interstitial space per day (10% to lymphatic system)

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11
Q

What happens with fluid overload?

A

Lymphatic system helps prevent tissue damage by clearing the excess

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12
Q

How does lymphatics play role in purification & cleansing?

A

Lymph fluid bathes organs & cleanses extracell spaces of particulate matter, toxins, bacteria, etc

Fluid then travels from vessels to nodes & then in venous system

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13
Q

Lymphatics role in defense

A

Lymph fluid brings toxins/bacteria/viruses into contact w/ organized lymph tissue that have high conc of immune cells

free flow of lymph is necessary for appropriate immune function

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14
Q

Lymphatics role in nutrition (proteins & fats)

A

Fat absorption via chylomicrons b/c too big to cross capillary junctions

Travel via lacteals in small intestine to larger lymph vessels to thoracic duct & into venous system

Returns proteins to vasculature

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15
Q

What is lymph fluid?

A

Substances that leak out of arterial capillaries into interstitium get taken up by lymphatic capillaries

Basically, a filtrate of blood

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16
Q

Where does lymph go?

A

Everywhere except:

Epidermis
Endomysium of muscle
Cartilage
Bone marrow

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17
Q

Flow of lymph in lymphatic vessels

A

Terminal lymphatics to collecting vessels to afforestation lymph vessels to nodes to efferent lymph vessels to trunks to thoracic duct or right lymphatic duct to venous system

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18
Q

Where does lymph formation begin?

A

In the interstitial space of tissues w/ initial lymphatics & lymph capillaries

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19
Q

What do the terminal lymphatics become?

A

Collecting vessels

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20
Q

What are collecting vessels?

A

Consist of chains of muscular units (LYMPHANGION) that possess 2 leaflet bicuspid valves

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21
Q

How do lymphagnions move lymph?

A

Contract regularly thru out lymphatic system & move lymph in peristaltic waves due to ANS innervation

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22
Q

What are lymph nodes?

A

Organized lymphoid tissue dispersed along course of lymph vessels

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23
Q

Superficial LNs

A

W/ in subcutaneous tissue (cervical, axillary, inguinal)

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24
Q

Deep LNs

A

Beneath fascia, muscles & organs

25
Q

LN function

A

Filtration of lymph fluid
Maturation of lymphocytes
Phagocytosis of bacteria & cellular debris

26
Q

Describe path of lymph flow thru a lymph node

A 
Afferent lymphatics
Subcapsular space
Outer cortex
Deep cortex
Medullary sinus
Efferent lymphatics
27
Q

What are lymphatic trunks?

A 
Where lymphatic vessels drain into:
Lumbar
Intestinal
Bronchomediastinal
Subclavian
Jugular
28
Q

Where is cisterns chyli & what does it do?

A

Located @ L1-L2 & drains lymphatic trunks of lower body (gives rise to thoracic duct)

29
Q

What is the thoracic duct?

A

Master lymph vessels & drains

L head/neck
L UE
L thorax/abdomen
Everything inferior to umbilicus
Receives from lumbar lymphatics
30
Q

Right Lympathric duct

A

From junction of R jugular & subclavian trunks

Drains:
R head/neck
R UE
R thorax 
Heart
Lungs
31
Q

What is important when evaluating LNs?

A

Shape, size, consistency, tenderness, mobility

32
Q

If a LN is swollen, soft, painful..

A

Infectious (look for source)…acute fluid overload

33
Q

If a LN is swollen, hard, non-painful & fixed…

A

Evaluate for malignancy

34
Q

What is Virchow’s node?

A

Left Supra-clavicular region (for intra-thoracic & abdominal cancer)

35
Q

What are epitrochlear nodes?

A

In cubittal fossa (secondary to syphilis)

36
Q

Location & fxn of spleen

A

Beneath ribs 9-11 on L

Destroy damaged/deformed RBCs
Synthesize IgGs
Clear bacteria

37
Q

How is fluid moved thru spleen?

A

Pressure sensitive movement of diaphragm drives spleen fluid movement

38
Q

Location & fxn of liver

A

RUQ

Where 1/2 of body lymph is formed
Clears bacteria
Gate keeper of hepato-biliary-pancreatic venous & lymphatic drainage

39
Q

Location & fxn of thymus

A

Anterior mediastinum

Maturation site for T cells
Little or no fxn in adult (will ave Sail Sign in peds)

40
Q

Location & fxn of tonsils

A

Palatine, Lingual & Pharyngeal

Provide cells to influence & build immunity early in life
Non essential to adult immune function

41
Q

Location & fxn of appendix

A

@ proximal end of cecum

Contains lymph tissue
Part of gut associated lymphoid tissue (GALT)

42
Q

What are assoc w/ GALT?

A

Pyers patches (ileum)
Lacteals (small bowel)
Pulmonary lymphoid tissue (filters toxins from lungs)

43
Q

How does lymphatic fluid flow?

A

According to interstitial fluid pressure which is normally negative (changes in pressure will cause increase in capillary permeability for lymph fluid to move)

44
Q

Direct Diaphragmatic Pressure

A

Interaction between thoracic diaphragm & pelvic diaphragm

45
Q

How does sympathetic NS affect lymphatics?

A

SNS effects lymph valves (constricted valves will decrease flow into venous system)

SNS effects lymphatic smooth muscle (decreased peristalsis increases lymphatic congestion)

46
Q

Major consequence of poorly functioning lymphatic system

A

EDEMA (buildup of interstitial fluid)

47
Q

Major effects of edema

A

Compression of local structures
Decreased tissue waste removal (alters pH)
Decreased pathogen clearance & immunity
Chronic states (b/c fibroblast recruitment & activation)

48
Q

What is lymphatic OMT?

A

Diverse group of techniques designed to remove impediments to lymphatic circulation & promote & augment the flow of interstitial fluid & lymph

49
Q

What is the purpose of lymphatic OMT?

A

To improve functional capacity of lymphatic system (enhancement of immune response & improve tissue nutrition)

50
Q

What is the major goal of OMT for lymphatic system?

A

Balanced, well functioning system in which no edema occurs

51
Q

Indications for lymphatic OMT

A 
Lymphatic congestion
Mild CHF
Upper or lower respiratory infections
Asthma
COPD
Ligament sprain or muscular strain
Acute SD
Pregnancy
52
Q

Absolute contraindications for Lymphatic OMT

A

Anuria
Necrotizing fasciitis
Pt unable to tolerate treatment
Pt refuses treatment

53
Q

Relative contraindications for lymphatic OMT

A 
Inability to tolerate excessive preload in CHF pt
COPD
Acute asthma exacerbation
Unstable cardiac conditions
Cancer
Osseous fracture
Bacterial infection
Chronic infections
Diseased organ
Pregnancy
Circulatory disorders
54
Q

Principles of Diagnosis from a Lymphatics approach

A 
Evaluate risk-benefit ratio
Evaluate fasciae patterns of Zink
Evaluate diaphragms/fascia
Evaluate for SD
Evaluate tissue congestion
55
Q

Risk to benefit ratio

A

Clinical judgment must be used in employing lymphatic techniques, w/ particular attention to pt diagnosis, clinical condition & medical therapy

Influence choice of appropriate technique, dose, duration & freq of treatment

56
Q

Compensatory patterns

A

In 80% of healthy people, directions will be opposite @ each level

OA, CT, TL, LS (L, R, L, R)

57
Q

Uncompensated patterns

A

Usually symptomatic & trauma involved (direction of lymph flow in 4 regions is all over the place)

58
Q

What are the transition zones of the spine?

A 
OA (C1, C2)
Thoracic Inlet (C7, T1)
Thoracolumbar Diaphragm (T12, L1)
Pelvic Diaphragm (L5, sacrum)
59
Q

What is the sequence of treatment in lymphatic OMT?

A

Open pathways to remove restriction to flow
Maximize diaphragmatic functions
Increase pressure differentials or transmit motion
Mobilize targeted tissue fluids

OS (18 decks)

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