Lymphatics Lecture Flashcards
What did Olaf Rudbeck do and in what year?
First described lymphatics as a system in 1653
What did AT Still document about lymphatics and in what year?
In 1874, emphasized that diagnosis of fascia & treatment of lymphatic system was vital for maintaining health & treating disease
What is important about 1898?
Faculty in Kirksville used early form of X-ray to research the distribution of vascular & lymphatic system
What did Frederic Millard do and in what year?
in 1922, published “Applied Anatomy of the Lymphatics”
3 anatomical components of lymphatic system
Lymph fluid
Lymphatic vessels
Organized lymphatic tissues/organs
Physiologic function of lymphatic system
Major role in numerous homeostatic mechanisms of body (immune, digestive, fluid balance, waste)
Why is it important to maintain homeostasis?
To maintain health (balance of all systems to prevent disease)
Embryological development of lymphatics
In week 5
Mesoderm: lymphatic vessels, lymph nodes, spleen, myeloid tissue
Endoderm: thymus & parts of tonsils
Function of lymphatic system
Maintain fluid balance
Tissue cleansing/purification
Defense
Nutrition
Fluid balance
30L of fluid moves from capillaries to interstitial space per day (10% to lymphatic system)
What happens with fluid overload?
Lymphatic system helps prevent tissue damage by clearing the excess
How does lymphatics play role in purification & cleansing?
Lymph fluid bathes organs & cleanses extracell spaces of particulate matter, toxins, bacteria, etc
Fluid then travels from vessels to nodes & then in venous system
Lymphatics role in defense
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
Lymphatics role in nutrition (proteins & fats)
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
What is lymph fluid?
Substances that leak out of arterial capillaries into interstitium get taken up by lymphatic capillaries
Basically, a filtrate of blood
Where does lymph go?
Everywhere except:
Epidermis
Endomysium of muscle
Cartilage
Bone marrow
Flow of lymph in lymphatic vessels
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
Where does lymph formation begin?
In the interstitial space of tissues w/ initial lymphatics & lymph capillaries
What do the terminal lymphatics become?
Collecting vessels
What are collecting vessels?
Consist of chains of muscular units (LYMPHANGION) that possess 2 leaflet bicuspid valves
How do lymphagnions move lymph?
Contract regularly thru out lymphatic system & move lymph in peristaltic waves due to ANS innervation
What are lymph nodes?
Organized lymphoid tissue dispersed along course of lymph vessels
Superficial LNs
W/ in subcutaneous tissue (cervical, axillary, inguinal)
Deep LNs
Beneath fascia, muscles & organs
LN function
Filtration of lymph fluid
Maturation of lymphocytes
Phagocytosis of bacteria & cellular debris
Describe path of lymph flow thru a lymph node
Afferent lymphatics Subcapsular space Outer cortex Deep cortex Medullary sinus Efferent lymphatics
What are lymphatic trunks?
Where lymphatic vessels drain into: Lumbar Intestinal Bronchomediastinal Subclavian Jugular
Where is cisterns chyli & what does it do?
Located @ L1-L2 & drains lymphatic trunks of lower body (gives rise to thoracic duct)
What is the thoracic duct?
Master lymph vessels & drains
L head/neck L UE L thorax/abdomen Everything inferior to umbilicus Receives from lumbar lymphatics
Right Lympathric duct
From junction of R jugular & subclavian trunks
Drains: R head/neck R UE R thorax Heart Lungs
What is important when evaluating LNs?
Shape, size, consistency, tenderness, mobility
If a LN is swollen, soft, painful..
Infectious (look for source)…acute fluid overload
If a LN is swollen, hard, non-painful & fixed…
Evaluate for malignancy
What is Virchow’s node?
Left Supra-clavicular region (for intra-thoracic & abdominal cancer)
What are epitrochlear nodes?
In cubittal fossa (secondary to syphilis)
Location & fxn of spleen
Beneath ribs 9-11 on L
Destroy damaged/deformed RBCs
Synthesize IgGs
Clear bacteria
How is fluid moved thru spleen?
Pressure sensitive movement of diaphragm drives spleen fluid movement
Location & fxn of liver
RUQ
Where 1/2 of body lymph is formed
Clears bacteria
Gate keeper of hepato-biliary-pancreatic venous & lymphatic drainage
Location & fxn of thymus
Anterior mediastinum
Maturation site for T cells
Little or no fxn in adult (will ave Sail Sign in peds)
Location & fxn of tonsils
Palatine, Lingual & Pharyngeal
Provide cells to influence & build immunity early in life
Non essential to adult immune function
Location & fxn of appendix
@ proximal end of cecum
Contains lymph tissue
Part of gut associated lymphoid tissue (GALT)
What are assoc w/ GALT?
Pyers patches (ileum)
Lacteals (small bowel)
Pulmonary lymphoid tissue (filters toxins from lungs)
How does lymphatic fluid flow?
According to interstitial fluid pressure which is normally negative (changes in pressure will cause increase in capillary permeability for lymph fluid to move)
Direct Diaphragmatic Pressure
Interaction between thoracic diaphragm & pelvic diaphragm
How does sympathetic NS affect lymphatics?
SNS effects lymph valves (constricted valves will decrease flow into venous system)
SNS effects lymphatic smooth muscle (decreased peristalsis increases lymphatic congestion)
Major consequence of poorly functioning lymphatic system
EDEMA (buildup of interstitial fluid)
Major effects of edema
Compression of local structures
Decreased tissue waste removal (alters pH)
Decreased pathogen clearance & immunity
Chronic states (b/c fibroblast recruitment & activation)
What is lymphatic OMT?
Diverse group of techniques designed to remove impediments to lymphatic circulation & promote & augment the flow of interstitial fluid & lymph
What is the purpose of lymphatic OMT?
To improve functional capacity of lymphatic system (enhancement of immune response & improve tissue nutrition)
What is the major goal of OMT for lymphatic system?
Balanced, well functioning system in which no edema occurs
Indications for lymphatic OMT
Lymphatic congestion Mild CHF Upper or lower respiratory infections Asthma COPD Ligament sprain or muscular strain Acute SD Pregnancy
Absolute contraindications for Lymphatic OMT
Anuria
Necrotizing fasciitis
Pt unable to tolerate treatment
Pt refuses treatment
Relative contraindications for lymphatic OMT
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
Principles of Diagnosis from a Lymphatics approach
Evaluate risk-benefit ratio Evaluate fasciae patterns of Zink Evaluate diaphragms/fascia Evaluate for SD Evaluate tissue congestion
Risk to benefit ratio
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
Compensatory patterns
In 80% of healthy people, directions will be opposite @ each level
OA, CT, TL, LS (L, R, L, R)
Uncompensated patterns
Usually symptomatic & trauma involved (direction of lymph flow in 4 regions is all over the place)
What are the transition zones of the spine?
OA (C1, C2) Thoracic Inlet (C7, T1) Thoracolumbar Diaphragm (T12, L1) Pelvic Diaphragm (L5, sacrum)
What is the sequence of treatment in lymphatic OMT?
Open pathways to remove restriction to flow
Maximize diaphragmatic functions
Increase pressure differentials or transmit motion
Mobilize targeted tissue fluids
