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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
LN function
Filtration of lymph fluid Maturation of lymphocytes Phagocytosis of bacteria & cellular debris
26
Describe path of lymph flow thru a lymph node
``` Afferent lymphatics Subcapsular space Outer cortex Deep cortex Medullary sinus Efferent lymphatics ```
27
What are lymphatic trunks?
``` Where lymphatic vessels drain into: Lumbar Intestinal Bronchomediastinal Subclavian Jugular ```
28
Where is cisterns chyli & what does it do?
Located @ L1-L2 & drains lymphatic trunks of lower body (gives rise to thoracic duct)
29
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 ```
30
Right Lympathric duct
From junction of R jugular & subclavian trunks ``` Drains: R head/neck R UE R thorax Heart Lungs ```
31
What is important when evaluating LNs?
Shape, size, consistency, tenderness, mobility
32
If a LN is swollen, soft, painful..
Infectious (look for source)...acute fluid overload
33
If a LN is swollen, hard, non-painful & fixed...
Evaluate for malignancy
34
What is Virchow’s node?
Left Supra-clavicular region (for intra-thoracic & abdominal cancer)
35
What are epitrochlear nodes?
In cubittal fossa (secondary to syphilis)
36
Location & fxn of spleen
Beneath ribs 9-11 on L Destroy damaged/deformed RBCs Synthesize IgGs Clear bacteria
37
How is fluid moved thru spleen?
Pressure sensitive movement of diaphragm drives spleen fluid movement
38
Location & fxn of liver
RUQ Where 1/2 of body lymph is formed Clears bacteria Gate keeper of hepato-biliary-pancreatic venous & lymphatic drainage
39
Location & fxn of thymus
Anterior mediastinum Maturation site for T cells Little or no fxn in adult (will ave Sail Sign in peds)
40
Location & fxn of tonsils
Palatine, Lingual & Pharyngeal Provide cells to influence & build immunity early in life Non essential to adult immune function
41
Location & fxn of appendix
@ proximal end of cecum Contains lymph tissue Part of gut associated lymphoid tissue (GALT)
42
What are assoc w/ GALT?
Pyers patches (ileum) Lacteals (small bowel) Pulmonary lymphoid tissue (filters toxins from lungs)
43
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)
44
Direct Diaphragmatic Pressure
Interaction between thoracic diaphragm & pelvic diaphragm
45
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)
46
Major consequence of poorly functioning lymphatic system
EDEMA (buildup of interstitial fluid)
47
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)
48
What is lymphatic OMT?
Diverse group of techniques designed to remove impediments to lymphatic circulation & promote & augment the flow of interstitial fluid & lymph
49
What is the purpose of lymphatic OMT?
To improve functional capacity of lymphatic system (enhancement of immune response & improve tissue nutrition)
50
What is the major goal of OMT for lymphatic system?
Balanced, well functioning system in which no edema occurs
51
Indications for lymphatic OMT
``` Lymphatic congestion Mild CHF Upper or lower respiratory infections Asthma COPD Ligament sprain or muscular strain Acute SD Pregnancy ```
52
Absolute contraindications for Lymphatic OMT
Anuria Necrotizing fasciitis Pt unable to tolerate treatment Pt refuses treatment
53
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 ```
54
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 ```
55
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
56
Compensatory patterns
In 80% of healthy people, directions will be opposite @ each level OA, CT, TL, LS (L, R, L, R)
57
Uncompensated patterns
Usually symptomatic & trauma involved (direction of lymph flow in 4 regions is all over the place)
58
What are the transition zones of the spine?
``` OA (C1, C2) Thoracic Inlet (C7, T1) Thoracolumbar Diaphragm (T12, L1) Pelvic Diaphragm (L5, sacrum) ```
59
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

OS (18 decks)

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