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OS Exam I > Lymphatics (lecture And Lab) > Flashcards

Lymphatics (lecture And Lab) Flashcards

1
Q

Indications for lymphatic tx

A 
Acute SD
Sprains/strains
Edema/tissue congestion
Lymphatic/venous stasis
Pregnancy
Infection
Inflammation
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2
Q

What are the 2 ABSOLUTE contraindications for lymphatic tx?

A

Anuria

Necrotizing fasciitis

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3
Q

What are some relative contraindications to lymphatic tx?

A

Malignancy
Fracture/dislocation

Certain infections (mono, abscess, chronic osteomyelitis)

Certain circulatory disorders (venous obstruction, embolism, hemorrhage, patients on AC therapy)

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4
Q

One of the principles of lymphatic dx is to evaluate fluid pumps; how would you do this?

A

Observe and palpate for restriction of motion at thoracic inlet, thoracic diaphragm, and pelvic diaphragm

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5
Q

What are the 4 principles of diagnosis for lymphatic SD?

A
  1. Evaluate for indications/risk-benefit ratio
  2. Evaluate for spinal involvement
  3. Evaluate fluid pumps
  4. Evaluate peripheral/regional pathways
  5. Evaluate central myofascial pathways
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6
Q

When palpating the LNs, what are you feeling for?

A

Either normal or bogginess, when severe you may feel LNs themselves

Characteristics:
Size, shape, consistency, tenderness, mobility, overlying skin

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7
Q

What is normal vs. abnormal for size of LNs?

A

Normal = pea-sized

Abnormal = large

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8
Q

What is normal vs. abnormal for shape of LNs?

A

Normal = round, regular

Abnormal = irregular

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9
Q

What is normal vs. abnormal for consistency of LNs?

A

Normal = spongy

Abnormal = hard

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10
Q

What is normal vs. abnormal for mobility of LNs?

A

Normal = mobile

Abnormal = fixed

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11
Q

What is normal vs. abnormal for overlying skin of LNs?

A

Normal = baseline

Abnormal = red, warm, edematous

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12
Q

What 6 areas would you palpate for lymphatic congestion?

A
  1. Supraclavicular space
  2. Epigastric region
  3. Posterior axillary
  4. Inguinal region
  5. Popliteal space
  6. Achilles region
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13
Q

What junctions are palpated when evaluating central myofascial pathways?

A
  1. Craniocervical
  2. Cervicothoracic
  3. Thoracolumbar
  4. Lumbopelvic
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14
Q

What are the 4 major principles of lymphatic tx?

A
  1. Open pathways to remove restriction to flow
  2. Maximize diaphragmatic functions
  3. Increase pressure differentials or transmit motion
  4. Mobilize targeted tissue fluids
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15
Q

What are the 2 phases pertaining to step 1 of lymphatic tx: open pathways to remove restriction to flow?

A

Phase 1: transverse myofascial restrictors

Phase 2: regional lymphatic drainage

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16
Q

What is the key rule to remember when treating the transverse myofascial restrictors in lymphatic tx?

A

Always treat upstream first! Don’t want to block fluid flow

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17
Q

Phase 2 of opening pathways to remove restriction to flow involves regional lymphatic drainage. What are some techniques for this?

A

Effleurage/petrissage

Tapotement

Regional LN drainage

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18
Q

What MFR technique is always performed first in lymphatic tx?

A

Thoracic inlet MFR

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19
Q

After first performing thoracic inlet MFR for a lymphatic problem inferior to the diaphragm, what technique would you perform next?

A

Doming the diaphragm

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20
Q

After first performing thoracic inlet MFR for an HEENT lymphatic problem, what technique would you perform next?

A

Suboccipital release

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21
Q

After first performing thoracic inlet MFR for a lymphatic problem in the lower extremities, you would dome the diaphragm. What is the 3rd technique you would perform?

A

Ischiorectal fossa release

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22
Q

What lymphatic technique might you use to treat upper and lower extremity lymphatic congestion?

A

Effleurage and petrissage

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23
Q

What lymphatic technique might you use to treat lower extremity lymphatic congestion?

A

IT band effleurage

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24
Q

What lymphatic technique might you use for chest, thoracic, or lumbar lymphatic congestion?

A

Tapotement

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25
Q

What are some lymphatic techniques for HEENT lymphatic congestion?

A

Submandibular drainage
Cervical chain drainage
Auricular drainage
Cervical stroking

26
Q

What lymphatic techniques are used to increase pressure differentials to transmit motion?

A 
Pectoral traction
Rib raising (supine or seated)
Thoracic pump (repetitive or vacuum mod)
Abdominal pump
Sacral rock
Pedal pump
27
Q

What are some lymphatic techniques for mobilizing targeted tissue fluids?

A 
Anterior cervical arches release
Mandibular drainage (Galbreath)
28
Q

During the 1917-1919 influenza pandemic, osteopaths had a 0.486% death rate while overall medical care had a 1.08% death rate. What did osteopathic physicians do differently for their patients?

A

Maximize respiratory function
Raise the ribs
Mobilize restricted spinal regions
Increase vascular and lymphatic flow

29
Q

Lymphoid organs produce lymphocytes which circulate within body and react to foreign material. what are some lymphoid organs?

A 
Spleen
Thymus
Tonsils
Appendix
MALT
Liver
30
Q

When does lymphatic development begin?

A

During 5th week of gestation, significant by 20 weeks

31
Q

Lymphatic system is immature at birth, but development continues until it regresses at what point in time?

A

Lymphoid tissue increases until puberty when the immune system continues to mature, but then begins regressing

32
Q

What is the largest single mass of lymphoid tissue and acts as a filter between an artery and a vein?

A

Spleen

33
Q

Which lymph organ does not contain any lymphatics? (I know, wtf.)

A

Spleen

34
Q

Which tonsils are located in lateral pharynx?

A

Palatine

35
Q

Which tonsils are located at posterior 1/3 of tongue?

A

Lingual

36
Q

Which tonsils are at the nasopharyngeal border?

A

Pharyngeal tonsils/adenoids

37
Q

Which organ is the pressure-sensitive “gate-keeper” of lymphatic drainage, in which 1/2 of the body’s lymph is formed?

A

Liver

38
Q

Which visceral lymph tissue allows fats from the digestive tract into the circulatory system?

A

GALT - contains peyer’s patches and lacteals

39
Q

If a pt is found to have a swollen, painful LN, what might you look for near the node?

A

Cut
Bite
Rash
Infection

40
Q

If a pt is found to have swollen/indurated, but non-painful LN, what might you be suspicious of?

A

Malignancy/disease

41
Q

What is Virchow’s node?

A

Enlarged left supraclavicular node suspicious for intra-abdominal cancer

42
Q

Lymphatic channels perfuse all tissues of the body except which 4?

A
  1. Epidermis (including hair and nails)
  2. Endomysium (muscles and cartilage)
  3. Bone marrow
  4. Select portions of peripheral nerves
43
Q

Describe the histology of lymphatic vessels

A

Composed of endothelium that lacks basement membrane

44
Q

Which lymphatic duct drains the majority of the body?

A

Thoracic duct

45
Q

The thoracic duct empties into the venous system at the junction of what 2 veins?

A

Left internal jugular v.

Left subclavian v.

46
Q

______ _____ = dilated collecting sac in the abdomen where the lymphatic trunks draining the lower half of the body merge; ascends from collecting sac as the thoracic duct into the thorax

A

Cisterna chyli

47
Q

What does the right lymphatic duct drain?

A

Right side of the head, neck, and thorax

Right upper limb

[empties into venous system at the junction of the right internal jugular v. and right subclavian v.]

48
Q

What is found anterior to L1-L2, posterior to the right crura of the diaphragm?

A

Cisterna chyli of thoracic duct

49
Q

The thoracic duct lies against the vertebral column, and at _____ it moves LEFT of the midline, between the ______ and ______ _______

A

T4

aorta; azygous vein

50
Q

Lymph fluid leaks out of arterial capillaries –> interstitium –> single lymphatic vessels

____% of the plasma proteins that diffuse out of the vascular system in a 24 hr period return to the body via the lymphatic system

A

50

51
Q

35-60% of the drainage through the thoracic duct is associated with ___________, which is associated with the “pump” effect of the diaphragmatic crura on the cisterna chyli. The junctures are under sympathetic control

A

Respiration

52
Q

What are the 4 primary functions of the lymphatic system?

A

Fluid balance
Purification and cleansing
Defense
Nutrition

53
Q

Interstitial fluid pressure is increased by:

_____ arterial pressure
_____ capillary permeability
_____ plasma oncotic pressure
_____ interstitial fluid protein

A

Increased
Increased
Decreased
Increased

54
Q

Mechanisms of lymph flow include lymphatic pumps, what is the diff between intrinsic pumps and extrinsic pumps?

A

Intrinsic = pressure gradients caused by large vessel distension (smooth muscle contraction) and small vessel distension (activation of endothelial cell contractile fibers)

Extrinsic = direct pressure on lymphatic vessels (thoracic and pelvic diaphragms)

55
Q

What is lymphangitis?

A

Inflammation of lymphatic vessels

56
Q

What is lymphadenitis?

A

Inflammation of lymph nodes

57
Q

______ _____ = junction of thoracic duct with venous system

A

Thoracic inlet

58
Q

______ ______ syndrome = compression of the arteries, veins, and/or nerves of the upper extremity by the clavicle, first rib or scalene muscles

A

Thoracic outlet

59
Q

_____ ____ = suprapleural membrane. The thoracic duct travels cephalad through this to the level of C7, then U-turns to the thoracic inlet

A

Sibson’s fascia

60
Q

What is the most common compensated myofascial pattern?

A

L/R/L/R

OS Exam I (18 decks)

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