Lymphatics (lecture And Lab) Flashcards
Indications for lymphatic tx
Acute SD Sprains/strains Edema/tissue congestion Lymphatic/venous stasis Pregnancy Infection Inflammation
What are the 2 ABSOLUTE contraindications for lymphatic tx?
Anuria
Necrotizing fasciitis
What are some relative contraindications to lymphatic tx?
Malignancy
Fracture/dislocation
Certain infections (mono, abscess, chronic osteomyelitis)
Certain circulatory disorders (venous obstruction, embolism, hemorrhage, patients on AC therapy)
One of the principles of lymphatic dx is to evaluate fluid pumps; how would you do this?
Observe and palpate for restriction of motion at thoracic inlet, thoracic diaphragm, and pelvic diaphragm
What are the 4 principles of diagnosis for lymphatic SD?
- Evaluate for indications/risk-benefit ratio
- Evaluate for spinal involvement
- Evaluate fluid pumps
- Evaluate peripheral/regional pathways
- Evaluate central myofascial pathways
When palpating the LNs, what are you feeling for?
Either normal or bogginess, when severe you may feel LNs themselves
Characteristics:
Size, shape, consistency, tenderness, mobility, overlying skin
What is normal vs. abnormal for size of LNs?
Normal = pea-sized
Abnormal = large
What is normal vs. abnormal for shape of LNs?
Normal = round, regular
Abnormal = irregular
What is normal vs. abnormal for consistency of LNs?
Normal = spongy
Abnormal = hard
What is normal vs. abnormal for mobility of LNs?
Normal = mobile
Abnormal = fixed
What is normal vs. abnormal for overlying skin of LNs?
Normal = baseline
Abnormal = red, warm, edematous
What 6 areas would you palpate for lymphatic congestion?
- Supraclavicular space
- Epigastric region
- Posterior axillary
- Inguinal region
- Popliteal space
- Achilles region
What junctions are palpated when evaluating central myofascial pathways?
- Craniocervical
- Cervicothoracic
- Thoracolumbar
- Lumbopelvic
What are the 4 major principles of lymphatic tx?
- Open pathways to remove restriction to flow
- Maximize diaphragmatic functions
- Increase pressure differentials or transmit motion
- Mobilize targeted tissue fluids
What are the 2 phases pertaining to step 1 of lymphatic tx: open pathways to remove restriction to flow?
Phase 1: transverse myofascial restrictors
Phase 2: regional lymphatic drainage
What is the key rule to remember when treating the transverse myofascial restrictors in lymphatic tx?
Always treat upstream first! Don’t want to block fluid flow
Phase 2 of opening pathways to remove restriction to flow involves regional lymphatic drainage. What are some techniques for this?
Effleurage/petrissage
Tapotement
Regional LN drainage
What MFR technique is always performed first in lymphatic tx?
Thoracic inlet MFR
After first performing thoracic inlet MFR for a lymphatic problem inferior to the diaphragm, what technique would you perform next?
Doming the diaphragm
After first performing thoracic inlet MFR for an HEENT lymphatic problem, what technique would you perform next?
Suboccipital release
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?
Ischiorectal fossa release
What lymphatic technique might you use to treat upper and lower extremity lymphatic congestion?
Effleurage and petrissage
What lymphatic technique might you use to treat lower extremity lymphatic congestion?
IT band effleurage
What lymphatic technique might you use for chest, thoracic, or lumbar lymphatic congestion?
Tapotement
What are some lymphatic techniques for HEENT lymphatic congestion?
Submandibular drainage
Cervical chain drainage
Auricular drainage
Cervical stroking
What lymphatic techniques are used to increase pressure differentials to transmit motion?
Pectoral traction Rib raising (supine or seated) Thoracic pump (repetitive or vacuum mod) Abdominal pump Sacral rock Pedal pump
What are some lymphatic techniques for mobilizing targeted tissue fluids?
Anterior cervical arches release Mandibular drainage (Galbreath)
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?
Maximize respiratory function
Raise the ribs
Mobilize restricted spinal regions
Increase vascular and lymphatic flow
Lymphoid organs produce lymphocytes which circulate within body and react to foreign material. what are some lymphoid organs?
Spleen Thymus Tonsils Appendix MALT Liver
When does lymphatic development begin?
During 5th week of gestation, significant by 20 weeks
Lymphatic system is immature at birth, but development continues until it regresses at what point in time?
Lymphoid tissue increases until puberty when the immune system continues to mature, but then begins regressing
What is the largest single mass of lymphoid tissue and acts as a filter between an artery and a vein?
Spleen
Which lymph organ does not contain any lymphatics? (I know, wtf.)
Spleen
Which tonsils are located in lateral pharynx?
Palatine
Which tonsils are located at posterior 1/3 of tongue?
Lingual
Which tonsils are at the nasopharyngeal border?
Pharyngeal tonsils/adenoids
Which organ is the pressure-sensitive “gate-keeper” of lymphatic drainage, in which 1/2 of the body’s lymph is formed?
Liver
Which visceral lymph tissue allows fats from the digestive tract into the circulatory system?
GALT - contains peyer’s patches and lacteals
If a pt is found to have a swollen, painful LN, what might you look for near the node?
Cut
Bite
Rash
Infection
If a pt is found to have swollen/indurated, but non-painful LN, what might you be suspicious of?
Malignancy/disease
What is Virchow’s node?
Enlarged left supraclavicular node suspicious for intra-abdominal cancer
Lymphatic channels perfuse all tissues of the body except which 4?
- Epidermis (including hair and nails)
- Endomysium (muscles and cartilage)
- Bone marrow
- Select portions of peripheral nerves
Describe the histology of lymphatic vessels
Composed of endothelium that lacks basement membrane
Which lymphatic duct drains the majority of the body?
Thoracic duct
The thoracic duct empties into the venous system at the junction of what 2 veins?
Left internal jugular v.
Left subclavian v.
______ _____ = 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
Cisterna chyli
What does the right lymphatic duct drain?
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.]
What is found anterior to L1-L2, posterior to the right crura of the diaphragm?
Cisterna chyli of thoracic duct
The thoracic duct lies against the vertebral column, and at _____ it moves LEFT of the midline, between the ______ and ______ _______
T4
aorta; azygous vein
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
50
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
Respiration
What are the 4 primary functions of the lymphatic system?
Fluid balance
Purification and cleansing
Defense
Nutrition
Interstitial fluid pressure is increased by:
_____ arterial pressure
_____ capillary permeability
_____ plasma oncotic pressure
_____ interstitial fluid protein
Increased
Increased
Decreased
Increased
Mechanisms of lymph flow include lymphatic pumps, what is the diff between intrinsic pumps and extrinsic pumps?
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)
What is lymphangitis?
Inflammation of lymphatic vessels
What is lymphadenitis?
Inflammation of lymph nodes
______ _____ = junction of thoracic duct with venous system
Thoracic inlet
______ ______ syndrome = compression of the arteries, veins, and/or nerves of the upper extremity by the clavicle, first rib or scalene muscles
Thoracic outlet
_____ ____ = suprapleural membrane. The thoracic duct travels cephalad through this to the level of C7, then U-turns to the thoracic inlet
Sibson’s fascia
What is the most common compensated myofascial pattern?
L/R/L/R
