Lymphatics (Ogden) Flashcards
Spleen: location, functions
beneath ribs 9, 10, 11, inbetween hemi-diagphragm and and peritoneal cavity
diaphragm important for homeostatic movement of splenic fluids
functions: cleans blood of RBCs, synthesizes Ig, clearance site for microorganisms, Ags, poorly organized bacteria
Liver: function
half the body’s lymph formed here
pressure sensitive organ: affected by muscular action of thoraco-abdominal diaphragm
“gate keeper” of hepato-bilitary-pancreativ venous and lymphatic region
ALSO clears bacteria
“components of system” overview
organized lymph tissue
vessels/ducts
lymph fluid
“organized lymph tissue” over view
spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue (gastrointestinal and pulmonary)
Thymus: function, location
superiorly in mediastinum, anteriorly, goes into neck region
largest around age 2, then replaced by fat
nonfunctional in adults
T lymphocyte development
Tonsils: function
palatine, lingual, and pharyngeal (adenoids)
provide cells to influence and build immunity early in life
nonessential to adult immune function
Appendix: location/function
located on the medial surface of the cecum
function largely unknown
Pulmonary and GI roles in lymphatics
Pulmonary aids filtration of toxins from lungs
GI has Payer’s patches, lacteals (lymphatic capillaries in each vili in small bowel)
FATs enter circulation via GI system lacteals
LN: what does ogdan say
most highly organized lymphoid tissue
dispersed along the course of the lymph vessels
primary purpose is for filtration of lymph
two types:
superficial and depp
400-450 nodes
Superficial and Deep LNs
S: follows subcutaneously with superficial veins
D: beneath fascia and muscles, follows deep veins
Superficial Nodes: where do they receive and where do they drainage
receive lymph from superficial and deep structures in Lower/upper extremities, as well as head/neck
Superficial nodes: cervical
head/superclavicular and upper extremity drains into jugular nodes
Superficial nodes: axillary
infraclavicular to umbilicus, drains to axillary nodes and then subclavian
Superficial nodes: inguinal
Caudal to umbilicus drain to inguinal nodes and then lumbar
Lymph channels/ducts
what do they “follow” and what don’t they perfuse?
follow veins (superficial and dee)
they dont perfuse: CNS epidermis endomysium of muscles/cartilages bone marrow selected portions of peripheral nerves
CNS
previously they thought it possessed no lymphatics, but new research has found they do
Structure
flow is one way
vessels have valves
vessels surrounded by major organs
drain into thoracic duct or right lymphatic duct
Major nodes that can be assessed head/neck
Subparotid Facial Mandibular and submandibular submental suprahyoid anterior deep cervical (pretracheal/thyroid) occipital thoracic Virchow's
Major nodes of the superficial thoracic region
subclavian (apical axillary)
parasternal
subscapular (posterior axillary)
Pectoral( anterior axillary nodes)
Major nodes of the upper extremities
deltopectoral node axillary nodes (along axillary vein) cubital nodes
Major nodes of the lower extremities
Superficial INGUINAL nodes
popliteal lymph node `
Major nodes in the viscera
Thoracic duct
Cisterna chyli
PREAROTIC nodes: celiac, superior mesenteric, inferior mesenteric
Superficial inguinal nodes
superficial epigastric, external pudendal, superficial circumflex iliac and great saphenous groups
Thoracic duct
largest duct
lies between aorta and azygous vein
Where does the thoracic duct connect to the subclavian and brachiocephalic veins?
around T4, it makes a midline shift and connects to the junction running into those two
Thoracic Duct drains:
left side of head/neck left arm left side of thorax left and right lower body viscera of thoracic
Cisterna chyli
dilation of distal thoracic duct
anterior to L1-L2; posterior to right crura of diaphragm
Right lymphatic duct
drains right arm
right head/neck
right chest
connects to the venous system at the jugular subclavian junction
Why would stress cause decongestion?
both thoracic duct and right lymphatic duct have one way valves and smooth muscle which are under sympathetic control, which is increased by stress (causing tissue congestion)
lymph fluid
fluid that leaks out of interstitial capillaries into interstitium
components:
proteins, salts, fats, primary lymphocytes, clotting factors, bacteria and viruses
Name four functions of lymphatic system
fluid balance
purification and cleansing
defense
nutrition
Fluid balance
50% of plasma proteins re-enter circulation through lymph
can pick up fluid from peritoneum, pleura, cartilages, pericardium and join
excess of 3 liters/24 hrs
large proteins can enter lymphatic circulation
aids in homeostasis in fluid overload situation
Purification
Lymph fluid baths all organs, this picks up particulate matter and cleans out crevices and returns them to nodes
node is a “purifying” filter
Defense
lymph fluid delivers toxins, bacteria, viruses into contact with lymphatic system
lymph returns proteins back to vascular system
proteins bind to nutrients
fast are absorbed via lymph system
Mechanisms of flow
interstitial fluid pressure
lymphatic pump: intrinsic/extrinsic
Interstitial fluid pressure
normal = -6.3 mmHg
increase in pressure will increase flow
efficiency ceiling at 0 mmhg
above 0 mmHg will collapse vessels and obstruct flow
Interstitial fluid pressure is increased by….
1) increased arterial capillary pressure (HTN)
2) decreased colloidal osmotic pressure (hepatic cirrhosis)
3) ncreased interstitial fluid protein (starvation and plasma hypoalbuminemia)
4) increased capillary permeability (toxins = rattlesnake poisoning)
“intrinsic pump”
distension of larger vessels causes —> constriction in small vessels –> causing pumping
this happens because endothelial cells have contractile fibers that respond to distension
contraction causes pressure gradients to help move fluid
example: aortic pulse can act on the lymphatic duct and help move lymph through
“extrinsic pump”
Direct pressure on vessels moves lymph
internally anywhere pressure exercted will increase flow
Thoracic diaphragm:
Crura acts on cisterna chyli
respiration produces pressure gradients between thorax and abdomen
pressure gradients and one-way valves pull lymph toward venous circulation
Pelvic diaphragm:
synchronous with abdominal diaphragm
moves interstitial fluid from pelvis
important in dysmenorrhea, preparation for labor+delivery
prostate irritation in benign prostatic hypertrophy and other prostate problems
Clinical problems of poorly functioning lymphatic system
edema.
edema = collapsed lymphatic vessels or too much interstitial pressure
TOO much fluid running into interstitium
TOO little fluid running out of interstitium
TOO much interstitial pressure = retards intrinsic pump
Effects of edema
compression of lymph vessels and neurovascular structures
tissue congestion
fluid stasis changes pH of tissue/organ
chronic states have fibroblasts leaving fibrotic structures: fibrosis/contractures
effects include decreased delivery of nutrients
decreased bioavailability of drugs/hormones
Area 1 of OMT
Thoracic inlet
Area 2 of OMT
Abdomen
Area 3 of OMT
Upper extremity
Area 4 of OMT
Lower extremity
Area 5 of OMT
Head and neck
unofficial area 6
thoracic inlet, always return to it
conditions that warrant general lymphatic treatment
early carcinoma/metastatic cancer osseous fracture acute bacterial infection/w temp 102 acute hepatitis infectious mononucleosis circulatory disorders ANURIA (not urinating)
What conditions would NOT allow OM lymphatic treatment?
IF the patient is supine
IF the patient has an acute bacterial infection (Temp over 102)
IF the patient
where do superficial LNs drain into?
cervical, axillary, and inguinal
