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MSK I > Lymphatics (Ogden) > Flashcards

Lymphatics (Ogden) Flashcards

1
Q

Spleen: location, functions

A

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

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2
Q

Liver: function

A

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

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3
Q

“components of system” overview

A

organized lymph tissue
vessels/ducts
lymph fluid

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4
Q

“organized lymph tissue” over view

A

spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue (gastrointestinal and pulmonary)

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5
Q

Thymus: function, location

A

superiorly in mediastinum, anteriorly, goes into neck region

largest around age 2, then replaced by fat

nonfunctional in adults

T lymphocyte development

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6
Q

Tonsils: function

A

palatine, lingual, and pharyngeal (adenoids)

provide cells to influence and build immunity early in life

nonessential to adult immune function

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7
Q

Appendix: location/function

A

located on the medial surface of the cecum

function largely unknown

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8
Q

Pulmonary and GI roles in lymphatics

A

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

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9
Q

LN: what does ogdan say

A

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

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10
Q

Superficial and Deep LNs

A

S: follows subcutaneously with superficial veins
D: beneath fascia and muscles, follows deep veins

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11
Q

Superficial Nodes: where do they receive and where do they drainage

A

receive lymph from superficial and deep structures in Lower/upper extremities, as well as head/neck

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12
Q

Superficial nodes: cervical

A

head/superclavicular and upper extremity drains into jugular nodes

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13
Q

Superficial nodes: axillary

A

infraclavicular to umbilicus, drains to axillary nodes and then subclavian

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14
Q

Superficial nodes: inguinal

A

Caudal to umbilicus drain to inguinal nodes and then lumbar

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15
Q

Lymph channels/ducts

what do they “follow” and what don’t they perfuse?

A

follow veins (superficial and dee)

they dont perfuse:
CNS 
epidermis 
endomysium of muscles/cartilages 
bone marrow 
selected portions of peripheral nerves
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16
Q

CNS

A

previously they thought it possessed no lymphatics, but new research has found they do

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17
Q

Structure

A

flow is one way
vessels have valves
vessels surrounded by major organs
drain into thoracic duct or right lymphatic duct

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18
Q

Major nodes that can be assessed head/neck

A 
Subparotid
Facial
Mandibular and submandibular 
submental 
suprahyoid 
anterior deep cervical (pretracheal/thyroid) 
occipital 
thoracic 
Virchow's
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19
Q

Major nodes of the superficial thoracic region

A

subclavian (apical axillary)
parasternal
subscapular (posterior axillary)
Pectoral( anterior axillary nodes)

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20
Q

Major nodes of the upper extremities

A 
deltopectoral node 
axillary nodes (along axillary vein)
cubital nodes
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21
Q

Major nodes of the lower extremities

A

Superficial INGUINAL nodes

popliteal lymph node `

22
Q

Major nodes in the viscera

A

Thoracic duct
Cisterna chyli
PREAROTIC nodes: celiac, superior mesenteric, inferior mesenteric

23
Q

Superficial inguinal nodes

A

superficial epigastric, external pudendal, superficial circumflex iliac and great saphenous groups

24
Q

Thoracic duct

A

largest duct

lies between aorta and azygous vein

25
Q

Where does the thoracic duct connect to the subclavian and brachiocephalic veins?

A

around T4, it makes a midline shift and connects to the junction running into those two

26
Q

Thoracic Duct drains:

A 
left side of head/neck 
left arm
left side of thorax 
left and right lower body 
viscera of thoracic
27
Q

Cisterna chyli

A

dilation of distal thoracic duct

anterior to L1-L2; posterior to right crura of diaphragm

28
Q

Right lymphatic duct

A

drains right arm
right head/neck
right chest

connects to the venous system at the jugular subclavian junction

29
Q

Why would stress cause decongestion?

A

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)

30
Q

lymph fluid

A

fluid that leaks out of interstitial capillaries into interstitium

components:
proteins, salts, fats, primary lymphocytes, clotting factors, bacteria and viruses

31
Q

Name four functions of lymphatic system

A

fluid balance
purification and cleansing
defense
nutrition

32
Q

Fluid balance

A

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

33
Q

Purification

A

Lymph fluid baths all organs, this picks up particulate matter and cleans out crevices and returns them to nodes

node is a “purifying” filter

34
Q

Defense

A

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

35
Q

Mechanisms of flow

A

interstitial fluid pressure

lymphatic pump: intrinsic/extrinsic

36
Q

Interstitial fluid pressure

A

normal = -6.3 mmHg
increase in pressure will increase flow
efficiency ceiling at 0 mmhg
above 0 mmHg will collapse vessels and obstruct flow

37
Q

Interstitial fluid pressure is increased by….

A

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)

38
Q

“intrinsic pump”

A

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

39
Q

“extrinsic pump”

A

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

40
Q

Clinical problems of poorly functioning lymphatic system

A

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

41
Q

Effects of edema

A

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

42
Q

Area 1 of OMT

A

Thoracic inlet

43
Q

Area 2 of OMT

A

Abdomen

44
Q

Area 3 of OMT

A

Upper extremity

45
Q

Area 4 of OMT

A

Lower extremity

46
Q

Area 5 of OMT

A

Head and neck

47
Q

unofficial area 6

A

thoracic inlet, always return to it

48
Q

conditions that warrant general lymphatic treatment

A 
early carcinoma/metastatic cancer 
osseous fracture 
acute bacterial infection/w temp 102 
acute hepatitis 
infectious mononucleosis 
circulatory disorders 
ANURIA (not urinating)
49
Q

What conditions would NOT allow OM lymphatic treatment?

A

IF the patient is supine
IF the patient has an acute bacterial infection (Temp over 102)
IF the patient

50
Q

where do superficial LNs drain into?

A

cervical, axillary, and inguinal

MSK I (14 decks)

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