Lymphatics System Flashcards
When are the lymphatics developing?
what dermal layers and what things are part of it?
begins during 5th week. significantly there by week 20
Mesoderm –> vessels, nodes, spleen, myeloid
Endoderm –> thymus and tonsils
Lymhoid tissue increases when?
what happens during geriatric stage?
birth until puberty. immune system continues to mature but regresses and then levels off
declines and patients may not mount a fever
What are the main functions of the body?
Immune
Digestive
Fluid Balance
Waste
Spleen is where?
why is it called “pressure sensitive”?
beneath ribs 9-11 on the left
it’s normally not palpable
movement of the diaphragm drives splenic fluid movement
What organ has the most lymphoid tissue?
what is its function?
spleen
synthesize Ig’s, clear fluid, and synthesize RBC
Liver is found where?
why is it pressure sensitive?
RUQ. right costal margin
like the spleen, movement of the diaphragm for the homeostatic movement of hepatic fluids
What is the liver’s lymphatic function?
half of the body’s lymph is formed here.
clears bacteria
gate keeper of shared hepatic-biliary-pancreatic venous and lymphatic drainage
Thymus is found where?
what’s good to know about adults vs kids?
function?
Anterior Mediastinum
large in infancy, size peaks at 2 y/o. after puberty it becomes fat.
maturation for T cells, little to no fn in adults
Tonsils?
3 of them.
most visible 6-9 mo, enlarged through childhood.
Appendix?
proximal portion of the cecum
lymphoid pulp in it.
part of the GALT.
Visceral Lymphoid Tissue?
GALT
these have large chylomicrons that we need to move around and they can’t travel through blood so need to go through lymphatic system
What is lymphatic fluid?
substances that leak out of the capillaries into the interstitium. (fluids, proteins, electrolytes, and cells)
How does lymphatics help with fluid balance?
what if you overload that?
30L of fluid move from capillaries to interstitial space each day
90% to capillaries, 10% to lymphatic system.
2nd or third spacing.
where does most of the lymphatic drainage happen/
what is this spot associated with?
thoracic duct.
respiration
how do you start lymphatic treatment?
clearing the thoracic duct (inlet)
What tissues do not have lymphatic vessels but use d direct diffusion?
epidermis, endomysium, cartilage, bone marrow
lymph tubes are what type?
blind endothelial tubes or capillaries.. they’re leaky
starting from lymphatic capillaries, what’s the pathway?
lymphatic capillaries –> collecting lymphatics –> afferent lymphatic vessels –> efferent lymphatic vessels –> thoracic duct or R lymphatic duct –> venous system
What are Lymphangions?
muscular units or “chains” that are two-leaflet bicuspid valves that make sure there isn’t back flow.
Lymph node types? function?
Superficial + Deep
filter fluid, maturation of lymphocytes, phagocytosis
pathway of the lymph node from afferent lymphatics?
Afferent lymphatics –> sub capsular space –> outer cortex –> deep cortex –> medullary sinus –> efferent lymphatics through Hilum
Malignancy in the neck, what node are you going to look at? where is it at?
Virchow’s node. L supraclavicular space
What lymph node is associated with secondary syphilis?
Epitrochlear Nodes
Where does the Thoracic duct originate from?
Where does it terminate?
Cisterna Chyli as a dilation at L1-L2 level
terminates by piercing Sibson’s fascia at superior inlet, U-turns to empty into L subclavian/IJ veins
What is the thoracic duct major function?
master lymph vessel and drains L UE, L head/neck, L thorax, abdomen, everything inferior to belly button.
what does lymph fluid do to organs?
bathes organs
cleanses EC spaces of bad shit. travels from vessel –> node
node is the purifying filter
What’s the primary way we move lymph? (flow)
what pressure allows movement of lymph?
what pressure collapses lymph capillaries
Interstitial fluid pressure (Pif)
negative
greater than 0
Pelvic diaphragm works how?
works with the thoracic diaphragm. helps move fluids from lower to the thoracic duct.
SNS on the lymph valves?
SNS on the lymphatic smooth muscle?
What does OMT do?
higher tone == tighter valves = lower flow
higher tone = lower peristalsis = lymphatic congestion
lowers the SNS activity
What is the consequence of a poorly functioning lymphatic system?
edema.. third spacing out into different place. imbalance of starting forces.
What are the effects of edema on vascular? neuronal? SOB?
lower delivery of O2, nutrients, meds
lower sensation, pain, or paresthesia
pulmonary SOB
How does edema effect the body if chronic?
fibroblast recruitment and activation is affected.. leading to fibrosis / contraction
Indications for Lymphatic OMT? chronic conditions?
edema, tissue congestion, lymphatic stasis
infection
inflammation
be careful
Absolute Contraindications for lymphatic OMT?
Anuria (no urine at all)
Necrotizing fasciitis in treatment area (spreads easy)
can’t tolerate treatment
patient consent
Relative Contraindications for Lymphatic OMT?
COPD, acute asthma exacerbation, unstable cardiac conditions.
bacterial/chronic infections.
Cancer is up in the air.
What are the 5 principles of diagnosis from a lymphatic approach?
- evaluate risk-benefit ratio
- evaluate fascial patterns of Zink
- Evaluate diaphragms/fascia
- evaluate SD
- Evaluate tissue congestion
Zink’s patterns
L/R/L/R compensatory
R/L/R/L (less common)
What is the sequence of treatment?
- open pathways to remove restriction to flow
- maximize diaphragmatic function
- increase pressure differentials or transmit motion (fluid pumps)
- Mobilize targeted tissue fluids
Zink’s compensatory pattern
look at the 4 junctions (cranial cervical, cervicothoracic, thoracolumbar, lumbosacral)
LRLR pattern through rotation or uncommon or uncompensated compensatory
