LymphaticsII Flashcards
What are key points about lymph flow? (hint: intra-capillary pressure, amount of leak per day, % reabsorbed? % drained from ISF, Rate of lymph through the TD per day)
- High intra-capillary pressure- 20-30 liters of plasma leak per day- become interstitial fluid (ISF)- 90% is reabsorbed by veins- 10% is drained form ISF by lymph capillaries- 2-5L of lymph pass through the thoracic duct per day.
What provides propulsion for capillaries?
Extrinsic forces b/c no smooth muscles in the capillaries
What part of the lymph flow system has smooth muscles?
The lymphangion (which are segments inbetween bicuspid valves)
What is the largest lymph vessel in the body?
Thoracic Duct
Where does the thoracic duct begin? Where does it travel? Where does it empty into?
- Begins at ~L2 (from the Cisterna Chyli)- Travels through diaphragm within the aortic hiatus and arches 3-4 cm above the clavicle- Empties into the venous system at the juncture of the left internal jugular vein and the left subclavian vein
Where does the Right lympahtic duct empty out into?
The juncture of the right internal jugular vein and the right subclavian vein
True or False: Only some organs contribute to the two main lymphatic functions of homeostasis and self defense.
False; ALL ORGANS contribute to the two main functions
Which tissues do not have lymphatics?
Vascularized Tissue: Central Nervous System (CNS)/Brain Bone Bone Marrow Maternal Placenta Endomyceum around muscle fibersNonvascularized Tissues: Cartilage Lens of the eye Cornea of the eye Epidermis Inner portion of the wall of blood vessels
Does the brain have a lymphatic system? How does it remove extra fluid?
No, it does not have a lymphatic system! It uses CAPILLARIES
What Non-Vascularized tissues lack lymphatics?
CartilageLens of the eyeCorena of the eyeEpidermisInner portion of the wall of blood vessels
Describe the general gross anatomy of the diaphragm
- Parachute shaped- a huge muscle with a central tendon - Has left and right Crura that goes down to L2 (level of cysterna chylie)
What are functions of the Crura?
- Pump for cysterna chylie- May obstruct flow when tense
How is the diaphragm like a sponge?
Has holes (called stomata) that absorbs fluid from the peritoneal/pelvic cavity, pleural cavity, pericardial cavity, lower body wall, and lower extremity
What does the Diaphgram absorb fluid from?
Peritoneal/Pelvic CavityPleural CavityPericardial CavityPosterior body wallLower extremity
What substance regulates stomata? What actions does it regulate?
Nitric Oxide (NO) regulates the opening and absorption of the stomata
Where does the Diaphragm drain into?
Cysterna Chylie and the Thoracic Duct
What technology do we use to study the lymphatic system?
Radiolabeled tracers
What percentage of peritoneal fluid is drained by the diaphragm?
42-55%
What happens to the diaphragm when you inhale? Exhale?
Inhale = Diaphragm contracts, descends, and flattensExhale = diaphragm relaxes and domes back up
What are the two theories for where the lymphatics are located in the lungs?
1) Only in limited areas close to the bronchioles; no lymph vessels deep in the pulmonary lobule2) In the deep tissues and around small blood vessels of the lungs
Where are the lymphatics in the GI Tract?
embedded in epithelial cells (in the lamina) along the GI tract
What are the two types of GI Tract tissues?
1) GALT - Gut Associated lymphoid tissue2) MALT - mucosa associated lymphoid tissue
What three locations do lymphoid nodules generally organize and cluster up?
TonsilsAppendixPeyer’s Patches (in small intestine)
Describe the drainage of the GI Colon Lymph
Two parts:1) Entire colon on the proximal 2/3 of the rectum drain into the para-aortic vessels (on either side of the aorta). These drain into cisterna chyle and then to the thoracic duct2) Distal 1/3 of rectum drain into the internal iliac superficial inguinal area (pelvis region) that drains into the Cysterna Chyle, which drains into the thoracic duct.
True or False: The Colon lymph drainage can be obstructed with increased tissue tension?
True. This is a type of somatic dysfunction!
How much does the GI system accounts for total lymph flow?
50%
Could Inflammatory Bowel Disease be a lymphatic system problem? By what mechanism?
Yes! Problems with lymphatic obstruction can lead to fibrosis, which can lead to severe inflammation and bowel damage
Describe the drainage flow of the Genitourinary system (reproductive organs).
Most drain into the external and internal iliac nodes, which drains into the common iliac nodes, which drain into the lumbar (periaortic) ascending vessels to the cysterna chyle
Which reproductive organs drain into the external iliac nodes?
Inguinal nodesexternal genitaliavaginacervix
Which reproductive organs drain into the internal iliac/Sacral nodes?
CervixProstateRectumPenneumBottock Thigh
Which reproductive organs drain directly into the common iliac nodes
TestesOvaries
Describe the drainage of the Kidney.
Drains from the hilium of the kidney, follows the renal vein, and drains into the Upper Ureters
Describe the lymphatic drainage of the Ureters in the urinary tract.
The upper 2/3 of the ureters drain into the lumbar (aortic)nodesThe lower 1/2 of the ureter and the bladder drain into the internal and external iliac nodes, then the lumbar aortic nodes.The lumbar aortic nodes drain then into the cisterna chyle and thoracic duct.
Describe lymphatic drainage of the pancreas and spleen
There are a lot of nodes surrounding the pancreas and the spleen.These nodes drain via collecting vessels into the the following three nodes: 1) Splenic 2) Celiac 3) Superior mesenteric
What is a potential cause of chronic pancreatitis?
Fibrosis leads to the obliteration of lymphatics, reducing the capacity of lymph drainage of the pancrease
What are the functional cells of the lymph system?
T CellsB CellsNK cells (natural killer cells)
What is the effect of exercise on the lymphatic system?
Increase in T and B cells after 15 minutes on an exercise bike and 30 minutes on a treadmill.Increase in Natural Killer cells by 4-5 times after 5 minutes on stairs
How is the risk of cancer influenced by exercise?
Growth rate of experimental tumors lessened with exercise 108 weeks prior to tumor implantation
What are the symptoms and causes of lymphadema?
Lymphadema is a lymphatic obstruction. Symptoms - tissue swelling in extremitiesCause: obstruction results in localized fluid retention (b/c the lymph system cannot drain properly) in the interstitial tissues
What is the difference between primary and secondary lymphedema?
Primary lymphedema is a result of genetic defects, whereas secondary lymphedema is acquired and caused by compromised lymphatics due to an infection, surgery, radiation, or compression
What are the four categories of primary lymphedema?
1) Congenital lymphedema (at birth)2) Lymphedema praecox (early onset)3) Meige’s Syndrome (Onset from 1-35 y/o)4) Lymphedema tarda (late onset) (35+ y/o)
True or False: Secondary lymphadema can be the result of a lymphaedenectomy
True
Does congestive heart failure lead to primary or secondary lymphedema?
Secondary lymphedema. Very common.
How many stages of lymphedema are there?
Three stages
What are key characteristics of stage 1 Lymphedema?
- Pressing the swollen limb leaves a pit- “Pitting edema”- REVERSIBLE if only a small amount of fibrosis- Elevation of extremity can reduce swelling
What are key characteristics of stage 2 Lymphedema?
- Edema does not pit upon manual pressure- Elevation of extremity does not help- Can become fibrotic
What are key characteristics of stage 3 Lymphedema?
(aka elephantasis)- IRREVERSIBLE- Typically lower extremities
What does 2+ edema mean?
At least 4mm pitting when pushed.
What are the consequences of edema?
- Compression of tissues (neural and vascular lymphatic)- Compromised nutrition- Changes in tissue and organ function- Changes in medical management
What are conditions that contribute to secondary lymphedema?
Mechanical conditions:- Kyphoscoliosis- Poor posture- Gravity- Decreased respiration - Abdominal or thoracic surgery- Pregnancy
How do you treat Lymphedema?
Secure “terminal drainage” - Check site of injury and continue checking the system all the way to the thoracic duct
What kind of treatment/manipulation techniques are there for the periphery?
- Direct pressure (massage; fascial release)- Body movement (exercise)- Diaphragmatic movement (restore breathing)- Anti gravity (elevate extremity)- Osteopathic manipulation (i.e. ANKLE PUMP)
How does manipulation facilitate lymph drainage and heeling?
- Release mechanical barriers- Increase fluid reabsorption, relieve congestions0 Decreases proteins in the interstitum- Increases circulation- Improves respiration and diaphragm mechanics- PH changes with increases oxygenation- Improve visceral (organ) response to stress
IMPORTANT: What is the sequence of Treatment techniques?
1) Superior Thoracic inlets2) 2-3 Thoracic techniques3) 2-3 Abdominal techniques4) 2-3 extremity techniques5) Entire cervical sequence of techniques6) Repeat 2 Thoracic Techniques
True or False: External compression devices should be level or above the thoracic inlet?
False. It needs to be ABOVE the heart so it can pump DISTALLY to PROXIMALLY.
How many lymphedema cases are primary (congenital) lymphedema?
10-25%
Are males or females more likely to acquire primary lymphedema?
Females (2:1 chance)
Which extremity is affected more often in primary lymphedema? Lower extremity or upper extremity?
Lower Extremity (3:1 ratio)
What proportion of primary lymphedema is bilateral?
2/3 of all congential cases are bilateral
True or False: Primary lymphedema is permanent?
False. It may spontaneously improve with age.
What is the histology of lymphedema?
Anaplastic pattern without subcutaneous lymph trunks.
