Lymphedema Flashcards
Lymph structures of the body
Vessels Nodes Spleen Thymus gland Lymphocytes Peyer's Patch
Peyer’s patch is what
A collection of lymphoid tissue around the ilium
Lymph vessels of the small intestine absorb what
Fat and proteins
Lymph from the intestines is called
Chyle
It is a milky-white in appearance
Lymph vessels occur where
throughout the body with a few exceptions
- Bone, Cartilage, CNS
Lymph vessels are
Close ended vessels
Follow along with the superficial and deep arterial and venous systems
Lymphatic capillaries to what
Procollectos Collectors Lymph nodes Transport vessels (trunks) Venous system
Lymphatic capillaries are what
Overlapping endothelial cells
Only one cell thick
Each cell has an anchoring filament to prevent collapse
Pre-collectors are what
Basically a larger lymphatic capillary
Direct fluid into the collectors
Wall structure varies
Collectors are what
Larger vessels that are segmented into sections known as lymphangions
Series of tricupsid valves spaced 6 to 20 mm apart
Contractile tissue
6 to 10 contractions/minute pushing fluid
Things that we do to impact the lymph system
Breathing
Muscle contraction
Vasomotion (arteries)
External compression
Lymph enters the nodes via ____ and exits via ____
Enters via afferent vessels
Exit via the efferent vessel and into a transport vessel
How many lymph nodes
about 600-700
Lymph nodes - anatomy
Encapsulated, peripheral lymphoid organs
Distributed along the course of lymphatic vessel
Act like a series of filters
Lymphatic trunks/ducts - Trunks are formed by
the union of efferent vessels coming from various nodes - empty into ducts
Lymphatic trunks/ducts - muscle layer
Is thicker
Lymphatic trunks/ducts - Largest lymph vessel is
the thoracic duct which empties into the angle of the left subclavian and internal jugular veins
Lymphatic trunks/ducts - Thoracic duct starts at ___
The abdominal portion is __
L2
The abdominal portion is the Cisterna Chyli
Drainage fields
Two of them
Right
Left
Right drainage field
Right head, face, shoulder, upper quadrant - all flow into right lymphatic duct
This then empties into the subclavian vein
Left drainage field
Left head, arm, upper quadrant, and both sides of the lower trunk, and both LEs drain into the thoraic duct
This then empties into the left subclavian vein
Lymphatic watersheds/Anastamoses
Drainage pathways: Across sternum Across scapulae Axilla to inguinal area B Across pubic area Inguinal to inguinal area Post - along superior gluteal region
Function
1 Removes excessive fluid from body tissues
2 Lymphoid tissue plays role in acquired immunity
3 With inc interstitial pressure, more valves open and allow fluid to move through the system
4 During inflammation the collecting vessels in the area act very similar to the venous system
Lymph load
Proteins Water Cells Waste products Fat
Lymphangitis
Inflammation of the lymph vessels
Lymphadenitis
Inflammation of lymph nodes
Lymphedema
Accumulation of protein and cell rich fluid in various parts of the body related to a lymph system dysfunction
Elephantiasis
A chronic infectious condition
end stage of lymphedema
Lymphedema - Etiology (primary)
Hereditary
Congenital
Accounts for 10%
Lymphedema - Etiology (secondary)
Most common
There is a precipitating cause
High output vs. Low output failure
Lymphokinetic motion and pressure gradient
Blood capillaries (highest pressure) - interstitial fluid - lymph capillaries - lymph veins - lymph ducts - large circ veins (lowest pressure)
Lymph load increase - can be from
Active hyperemia
Passive hyperemia
Hypoproteinemia
Lymph load increase - from active hyperemia
Dilation of pre capillary sphincters
Can happen with heat application, massage
Lymph load increase - from passive hyperemia
with venous obstruction, venous HTN, CHF, DVT
Lymph load increase - from hypoproteinemia
Dec protein in the blood (can be from liver/renal failure or malnutrition)
High output failure
Normal, intact lymph system is overwhelmed by demandNo change in protein component
High output failure - Normal lymph system filters
about 10% of the normal fluid flow
System can handle up to 10x that amount
Low output failure
Dec ability of the lymph transport system
High protein content within interstitial spaces resulting in inc oncotic pressures (moves H20 into tissue)
Inc collagen buildup within interstitial spaces
Becomes a chronic inflammatory condition
