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3 Haematology > Structure and function of lymph nodes and spleen > Flashcards

Structure and function of lymph nodes and spleen Flashcards

1
Q

where do lymphoid cells originate from

A

Haemopoetic stem cells

Precursor lymphoid cells

B-cells mature in the bone marrow

T cells mature in the thymus

both then migrate to secondary lymphoid organs

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2
Q

what are the central (primary) lymphoid tissues

A

bone marrow

thymus

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3
Q

what are the peripheral (secondary) lymphoid tissues

A 
lymph nodes
spleen 
tonsils (waldeyer's ring) 
epithelia-lymphoid tissues 
bone marrow
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4
Q

functions of the lymphatic system

A

Return lymph to circulation

  • important for fluid homeostasis
  • prevents excessive accumulation of fluid in the tissues

Permits

  • lymphoid cells to pass through
  • cell trapping
  • interaction with cells of the immune system - protective function
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5
Q

what are lymph nodes

A

small oval bodies up to 2.5cm located along the course of lymphatic vessels

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6
Q

what are lymphatic channels

A

blind-ending vascular channels that collect fluid from tissues and return to the blood stream

passive movement of fluid

valves ensure direction of flow

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7
Q

what happens inside the lymph node

A

lymph drains in via afferent channels into the peripheral sinus

filters through the node and an efferent vessel leaves from the hilum

cells move between the lymph nodes and the parenchyma

interactions occur between cells in the node and substances in the lymph

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8
Q

where does lymph enter the venous system

A

junction of L or R subclavian and jugular veins (right and left lymphatic ducts)

right thoracic duct drains upper right quadrant

left thoracic duct drains everything else

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9
Q

how does the lymphoid system work as defence

A

houses cells of the innate immune system

traffic of antigen presenting cells which links innate and adaptive immune responses

allows the adaptive immune response to happen

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10
Q

what cells are found in lymph nodes

A 
B cells 
T cells 
NK cells 
Macrophages 
antigen presenting cells 
endothelial cells
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11
Q

what are CD20 and CD3

A 
CD20 = B cell marker 
CD3 = T cell marker
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12
Q

what are the types of lymphadenopathy

A

localised or generalised

peripheral or central (internal)

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13
Q

what causeslymphadenopathy

A

local infection
systemic infection
malignancy
others (sarcoidosis, IgG4 related disease)

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14
Q

what is sarcoidosis

A

a granulomatous condition causing granuloma formation (lumps if inflammatory cells) around the body including in the lymph nodes

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15
Q

what is lymphangitis

A

in infected superficial lymph nodes you can see reg lines extending from the inflamed lesion

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16
Q

causes of superficial regional lymphadenopathy

A

often first sign of malignancy

need to know where the nodes drain to identify the primary lesion

17
Q

causes of systemic lymphadenopathy

A

Systemic inflammation

wide spread malignancy (lymphoma/leukemia)

18
Q

what causes a predominant B cell response in a lymph node

A

Auto-immune conditions

infections

19
Q

what causes a predominantly phagocytic response in lymph nodes

A

draining tumour site

20
Q

what causes a prodominant T cell response in lymph nodes

A

viral infections

drugs eg. phenytoin

21
Q

what is a malignant lymph node called

A

lymphoma

22
Q

what is the normal weight of the spleen

A

150-200g

23
Q

what are the two key aspects (surfaces) of the liver

A

Diaphragmatic surface
Visceral surface
-left kidney, gastric fungus, tail of pancreas, splenic flexure colon

24
Q

what is the blood supply to the spleen

A

splenic artery (branch of coeliac trunk)

drained by the splenic vein (with superior mesenteric vein forms the portal vein)

25
Q

causes of spleen rupture

A

trauma
diseased spleen more prone to rupture

surgical emergency

26
Q

what is the structure of the spleen

A

parenchyma made up of red pulp and white pulp

27
Q

what is the function of the spleen

A

detects, retains and eliminates unwanted foreign or damaged material

facilitates immune responses to blood born antigens

28
Q

what makes up the red pulp of the spleen

A

red pulp contains sinusoids and cords

sinusoids are:

  • fenestrated (have gaps in endothelium)
  • lined by endothelial cells
  • supported by hoops of reticulin

cords contain:

  • macrophages
  • fibroblasts
  • cells in transit (RBC,WBC, Platelets)
29
Q

what makes up the white pulp of the spleen

A

peri-arteriolar lymphoid sheath

CD4+ lymphoid cells

antigen reaches white pulp via blood, APCs in the white pulp present antigens to immune reactive cells

when stimulated by antigens, T and B cell responses may occur

30
Q

what are the features of splenomegaly

A

dragging sensation in LUQ

discomfort with eating

pain if infarction

31
Q

what is the triad of hypersplenism

A

triad of:

  1. splenomegaly
  2. fall in one or more cellular blood components
  3. correction of cytopenias by splenectomy
32
Q

causes of splenomegaly

A

Infection
(EBV, malaria, TB, typhoid etc)

Portal congestion (hepatic cirrhosis, portal/splenic vein thrombosis, cardiac failure)

haematological diseases (lymphoma/leukaemia, haemolytic anaemia, myeloproliferative disorders)

inflammatory conditions (RA, SLE)

storage diseases

Miscellaneous (amyloid, tumours, cysts)

33
Q

what are the 2 types of abnormal splenic function

A

hypersplenism

hyposplenism

34
Q

what causes hypersplenism

A

conditions associated with splenomegaly

35
Q

what is hypersplenism

A

increased splenic function

only can be diagnoses if improvement after splenectomy

36
Q

what causes hyposplenism

A

splenectomy (immunisation must be given beforehand)

coeliac disease
sickle cell disease
sarcoidosis
iatrogenic (non-surgical)

37
Q

features of hyposplenism

A

due to reduced red pulp function

Howell-Jolly bodies
other red cell abnormalities

can cause some immune deficiency

3 Haematology (25 decks)

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