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3MB Haematology > Structure & Function of Lymph Node & Spleen > Flashcards

Structure & Function of Lymph Node & Spleen Flashcards

1
Q

Give examples of primary/central lymphoid structures

A

Bone marrow and
thymus

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2
Q

Give examples of secondary/peripheral lymphoid structures

A

Lymph nodes
Spleen
Tonsils/adenoids
Peyer’s patches in intestine

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3
Q

Define lymph node

A

Encapsulated collections of lymphoid tissue

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4
Q

Give examples of superficial node groups

A

In the cervical, axillary and
inguinal regions) can be palpated

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5
Q

Give examples of internal node groups

A

Mediastinal, para-aortic can be viewed radiologically

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6
Q

T or F: Groups of nodes drain particular territories. Particular territories drain to specific node group

A

True

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7
Q

What can cause Lymphadenopathy?

A

Local inflammation - infection
Systemic inflammatory - autoimmune
Malignancy - lymphoma / leukaemia
Sarcoidosis, Kikuchi’s lymphadenitis, Castlemans Disease, IgG4

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8
Q

Superficial infection may see red lines extending from an inflamed lesion

A

Lymphangitis - regional lymphadenopathy

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9
Q

_________ lymphadenopathy may be the first sign of underlying malignancy

A

Superficial

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10
Q

What is a sentinel lymph node?

A

The first lymph node to which cancer cells are most likely to spread

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11
Q

Describe the direction of lymph nodes

A

Afferent lymphatics penetrate the capsule and drain into subcapsular sinus
From there lymph percolates through the node
Lymph enters medullary cords and sinuses
Sinuses merge at hilum and form efferent lymphatics
Lymph rejoins extranodal lymphatic circulation

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12
Q

What are the three important regions of lymph nodes?

A

Cortex
Paracortex
Medulla

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13
Q

Give examples of lymph organs

A

Spleen - removes old RBCs
Thymus - development and maturation of T lymphocytes
Red bone marrow - same as thymus

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14
Q

Some lymphatic tissue is located in the…

A

Tonsils, appendix, and in the walls of the gastrointestinal tract

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15
Q

On average, an adult has around 400 to 450 different lymph nodes spread throughout the body – with the majority located within the..

A

Abdomen

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16
Q

Why are lymph nodes palpable during infection?

A

Each node contains T/B lymphocytes, and other immune cells. They are exposed to the fluid as it passes through the node, and can mount an immune response if they detect the presence of a pathogen. This recruits more inflammatory cells into the node

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17
Q

Lymph fluid enters the node through ________ lymphatic channels and leaves the node via ________ channels

A

Lymph fluid enters the node through afferent lymphatic channels and leaves the node via efferent channels

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18
Q

__________- located within the sinuses of the lymph node act to filter foreign particles out of the fluid as it travels through

A

Macrophages

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19
Q
A
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20
Q

Superficial vessels arise in the _________ tissue, and tends to accompany _________ flow. They eventually drain into deep vessels

A

Superficial vessels arise in the subcutaneous tissue, and tends to accompany venous flow. They eventually drain into deep vessels

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21
Q

Deep vessels drain the deeper structures of the body, such as the internal organs. They tend to accompany _____ arteries

A

Deep

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22
Q

The drainage of lymph begins in ____________, which start as blind ended capillaries and gradually develop into vessels. These vessels travel proximally, draining through several lymph nodes

A

Lymph channels

23
Q

Vessels empty into lymphatic trunks (also known as collecting vessels) – and these eventually converge to form the..

A

Right lymphatic duct and the thoracic duct

24
Q

The right lymphatic duct is responsible for draining the lymph from the..

A

Upper right quadrant of the body - right side of the head and neck, the right side of the thorax and the right upper limb

25
Q

The thoracic duct is responsible for draining the lymph from the..

A

Rest of the body

26
Q

The thoracic and right lymphatic duct then empty into the venous circulation at the __________ veins, via the right and left venous angles

A

Subclavian

27
Q

Lymph is a _____________ fluid that is transparent and yellow

A

Transudative

28
Q

Lymph is formed when fluid leaves the capillary bed in tissues due to..

A

Hydrostatic pressure

29
Q

The composition of lymph is fairly similar to that of..

A

Blood plasma

30
Q

B cell follicles in lymphoid organs can exist in either of two states. What are they?

A

Quiescent (primary) follicles - naïve B cells migrating extensively in search of cognate antigen

Activated (secondary) follicles - central germinal center (GC) full of B cell blasts undergoing events associated with antibody affinity maturation

31
Q

Antigen-antibody complexes in a follicles are captured by..

A

Follicular dendritic cells (FDCs) - mesenchymal and form meshworks through the germinal centre

The antigens on the FDCs are then presented to naive B cells (T helper cells assist)

32
Q

GC B cells cycle through the two distinct zones of the germinal center: the light zone and the dark zone. As they undergo rapid and mutative cellular division, B cells of the germinal center’s dark zone are known as…

A

Centroblasts

33
Q

GC B cells cycle through the two distinct zones of the germinal center: the light zone and the dark zone. Once B cells have stopped proliferating in the dark zone and moved to the light zone, they are known as __________, and are subjected to selection by ______________ cells in the presence of ________________

A

GC B cells cycle through the two distinct zones of the germinal center: the light zone and the dark zone. Once B cells have stopped proliferating in the dark zone and moved to the light zone, they are known as centrocytes, and are subjected to selection by follicular helper T (TFH) cells in the presence of follicular dendritic cells (FDCs)

34
Q

There are three possible fates for GC B cells that have been positively selected in the light zone..

A

Plasma cell
Memory B cell
B cell licensed to return to the dark zone for proliferation and mutation

35
Q

How do T cells assist in the light zone?

A

FDCs present antigens to B cells
B cells bind and internalise the antigen
Antigen bound by MHC class II, presented to T cell

36
Q

What type of cells does the medullary cord contain?

A

Plasma cells
B cells
Macrophages

37
Q

What type of cells does the medullary sinuses contain?

A

Histiocytes, reticular cells
Lymph then drains into efferent vessels

38
Q

Give examples of conditions that can cause granulomatous lymphadenitis

A

Sarcoidosis

39
Q

Give examples of conditions that can cause granulomatous inflammation

A

TB

40
Q

Stimulation of an immune reaction in a lymph node can cause a mixed pattern of changes. Explain this

A
41
Q

What are the two key aspects of spleen?

A

Diaphragmatic surface
Visceral surface - Left Kidney, gastric fundus, tail of pancreas, splenic flexure of colon

42
Q

Supply and drainage of spleen

A

Supplied by splenic artery (branch of coeliac trunk) and drained by splenic vein (with sup. mesenteric vein forms portal vein)

43
Q

What are the two major functional zones of the spleen?

A

Hematogenous red pulp and the lymphoid white pulp

44
Q

What does the red pulp of the spleen contain?

A

Cords (macrophages and some fibroblasts and cells in transit (RBC, WBC, PC and some CD8+ T cells) and sinusoids (fenestrated, lined by endothelial cells, supported by hoops of reticulin)

45
Q

Why is the spleen red?

A

Spleen contains connective tissue (cords of Bilroth) and sinusoids engorged with blood (hence the red)

46
Q

Cords in the spleen, contain lots of monocytes, generally lots of…

A

White blood cells and erythrocytes

47
Q

What does the white pulp of the spleen contain?

A

Periarteriolar lymphoid sheath (CD4+ lymphoid cells)

This is expansed by lymphoid follicles (B cells, may show reactive changes as in lymph node)

48
Q

What causes Hyposplenism?

A

Splenectomy - Coeliac disease, sickle cell disease, sarcoidosis

49
Q

Which feature would you see due to hyposplenism?

A

Howell-Jolly bodies

50
Q

Triad for Hypersplenism

A

Splenomegaly
Fall in one or more cellular components of blood (cytopenias)
Correction of cytopenias by splenectomy

51
Q
A
52
Q
A
53
Q
A

3MB Haematology (23 decks)

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