The lymphatics

Question 1

What is the lymphatic system?

Answer 1

Drainage system: Returns extracellular fluid to bloodstream

Question 2

What are some extracellular fluid that is returned to the blood stream in the lymphatic system? 3

Answer 2

1. Plasma
2. Interstitial fluid
3. Lymph

Question 3

Where does plasma seep?

Answer 3

Through the capillary walls

Question 4

Where does the interstitial fluid seep?

Answer 4

Plasma seeps through the capillary walls and circulates among the body tissue

Question 5

Where does the lymph drains out of?

Answer 5

Interstitial fluid that drains out of the tissue and enters the lymphatic ducts

Question 6

What is the lymphatic system similar to?

Answer 6

Circulatory system

Question 7

What are some differences between the circulatory and lymphatic system? 3

Answer 7

1. no pump
2. One direction
3. Lymph nodes

Question 8

What does the lymphatic system consist of? 4

Answer 8

1. Capillaries
2. Vessels
3. Ducts
4. Nodes

Question 9

Where is the lymphatic system located?

Answer 9

Throughout the body

Question 10

Where does the lymphatic system course?

Answer 10

Along the circulatory system

Question 11

The capillaries are what kind of structures?

Answer 11

Blind-ended structures in the interstitial spaces

Question 12

What does the capillaries wall consist of?

Answer 12

A single endothelial layers

Question 13

What does the capillaries join and do?

Answer 13

They join to form larger vessels (valves control direction of flow)

Question 14

What is the direction of the capillaries? (what is the pathway)

Answer 14

Superficial > deep> Nodes > towards chest > Bloodstream

Question 15

What are important components of the RE system? And how are they distributed?

Answer 15

Nodes, which are distributed throughout the body

Question 16

What is the shape of the nodes?

Answer 16

Beam shaped (ovoid) accumulations of lymph tissues, flusters along lymph vessels

Question 17

What is the measure of the lymph nodes?

Answer 17

From 1mm to 1-2 cm

Question 18

What is the nodes surrounded by?

Answer 18

Connective tissue capsule

Question 19

What does afferent vessels drain into?

Answer 19

Nodes

Question 20

What does afferent vessels carry?

Answer 20

Lymph through sinuses

Question 21

What does the afferent vessels filter?

Answer 21

Filter out/ destroy bacteria and malignant cells

Question 22

What do the germinal centers of the afferent vessels do? 2

Answer 22

1. Produce lymphocytes
2. Empty into the lymph prior to leaving the node

Question 23

Where doe the efferent vessels leave?

Answer 23

Only at the hilum

Question 24

Are the lymph nodes a site of disease?

Answer 24

Rarely site of primary disease, usually secondary

Question 25

Where is the major node bearing areas? 2

Answer 25

Retroperitoneum at the 1. Iliac/ hypogastric 2. Aorta/IVC (360 degrees)

Question 26

What are other lymphatic tissues we need to know? 3

Answer 26

1. Tonsils 2. Thymus 3. Spleen

Question 27

What kind of channels is the lymphatic circulation?

Answer 27

Deep and superficial channels

Question 28

Nodes are clustered at what key locations? 4

Answer 28

1. Axillary nodes (upper limbs) 2. Cervical nodes (Neck) 3. Inguinal nodes (lower limbs) 4. Intestinal nodes (peyers patch)

Question 29

The lymphatic circulation drain into how many vessels and what are they?

Answer 29

Two vessels 1. RT lymphatic duct: drains RUQ 2. Thoracic duct (LT): Remaining 3/4 of body

Question 30

What is the physiology of lymph? What is it similar to? What kind of enzymes are they? What's the albumin mix?

Answer 30

1. Extracellular fluid formation 2. Similar to plasma 3. Higher albumin with a small # of leukocytes/ no erythrocytes 4. Digestive enzymes

Question 31

What is lymph flow like? 2

Answer 31

1. Slow under resting conditions 2. Flow depends kneading action of muscles and valves

Question 32

What is the function of the lymphatic system? 4

Answer 32

1. Phagocytosis 2. Immunity 3. Drainage 4. Excretion

Question 33

What is the excretion function of the lymphatic system?

Answer 33

Absorption and circulation of end products of fat digestion

Question 34

What is the patient scanning position of the lymphatic system?

Answer 34

Midline, in supine or decubitus

Question 35

What planes do we scan the lymphatic system in?

Answer 35

2 planes 1. Sag 2. Trans

Question 36

What are common sites for lymph nodes? 5 (in the abdomen)

Answer 36

1. para-aortic, para caval 2. Mesenteric and celiac axis 3. Around the pancreas 4. Renal splenic hilum, porta hepatis 5. Along iliac vessels

Question 37

What kind of pressure do we use to scan and why?

Answer 37

Gentle pressure to displace bowel

Question 38

What should a sonographer see? 3 (in terms of a lymph node)

Answer 38

1. Not typically visualized in the abdomen 2. Homogenous 3. Low level echoes

Question 39

What is the AP measure of the lymphatic system in AP?

Answer 39

<1CM

Question 40

What are some pitfalls of scanning the lymphatic system? 4

Answer 40

1. Enlarged para-aortic nodes may mimic aneurysm 2. Bowel gas may obscure our visualization of lymph nodes 3. Enlarged lymph nodes surrounding vessels may make evaluation of these vessels and their bifurcations difficult 4. Fluid filled areas (such as hydronephrosis) may obscure enlarged nodes