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Haematology > The Lymphoid System > Flashcards

The Lymphoid System Flashcards

1
Q

where are haematopoietic stem cells made

A

foetal liver

postnatal bone marrow

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2
Q

where are B cells matured

A

bone marrow

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3
Q

where are T cells matured

A

thymus

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4
Q

what are the central/ primary lymphoid tissues

A

bone marrow

thymus

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5
Q

what are the peripheral/ secondary lymphoid tissues

A 
lymph nodes 
spleen
tonsils waldeyers ring)
epithelio-lymphoid tissues 
bone marrow
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6
Q

what are the main roles of the lymphoid system

A

filtration of circulatory fluids

location for cells of the immune system (lymphoid and accessory)

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7
Q

what are the functions of the lymphatic system (nodes and lymphatics)

A

return lymph to the circulation

  • maintains fluid homeostasis
  • prevents tissue oedema

permits:
- cell traffic
- cell trapping
- mixing of cells and molecules with cells of the immune system

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8
Q

what can happen to arm after breast cancer surgery

A

lymphoedema

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9
Q

what is chylous ascites

A

leakage of lipid rich lymph into peritoneal cavity due to disruption of lymphatic system (usually mass or trauma e.g. iatrogenic)

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10
Q

can lymph nodes be imaged radiologically

A

yes major groups can e.g. mediastinal, para aortic

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11
Q

where do lymphatic vessels end

A

are blind ending- collect fluid from tissues and return it to blood stream

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12
Q

what created flow in lympathics

A

passive movement, valves ensure direction of flow

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13
Q

what is the structure of a lymph node

A

afferent channels drain through the capsule of the node into the peripheral sinus
lymph filters through the node parenchyma
efferent vessel leaves through the hilum
arterial and venous vessels serving the node also enter and exit at hilum

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14
Q

where does lymph re enter the venous system

A

at the junction of L or R subclavian and jugular veins

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15
Q

where does lymph go after leaving the node

A
  • cisterna chyli/ thoracic duct
  • L jugular, subclavian or bronchomediastinal trunks
  • R jugular, sublacavian or bronchomediastonal trunks

then into venous system

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16
Q

how is lymph filtered in the node

A

via interactions between cells in the node and cells/ substances in the lymph fluid

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17
Q

what is lymphs role in the immune system

A

nodes house cells of the innate and immune system

traffic of immune presenting cells links innate and adaptive immune responses

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18
Q

what cells are housed within lymph nodes

A

lymphocytes: B cells (plasma cells, mainly in medulla), T cells, NK cells
non nuclear phagocytes (macrophages), antigen presenting cells and dendritic cells
endothelial cells

19
Q

what is lymphadenopathy

A

lymph node enlargement (can be localised/ wide spread/ generalised and peripheral/ central (internal))

20
Q

what can cause lymphadenopathy

A

local inflammation: infection, vaccination, dermatopathic
systemic inflammation: infection e.g. viral infections, autoimmune/ CTD
malignancy: haematological (lymmphoma/ leukaemia), mets
sarcoidosis
castlemans disease (IgG4)

21
Q

what is sarcoidosis

A

multisystem granulomatous disorder of unknown cause

22
Q

what should you examine in a patient with regional lymphadenopathy

A

the territory that drains to that group of nodes

23
Q

what might you see in lymphangitis

A

red line extending from an inflamed lesion along path of lymph drainage

24
Q

what can superficial lymphadenopathy be a sign of

A

underlying malignancy

25
Q

what does generalised lymphadenopathy suggest

A

systemic inflammation/ widespread malignancy (lymphoma/ leukaemia)

26
Q

what test should you always do in generalise lymphadenopathy

A

FBC

27
Q

what causes predominantly B cell response in lymph node

A

autoimmune conditions and infections

28
Q

what causes a predominantly phagocytic response in lymph nodes

A

if they are draining a tumour site

29
Q

what causes a predominantly t cell response in lymph nodes

A

viral infections and drugs (e.g. phenytoin)

30
Q

what is lymphoma

A

types of cancer developed from lymphocytes

31
Q

where is the spleen

A

upper left quadrant

32
Q

what is the anatomy of a healthy spleen like

A

150-200 g
has diaphragmatic surface and a visceral surface (left kidney, gastric fundus, tail of pancreas, splenic flexure of colon)

33
Q

what is the vasculature supply to the spleen

A 
splenic artery (branch of coeliac axis) 
drain by splenic vein (forms portal vein with SMV)
34
Q

what can rupture the spleen

A

trauma (diseased spleen more likely to rupture)

35
Q

describe the structure of the spleen

A

encapsulated
parenchyma made of red and white pulp
red pulp contains:
-sinusoids (fenestrated, lined by endothelial cells, supported by reticulin loops)
-cords (contain macrophages, fibroblasts, cells in transmit (RBCs, WBCs, plasma cells and CD8+ T cells)

white pulp= the peri-arteriolar lymphoid sheath
-CD4+ T cells

36
Q

what is the role of the spleen

A

filters the blood:

  • detects, retains and eliminates unwanted foreign or damaged material
  • facilitates immune responses to blood borne antigens
37
Q

what is the role of the white pulp in the spleen

A

is expanded by lymphoid follicles - shows reactive changes
antigens reaches white pulp by blood
APCs in the white pulp present antigen to immune reactive cells

38
Q

what are the features of splenic enlargement

A

draggin sensation in LUQ
discomfort when eating
pain if infarction

39
Q

what is the triad of hypersplenism

A

splenomegaly
fall in one/ more cellular components of blood
correction of cytopenias by splenectomy

40
Q

what can cause splenomegaly

A

infection (EBC, malaria, TB, typhoid, brucellosis, leishmaniasis, trypanosomiasis)

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

haem diseases (lymphoma, leukaemia. haemolytic anaemia, ITP, myeloproliferative disorders)

inflammatory conditions (RA, SLE)

storage diseases (gauchers, niemann pick disease)

miscellaneous (amyloid, tumours, cysts)

41
Q

what types of conditions are associated with hypersplenism

A

those that cause splenomegaly

42
Q

what causes hyposplenism

A 
most commonly- splenectomy 
coeliac disease 
sickle cell 
sarcoidosis 
iatrogenic
43
Q

what are the features of hyposplenism

A

(result from reduced red pulp function)
howell jolly bodies
red cell abnormalities

Haematology (27 decks)

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