Week 13- Lymphatic System Flashcards
A one-way regional system responsible for carrying this capillary ultrafiltrate fluid volume and the escaped plasma proteins# back to the blood circulation
Lymphatic system
The lymphatic system is a pressure-driven system based on the principles of ___________
Osmotic diuresis
Function of the lymphatic system
-Absorb macromolecules (protein and fatty acids)
-Help maintain fluid balance in the tissues
-Fight infection
-Assist in the removal of cellular debris and waste products from the extracellular spaces
If the normal lymphatic transport mechanisms are disrupted, significant accumulations of water and protein can remain in the tissue spaces, resulting in latent, acute, or chronic ___________
Lymphedema
True or false: The challenge for PT with lymphedema is to effectively move fluid and protein back into functioning lymphatics and then into the central circulation
True
The laws of basic fluid dynamics says that fluid flows from an area of ___________ pressure to an area of ___________ pressure until equilibrium is reached
-High
-Lower
Starling’s Law says that fluid at the arterial end of the capillary will tend to flow into the tissue spaces because plasma (blood) hydrostatic pressure is higher at the ____________ end compared with the tissue _____________ of the tissues
-Arterial end
-Tissue hydrostatic pressure (THP)
Organs involved in the lymphatic system
-Superficial and deep lymph vessels and nodes
-Thymus
-Bone marrow
-Spleen
-Tonsils
-Peyer patches of the small intestine
True or false: The superficial lymphatic drainage to regional nodes is very asymmetric, but the deep lymphatic drainage is very symmetric
False
(symmetric; asymmetric)
Right upper extremity and thoracic lymphotome drain into the _________ lymphatic duct
Right
Left upper extremity, left thoracic lymphotome, and both lower extremities, external genital areas, and abdominal lymphotomes drain into the ___________ subclavian vein
Left
Three-fourths of the total flow draining to the __________ subclavian vein
Left
____________ enhances flow in the trunks and ducts
Respiratory effort
____________ rely on an interaction of oncotic and hydrostatic pressures, muscle contraction, arterial pulsation, and gentle movement of the skin to absorb and transport lymph fluid
Superficial vessels
____________, which generally parallel the venous system, contain smooth muscle and valves and help prevent backflow
Deeper vessels
Initial lymphatics are the ____________ lymphatic vessels; vessel walls are ______ cell thick
-Smallest
-One
Initial lymphatics function as ____________ powered by variations in ___________ caused by movement; muscular contraction; and variations in external pressure caused by stretch, gravity, change in position, and other similar factors
-Force pumps
-Total tissue pressure
Without changes in total tissue pressure, force pumps cannot function, and fluid will accumulate in the interstitium, leading to ___________
Edema
Each segment of collecting lymphatic vessels between valves
Lymphangion
True or false: Lymphatic valves prevent backflow and some muscle tissue in their walls to further enhance their pumping action
True
Other ways to increase pumping action of lymphatic valves
-Extrinsic muscle contraction
-Autonomic stimulation
-Manual lymphatic drainage (MLD)
True or false: Collecting lymphatics do form a plexus
False
(do not form a plexus, but there can be some connections between them)
Gradual increase in diameter size of collecting lymphatics
Lymph trunks
Muscle in the collecting lymphatic walls contracts _____________
Rhythmically
__________ muscle cells around the endothelial cell layer face the __________ of the vessel
-Smooth
-Lumen
The lymph vessel network is innervated by the _______ and contract at rest an average of ___ to ____ times per minute
-ANS
-5-10
If many lymphangions contract at once and outflow is obstructed (e.g., by scarred or irradiated lymph nodal areas), pressure inside the vessel can reach ______ mm Hg or more
100
Sustained high intravascular pressure __________ the muscle wall
Fatigues
Sustained high intravascular pressure can lead to…
-Ineffective smooth muscle contraction
-Vessel failure
Lymphatic walls dilate, preventing __________ of valve flaps
-Closure
Backflow of lymph distal to the site of obstruction causes ___________
Lymphedema
The _______ lymphatic vessels are embedded in __________ and accompany the chains of lymph nodes along the blood vessels
-Deep
-Fatty tissue
True or false: Injury to blood vessels in an area also implies injury to lymphatic vessels in that area, regardless of whether it is unexpected or controlled trauma, as in surgery
True
Function of lymph nodes
-Act as filters to cleanse the lymph of waste products and cellular debris
-Adjust the fluid concentration
-Produce lymphocytes and macrophages
-Destroy foreign bacteria, harmful viruses, and cancer cells
Why are lymph nodes often the sites of obstruction in lymphatic dysfunction?
Lymph nodes offer 100 times the normal resistance to flow of lymph within the lymphatic vessels themselves
____________ separate territories
Watersheds
Within a territory, smaller divisions called ____________ designate areas specific to certain of the regional nodes
Lymphotomes
Drainage can be changed from one lymphotome to another by…
Expelling lymph from an overloaded one toward a normal one
Trunk quadrants
The left and right axillary territories and the right and left inguinal territories
Improper treatment of extremity edema without considering the impact of that treatment on the trunk quadrant adjacent to the limb or limbs involved can result in the development of __________, __________, or ___________ edema, when none existed before intervention for the extremity edema
-Truncal
-Breast
-Genetical
True or false: Palpable lymph nodes do always indicates serious or ongoing disease
False
(not always, but this determination requires an evaluation by a physician)
Evaluation for identifying suspicious nodes
-Changes in size (>2 cm) of lymph nodes
-Immobile lymph nodes
-Firm or hard lymph nodes in one or more areas or the presence of painless enlarged lymph nodes
Inflammation of a lymphatic vessel
Lymphangitis
Inflammation of one or more lymph nodes
Lymphadenitis
An increased amount of lymph fluid in the soft tissues
Lymphedema
Enlargement of the lymph nodes
Lymphadenopathy
Lymph nodes act as __________ and are secondarily involved in virtually all systemic __________ and in many _____________ arising elsewhere in the body
-Defense barriers
-Infections
-Neoplastic disorders
The specific node, or nodes, affected in an infectious disease depends on…
-Location of the infection
Nature of the invading organism
-Severity of the disease
A swelling of the soft tissues that results from the accumulation of protein-rich fluid in the extracellular spaces
Lymphedema
Lymphedema is accompanied by ___________ secondary to ___________ with prolonged swelling
-Tissue fibrosis
-Chronic inflammation
Lymphedema is caused by…
Decreased lymphatic transport capacity and/or excessive lymphatic load
Lymphedema is most commonly seen in the ____________ and ___________ extremities
-Upper
-Lower
Two categories of lymphedema
-Primary (idiopathic)
-Secondary (acquired)
The stages of lymphedema start from __________ to __________
-Stage 0 (latent)
-State III (lymphostatic elephantiasis)
Examples of incidence associated with cause
-Individuals who undergo lumpectomy receive either axillary lymph node dissection (ALND)or sentinel lymph node biopsy (SLNB) and radiation therapy would have higher risk of developing lymphedema
-Inguinal lymph node dissection to treat melanoma
-Prostate cancer after pelvic node dissection
-Gynecologic cancers
Etiologic factors of primary lymphedema
-Unknown
-Hereditary
-Developmental abnormality
-Aplasia
-Hypoplasia
-Hyperplasia
Etiologic factors of secondary lymphedema
-Filariasis
-Invasive procedures used in the diagnosis and treatment of cancer
-Any trauma or surgery that impairs the lymphatics
-Multiple abdominal surgeries (particularly in obese individuals)
-Bacterial or viral infection
-Repeated pregnancies
-Crush injuries, severe burns, compound fractures, or severe lacerations or degloving injuries to the skin can significantly impair lymph flow
The most common cause of secondary lymphedema worldwide
Filariasis
Parasitic worm, introduced to the body by a mosquito bite in endemic regions
Filariasis
The most common cause of secondary lymphedema
Invasive procedures used in the diagnosis and treatment of cancer
True or false: Regional lymph node dissection for diagnostic staging and eradication of tumor sites disrupts the lymphatic system
True
Examples of invasive procedures
-Radiation therapy
-Reconstructive
-Other surgical procedures
-Local radiation treatment after surgery for cancer
True or false: Surgery is not trauma
False
(it is lol)
True or false: Secondary lymphedema can develop immediately postoperatively or weeks, months, or years after surgery
True
Clinical magnifications
-A full, heavy, or tight sensation in the affected body part
-Numbness, burning, aching, pain
-Decreased flexibility in the hand, wrist, or ankle
-Difficulty fitting into shoes or clothing in one specific area; or jewelry tightness
-Increased girth and weight of the limbs along with postural changes and limitation in joint motion leads to functional deficits
-Loss of skin integrity (in advanced cases) allows portals of entry for bacteria to invade the skin and cause recurrent infection
-Significant edema of the head and neck can cause severe functional impairments in speech, swallowing, and respiration, in addition to the pain and psychologic trauma from cosmetic disfigurement
-These physical impairments can lead to functional limitations and disability along with the potential for psychosocial morbidity (e.g., social isolation, depression, or suicide)
True or false: Infections elsewhere in the body do not lead to lymphadenopathy
False
(they do lol)
Lymph nodes are enlarged, tender warm, and reddened
Acute lymphadenitis
Results in scarred lymph nodes with fibrous connective tissue replacement
Chronic lymphadenitis
Acute inflammation of the subcutaneous lymphatic channels
usually occurs as a result of _____________ or ____________ entering a wound
-Streptococci
-Staphylococci
