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Osteopathy Y3S1 > Week 5 - Lymphatic System and Associated Disorders > Flashcards

Week 5 - Lymphatic System and Associated Disorders Flashcards

1
Q

Outline the different types and functions of:

c) Supporting cells

A

produce a connective tissue stroma (‘blanket’) for lymphoid tissues and organs

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2
Q

What clinical features may be associated with splenomegaly?

A

If portal hypertension… varicose veins, ascites

NOT SURE??

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3
Q

Use the following headings to compare and contrast Hodgkin’s and non-Hodgkin’s lymphoma

b) Likelihood of extranodal involvement

A

HL - extranodal lymphoid involvement is uncommon

NHL - extranodal lymphoid involvement is common, and features reflect affected organs

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4
Q

How would you introduce the spleen in the setting of a lab exam (structure/function/location)?

A
  • Structure = largest lymphoid organ, roughly the size of a clenched fist and shaped as an ovoid.
  • Location = found within the left hypochondriac region or LUQ behind stomach; it is roughly deep to ribs 9-11 and rests on the left colic flexure
- Function = BREWRI
Blood filter (macrophages remove debris, foreign matter)

Reservoir (blood, platelets, monocytes)

Erhthropoiesis (involved in production of RBC)

When needed, spleen contracts and releases these substances into the circulation

Recycles by-products of RBC breakdown

Immunity (site for lymphocyte proliferation, surveillance and response)

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5
Q

What strategies can be used to manipulate the human microbiome?

A
  • human nutrition
  • antibiotics
  • microbial supplementation (probiotic)
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6
Q

Describe the functions of lymphoid tissue

A
  • proliferation site for lymphocytes

- surveillance point for lymphocytes and macrophages

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7
Q

Define microbiota

A

A collection of microbes

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8
Q

Differentiate a primary lymphoid organ from a secondary lymphoid organ. Provide examples.

A

Primary lymphoid organ - site of B and T cells maturation e.g. red bone marrow; thymus gland

Secondary lymphoid organ - site where mature B and T cells first encounter their antigens and become activated e.g. lymph nodes, spleen, tonsils, appendix

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9
Q

How would you introduce a lymph node in the setting of a lab exam (structure/function/location)?

A

Structure - gross structure is covered by dense fibrous capsule, compartmentalised by trabeculae and supported by a stroma of reticular connective tissue

Location - lymph nodes are widely distributed secondary lymphoid organs, clustered along lymphatic vessels

Function - house lymphocytes and macrophages; site of immune system activation; filtering of lymph (microorganisms, debris)

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10
Q

Use the following headings to compare and contrast Hodgkin’s and non-Hodgkin’s lymphoma

c) Compressive features

A

HL -

  • occur secondary to nodal enlargement
  • dysphagia, dyspnoea, engorged neck veins, neural compression

NHL -
- occur secondary to nodal enlargement

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11
Q

What name is given to the tumour formed in multiple myeloma?

A

Plasmacytomas

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12
Q

Provide examples of conditions that have been associated with (i) the GIT microbiome and (ii) the vaginal/urethral microbiome

A

GIT -

  • dental cavities
  • peptic ulceration
  • obesity
  • ulcerative colitis, Crohn’s disease
  • irritable bowel syndrome
  • sleep, mood, stress disorders

Vaginal and urethral microbiome -

  • bacterial vaginosis
  • recurrent UTIs
  • susceptibility to infection during pregnancy
  • pre-term birth
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13
Q

Outline the common sites for the development of plasmacytomas

A

Intraosseous plasmacytomas - vertebral column, ribs, skull, pelvis, femur, clavicle, scapula

May commonly spread to: lymph nodes, other bones, spleen, liver, kidneys, lungs

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14
Q

List three factors that can influence the flow of lymph

A

There are many factors affecting flow of lymph:

  • rhythmic contraction of lymphatic vessels (thin layer of smooth muscles) and pulsations of nearby arteries
  • intermittent pressure on lymphatic vessels (e.g. skeletal muscle contractions, movement of viscera)
  • pressure changes in the thorax during respiration
  • flow is almost negligible in an immobile limb
  • effect of removing lymphatic vessels, leading to lymphoedema
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15
Q

Summarise the pathophysiology of glandular fever – including the progression of the disease and the body’s immune response

A
  1. EBV initially infects the oropharynx, nasopharynx and salivary epithelial cells
  2. later, extends into lymphoid tissues and B cells

Then.. Adaptive immune response:

  • unaffected B cells produce antibodies against EBV
  • cytotoxic T cells attack virus-infected B-cells directly
  • enlargement of lymphoid tissues occurs due to proliferation of lymphocytes and removal of dead/damaged B cells
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16
Q

Define the term multiple myeloma

A

Lymphoid malignancy of the bone marrow, characterised by the uncontrolled replication of plasma (immunoglobulin-secreting) cells

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17
Q

Describe two functions of the lymphatic system

A
  • circulatory function (returns fluid that has leaked from the vascular system to the blood; transports nutrients, hormones and wastes)
  • immunity (lymphocytes housed within lymphoid organs are activated by immune responses; some lymphoid organs also contain macrophages, which engulf foreign material)
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18
Q

Differentiate diffuse lymphoid tissue from lymphoid follicles

A
  • diffuse lymphoid tissue have a loose arrangement of lymphoid cells and reticular fibres; occur in most organs of the body e.g. lamina propria of the GIT
  • lymphoid follicles ave a solid, spherical bodies consisting of tightly packed lymphoid cells and reticular fibres; form part of lymphoid organs; have germinal centres of proliferating B lymphocytes
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19
Q

Define glandular fever. How may the disease be transmitted?

A

Acute infection of B lymphocytes with Epstein-Barr Virus (EBV), also referred to as infectious mononucleosis

Transmitted through close personal contact - most commonly, saliva. i.e. mucosal secretions of the respiratory tract, genital tract, blood

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20
Q

Explain how dysbiosis can potentially lead to disease

A

Shifts a healthy microbiome to a disease-associated state
Disease can arise when…
- microbiome diversity increases at sites that normally have restricted diversity
- or when there is reduced diversity at body sites that usually have great diversity

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21
Q

The capsule of the spleen also contains elastin and collagen fibres. What ability do these fibres give to the spleen?

A

Ability to change in size - the spleen can enlarge when the body requires an increased proliferation of lymphocytes

NOT SURE ABOUT THIS ANSWER

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22
Q

Outline the different types and functions of:

b) Auxiliary immune cells

A
  • Macrophages = phagocytosis, enhancement of inflammatory response, presentation of antigens to T cells
  • Dendritic cells = present antigens to naive lymphocytes (initiates adaptive immune response)
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23
Q

Define pathogen

A

An organism that is detrimental to the host or causes disease

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24
Q

Identify common modes of transmission for human immunodeficiency virus

A

Predominantly through the exchange of body fluids (blood, semen), BUT not transmitted via formites

25
Q

What clinical features are commonly associated with chronic leukaemia? How does the speed of progression of chronic leukaemia differ to that of acute leukaemia?

A
  • there is an insidious onset of symptoms
  • many patients are asymptomatic and diagnosed incidentally via routine blood test
  • common initial symptoms include: splenomegaly, extreme fatigue, weight loss, night sweats, fever

speed of progression of clinical features is much slower in chronic versus acute leukaemia

26
Q

Outline the pathophysiology of HIV

A
  1. Entry into cell
    - HIV binds to CD4 receptor and chemokine co-receptor on the host cell
    - viral envelope and cell membrane fuse
    - HIV RNA injected into the host cell’s cytoplasm
  2. Conversion of viral RNA
    - HIV RNA converted to double-stranded DNA by the viral enzyme reverse transcriptase
    - viral DNA is integrated into the host cell’s DNA by the viral enzyme, integrase
  3. Dormancy
    - if host cell is NOT activated, viral DNA remains dormant
  4. Activation
    - if host cell is activated by cytokines, the virus proliferates
    - the viral enzyme protease modifies new virions
  5. Host cell death
    - release of new virions results in host cell lysis (necrosis)
    - new virions free to infect other CD4-bearing cells
27
Q

List five disorders that can result in splenomegaly

A

RIPLI is SPLENdid

Red blood cell disorders (where the body breaks down abnormal haemoglobin earlier than the normal 120 day period e.g. thalassaemia)

Infections (e.g. glandular fever, TB, syphilis, HIV)

Portal hypertension (e.g. cirrhosis, cardiac failure)

Lymphoid disorders (e.g. leukaemia, lymphoma, multiple myeloma)

Inflammatory conditions (e.g. rheumatoid arthritis, systemic lupus erythematosus)

28
Q

Define the term lymphoma

A

Discrete, malignant tumours arising in the lymphatic system (cost commonly lymph nodes)

29
Q

Define the term cisterna chyli. Where is it located and which vessels contribute to its formation?

A

It is an enlarged sac formed by the convergence of the lumbar and intestinal trunks (anterior to L1/2 vertebrae)

30
Q

Outline the body regions drained by the thoracic duct and right lymphatic duct

A

Right lymphatic duct - Drains right upper limb and right side of head and thorax

Thoracic duct - Drains rest of the body

31
Q

Explain how leukaemia is classified

A

Two classification:

  • based on the predominant cell of origin (lymphoid or myeloid)
  • based on degree of differentiation before the cells become malignant (acute = rapid growth of immature cells, chronic = slow growth of more differentiated cells)
32
Q

Summarise the general pathway of lymphatic flow from the interstitial space back to the bloodstream

A

(near capillaries in tissue) Lymphatic capillaries - lymphatic collecting vessels - lymphatic trunks - lymphatic ducts - returns fluid to the venous system (right and left subclavian and internal jugular veins)

33
Q

Use the following headings to compare and contrast Hodgkin’s and non-Hodgkin’s lymphoma

a) Nature of lymphadenopathy

A

Same: nodes are typically painless and discrete

Different:
HL - occurs in single or related group of superficial lymph nodes
NHL - usually originate in multiple sites - cervical, axillary, inguinal and femoral nodes commonly affected

HL - spread occurs to adjacent nodes
NHL - spread occurs to non-contiguous nodes

34
Q

Define commensal

A

A colonising organism that is neither beneficial nor detrimental

35
Q

Explain how a lymphadenopathy may be classified. Provide examples for each type of classification

A

Localised = present in 1 body area
E.g. dental or tonsillar infection (leads to cervical lymphadenitis)

Generalised = present in 2 or more non-contiguous nodal groups
E.g. gandular fever, lymphoma, leukaemia, neoplasia, HIV infection, tuberculosis

36
Q

Use the following headings to compare and contrast Hodgkin’s and non-Hodgkin’s lymphoma

d) B symptoms and constitutional symptoms

A

HL -

  • have prognostic significance
  • unexplained fever, drenching night sweats, unexplained weight loss in preceding 6 months

NHL -
- can also exist

37
Q

Define dysbiosis

A

A loss of balance within a microbial community

38
Q

Valves are especially needed in lymphatic vessels to prevent backflow. Why is this the case?

A

Lymphatic system lacks a pump, therefore placing a reliance on valves to prevent backflow

39
Q

Define probiotic

A

An organism that elicits health benefits to the host

40
Q

Summarise the clinical features of multiple myeloma. Which features are especially relevant to osteopathic practice?

A
  • often insidious for years
  • bone destruction (bony pain, pathological fracture, hypercalcaemia = confusion, weakness, lethargy, thirst, constipation)
  • marrow overcrowding (decreased immunity, anaemia)
  • overproduction of light-chains (deposited in kidneys as amyloid protein = toxis)
  • extraosseous plasmacytomas
  • OLD CRABI = OLDer populations, Renal failure, Anaemia, Bony lesions, Infections
41
Q

List the classes of anti-retroviral medications that can be used in the management of HIV infection.

For each class of medication, briefly describe its mechanism of action (refer to the slides on pathophysiology and pharmacology)

A

Entrance inhibitors - prevent fusion of HIV membrane with host cell

Reverse transcriptase inhibitors - prevents HIV RNA genome from becoming proviral DNA

Integrase inhibitors - prevents integration of provirus into host cell genome

Protease inhibitors - prevents assembly of virion core

42
Q

Outline the stages of HIV infection, and associated clinical features

A

Stage 1: Acute Infection

  • ~50% of infected people experience acute illness soon after initial exposure
  • due to sudden increase of viruses in the host
  • clinical features:
  • *non-specific flu-like symptoms, including: fever, night sweats, fatigue, lymphadenopathy, sore throat, headache, photophobia, myalgia, arthralgia, diarrhoea, generalised maculopapular rash
    • most symptoms subside in 1-3 weeks, although chronic lethargy, depression and irritability can persist
    • HIV antibodies may not be detectable for some months, however, viral transmission is still possible

Stage 2: Chronic Infection (Clinical Latency)

  • relatively symptom free +/- lymphadenopathy
  • can be 2 months to 20 years before the onset of AIDS (median period is 10 years)
  • virus multiplies but is only released sporadically
  • CD4+ lymphoctyes gradually decrease

Stage 3: Acquired Immune Deficiency Syndrome

  • AIDS can be diagnosed when various criteria are fulfilled
  • most common diagnostic criterion met: CD4+ lymphocyte count of <200 cells/mcL
  • AIDS-defining conditions
43
Q

Where does the thoracic duct and right thoracic duct enter the venous system?

A

Right lymphatic duct - drains into right jugular, subclavian and bronchomediastinal trunks

Thoracic duct - drains into left internal jugular and left subclavian veins

44
Q

Explain why trauma to the spleen can be potentially life-threatening

A

Due to the extensive blood supply within the spleen, and its predisposition to be punctured during rib fracture given its location, rupture can lead to extensive haemorrhaging and death.

45
Q

Explain how lymphoma is classified. What characteristic cell is required for the diagnosis of Hodgkin’s lymphoma?

A

Traditional classification: Hodgkin’s lymphoma vs non-hodgkin’s lymphoma

Reed-Sternberg (RS) cell is involved in Hodgkin’s lymphoma - it is a distinctive neoplastic cell, that are large and binucleate. They secrete cytokines to promote tumour growth.

46
Q

Define the term leukaemia

A

A malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. These suppress the production of normal blood cells, leading to anaemia and other symptoms.

47
Q

Outline the clinical features associated with acute leukaemia. Can you explain the pathophysiological origin of these features?

A
  • rapid onset of symptoms (pts usually present within 3 months)
  • proliferation of blast cells overcrowd bone marrow (suppressing formation of other blood cells)
    • anaemia (decreased RBCs) = fatigue, pallor, weakness
    • decreased immunity (decreased normal WBCs) = fever, mouth ulcers, recurrent infections
    • bleeding tendencies (decreased platelets) = gum bleeding, epistaxis
  • bone pain (marrow expansion)
  • splenomegaly, hepatomegaly, lymphadenopathy (sequestration of blasts)
  • non-specific features: anorexia, weight loss, muscle wasting
  • nervous system infiltration: headache, vomiting, palsies, visual/auditory changes
48
Q

What clinical features may be associated with glandular fever?

A
  • long incubation period: 30-50 days
  • classical symptoms include fever, sore throat, cervical lymphadenopathy, fatigue
  • progression of disease: generalised lymphadenopathy, splenomegaly, heptamegaly (affects multiple glandular tissue)
  • rare complications: ocular, cardiac, CNS involvement
49
Q

List aetiological factors associated with lymphoma

A

Risk factors include:

  • family history
  • certain infections e.g. EBV, HIV
  • obesity (adipose tissue possesses endocrine and metabolic properties, and have the ability to drive malignant processes)
  • iatrogenic immunosupression (e.g. anti-rejection therapy)
  • autoimmune conditions (RA, SLE)
  • exposure to ionizing radiation or mutagenic chemicals
50
Q

Describe the normal flow of lymph through a lymph node

A
  1. Lymph enters into the lymph node through numerous afferent lymph vessels (on convex side)
  2. Lymph moves through the subscapular sinus towards the medulla
  3. Flows occurs through medullary sinuses
  4. It exits via efferent lymph vessels located at the hilum (indented region on concave side)
51
Q

Discuss the difference between red pulp and white pulp

A

White pulp is the site of immune function, composing 25% of tissue and where lymphocytes are suspended on reticular fibre

Red pulp is where RBC and blood-borne pathogens are destroyed, and compose 75% of tissue; there are huge numbers of erythrocytes and macrophages that engulf them

52
Q

Differentiate the terms lymphadenopathy and lymphadenitis

A

lymphadenitis = lymphadenopathy + pain + other signs of inflammation

53
Q

List aetiological factors associated with leukaemia

A
  • exact cause is unknown, likely a complex interplay between environmental and genetic factors
  • risk factors include:
  • genetic factors
  • exposure to cigarette smoke, benzene, ionising radiation
  • certain infections (e.g. HIV_
  • chemotherapy for the treatment of lymphoma, multiple myeloma, ovarian and breast cancer
  • chronic myeloid leukaemia
54
Q

Considering the functions of the spleen, what special precautions should a patient take post-splenectomy?

A
  • take all precautionary vaccines prior to travelling to a different country
  • take precautionary dose of antibiotics prior to travel
55
Q

Outline the different types and functions of:

a) Lymphocytes

A
  • T-cells = cellular adaptive immunity
  • B-cells = humoural adaptive immunity
  • Natural Killer cells = innate (non specific immunity)
56
Q

Explain where immune cells are located within a lymph node (refer to the slide on histological structure)

A
  • Cortex (germinal centres of proliferating B cells; T cells in transit; numerous dendritic cells)
  • Medulla (contain numerous B and T cells)
  • Lymph sinus (macrophages reside on reticular fibres)
57
Q

The capsule of the spleen contains smooth muscle fibres. In which situations would this organ need to contract?

A

Smooth muscle fibres contract when the organ releases erythropoiesis into the blood stream when low levels are detected

58
Q

Define microbiome

A

A collection of microbial genomes

Osteopathy Y3S1 (11 decks)

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