Lymphatic System: Danto Flashcards

1
Q

KCU started in

A

1916

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2
Q

first described lymphatics as a system

A

1653: Olaf Rudbeck

(Sweden)

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3
Q

Date: _____ emphasized that diagnosis of the fascia and treatment of the lymphatic system was vital for maintaining health and treating disease

A

•1874: A. T. Still

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4
Q

______________ (date) published Applied Anatomy of the Lymphatics

A

1922: Frederic Millard, D.O.,

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5
Q

Lymphatic development begins _______ and is of significant prescense by _________

A

during 5th week of gestation

signficant prescene by 20 weeks

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6
Q

Where is lymphatic system derived from?

A

Mesoderm,

but thymus and part of tonsils are endoderm

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7
Q

Lymphatic development

A

Lymphoid tissue is immature @ birth and increases UNTIL puberty when immine system continues to mature, by lymphoid tissue regresses and levels off

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8
Q

immune system in geriatrics

A

delines and patients may not mount a fever

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9
Q

3 components of lymphatic system

A
  1. organized lymphatic tissue and organs (spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue, lymph nodes)
  2. Fluid
  3. vessels
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10
Q

Fx of lymphatic system

A

Maintain homeostasis (immune, digestive, fluid balance and waste)

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11
Q

Spleen

Location:

Characteristics:

Functions:

A

Spleen

Location: L side, below ribs 9-11

Characteristics: spleen is the largest mass of tissue and sensitive to pressure

Functions: destroy damaged/ deformed RBC, make Ig’s, clear bacteria

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12
Q

Moving the diapragm does what?

A

drives splenic fluid

drives hepatic fluid

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13
Q

LIVER

Location:

Characteristics:

Functions:

A

Location: RUQ, can palpate at the R costal margin

Characteristics: pressure sensitive

Functions: forms half of bodies lymph, clears bacteria, gatekeeper of hepatobiliary pancreatic venous and lymphatic drainage

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14
Q

Thymus

Location:

Characteristics:

Fx:

A

Loccated: anterior mediastinum

Characteristics–> large in infancy and peaks at 2yo. After puberty, it is replaced by fatty tissue

Fx: makes T cells in kids and little /no fx in adults

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15
Q

Tonsils

Location:

Characteristics:

Fx:

A

Location: located in posterior oropharynx: palatine (lateral pharynx-traditional), lingual (posteiror 1/3), pharyngeal (adenoids at nasopharyngeal border)

Characteristics: most are not visible 6-9 monthes, remains englarged through childhook

Fx: allows cells to build immunity early in life, not needed

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16
Q

Appendix

Location

Characterists

Fx

A

Location–> proximal end of cecum (LI)

Characteristics- has lymphoid pulp; dies with age

Fx- part of the gut-assx lymphoid tissue (GALT)

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17
Q

Visceral lymphoid tissue (gastrointestinal assx lymphoid tissue :GALT))

A

peyers path, lacteals (lymphatic capillaries of small bowel)

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18
Q

What is lymph fluid?

A

•Substances that leak out of the arterial capillaries into the interstitiumget taken up by the lymphatic capillaries like fluids, proteins, electrolytes, and cells

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19
Q

•30 L of fluid move from capillaries to interstitial space each day

–90% to capillaries; 10% to lymphatic system

–½ of diffused plasma proteins re-enter system via lymph

•When fluid overload occurs, lymphatic system helps prevent tissue damage by clearing the excess

–“Second/third spacing”

A
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20
Q

35%-60% of the drainage through the thoracic associated with _________

A

RESPIRATION

•“pump” effectof the diaphragmatic crura onthe cysternachyli

•Junctures areunder sympathetic control

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21
Q

Restrictions of lymphatic flow must be first drained through the _______________

A

the assx terminal area

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22
Q

Where does lymph go?

A

Lymph bathes all tissues.

Some tissue that does not have lymphatic vessels, but uses diffusion are the [epidermis, endomysium, catilage, bone marrow]

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23
Q

Lymph channels begin as what?

A

Blind endothelial tubes or capillaries made up of 1 layer of leaky squamous epithelium made up of anchoring filaments.

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24
Q

What is the flow of lymphatics?

A

Lymphatic capillaries–> collecting lymphatics–> afferent lymphatic vessels–> efferent lymphatic vessels–> thoracic duct or R lymphatic duct–> venous system

lymphatics run with veins

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25
Q

Extracellular fluid is sucked in by _____-level of negative pressure

A

LOW

26
Q

lymphatic collectors

A

chains of muscular units called lymphangions, which have 2-leaflet bicuspid valves. they contract and move lymph in peristaltic waves

27
Q

path of lymph flow through a lymph node

A

–> afferent lymphatic –> subscapular space–> outer CTX –> deep CTX–> medullary sinus –> efferent lymphatics via the hilum

28
Q

lymph nodes

A

-LN ar the most highly organized lymphoid tissue in lymph cessesl. There is superficial and deep.

29
Q

Fx of lymph nodes

A

filtration of lymph fliud,

maturation of lymphocytes,

phagocytoze bacteria and debris

30
Q

What is the master lymph vessel?

A

THORACIC DUCT

Drains L side of upper body,

& belly button down

-origin at the cisterna chyli

31
Q

track of thoracic duct

A

Originates at the cisterna chyli as a dilation of vessel around L1-2

pierces Sibson’s fascia, makes a U turn to empty into L subclavian/IJ veins

32
Q

R lymphatic duct

A

drains the RU body (inc heart and lungs)

33
Q

4 lymphatic fxs

A
  1. maintain fluid balance
  2. tissue cleansing and purification
  3. defense
  4. nutrition
34
Q

4 lymphatic fxs

A
  1. maintain fluid balance
  2. clean and purify tissue–> baths organs and cleans excellular spaces of particles and byproducts. Lymph then goes from vessel–> node
  3. defense
  4. nutrition- lymph absorbs fat via chylomicrons and returns proteins to vsaculature
35
Q

What type of tissue fluid enders lymph vessel

A

tissue fluid wilth cell wasts products

36
Q

___ flow of lymph is necessary for approp immune fx

A
37
Q

What causes peristalsis in lymph vessels

A

SM contraction in large lymph vessels–> pressure gradients –> peristalsis

38
Q

Machanisms of flow include what

A
  1. Interstitial fluid pressure
  2. Direct diagphragmatic pressure
  3. Symphatic NS
39
Q

Thoracic diapgram - direct diaphragmatic pressure

A

Contraction increases the negative intrathoracic pressure and pulls the fluid centrally and superiorly by exerting a direct force on cisterna chyli

40
Q

Pelvic diaphragm- direct diaphragmatic pressure

A

helps move fluid from LE and pelvis –> thoracic duct.

41
Q

SNS effects lymph valves.

Increasing sympathic tone does what?

A

tighter valves–> decrease lymph flow

42
Q

SNS effects lymphatic smooth muscle

A

–> decrease peristalsis–> causing congestion of lymb

43
Q

OMT to tx _________ improves lymphatic fx

A

OMT to address hypersympatheticonia lymphatic function.

44
Q

Now what happens when the flow is sufficiently inhibited, or the lymph system is poorly functioning???

A

EDEMA!- imbalance of starling forces

  • increase arterial pressure, venous pressure
  • decrease plasma oncotic pressure
  • increase permability of capillaries
45
Q

Effects of edema

A
  1. Compresses local structures
  2. decreases removal of tissue waste
  3. decreases pathogen clearance and immunity
  4. chronic states can lead to fibroblast recruitment and activation (causing scar contraction!)
46
Q

Def of lymphatic OMT

A

diverse techniques desgined to remove impediments to lymphatic circulation and promote and augment the flow of ISF and lymph

47
Q

Lymphatic OMT purpose

A

infprove functional capacity of lymphatic system: including maintenance of body fluid, purification and cleaning, enhance immune response, improve tissue nutrition

48
Q

Indications for lymphatic oMT

A
  1. edema, tissue congestion, lymphatic stasis
  2. infection
  3. inflammation

chronic conditions should be gentler and shorter, but more FREQUENT

49
Q

Contraindicaitions

A

Clinical judgment

50
Q

Absolute contraindications

A
  1. Anuria–> kidneys NEED to fx so process extra fluid
  2. Necrotixing fasciatis
  3. Patient cant tolerate tx or refuses
51
Q

Relative contraindications

A
  1. Splenomegaly/Hepatitis–
  2. If the problem is CHF is the pump isn’t working as well, causing fluid backup. Do we want to put more fluid into the pump system??
  3. Osseous fx
  4. COPD
  5. acute asthsma exacerbation
  6. untreated coagulapathies or patiens on anticoagulants
  7. cancer
52
Q

Pricinples of dx from a lymphatics approach

A
  1. Look at risk-benefit ration
  2. Evaulate fascial patterns of Zink
  3. Evaulate diaphragms and fascia
  4. Loof for SD
  5. Look for tissue congestion (excess fluid in ISF)
53
Q

Common compensaroy pattern (80% of people)

A

L, R L R

54
Q

Uncommon compensaroy pattern (20% of people)

A

RLRL

symptomatic and trauma is involved

55
Q

Transition zones of spine

A
  1. OA, C1 and C2
  2. C7 and T1
  3. T12 and L1
  4. L5 and sacrum
56
Q

Transverse restrictors

A

1. tentorium cerebelli

2. thoracic inlet

3. thoracolumbar diaphragm

4. pelvic diaphragm

57
Q

Evaluate for Lymphatic Congestion

Where do we feel?

A

The regional collection sites where lymph collects prior to drainage into the thoracic duct

58
Q

Sequence of Tx for Lymphatics

A
  1. Open path and remove restriction to flow via the transverse myofascial restrictors
  2. Maximize diaphragmatic functions (abdominal and pelvic diaphram)
  3. Increase pressure differentials or trasmit motion via fluid pumps
  4. Mobilize targeted tissue fluids
59
Q

Zink’s compensatory patterns

A

•Look at the 4 functional diaphragms to move lymph.

Dysfunction of these may impede the flow of lymph

Assess: cranial cervical joint, cervicothoracic joint, thoracolumbar junction, lumbosacral

60
Q

vertebra assx with thoracic inlet

A

T1-4

61
Q

•The lymphatic system is particularly vulnerable to fascial dysfunction in the region of the ___________

A

superior thoracic inlet

62
Q

•Initialdraining of the lymphatic system must always be done through __________

A

terminal areas