Lymphatic System

Question 1

Role of lymphatic system?

Answer 1

Maintain fluid balance within tissues
Absorb and carriage of water soluble fats from intestine
Protection of the body through generation of immune response

Question 2

Components of lymphatic system?

Answer 2

Lymphatic vessels
Lymph nodes
Spells
Thymus

Question 3

What is the cisterna Chyli?

Answer 3

Sac on Right side L1/2 and receives lumber and intestinal lymph trunks

Question 4

Where does most lymph drain into?

Answer 4

The left lymph duct (lower limbs, and left upper limb)

Question 5

Where does the right upper lymph drain into?

Answer 5

Into the right lymph duct

Question 6

Role of lymph node?

Answer 6

Allows interaction of antigen, APC and Lymphoid cells in generation of immune response

Lymph nodes all around body

Question 7

Symptoms that suggest lymphadenopathy?

Answer 7

Tenderness and pain in the lymph nodes
Swelling >1cm of concern

Question 8

Role of spleen?

Answer 8

Traps and presenting antigens in circulating blood
Culling of old red cells

Question 9

Symptoms of splenomegaly?

Answer 9

-typically, won’t present with any
- Pain or fullness in left upper belly that can spread to left shoulder
- Feeling of fullness without eating much – spleen presses on stomach
- Hypersplenism – low RBC anaemia, becomes overactive, removes too many RBCs
- Frequent infections
- Bleeding easily
- Becomes palpable – even easily visible if serious
- Can rupture if not treated – life threatening

Question 10

What size should be spleen be?

Answer 10

Less than 12cm

Question 11

Infective causes of splenomegaly?

Answer 11

B - TB, endocarditis
V - Infective mononucleosis
P - Malaria, leishmaniasis

Question 12

Other causes of splenomegaly?

Answer 12

Haem - Haemolytic anaemia
Immunological - RA, sarcoidosis
metabolic - Rare inherited enzyme deficiency, Gauchers
Vascular - Portal hypertension (cirrhosis)
Neoplastic - lymphoma, leukaemia, myeloproliferative disorders

Question 13

Causes of lymphadenopathy?

Answer 13

Infective - bacterial infection/ infective mononucleosis/ TB/ HIV
Neoplastic - primary (lymphoma) secondary (mets)
Immunological - sarcoidosis, RA
Metabolic - thyrotoxicosis
Drugs - phenytoin, penicillin, allopurinol

Question 14

What are the two main groups of lymphoma?

Answer 14

Hodgkin and non-Hodgkin

Question 15

Describe Hodgkin lymphoma

Answer 15

Characterised by proliferation of atypical lymphoid cell
Half of cases triggered by EBV

Question 16

Describe two types non-Hodgkin lymphoma

Answer 16

High grade (fast growing)
Low grade (slow growing)

Question 17

Difference between Hodgkin and non Hodgkin lymphoma?

Answer 17

HL - tend to present earlier in malignancy
NHL - later presentation

HL - spread to nodes in contiguous manner
NHL - more haphazard spread

NHL - extra nodal sites more common

Question 18

Describe disease staging of lymphoma?

Answer 18

Stage 1 - one lymph node group involved
s2 - two node groups involved on same side of diagram
S3 - more than 2 node group on different sides of diaphragm
S4 - mets lymph (bone marrow involvement and liver)

Question 19

Best way to stage lymphoma?

Answer 19

PET scan to see the glucose uptake(metabolic activity) of the nodes