Lymphatic System (Chapter 10)

Question 1

What is the lymphatic system’s functions?

Answer 1

1. Management of fluid including conserving fluid and plasma that leak from capillaries.
2. Immune response
3. Absorbing lipids in the GI tract

Question 2

How does the lymph system manage fluid in the body?

Answer 2

The lymphatic system is present in all body tissue except the placenta and the brain. It acts as a drainage system, transporting excess fluid away from tissues.

Filters fluid before returning it to the bloodstream.

Question 3

What roles does the lymphatic system play in immune function? Where are lymph node cells created?

Answer 3

The lymphatic system provides a highway for lymphocytes and other WBC to travel on.

Creation of lymphocytes, which play a primary role in regulating the bodies immunity. These cells largely are phagocytic cells.

Lymph nodes are the site of creation for lymphocytes.

Question 4

What is lymph?

Answer 4

Clear, sometimes milky white liquid that contains a variety of WBCs and sometimes RBCs

Question 5

Describe the journey of lymph fluid throughout the body

Answer 5

Lymph fluid is fluid that is collected from the interstitial space due to excess. The fluid is collected at small tubules. These small tubules connect to larger ducts that transport the lymph fluid to lymph nodes around the body. The lymph nodes send the lymph fluid to the venous system at the subclavian veins.

Question 6

What are lymph nodes? What are their functions?

Answer 6

Nodes that are found superficial and deep in the body. They typically occur in groups.

Lymph nodes are centers of the lymphatic system. Lymph nodes work to filter microorganisms and particles out of the blood. They house many WBCs to phagocytize invading pathogens. They help lymphocytes and monocytes mature.

Question 7

What is important about superficial lymph nodes?

Answer 7

Superficial lymph nodes are available for inspection and palpation. These features allow the provide to clue in on possible infection or malignancy.

Question 8

What are is considered a probable sign of malignancy if there is palpable (swollen) lymph nodes there?

Answer 8

Palpable lymph nodes found at the supraclavicular area is a probable sign of malignancy.

Question 9

Describe the exam of a normal lymph node

Answer 9

Normally lymph nodes are invisible and non-palpable.

If they are palpable they will appear small, oval shaped, a firm or rubbery lump.

Lymph nodes are typically non-tender.

Lymph nodes are typically mobile upon palpation.

Question 10

Describe an abnormal lymph node..
- malignant
- infectious

Answer 10

Palpable lymph nodes in itself can be abnormal in some people.

Lymph nodes that are larger (greater than 2cm) are abnormal.

Lymph nodes that are hard or boggy are abnormal. Hard lymph nodes are associated with malignancy. Boggy lymph nodes are associated with infection.

Lymph nodes that are tender indicate infection or inflammation.

Lymph nodes that are fixed, nonmobile are indicative of cancer.

Question 11

Lymph node that is large, 3 cm in diameter. Hard and immobile upon palpation.

Answer 11

Indicate malignancy

Question 12

Lymph node that is swollen, 3 cm in diameter. Boggy and tender.

Answer 12

Indicate infection

Question 13

What are the lymphocytes?

Answer 13

Lymphocytes are the WBCs created in the lymphatic system. These include B-lymphocytes, T-lymphocytes.

B-lymphocytes have a primary role in humoral immunity. They produce antibodies.

T-lymphocytes have a primary role in adaptive immunity. Help regulate B-lymphocyte production of antibodies.

Question 14

Thymus
- What does it do?
- Where is it?
- Adult VS children?

Answer 14

The thymus gland is most active during early childhood and atrophies during puberty. It has the important role of creating T-lymphocytes during childhood to help build the immune system.

The thymus is located in the superior mediastinum, extending up into the base of the neck.

Question 15

Spleen
- What does it do?
- Where is it?

Answer 15

The spleen is a highly vascular organ located in the upper left quadrant of the abdomen.

The spleen is the site of old RBC breakdown, storage of RBCs, creation of antibodies, and site of filtration of the blood from microorganisms.

Question 16

Tonsils and adenoids
- Where are they?
- What do they do?

Answer 16

Tonsils are located toward the base of the tongue. They are small diamond shaped patches of lymphoid tissue. Plays a role in immune response to inhaled or consumed substances.

The adenoids are the pharyngeal tonsils. Located at the nasopharyngeal border.

Question 17

Peyer patches
- Where are they?
- What do they do?

Answer 17

These are small, raised areas of lymph found in the mucosa of the small intestine. Detect microorganism activity in the small intestine.

Question 18

How does the lymphatic system differ between children and adults?

Answer 18

The lymphatic system in children is immature. The thymus plays a larger role and declines after puberty. Tonsils are larger and more active during childhood. Lymphatic system reaches maturity around ages 7-9.

Question 19

What qualities should be considered when assessing lymph nodes?

Answer 19

1. Size
2. Shape
3. Mobility
4. Consistency
5. Tenderness

Question 20

Lymphadenopathy

Answer 20

Enlarged lymph nodes

Question 21

Lymphadenitis

Answer 21

Inflamed and enlarged lymph nodes

Question 22

Lymphedema

Answer 22

edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate drainage.

Question 23

Shotty

Answer 23

small-nontender nodes that feel like BBs. Typically harmless finding

Question 24

Matted

Answer 24

Lymph nodes that feel connected and move as a unit when palpated

Question 25

Transilluminates - When is this done when assessing lymph nodes?

Answer 25

A medical technique accomplished by shining light through the object to see if it is penetrable by light. - To tell the difference between cysts and nodes

Question 26

How to differentiate between lymph nodes, cysts, and masses?

Answer 26

- Transillumination (seeing if light can penetrate the node) can differentiate between nodes and fluid filled cysts. Nodes do not allow light to penetrate. - Stethoscope - auscultation of the area listening for bruit can tell the provider if they area in question is arterial in nature instead of a node. - Location of the area in question

Question 27

What findings are most indicative of malignancy?

Answer 27

1. Hard, fixed nodule 2. Larger than normal 3. Rapidly increasing in size 4. Non-tender 5. If found supraclavicular (Virchow node)

Question 28

How is the immune function altered during pregnancy?

Answer 28

Immune function alters during pregnancy. Autoimmune and inflammatory processes can improve during this time (remission).

Question 29

Slowly enlarging lymph node vs quickly enlarging lymph node

Answer 29

Slowly - typically a benign process Quickly - more commonly malignant in nature

Question 30

What is the order of assessment when palpating head and neck lymph nodes. 1. Head 2. Neck

Answer 30

Head: 1. Occipital nodes at the back, base of the skull 2. Postauricular nodes, located over the mastoid process 3. Preauricular nodes, located in front of the ear 4. Parotid and retropharyngeal (tonsillar) nodes at the angle of the mandible 5. Submandibular nodes located halfway between the angle and the tip of mandible 6. Submental nodes located midline behind the tip of the mandible Neck: 1. Superficial cervical nodes at the sternocleidomastoid muscle 2. Posterior cervical nodes along the anterior border of the trapezius muscles 3. Cervical nodes deep to the sternocleidomastoid muscle 4. The supraclavicular areas located deep in the angle formed by the clavicle and the sternocleidomastoid muscle.

Question 31

Where are the supraclavicular lymph nodes?

Answer 31

They are located deep in the angle formed by the clavicle and the sternocleidomastoid muscle.

Question 32

Enlarged lymph nodes and tonsils in children

Answer 32

This is a common finding and should be considered in the context of the overall presentation before jumping to conclusions.

Question 33

Lymphedema - Subjective - Objective

Answer 33

Edematous swelling due to excess accumulation of lymph fluid in the tissues caused by inadequate lymph drainage. Subjective: - Painless swelling that typically is unilateral - Gradual onset - Recent trauma, surgery, or radiation - Filariasis Objective: - Swelling, often grotesque - Overlying skin thickens Unaffected by elevation or diuretics like normal edema.

Question 34

Lymphatic Filariasis - AKA - Subjective - Objective

Answer 34

Massive accumulation of lymphedema throughout the body. Caused by infection of filarial worms. More commonly obtained in third-world countries. AKA - elephantiasis - Subjective - swelling of limb and body. Recent travel to 3rd world country where worms are present. - Objective - gross lymphedema present

Question 35

Hodgkin Lymphoma - Subjective - Objective

Answer 35

Malignant lymphoma - Subjective - painless swelling of lymph nodes. Fever. History of mononucleosis. - Objective - most commonly affects the cervical lymph nodes with a unilateral presentation.

Question 36

Epstein-Barr Virus

Answer 36

Infectious mononucleosis. AKA kissing disease. - Subjective - malaise, fatigue, headache, sore throat - Objective - lymphadenopathy seen generalized but most commonly affecting the anterior and posterior cervical nodes and the epitrochlear nodes. Hepatomegaly Splenomegaly Moderate to severe pharyngitis Petechiae Monospot test to dx