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Flashcards in Lymphatics Deck (33):

What are possible effects of lymphatic dysfunction?

  1. Elephantiasis
  2. Lymphedema secondary to radical mastectomy
  3. Immunodeficiency
  4. Obesity
  5. Dementia/Neurodegenerative Disease


What is the anatomical distribution of lymphatics?

  1. Start distal and run adjacent to veins due to embryological development from veins. 
  2. Contain nodes along the chain


What organs are considered to play a role in the lymphatics?

  1. Thymus
  2. Spleen
  3. Peyer's Patches
  4. Bone Marrow


What is the cystern chyli?

  1. Point of convergence retroperitoneal to abdominal aorta at LV1-LV2
  2. Provides convergence of drainage from the lower extremity and abdomen


What is the course lymph takes from the cystern chyli?

  1. Follows aorta through diaphragm at TV12.
  2. Ascends on to the right side of body adjacent to aorta and azygos vein.


What is responsible for draining the left thorax, lower right thorax, left upper extremity and lower limbs?

  1. lymph travels to cystern chyli, then up adjacent to aorta and azygos vein through the thorax. From there it will cross over midline to join with lymph from the L head, and join at the jugulovenous junction of L subcalvian and L jugular vein. 


Where does the L jugulovenous junction occur?

  1. TV5, site for all L lymph drainage into the venous system


What does the R lymphatic duct drain?

  1. R half of head.
  2. R upper extremity
  3. R upper half of thorax.


Head and neck areas drain to what lymph node cluster?

cervical lymph nodes


Lungs drain to what lymph node cluster?

Hilar lymph nodes


Trachea and esophagus drain to what lymph node cluster?

Mediastinal Lymph nodes


Upper limb, breast, and skin superior to umbilicus drain to what lymph node cluster?

Axillary lymph nodes


Liver, stomach, spleen pancreas and upper duodenum drain to what lymph node cluster?

Celiac Lymph nodes


Lower duodenum, jejunum, ileum, and colon to splenic flexure drain to what lymph node cluster?

Superior mesenteric lymph node


Colon from the splenic flexure to the upper rectum drain to what lymph node cluster?

Inferior mesenteric lymph node


Lower rectum to anal canal above the pectinate line, bladder, vagina, and prostate drain to what lymph node cluster?

Internal Iliac lymph node


Testes, ovaries, kidneys, and uterus drain to what lymph node cluster?

Para-aortic lymph node


Anal canal below pectinate line, skin inferior to umbilicus and scrotum all drain to what lymph node cluster?

Superficial inguinal lymph node


Dosrolateral foot and posterior calf both drain to what lymph node cluster?

Poppliteal lymph node


What is the current theory as to how lymph is propagated?

Mechanobiological control combined with adjacent skeletal muscle contraction.


What is the mechanobiological mechanism of lymph propagation?

  1. Ca influences smooth muscle contraction to drive lymphatics to contract, while nitric oxide drives smooth muscles to relax


What happens during inflammation to the lymphatic flow?

  1. based on the new model, it suggests that inflamation alters the "balanced" concentrations of Ca and NO, therefore causing a spastic contraction/relaxation pattern that prevents proper lymphatic flow.
  2. therefore even adjacent muscular contraction is reduced as the lymph vessels could be contracted closed due to excess Ca present from inflammation


What are the 5 basic functions of the lymphatic system?

  1. Complement the circulatory system (add/remove fluid based on pressures)
  2. Critical for immune system (migrate pathogens through body and development of mature lymphocytes)
  3. Formation of Peyer's patches in GI
  4. Transprot cholesterol and metabolic compounds
  5. Glymphatics of CNS


What are common side effects of dysfunctional lymphatics?

  1. Anatomical barrier alteration/restriction (excess fluid)
  2. Infections develop (no immune)
  3. Cancer development/progression
  4. Chronic Inflammation (no method to remove toxic compounds)
  5. Autoimmunity disorder (chronic inflammation)


What infections will a lymphatic dysfunciton most likely have reduced resistance to?

  1. Staph
  2. Strep
  3. Enterococcus


What are some unique features of the Peyer's patches?

  1. Will not locate in duodenum
  2. Locate in distal ileum; few found in jejunum
  3. Not encapsulated and always contain germinal centers; indicating continual immune stimulation due to presence of GI luminal antigen presence. 


What compound can be introduced to induce growth of lymphatics in a local area?



Lack of sleep and aging both contribute to dysfunctional glymphatics which can pre-dispose a chronically tired individual to what disease?

  1. Neurodegeneration (MS, ALS)
  2. Dementia (alzheimer's, fronto-temporal dementia)
    1. beta-amyloid is cleared via glymphatics preventing beta-amyloid plaque formation
  3. Parkinson's or Huntington's disease
  4. Traumatic Brain Injury (TBI)
  5. Stroke


What are the upper extremity baffles?

  1. Carpal tunnel
  2. Antecubital fossa
  3. Axilla

Any region where there is increased fascial restriction due to tight spaces, obstructing flow.


Where are the lower extremity baffles?

  1. Achilles tendon
  2. Popliteal fossa
  3. Inguinal ligament


What are considered "midline facets" baffles?

  1. Thoracic inlet (open first always)
  2. Abdominal diagphragm
  3. Pelvic diaphragm


What are indicators for lymphatic techniques to improve lymph flow?

  1. Pregnancy
  2. Pre/post op patient
  3. Bed bound patient
  4. Lymphedema
  5. Inflammation (GI/MSK)
  6. Cholesterol dysfunction/obesity
  7. Dementia
  8. CHF
  9. Cancer (CA)


What are relative contraindications for lymphatic techniques?

  1. Infections (cellulitis)
  2. CHF
  3. Cancer (CA)
    1. CA would help facilitate metastisis
    2. Cellulitis: help to spread a localized infection to body causing sepsis
    3. CHF patient have inability to remove fluid from vascular system, therefore introducing more fluid into system would overload heart and possibly send into MI