Lymphatics

Question 1

Fluid Pump locations

Answer 1

Thoracic Inlet

Thoracic Diaphragm

Pelvic Diaphragm

Question 2

Evaluation of Cranial-Cervical Jxn

Answer 2

Question 3

Evaluation of Cervical-Thoracic Jxn

Answer 3

Question 4

Evaluation of Thoracolumbar Jxn

Answer 4

Question 5

Evaluation of Lumbopelvic Jxn

Answer 5

Question 6

Lymph Node Palpation sites

Answer 6

Supraclavicular space

Epigastric region

Posterior axillary fold

Inguinal region

Popliteal space

Achilles region

Question 7

Thoracic Inlet MFR

Answer 7

Question 8

Doming the Diaphragm

Answer 8

Question 9

Ischiorectal Fossa Release

Answer 9

Question 10

Pectoral Traction

Answer 10

Question 11

Rib Raising, Supine

Answer 11

Question 12

Rib Raising, Seated

Answer 12

Question 13

Thoracic Pump (Repetitive/Oscillatory)

Answer 13

Question 14

Thoracic Pump (Vacuum/Atelectasis Modification)

Answer 14

Question 15

Abdominal Pump

Answer 15

Question 16

Sacral Rocking

Answer 16

Question 17

Pedal Pump

Answer 17

Question 18

Tapotement

Answer 18

Question 19

Effleurage and Petrissage

Answer 19

Question 20

IT Band Effleurage

Answer 20

Question 21

Anterior Cervical Arches Release

Answer 21

Question 22

Cervical Stroking

Answer 22

Question 23

Cervical Chain Drainage

Answer 23

Question 24

Submandibular Drainage

Answer 24

Question 25

Mandibular Drainage (Galbreath Technique)

Answer 25

Question 26

Auricular Drainage

Answer 26

Question 27

What gives rise to the Thymus and parts of the tonsils?

Answer 27

Endoderm

Question 29

When does lymphatic development begin? When is it's prevelance significant?

Answer 29

* Begins during 5th week of gestation * Significant presence by 20 weeks

Question 30

What does the mesoderm give rise to in terms of lymphatics?

Answer 30

Lymphatic vessels, lymph nodes, the spleen, and myeloid tissue

Question 31

How does age both from infant, to puberty, to elderly influence lympatics?

Answer 31

Lymphoid tissue increases until puberty when the immune system continues to mature, but lymphoid tissue regresses and then levels off. In elderly, the immune system may decline and they may not mount a fever.

Question 32

Spleen What is its location? Characteriztics and function?

Answer 32

Beneath ribs 9-11 on the left, just below diaphram Largest mass of lymphoid tissue, pressure sensitive (the movement of diaphragm can function to move lymph)

Question 33

What is the function of the liver in terms of lymphatics?

Answer 33

Location in the right costal margin Half of the body’s lymph is formed here Clears bacteria “Gate-keeper” of the shared hepato-biliary -pancreatic venous and lymphatic drainage

Question 34

Name the location of the tonsils

Answer 34

Palatine – lateral pharynx (traditional “tonsils”) Lingual – posterior 1/3 of tongue Pharyngeal – adenoids at nasopharyngeal border

Question 35

What organ is significant to the gut associated lymphoid tissue? What occurs to it with age?

Answer 35

The apendix Atrophy

Question 36

Where are peyer's patches located in the intestine?

Answer 36

The ileum

Question 37

What is the function of lacteals?

Answer 37

Transport large chylomicrons that cannot cross the intracellular junctions of circulatory capillaries

Question 38

How much fluid enters the interstitial fluid daily?

Answer 38

30L

Question 39

What is the importance of the diaphragm in lymphatics? What innervation effects the diaphragms effects on lympatics?

Answer 39

• 35%-60% of the drainage through the thoracic duct is associated with respiration • “pump” effect of the diaphragmatic crura on the cysterna chyli • Junctures are under sympathetic control

Question 40

How do lymphatic collectors move lymph?

Answer 40

Through the **lymphagions** (valves) Larger vessels may have smooth muscle with sympathetic innervation

Question 41

What does the thoracic duct drain? Where does it originate/terminate?

Answer 41

The entire lower bottom extremities and the upper left Origin: cisterna chyli as a dilation at L1-2 level Termination: Pierces Sibson’s fascia at superior inlet, U-turns to empty into L subclav/IJ veins

Question 42

What is the origin and termination of the right lympatic duct?

Answer 42

Origin: from the junction of R jugular and subclavian trunks (and occasionally the bronchomediastinal trunk) Termination: Empties at R subclav./IJ venous junction

Question 43

Indications of OMT for lymph

Answer 43

1. Edema, tissue congestion, or lymphatic stasis 2. Infection 3. Inflammation

Question 44

Absolute Contraindications for Lymph

Answer 44

Anuria – need kidneys functioning to process the extra fluid return Necrotizing fasciitis – in the treatment area Patient unable to tolerate treatment Patient refuses treatment

Question 45

Most common compensitory pattern is ____ at \_\_\_%

Answer 45

LRLR, 80%

Question 46

Steps in Lymphatics

Answer 46

A. Open pathways to remove restriction to flow a. Thoracic inlet b. Anterior and posterior axillary fold techniques c. Popliteal fossa release B. Maximize diaphramic functions a. Dome the diaphragm b. Ischiorectal fossa release C. Increase pressure differentials or transmit motion a. Pectoral traction b. Rib raising (supine or sitting) c. All other techniques