Lymphatics Flashcards

(74 cards)

1
Q

Lymphatic System Functions

A

Drain excess Interstitial Fluid
Transport dietary lipids
Protect against invasion
Unwanted role in providing pathway for spread of malignancy

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2
Q

What happens if 3L interstitial fluid not reabsorbed

A

Oedema

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3
Q

Components of lymphatic system

A

Lymph- 3L of IF that circulates
Lymphatic capillaries
Lymphatic vessels –> drain into trunks–> into ducts in venous system

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4
Q

Capillaries wall

A

Single wall

Porous membrane

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5
Q

Capillaries composition

A

Endothelial cells
Have loose flap arrangement
Permeable to hormones, fats + proteins found in ISF
Anchored by collagen filaments in interstitium

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6
Q

ECF reabsorption

A

Most ECF reabsorbed by capillaries

Approx 17L/day

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7
Q

Capillaries absorption MOA

A

When pressure in interstitium increases, flaps open –> allow influx of ISF
If pressure decreases, the flap closes

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8
Q

Lacteals

A

Specialised lymphatic capillaries
Found interspersed within the villi in the intestines
Help fatty molecules that cannot access the capillary bed to be absorbed
–> transported into venous system

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9
Q

Lymphatic plexus

A

Collection of lymphatic vessels within the capillary bed

Widen to become lymphatic capillaries

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10
Q

Flow of lymph

A

Lymphatic collecting vessels –> lymph nodes (filter lymph)–> drain into lymphatic trunk –> drain into lymphatic duct –> venous system in neck

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11
Q

Elephantitis (Lymphatic filariasis)

A

Roundworm larvae transported by mosquito
Hide within lymphatic system + obstruct vessels within lymphatics
Lymph can’t drain into venous system
Tissues begin to swell

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12
Q

Elephantitis complication

A

Scrotal Hydrocele

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13
Q

Lymphatic vessels pressure

A

Low pressure conduits

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14
Q

Aiding flow of Lymph

A
Musculo-venous pump
Valves to prevent backflow
Pressure changes in thorax
Pulsations
Smooth muscle in walls of trunks + ducts
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15
Q

Musculo-venous pump

A

Milking action of active skeletal muscle

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16
Q

Pressure changes in thorax

A

Pressure decreases in thorax –> vessels dilate –> flow of lymph

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17
Q

Deep lymphatics

A

Bundles in sheaths of CT with arteries

Pulsations of artery –> help promote flow of lymph

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18
Q

Inferior Lymphatic trunks

A

Lumbar trunks

Intestinal trunk

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19
Q

Lumbar trunk

A

Drain fluid from legs

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20
Q

Intestinal trunk

A

Drain fluid from intestines, spleen + liver

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21
Q

Superior Lymphatic trunks

A

Bronchomediastinal trunk- joining of smaller trunks
Subclavian trunks
Jugular trunks

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22
Q

Right Lymphatic Duct

A

Terminal end of lymphatic system on RHS
Drains at junction of internal jugular vein + right subclavian vein
Drains R Upper quadrant (right side of head, neck, thorax + right arm)

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23
Q

Thoracic Duct

A

Drains rest of body
Begins in abdomen as cisterna chyle
Duct ends at left venous angle in venous system

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24
Q

Lymph nodes

A

Only structures that can filter lymph

–> macrophages remove + destroy microorganisms + debris

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25
Unfiltered lymph journey
Enters lymph nodes through afferent lymphatic vessels Dendritic cells (APC) detect pathogen if present in lymph Present antigen to B lymphocytes B lymphocytes produce antibodies Antibodies in lymph neutralize pathogen T lymph attack antibody tagged pathogen
26
Superficial nodal components
Drains the skin | All eventually drain into deeper nodes
27
Cervical nodes
Drain lymph above clavicle | Vessels enter along course of External Jugular Vein
28
Axillary nodes
Drain lymph between clavicle + umbilicus
29
Inguinal nodes
Drain lymph below umbilicus
30
Deeper nodal components
Drain structures of thorax, abdomen, pelvis + perineum
31
Deep cervical nodes
Vertical chain along Internal Jugular Vein (posterior to SCM) Efferent vessels form right and left jugular trunks
32
Palpable lymph nodes
``` Submental Submandibular Tonsillar Parotid Preauricular Posterior auricular Occipital Superficial cervical Deep cervical Supraclavicular ```
33
Nodes that drain into central nodes
``` Humeral nodes (arm) Pectoral nodes (anterior chain) Subscapular nodes ```
34
Central nodes
Generally palpable in apical (infraclavicular) nodes | Drain into apical (infraclavicular) nodes
35
Apical nodes
Drain into supraclavicular nodes
36
Axillary nodes lymph journey
Humeral + Pectoral + Subscapular nodes --> central nodes --> apical nodes --> supraclavicular nodes --> subclavian lymphatic trunk --> right (or left) venous angle
37
Sentinel lymph nodes
First nodes/groups of nodes along route of tumour/infection spread that will collect inflammatory products or products from tumour itself
38
Breast exam
Can take biopsy Radioactive dye injected around area Probe follows its course in sentinel node Sentinel node removed + analysed
39
Radical Mastectomy
If sentinel node removed contains tumorous material, must remove nodes in that region as precaution Breast tissue removal + lymph node removal --> reduces lymphatic vessels/area for fluid can return to lymph system --> lymphoedema
40
Lymphoedema from radical mastectomy
Can take up to 12 months to progress due to disruption of flow in lymph system Approx 20% of patients will have
41
Lymph drainage abdomen (below umbilicus) + lower limb
2 groups of superficial inguinal lymph nodes which are palpable (horizontal + vertical)
42
Horizontal lymph nodes
Run superficial to inguinal ligament | Superficial lymphatics from anterior abdominal wall, perineum + external genitalia (excluding gonads)
43
Para-aortic nodes
Drain gonad lymph
44
Vertical lymph nodes
Lie along termination o great saphenous vein | Drain majority of superficial lymphatics from leg
45
Deep inguinal nodes
Efferents from superficial lymph nodes drain into here Not palpable Also receive lymphatics from deep structures of leg Efferents to external iliac nodes
46
Vertical + Deep Inguinal lymph node clearance
Cancerous lymphatic fluid has retracted from sole of foot Has presented in both vertical + horizontal superficial lymph nodes Inguinal lymph node clearance during surgery to remove malignant melanoma
47
Deep drainage of thorax
Subpleural plexus --> interlobar lymph vessels | And other nodes
48
Interpulmonary nodes
Within lung tissue itself
49
Bronchopulmonary nodes
Nodes at junction of lungs + bronchus
50
Inferior tracheobronchial nodes
Receive from the heart | At junction of trachea + bronchus
51
Superior tracheobroncal nodes
Above carina
52
Paratracheal nodes
Along sides of trachea
53
Posterior mediastinal node
Associated with aorta | In close association with tracheobronchial nodes
54
All nodes in lungs etc
Drain into bronchomediastinal trunks
55
External and internal iliac nodes
Common iliac nodes Lumbar lymph nodes R + L lumbar trunks
56
Vessels from abdomen
Pre-aortic lymph nodes | Intestinal lymph trunk
57
Cisterna chyle
Dilation that marks beginning of thoracic duct Located anterior to L1 and L2 Intestinal + R + L lumbar trunks drain into here
58
Virchow's Node/ Trosier's Sign
Supraclavicular nodes on LHS Associated with gastric cancer, and cancers in abdomen Receive drainage from abdomen
59
Infants + children
Lymph tissue increases to 2x adult mass between 6-9 yo, then goes back to adult level by puberty Tonsils larger during childhood
60
Older adults
No. + Size of lymph nodes decreases with age Nodes more fibrotic + fatty --> impaired ability to resist infection Thymus lost
61
Lymphoid organs
``` Only lymph nodes filter lymph, even if tissue make up of lymphoid organs (excluding thymus) is reticular connective tissue Spleen Thymus Peyer's patches of intestine Tonsils/Adenoids Myeloid tissue in BM ```
62
Spleen
Behind stomach Filters blood Provides site for lymphocyte proliferation, immune surveillance + response Blood cleansing functions Extract aged + defective blood cells + platelets
63
White pulp spleen
Lymphocytes (immunity)
64
Red pulp spleen
Macrophages to clear up debris
65
Spleen function pt 2
Stores/releases breakdown of RBCs Stores platelets Lot of lymphoid tissue can congregate around splenic artery
66
Spleen in foetus
Involved in haemopoiesis
67
Left hemidiaphragm
Stomach + spleen
68
Thymus location
Inferior neck + superior thorax deep to sternum
69
Thymus function
Secretes 2 polypeptides which cause differentiation + maturation of T cells - -> thymopoietin - -> thymosins (cause T lymphocytes to become immunocompetent)
70
Thymus growth
Prominent in newborns Continues to grow 1st year when highly active After puberty starts to atrophy
71
Tonsils
Create ring-like structure which trap pathogens which are ingested or inhaled Receptor mediated immune response
72
Tonsil names
``` Named according to location Palatine Lingual Pharyngeal (adenoids if enlarged) Tubal ```
73
Peyer's patches
Large isolated clusters of lymphoid tissue in wall of distal SI Lymphoid follicles also concentrated in wall of appendix
74
Peyer's patches MOA
Destroy bacteria --> prevent pathogens from breaching intestinal wall Generate memory lymphocytes for long term immunity