Flashcards in Lymphatics Deck (32)
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1
Overview of lymphatic principles when deciding treatment
Start centrally and work towards the periphery
Release the flow and promote the flow
Retain gain/prevent recurrence via ace wraps/compression
2
What is a constant lymphatic pump?
Thoracic Diaphragms
3
Contraindications for lymphatic pumps
Superficial thrombophlebitis or DVTs
Fracture of chest/thoracic or flail chest
Trauma and/or recent surgery especially to gallbladder
Any conditions that would cause friable liver/spleen. (Symptomatic mononucleosis)
- must wait at least 1 month for resolution
Acute hepatitis or cellulitis
Fever over 102
- only if no antibiotic therapy is initiated
Malignancy
- only if stage 3 or 4
Asymmetric limb swelling
- must rule out DVT first
4
Indications for lymphatic pumps
Congestive heart failure
- diuretic must administered first
Infective processes
- antimicrobial therapy must be administered
COPD
Upper lower GI dysfunction
Edema
Remove mechanical barriers to the lymph flow
Drain toxins
Stimulate immune function and diminish sympathetic tone
5
Boundaries of thoracic inlet
TI
First ribs
Costal cartilages
Manubrium
If constricted blocks both right and left lymphatic ducts
6
Sibsons fascia (suprapleural membrane or deep cervical fascia)
Thickened portion of endothoracic fascia extending over the cupola of the pleura
- attaches to the 1st rib and originates from the transverse process of C7
-acts like a 2nd diaphragm across the Thracian inlet
- possess three vertebromembranous bands of fascia from C&-T1 junction which all insert on the first rib and help with inspiration
7
Boundaries of the sibsons fascia
Vertebral column, first rib, levator scapulae and Scalene medius (posterior and lateral)
Superior mediastinal structures
(medially)
anterior scalene and sternocleidomastoid
(Anteriorly)
Reinforces the cupola of the pleura
8
How to diagnose thoracic inlet fascia
Palpate and assess for TART
Instruct patient to inhale and exhale to evaluate motion of the sibsons fascia.
Somatic dysfunction is inhalation or exhalation based on ease of motion
9
Respiratory diaphragm
Attachments
- right and left Crura = L1-3
- median arcuate ligament = T12
10
Overview of Lymphatic system
Development begins at 20 weeks in utero
Immature at birth and becomes mature at age 6-9 yrs and permanently at ages 15-16
Comprises 3% total body weight
Filters 30 L a day
- 27 drains back into venous system
- 3 drains via lymphatic channels
Consist of the following:
- lymphocytes
- bacteria, viruses
- antigens, antibodies
- salts
- fats
- proteins
11
Lymph flow from entrance into lymph system to entrance into the venous system
Lymph capillaries
- contain loose junctions that allow passage of large particles through capillaries
- contain overlapping cell layers that create unidirectional valves
Lymph capillary plexus
Lymph channels
Trunks
Thoracic duct
*flow is based off hydrostatic and osmotic gradients*
12
Anchoring filaments
Bundles of collagen that attach the external aspect of lymphatic endothelium and imbed into interstitial matrix
Function to:
- cause lymphatic vessels to change shape and volume in response to tissue movement
- prevent collapse of lymphatic vessels as interstitial pressure rises
13
Collecting vessels and lymphangions
Begin at first bicuspid valve after capillaries
- develops thin connective tissue layer that functions to support surrounding endothelium
- also function to aid unidirectional movement of lymph
14
Innervation of lymphatic system
Solely sympathetic and primarily alpha receptors
- suggested some beta exists but in low levels
15
Right lymphatic duct
Drains the right side of the head and neck, upper extremity and right lung
- also the heart
16
Lymphatic duct (left side)
Everything else is drained through this duct
17
What tissues do not possess lymphatic capillaries?
Any non-vascular tissues
- cartilage
- lens/cornea of eye
- epidermis
- CNS
- bone
- maternal placenta
- endomyceum surrounding muscles
18
Flow of lymph
Lymph moves dismally -> centrally and does not exceed 7 mmHh in pressure
* is a passive system that moves with muscles contraction*
19
Thoracic duct
Largest lymph vessel that drains both the right and left lymphatic ducts
- the site where the two lymphatic ducts merge is the cisterna chyli
Originates at L2 which is the site of cisterna chyli
Veers slightly to the left and arches 3-4 cm above clavicle
20
Where is the site of lymph draining into the venous system from the thoracic duct
At the junction of the left-internal jugular vein and left subclavian vein
21
How to increase lymph movement
Movements of the diaphragm
Direct compression pressure to tissues
Musculoskeletal movements and exercise
Arterial pulsation
Manipulation
Peristalsis
22
Causes of edema
Mechanical trauma
Increased blow flow
Decreased absorption
Decreased lymph flow
*edema is bad because it compresses neural and vascular tissues*
23
Mechanical causes of decrease lymphatic flow
Kyphosis And scoliosis increase
Surgery
Pregnant
Decreased respiration
24
Causes of increase lymph flow
Infections
Injuries
Increased capillary permeability
25
Decreased absorption
Change in protein content of blood and interstitial fluid
Salt imbalance
26
Pitting edema
Common edema present after lymph node dissection
- looks like a small pit in a site of edema
Graded from 1-4
-1 = 2mm deep
-2 = 4mm deep
-3 = 6mm deep
-4 = 8mm deep
27
Anasarca
Entire body edema usually caused by kidney/heart issues.
28
Inflammation effect on lymphatic
Increased influx of fluid and plasma into interstitium
Causes stasis in intravascular space and increased viscosity since proteins do not move back easily
Chronic causes scarring and fibrosis on the lymphatic system
29
Primary lymphedema
Congenital or hereditary causes that causes massive swelling
- actually causes are unknown
- only diagnosed once secondary lymphadenopathy is ruled out
30
Secondary lymphedema
Extreme swelling caused by inflammation, infection, trauma, clots or malignancy
Inflammation and infection present the same way
- warm, tender, enlarged lymph nodes
Malignancy presents with hard, non-tender lymph nodes
* can also be caused by Hives, autoimmune diseases, nephritis and hepatitis*
31
Types of diaphragms of the body
2 cranium
Thoracic
Respiratory
Pelvic
Popliteal
Foot/ankle
32
