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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

What are the diaphragms of the body?

Cranium (2)

Thoracic inlet and outlet

Respiratory, pelvic and popliteal diaphragms

Foot and ankle (1)