Lymphatics

Question 1

Lymphatic System: 3 Anatomic Components

Answer 1

1. Lymph Fluid
2. Lymphatic Vessels
3. Organized lymphatic tissues/organs

–Spleen, Liver, Thymus, Tonsils, Appendix, Visceral lymphoid tissue, Lymph nodes

Question 2

Lymphatic Development Embryology - beginning and significant presence?

Answer 2

–Begins during 5th week of gestation

–Significant presence by 20 weeks

Question 3

Why is breast feeding recommended?

Answer 3

Development of lymphoid tissue - immature at birth

Question 4

lymphoid tissue develops until ____ years.

Answer 4

Increases until 6-9 years

–At puberty, immune system matures, but lymphoid tissues slowly regress until 15-16 years

Question 5

Lymphatic System Functions (4)

Answer 5

• Maintain Fluid Balance
• Tissue Cleansing/Purification
• Defense
• Nutrition

Question 6

__ L of fluid move from capillaries to interstitial space each day

Answer 6

30 L of fluid move from capillaries to interstitial space each day

• –90% to veinules; 10% to lymphatic system*
• –½ of diffused plasma proteins re-enter system via lymph*

Question 7

What are chylomicrons, what is function, how do they move?

Answer 7

chylomicrons - packaged form of fats

function: Fat absorption
movement: Too big to cross capillary intercellular junctions
* Travel via lacteals to larger lymph vessels to thoracic duct to venous system*

Question 8

What substances make up lymph fluid?

Answer 8

•Substances that leak out of the arterial capillaries into the interstitium get taken up by the lymphatic capillaries

(Fluids, proteins, electrolytes, and cells)

• Immune cells
• Foreign antigens
• Bacteria and viruses
• Clotting factors
• Chylomicrons post-prandial

Question 9

Tissues that do NOT have lymphatic vessels:

Answer 9

–Epidermis (including hair and nails)
–Endomysium of muscle
–Cartilage
–Bone marrow

Question 10

Lymphatic Vessels PATH

Answer 10

Terminal lymphatics > collecting vessels > afferent lymph vessels > lymph node(s) > efferent lymph vessels > lymphatic trunks > thoracic duct or right lymphatic duct > venous system

Question 11

Collecting Vessels consist of chains of…

Answer 11

Consist primarily of chains of muscular units called “lymphangions,” which possess two-leaflet bicuspid valves

–“Lymphatic hearts”
–Contracting regularly throughout the lymphatic system and moving lymph in peristaltic waves

Question 12

Afferent or prenodal vessels

Answer 12

collecting vessels prior to lymph node

Question 13

Efferent or postnodal vessels

Answer 13

collecting vessels draining the lymph node

Question 14

Most highly organized lymphoid tissue

Answer 14

Lymph Nodes : Dispersed along the course of lymph vessels

Question 15

Types of lymph nodes:

Answer 15

Superficial – within the subcutaneous tissue
Ex. – cervical, axillary, and inguinal

Deep – beneath fascia, muscle, organs

Question 16

Function of lymph nodes:

Answer 16

–Filtration of lymph fluid
–Maturation of lymphocytes
–Phagocytosis of bacteria and cellular debris

Question 17

Path of lymph flow through a lymph node:

Answer 17

Afferent Lymphatics > subcapsular space (reticular fibers, macrophages, DC) > outer cortex (B cells) > deep cortex (T cells) > medullary sinus (B cells and plasma cells) > efferent lymphatics (exit at hilum)

Question 18

What are the 5 Lymphatic Trunks?

Answer 18

• Lumbar – drain lymph from lower limbs and pelvic organs
• Intestinal – drains abdominal viscera
• Bronchomediastinal – drains portions of thorax
• Subclavian – drains upper limbs
• Jugular – drains portions of neck and head

Question 19

Location of Cisterna Chyli:

Answer 19

Located at the level of L1-2

Question 20

list areas that the Thoracic Duct drains

Answer 20

Master lymph vessel and drains
–L head/neck
–L UE
–L thorax/abdomen
–Everything inferior to umbilicus
–Receives from lumbar lymphatics

Question 21

List areas the Right Lymphatic Duct drains

Answer 21

Drains:

–R head/neck
–RUE
–R thorax
–Heart
–Lungs (except LUL)

Question 22

Virchow’s Node

Answer 22

L supra-clavicular

indicative of Intra-thoracic/abdominal cancer

Question 23

Epitrochlear Nodes

Answer 23

indicative of secondary syphilis

Question 24

Spleen location:

Answer 24

Spleen

•Location: Beneath ribs 9-11 on the left; abuts diaphragm –Normally NOT palpable

Question 25

Spleen Characteristics:

Answer 25

•Characteristics: –Largest single mass of lymphoid tissue –Pressure-sensitive: Movement of diaphragm drives splenic fluid movement

Question 26

Spleen Functions:

Answer 26

•Functions: –Destroy damaged/deformed RBCs –Synthesize immunoglobulin –Clear bacteria

Question 27

Liver Location

Answer 27

Location: RUQ; palpable at R costal margin

Question 28

Liver Characteristics:

Answer 28

Characteristics:–Pressure sensitive (like spleen), ∴ movement of the diaphragm is important for the homeostatic movement of hepatic fluids

Question 29

Liver (lymphatic) Functions

Answer 29

Lymphatic Function: –Half of the body’s lymph is formed here –Clears bacteria –“Gate-keeper” of the shared hepato-biliary-pancreatic venous and lymphatic drainage

Question 30

Thymus location

Answer 30

Location: anterior mediastinum

Question 31

Thymus characteristics

Answer 31

Characteristics: Development: Large in infancy and size peaks at 2 y/o. After puberty involutes, replaced by fatty tissue

Question 32

Thymus function

Answer 32

Function: –Maturation site for T-cells –Little or no fn in adult

Question 33

Tonsils location

Answer 33

Location: 3 types – all located in posterior oropharynx ## Footnote –Palatine – lateral pharynx (traditional “tonsils”) –Lingual – posterior 1/3 of tongue –Pharyngeal – adenoids at nasopharyngeal border

Question 34

Tonsils Characteristics

Answer 34

Characteristics: Most are not visible until 6-9 m/o, remain enlarged through childhood

Question 35

Tonsils Function

Answer 35

Function:–Provide cells to influence and build immunity early in life –Nonessential to adult immune function

Question 36

Appendix location

Answer 36

Location: at the proximal end of the cecum (Lg intestine)

Question 37

Appendix characteristics

Answer 37

Characteristics: Contains lymphoid pulp–Lymphoid tissue atrophies with age

Question 38

Appendix function

Answer 38

Function: part of the gut-associated lymphoid tissue (GALT)

Question 39

Gastrointestinal Assoc. Lymphoid Tissue: examples, classification

Answer 39

EX –Peyer’s patches – ileum –Lacteals – small bowel Visceral Lymphoid Tissue

Question 40

Explain the Thoracic Diaphragm in Mechanisms of Flow

Answer 40

With each breath, contraction ↑ the negative intrathoracic pressure, pulls fluid centrally Also exerts a direct force on the cisterna chyli, pushing fluid superiorly

Question 41

Explain how the pelvic diaphragm affects mechanisms of lymph flow

Answer 41

* Synchronous with thoracic diaphragm * Helps move fluids from the lower extremities and pelvis to the thoracic duct * May be dysfunctional in dysmenorrhea, endometriosis, post labor and delivery, BPH, etc.

Question 42

How does SNS effect Lymph valves? Lymphatic smooth muscle?

Answer 42

SNS Effects Lymph Valves •↑sympathetic tone \> tighter valves \> ↓lymph flow into the venous system SNS Effects Lymphatic Smooth Muscle •↑sympathetic tone \> ↓peristalsis \> lymphatic congestion

Question 43

Absolute Contraindications for Lymphatic OMT

Answer 43

* **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 44

Principles of Diagnosis from a Lymphatics Approach (5 steps)

Answer 44

1. Evaluate risk-benefit ratio 2. Evaluate fascial patterns of Zink 3. Evaluate diaphragms/fascia, including thoracic inlet for restrictions that may limit lymphatic drainage. 4. Evaluate for somatic dysfunction affecting any motion that would normally enhance lymphatic flow. 5. Evaluate tissue congestion.

Question 45

Fascial patterns of Zink

Answer 45

describe fascial restrictions patterns that cause restriction of lymphatic flow Compensatory Patterns & Un-Compensated Patterns

Question 46

Sequence of Generalized Lymphatic Treatment

Answer 46

1. Open pathways to remove restriction to flow –Transverse myofascial restrictors: thoracic inlet, myofascial restrictors, broad fluid movement 2. Maximize diaphragmatic functions (abdominal & pelvic diaphragms) 3. Increase pressure differentials or transmit motion (fluid pumps) 4. Mobilize targeted tissue fluids (localized to specific somatic dysfunctions)