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Lymphatics (lecture And Lab) Flashcards

1
Q

Indications for lymphatic tx

A 
Acute SD
Sprains/strains
Edema/tissue congestion
Lymphatic/venous stasis
Pregnancy
Infection
Inflammation
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2
Q

What are the 2 ABSOLUTE contraindications for lymphatic tx?

A

Anuria

Necrotizing fasciitis

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3
Q

What are some relative contraindications to lymphatic tx?

A

Malignancy
Fracture/dislocation

Certain infections (mono, abscess, chronic osteomyelitis)

Certain circulatory disorders (venous obstruction, embolism, hemorrhage, patients on AC therapy)

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4
Q

One of the principles of lymphatic dx is to evaluate fluid pumps; how would you do this?

A

Observe and palpate for restriction of motion at thoracic inlet, thoracic diaphragm, and pelvic diaphragm

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5
Q

What are the 4 principles of diagnosis for lymphatic SD?

A
  1. Evaluate for indications/risk-benefit ratio
  2. Evaluate for spinal involvement
  3. Evaluate fluid pumps
  4. Evaluate peripheral/regional pathways
  5. Evaluate central myofascial pathways
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6
Q

When palpating the LNs, what are you feeling for?

A

Either normal or bogginess, when severe you may feel LNs themselves

Characteristics:
Size, shape, consistency, tenderness, mobility, overlying skin

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7
Q

What is normal vs. abnormal for size of LNs?

A

Normal = pea-sized

Abnormal = large

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8
Q

What is normal vs. abnormal for shape of LNs?

A

Normal = round, regular

Abnormal = irregular

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9
Q

What is normal vs. abnormal for consistency of LNs?

A

Normal = spongy

Abnormal = hard

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10
Q

What is normal vs. abnormal for mobility of LNs?

A

Normal = mobile

Abnormal = fixed

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11
Q

What is normal vs. abnormal for overlying skin of LNs?

A

Normal = baseline

Abnormal = red, warm, edematous

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12
Q

What 6 areas would you palpate for lymphatic congestion?

A
  1. Supraclavicular space
  2. Epigastric region
  3. Posterior axillary
  4. Inguinal region
  5. Popliteal space
  6. Achilles region
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13
Q

What junctions are palpated when evaluating central myofascial pathways?

A
  1. Craniocervical
  2. Cervicothoracic
  3. Thoracolumbar
  4. Lumbopelvic
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14
Q

What are the 4 major principles of lymphatic tx?

A
  1. Open pathways to remove restriction to flow
  2. Maximize diaphragmatic functions
  3. Increase pressure differentials or transmit motion
  4. Mobilize targeted tissue fluids
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15
Q

What are the 2 phases pertaining to step 1 of lymphatic tx: open pathways to remove restriction to flow?

A

Phase 1: transverse myofascial restrictors

Phase 2: regional lymphatic drainage

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16
Q

What is the key rule to remember when treating the transverse myofascial restrictors in lymphatic tx?

A

Always treat upstream first! Don’t want to block fluid flow

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17
Q

Phase 2 of opening pathways to remove restriction to flow involves regional lymphatic drainage. What are some techniques for this?

A

Effleurage/petrissage

Tapotement

Regional LN drainage

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18
Q

What MFR technique is always performed first in lymphatic tx?

A

Thoracic inlet MFR

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19
Q

After first performing thoracic inlet MFR for a lymphatic problem inferior to the diaphragm, what technique would you perform next?

A

Doming the diaphragm

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20
Q

After first performing thoracic inlet MFR for an HEENT lymphatic problem, what technique would you perform next?

A

Suboccipital release

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21
Q

After first performing thoracic inlet MFR for a lymphatic problem in the lower extremities, you would dome the diaphragm. What is the 3rd technique you would perform?

A

Ischiorectal fossa release

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22
Q

What lymphatic technique might you use to treat upper and lower extremity lymphatic congestion?

A

Effleurage and petrissage

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23
Q

What lymphatic technique might you use to treat lower extremity lymphatic congestion?

A

IT band effleurage

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24
Q

What lymphatic technique might you use for chest, thoracic, or lumbar lymphatic congestion?

A

Tapotement

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25
What are some lymphatic techniques for HEENT lymphatic congestion?
Submandibular drainage Cervical chain drainage Auricular drainage Cervical stroking
26
What lymphatic techniques are used to increase pressure differentials to transmit motion?
``` Pectoral traction Rib raising (supine or seated) Thoracic pump (repetitive or vacuum mod) Abdominal pump Sacral rock Pedal pump ```
27
What are some lymphatic techniques for mobilizing targeted tissue fluids?
``` Anterior cervical arches release Mandibular drainage (Galbreath) ```
28
During the 1917-1919 influenza pandemic, osteopaths had a 0.486% death rate while overall medical care had a 1.08% death rate. What did osteopathic physicians do differently for their patients?
Maximize respiratory function Raise the ribs Mobilize restricted spinal regions Increase vascular and lymphatic flow
29
Lymphoid organs produce lymphocytes which circulate within body and react to foreign material. what are some lymphoid organs?
``` Spleen Thymus Tonsils Appendix MALT Liver ```
30
When does lymphatic development begin?
During 5th week of gestation, significant by 20 weeks
31
Lymphatic system is immature at birth, but development continues until it regresses at what point in time?
Lymphoid tissue increases until puberty when the immune system continues to mature, but then begins regressing
32
What is the largest single mass of lymphoid tissue and acts as a filter between an artery and a vein?
Spleen
33
Which lymph organ does not contain any lymphatics? (I know, wtf.)
Spleen
34
Which tonsils are located in lateral pharynx?
Palatine
35
Which tonsils are located at posterior 1/3 of tongue?
Lingual
36
Which tonsils are at the nasopharyngeal border?
Pharyngeal tonsils/adenoids
37
Which organ is the pressure-sensitive "gate-keeper" of lymphatic drainage, in which 1/2 of the body's lymph is formed?
Liver
38
Which visceral lymph tissue allows fats from the digestive tract into the circulatory system?
GALT - contains peyer's patches and lacteals
39
If a pt is found to have a swollen, painful LN, what might you look for near the node?
Cut Bite Rash Infection
40
If a pt is found to have swollen/indurated, but non-painful LN, what might you be suspicious of?
Malignancy/disease
41
What is Virchow's node?
Enlarged left supraclavicular node suspicious for intra-abdominal cancer
42
Lymphatic channels perfuse all tissues of the body except which 4?
1. Epidermis (including hair and nails) 2. Endomysium (muscles and cartilage) 3. Bone marrow 4. Select portions of peripheral nerves
43
Describe the histology of lymphatic vessels
Composed of endothelium that lacks basement membrane
44
Which lymphatic duct drains the majority of the body?
Thoracic duct
45
The thoracic duct empties into the venous system at the junction of what 2 veins?
Left internal jugular v. Left subclavian v.
46
______ _____ = dilated collecting sac in the abdomen where the lymphatic trunks draining the lower half of the body merge; ascends from collecting sac as the thoracic duct into the thorax
Cisterna chyli
47
What does the right lymphatic duct drain?
Right side of the head, neck, and thorax Right upper limb [empties into venous system at the junction of the right internal jugular v. and right subclavian v.]
48
What is found anterior to L1-L2, posterior to the right crura of the diaphragm?
Cisterna chyli of thoracic duct
49
The thoracic duct lies against the vertebral column, and at _____ it moves LEFT of the midline, between the ______ and ______ _______
T4 aorta; azygous vein
50
Lymph fluid leaks out of arterial capillaries --> interstitium --> single lymphatic vessels ____% of the plasma proteins that diffuse out of the vascular system in a 24 hr period return to the body via the lymphatic system
50
51
35-60% of the drainage through the thoracic duct is associated with ___________, which is associated with the "pump" effect of the diaphragmatic crura on the cisterna chyli. The junctures are under sympathetic control
Respiration
52
What are the 4 primary functions of the lymphatic system?
Fluid balance Purification and cleansing Defense Nutrition
53
Interstitial fluid pressure is increased by: _____ arterial pressure _____ capillary permeability _____ plasma oncotic pressure _____ interstitial fluid protein
Increased Increased Decreased Increased
54
Mechanisms of lymph flow include lymphatic pumps, what is the diff between intrinsic pumps and extrinsic pumps?
Intrinsic = pressure gradients caused by large vessel distension (smooth muscle contraction) and small vessel distension (activation of endothelial cell contractile fibers) Extrinsic = direct pressure on lymphatic vessels (thoracic and pelvic diaphragms)
55
What is lymphangitis?
Inflammation of lymphatic vessels
56
What is lymphadenitis?
Inflammation of lymph nodes
57
______ _____ = junction of thoracic duct with venous system
Thoracic inlet
58
______ ______ syndrome = compression of the arteries, veins, and/or nerves of the upper extremity by the clavicle, first rib or scalene muscles
Thoracic outlet
59
_____ ____ = suprapleural membrane. The thoracic duct travels cephalad through this to the level of C7, then U-turns to the thoracic inlet
Sibson's fascia
60
What is the most common compensated myofascial pattern?
L/R/L/R

OS Exam I (18 decks)

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