Lymphatics (Ogden)

Question 1

Spleen: location, functions

Answer 1

beneath ribs 9, 10, 11, inbetween hemi-diagphragm and and peritoneal cavity

diaphragm important for homeostatic movement of splenic fluids

functions: cleans blood of RBCs, synthesizes Ig, clearance site for microorganisms, Ags, poorly organized bacteria

Question 2

Liver: function

Answer 2

half the body’s lymph formed here

pressure sensitive organ: affected by muscular action of thoraco-abdominal diaphragm

“gate keeper” of hepato-bilitary-pancreativ venous and lymphatic region

ALSO clears bacteria

Question 3

“components of system” overview

Answer 3

organized lymph tissue
vessels/ducts
lymph fluid

Question 4

“organized lymph tissue” over view

Answer 4

spleen, liver, thymus, tonsils, appendix, visceral lymphoid tissue (gastrointestinal and pulmonary)

Question 5

Thymus: function, location

Answer 5

superiorly in mediastinum, anteriorly, goes into neck region

largest around age 2, then replaced by fat

nonfunctional in adults

T lymphocyte development

Question 6

Tonsils: function

Answer 6

palatine, lingual, and pharyngeal (adenoids)

provide cells to influence and build immunity early in life

nonessential to adult immune function

Question 7

Appendix: location/function

Answer 7

located on the medial surface of the cecum

function largely unknown

Question 8

Pulmonary and GI roles in lymphatics

Answer 8

Pulmonary aids filtration of toxins from lungs

GI has Payer’s patches, lacteals (lymphatic capillaries in each vili in small bowel)

FATs enter circulation via GI system lacteals

Question 9

LN: what does ogdan say

Answer 9

most highly organized lymphoid tissue
dispersed along the course of the lymph vessels

primary purpose is for filtration of lymph
two types:
superficial and depp
400-450 nodes

Question 10

Superficial and Deep LNs

Answer 10

S: follows subcutaneously with superficial veins
D: beneath fascia and muscles, follows deep veins

Question 11

Superficial Nodes: where do they receive and where do they drainage

Answer 11

receive lymph from superficial and deep structures in Lower/upper extremities, as well as head/neck

Question 12

Superficial nodes: cervical

Answer 12

head/superclavicular and upper extremity drains into jugular nodes

Question 13

Superficial nodes: axillary

Answer 13

infraclavicular to umbilicus, drains to axillary nodes and then subclavian

Question 14

Superficial nodes: inguinal

Answer 14

Caudal to umbilicus drain to inguinal nodes and then lumbar

Question 15

Lymph channels/ducts

what do they “follow” and what don’t they perfuse?

Answer 15

follow veins (superficial and dee)

they dont perfuse:
CNS 
epidermis 
endomysium of muscles/cartilages 
bone marrow 
selected portions of peripheral nerves

Question 16

CNS

Answer 16

previously they thought it possessed no lymphatics, but new research has found they do

Question 17

Structure

Answer 17

flow is one way
vessels have valves
vessels surrounded by major organs
drain into thoracic duct or right lymphatic duct

Question 18

Major nodes that can be assessed head/neck

Answer 18

Subparotid
Facial
Mandibular and submandibular 
submental 
suprahyoid 
anterior deep cervical (pretracheal/thyroid) 
occipital 
thoracic 
Virchow's

Question 19

Major nodes of the superficial thoracic region

Answer 19

subclavian (apical axillary)
parasternal
subscapular (posterior axillary)
Pectoral( anterior axillary nodes)

Question 20

Major nodes of the upper extremities

Answer 20

deltopectoral node 
axillary nodes (along axillary vein)
cubital nodes

Question 21

Major nodes of the lower extremities

Answer 21

Superficial INGUINAL nodes

popliteal lymph node `

Question 22

Major nodes in the viscera

Answer 22

Thoracic duct
Cisterna chyli
PREAROTIC nodes: celiac, superior mesenteric, inferior mesenteric

Question 23

Superficial inguinal nodes

Answer 23

superficial epigastric, external pudendal, superficial circumflex iliac and great saphenous groups

Question 24

Thoracic duct

Answer 24

largest duct

lies between aorta and azygous vein

Question 25

Where does the thoracic duct connect to the subclavian and brachiocephalic veins?

Answer 25

around T4, it makes a midline shift and connects to the junction running into those two

Question 26

Thoracic Duct drains:

Answer 26

``` left side of head/neck left arm left side of thorax left and right lower body viscera of thoracic ```

Question 27

Cisterna chyli

Answer 27

dilation of distal thoracic duct | anterior to L1-L2; posterior to right crura of diaphragm

Question 28

Right lymphatic duct

Answer 28

drains right arm right head/neck right chest connects to the venous system at the jugular subclavian junction

Question 29

Why would stress cause decongestion?

Answer 29

both thoracic duct and right lymphatic duct have one way valves and smooth muscle which are under sympathetic control, which is increased by stress (causing tissue congestion)

Question 30

lymph fluid

Answer 30

fluid that leaks out of interstitial capillaries into interstitium components: proteins, salts, fats, primary lymphocytes, clotting factors, bacteria and viruses

Question 31

Name four functions of lymphatic system

Answer 31

fluid balance purification and cleansing defense nutrition

Question 32

Fluid balance

Answer 32

50% of plasma proteins re-enter circulation through lymph can pick up fluid from peritoneum, pleura, cartilages, pericardium and join excess of 3 liters/24 hrs large proteins can enter lymphatic circulation aids in homeostasis in fluid overload situation

Question 33

Purification

Answer 33

Lymph fluid baths all organs, this picks up particulate matter and cleans out crevices and returns them to nodes node is a "purifying" filter

Question 34

Defense

Answer 34

lymph fluid delivers toxins, bacteria, viruses into contact with lymphatic system lymph returns proteins back to vascular system proteins bind to nutrients fast are absorbed via lymph system

Question 35

Mechanisms of flow

Answer 35

interstitial fluid pressure | lymphatic pump: intrinsic/extrinsic

Question 36

Interstitial fluid pressure

Answer 36

normal = -6.3 mmHg increase in pressure will increase flow efficiency ceiling at 0 mmhg above 0 mmHg will collapse vessels and obstruct flow

Question 37

Interstitial fluid pressure is increased by....

Answer 37

1) increased arterial capillary pressure (HTN) 2) decreased colloidal osmotic pressure (hepatic cirrhosis) 3) ncreased interstitial fluid protein (starvation and plasma hypoalbuminemia) 4) increased capillary permeability (toxins = rattlesnake poisoning)

Question 38

"intrinsic pump"

Answer 38

distension of larger vessels causes ---> constriction in small vessels --> causing pumping this happens because endothelial cells have contractile fibers that respond to distension contraction causes pressure gradients to help move fluid example: aortic pulse can act on the lymphatic duct and help move lymph through

Question 39

"extrinsic pump"

Answer 39

Direct pressure on vessels moves lymph internally anywhere pressure exercted will increase flow Thoracic diaphragm: Crura acts on cisterna chyli respiration produces pressure gradients between thorax and abdomen pressure gradients and one-way valves pull lymph toward venous circulation Pelvic diaphragm: synchronous with abdominal diaphragm moves interstitial fluid from pelvis important in dysmenorrhea, preparation for labor+delivery prostate irritation in benign prostatic hypertrophy and other prostate problems

Question 40

Clinical problems of poorly functioning lymphatic system

Answer 40

edema. edema = collapsed lymphatic vessels or too much interstitial pressure TOO much fluid running into interstitium TOO little fluid running out of interstitium TOO much interstitial pressure = retards intrinsic pump

Question 41

Effects of edema

Answer 41

compression of lymph vessels and neurovascular structures tissue congestion fluid stasis changes pH of tissue/organ chronic states have fibroblasts leaving fibrotic structures: fibrosis/contractures effects include decreased delivery of nutrients decreased bioavailability of drugs/hormones

Question 42

Area 1 of OMT

Answer 42

Thoracic inlet

Question 43

Area 2 of OMT

Answer 43

Abdomen

Question 44

Area 3 of OMT

Answer 44

Upper extremity

Question 45

Area 4 of OMT

Answer 45

Lower extremity

Question 46

Area 5 of OMT

Answer 46

Head and neck

Question 47

unofficial area 6

Answer 47

thoracic inlet, always return to it

Question 48

conditions that warrant general lymphatic treatment

Answer 48

``` early carcinoma/metastatic cancer osseous fracture acute bacterial infection/w temp 102 acute hepatitis infectious mononucleosis circulatory disorders ANURIA (not urinating) ```

Question 49

What conditions would NOT allow OM lymphatic treatment?

Answer 49

IF the patient is supine IF the patient has an acute bacterial infection (Temp over 102) IF the patient

Question 50

where do superficial LNs drain into?

Answer 50

cervical, axillary, and inguinal