Week 13- Lymphatic System Flashcards by Amber Zimmer

A one-way regional system responsible for carrying this capillary ultrafiltrate fluid volume and the escaped plasma proteins# back to the blood circulation

Lymphatic system

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The lymphatic system is a pressure-driven system based on the principles of ___________

Osmotic diuresis

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Function of the lymphatic system

-Absorb macromolecules (protein and fatty acids)
-Help maintain fluid balance in the tissues
-Fight infection
-Assist in the removal of cellular debris and waste products from the extracellular spaces

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If the normal lymphatic transport mechanisms are disrupted, significant accumulations of water and protein can remain in the tissue spaces, resulting in latent, acute, or chronic ___________

Lymphedema

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True or false: The challenge for PT with lymphedema is to effectively move fluid and protein back into functioning lymphatics and then into the central circulation

True

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The laws of basic fluid dynamics says that fluid flows from an area of ___________ pressure to an area of ___________ pressure until equilibrium is reached

-High
-Lower

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Starling’s Law says that fluid at the arterial end of the capillary will tend to flow into the tissue spaces because plasma (blood) hydrostatic pressure is higher at the ____________ end compared with the tissue _____________ of the tissues

-Arterial end
-Tissue hydrostatic pressure (THP)

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Organs involved in the lymphatic system

-Superficial and deep lymph vessels and nodes
-Thymus
-Bone marrow
-Spleen
-Tonsils
-Peyer patches of the small intestine

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True or false: The superficial lymphatic drainage to regional nodes is very asymmetric, but the deep lymphatic drainage is very symmetric

False

(symmetric; asymmetric)

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Right upper extremity and thoracic lymphotome drain into the _________ lymphatic duct

Right

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Left upper extremity, left thoracic lymphotome, and both lower extremities, external genital areas, and abdominal lymphotomes drain into the ___________ subclavian vein

Left

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Three-fourths of the total flow draining to the __________ subclavian vein

Left

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____________ enhances flow in the trunks and ducts

Respiratory effort

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____________ rely on an interaction of oncotic and hydrostatic pressures, muscle contraction, arterial pulsation, and gentle movement of the skin to absorb and transport lymph fluid

Superficial vessels

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____________, which generally parallel the venous system, contain smooth muscle and valves and help prevent backflow

Deeper vessels

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Initial lymphatics are the ____________ lymphatic vessels; vessel walls are ______ cell thick

-Smallest
-One

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Initial lymphatics function as ____________ powered by variations in ___________ caused by movement; muscular contraction; and variations in external pressure caused by stretch, gravity, change in position, and other similar factors

-Force pumps
-Total tissue pressure

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Without changes in total tissue pressure, force pumps cannot function, and fluid will accumulate in the interstitium, leading to ___________

Edema

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Each segment of collecting lymphatic vessels between valves

Lymphangion

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True or false: Lymphatic valves prevent backflow and some muscle tissue in their walls to further enhance their pumping action

True

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Other ways to increase pumping action of lymphatic valves

-Extrinsic muscle contraction
-Autonomic stimulation
-Manual lymphatic drainage (MLD)

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True or false: Collecting lymphatics do form a plexus

False

(do not form a plexus, but there can be some connections between them)

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Gradual increase in diameter size of collecting lymphatics

Lymph trunks

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Muscle in the collecting lymphatic walls contracts _____________

Rhythmically

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__________ muscle cells around the endothelial cell layer face the __________ of the vessel

-Smooth -Lumen

The lymph vessel network is innervated by the _______ and contract at rest an average of ___ to ____ times per minute

-ANS -5-10

If many lymphangions contract at once and outflow is obstructed (e.g., by scarred or irradiated lymph nodal areas), pressure inside the vessel can reach ______ mm Hg or more

100

Sustained high intravascular pressure __________ the muscle wall

Fatigues

Sustained high intravascular pressure can lead to...

-Ineffective smooth muscle contraction -Vessel failure

Lymphatic walls dilate, preventing __________ of valve flaps

-Closure

Backflow of lymph distal to the site of obstruction causes ___________

Lymphedema

The _______ lymphatic vessels are embedded in __________ and accompany the chains of lymph nodes along the blood vessels

-Deep -Fatty tissue

True or false: Injury to blood vessels in an area also implies injury to lymphatic vessels in that area, regardless of whether it is unexpected or controlled trauma, as in surgery

True

Function of lymph nodes

-Act as filters to cleanse the lymph of waste products and cellular debris -Adjust the fluid concentration -Produce lymphocytes and macrophages -Destroy foreign bacteria, harmful viruses, and cancer cells

Why are lymph nodes often the sites of obstruction in lymphatic dysfunction?

Lymph nodes offer 100 times the normal resistance to flow of lymph within the lymphatic vessels themselves

____________ separate territories

Watersheds

Within a territory, smaller divisions called ____________ designate areas specific to certain of the regional nodes

Lymphotomes

Drainage can be changed from one lymphotome to another by...

Expelling lymph from an overloaded one toward a normal one

Trunk quadrants

The left and right axillary territories and the right and left inguinal territories

Improper treatment of extremity edema without considering the impact of that treatment on the trunk quadrant adjacent to the limb or limbs involved can result in the development of __________, __________, or ___________ edema, when none existed before intervention for the extremity edema

-Truncal -Breast -Genetical

True or false: Palpable lymph nodes do always indicates serious or ongoing disease

False (not always, but this determination requires an evaluation by a physician)

Evaluation for identifying suspicious nodes

-Changes in size (>2 cm) of lymph nodes -Immobile lymph nodes -Firm or hard lymph nodes in one or more areas or the presence of painless enlarged lymph nodes

Inflammation of a lymphatic vessel

Lymphangitis

Inflammation of one or more lymph nodes

Lymphadenitis

An increased amount of lymph fluid in the soft tissues

Lymphedema

Enlargement of the lymph nodes

Lymphadenopathy

Lymph nodes act as __________ and are secondarily involved in virtually all systemic __________ and in many _____________ arising elsewhere in the body

-Defense barriers -Infections -Neoplastic disorders

The specific node, or nodes, affected in an infectious disease depends on...

-Location of the infection Nature of the invading organism -Severity of the disease

A swelling of the soft tissues that results from the accumulation of protein-rich fluid in the extracellular spaces

Lymphedema

Lymphedema is accompanied by ___________ secondary to ___________ with prolonged swelling

-Tissue fibrosis -Chronic inflammation

Lymphedema is caused by...

Decreased lymphatic transport capacity and/or excessive lymphatic load

Lymphedema is most commonly seen in the ____________ and ___________ extremities

-Upper -Lower

Two categories of lymphedema

-Primary (idiopathic) -Secondary (acquired)

The stages of lymphedema start from __________ to __________

-Stage 0 (latent) -State III (lymphostatic elephantiasis)

Examples of incidence associated with cause

-Individuals who undergo lumpectomy receive either axillary lymph node dissection (ALND)or sentinel lymph node biopsy (SLNB) and radiation therapy would have higher risk of developing lymphedema -Inguinal lymph node dissection to treat melanoma -Prostate cancer after pelvic node dissection -Gynecologic cancers

Etiologic factors of primary lymphedema

-Unknown -Hereditary -Developmental abnormality -Aplasia -Hypoplasia -Hyperplasia

Etiologic factors of secondary lymphedema

-Filariasis -Invasive procedures used in the diagnosis and treatment of cancer -Any trauma or surgery that impairs the lymphatics -Multiple abdominal surgeries (particularly in obese individuals) -Bacterial or viral infection -Repeated pregnancies -Crush injuries, severe burns, compound fractures, or severe lacerations or degloving injuries to the skin can significantly impair lymph flow

The most common cause of secondary lymphedema worldwide

Filariasis

Parasitic worm, introduced to the body by a mosquito bite in endemic regions

Filariasis

The most common cause of secondary lymphedema

Invasive procedures used in the diagnosis and treatment of cancer

True or false: Regional lymph node dissection for diagnostic staging and eradication of tumor sites disrupts the lymphatic system

True

Examples of invasive procedures

-Radiation therapy -Reconstructive -Other surgical procedures -Local radiation treatment after surgery for cancer

True or false: Surgery is not trauma

False (it is lol)

True or false: Secondary lymphedema can develop immediately postoperatively or weeks, months, or years after surgery

True

Clinical magnifications

-A full, heavy, or tight sensation in the affected body part -Numbness, burning, aching, pain -Decreased flexibility in the hand, wrist, or ankle -Difficulty fitting into shoes or clothing in one specific area; or jewelry tightness -Increased girth and weight of the limbs along with postural changes and limitation in joint motion leads to functional deficits -Loss of skin integrity (in advanced cases) allows portals of entry for bacteria to invade the skin and cause recurrent infection -Significant edema of the head and neck can cause severe functional impairments in speech, swallowing, and respiration, in addition to the pain and psychologic trauma from cosmetic disfigurement -These physical impairments can lead to functional limitations and disability along with the potential for psychosocial morbidity (e.g., social isolation, depression, or suicide)

True or false: Infections elsewhere in the body do not lead to lymphadenopathy

False (they do lol)

Lymph nodes are enlarged, tender warm, and reddened

Acute lymphadenitis

Results in scarred lymph nodes with fibrous connective tissue replacement

Chronic lymphadenitis

Acute inflammation of the subcutaneous lymphatic channels usually occurs as a result of _____________ or ____________ entering a wound

-Streptococci -Staphylococci

Week 13- Lymphatic System Flashcards

(69 cards)