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CE Lymphatics
Mosby's chapter 9: Lymphatic Systems
74
Medical
Graduate
03/05/2012

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Term
Every tissue supplied by blood vessels has lymphatic vessels except which two organs?
Definition
brain and placenta
Term
roles of the lymphatic system
Definition
1. movement of lymph
2. production of lymphocytes
3. production of antibodies
4. phagocytosis
5. manufacture of blood when the primary sources are pathophysiologically compmromised
Term
lymphatic drainage point for the right upper body
Definition
lymphatic trunk that empties into the right subclavian vein
Term
lymphatic drainage point for the rest of the body (except right upper body)
Definition
thoracic duct into the left subclavian vein
Term
lymph drainage of the lower extremity
Definition
small saphenous lymph vessels --> popliteal nodes --> great saphenous lymphatic vessels --> inferior superficial inguinal nodes --> deep sublinguinal node --> superior superficial inguinal nodes
Term
lymphatic drainage of female genital tract
Definition
deep inguinal nodes --> superficial inguinal nodes --> obturator nodes --> external and internal iliac nodes --> common iliac nodes --> preaortic nodes
Term
lymphatic drainage of the trunk
Definition
preaortic nodes --> mesentery nodes (cisterna chiyli) --> mediastinal nodes --> bronchial nodes --> trachial nodes --> thoracic duct and lymphatic trunk
Term
lymphatic drainage of upper limb and shoulder
Definition
radial lymphatic vessels --> epitrochlear nodes --> brachial (axillary) nodes --> central nodes --> subclavian nodes --> supraclavicular
**brachial --> subscapular --> external mammary (anterior pectoral) --> central nodes
**medial pec = internal mammary --> mammary (Rotter) nodes --> central
Term
Lymph nodes of the ear
Definition
preauricular, posterior auricular (mastoid), parotid, sternomastoid, retropharyngeal (tonsilar), interanl jugular chain
Term
lymph nodes of the ear
Definition
submandibular, submental, sublingual, suprahyoid, thyrolinguofacial, anterior deep and superficial cervical, posterior cervical spinal nerve chain, posterior superficial cervical chain, internal jugular chain, supraclavicular
Term
normal size of lymph nodes
Definition
usually tiny but some as large as 0.5-1 cm
Term
from where do lymphocytes arise?
Definition
primarily produced in the bone marrow; also lymph nodes, tonsils, adenoids, and spleen
Term
B-lymphocytes
Definition
formed in bone marrow
produce antibodies and are characterized by various arrangements of immunoglobulins on their surface
responsible for humoral immune response
have relatively short life span = 3-4 days
Term
T-lymphocytes
Definition
made in bone marrow, and then flow to thymus for further differentiation
found in profusion in the centers of lymph nodes
responsible for controlling immune response brought on by B-lymphocytes (cellular response)
more numerous than B cells and live 100-200 days
Term
white pulp of spleen
Definition
made up of lymphatic nodules and diffuse lymphatic tissue
Term
red pulp of spleen
Definition
made up of venous sinusoids (contains blood-filtered macrophages)
Term
Palatine tonsils
Definition
"the tonsils", set between the palatine arches on either side of the pharynx
composed mainly of lymphoid tissue and organized in follicles and crypts (both covered by mucous membranes)
Term
Pharyngeal tonsils
Definition
"adenoids"
located at the nasopharyngeal border
Term
Lingual tonsils
Definition
located near the base of the tongue
Term
peyers patches
Definition
raised areas of lymph tissue in the mucosa of the small intestine (ilium)
consist of clustered lymphoid nodules
Term
when does the immune system and the lymphoid system begin to develop?
Definition
about 20 weeks of gestation
Term
when is the thymus the largest relative to the rest of the body?
Definition
shortly after birth
Term
when is the thymus at its greatest absolute weight?
Definition
at puberty
Term
which lymphoid tissue (tonsil) is much larger during early childhood than after puberty?
Definition
palatine tonsils
Term
which nodes are commonly palpable before 2 years of age, but would be abnormal/significant if palpable after 2 years of age?
Definition
inguinal, occipital and postauricular nodes
Term
which nodes are almost always abnormal if palpable at any age?
Definition
supraclavicular nodes
high association with malignancy
Term
which nodes are uncommonly palpable during the first year, but much more common in older children?
Definition
cervical and submandibular nodes
Term
effect of pregnancy on the immune system
Definition
1. leukocyte count increases (increased segmented neutrophils or granulocytes due to increased estrogen and cortisol levels)
2. increased susceptibility to certain infectious diseases
3. can lead to remission in the mother of autoimmune/inflammatory disease
Term
effect of old age on lymph system
Definition
1. number of lymph nodes my diminish and size may decrease
2. nodes are more likely to fibrotic and fatty = impaired ability to resist infection
Term
lymphadenopahty (adenopathy)
Definition
enlarged lymph nodes
Term
lymphangitis
Definition
inflammation of the lymphatics that drain an area of infection; tender erythematous streaks extend proximally from the infected area; region nodes may also be tender
Term
lymphedema
Definition
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
Term
hard and discrete nodes
Definition
more likely to be malignant
Term
tender nodes
Definition
most likely it is an inflammation
Term
benign vs. malignant node enlargement
Definition
benign = slow nodal enlargement over weeks or months
malignant = rapid enlargement without inflammation
Term
True or false: a node fixed to surrounding tissue is an expected finding.
Definition
false, this is a cause for concern
Term
lymphadenitis
Definition
inflamed or enlarged lymph node(s)
Term
Lymphangioma
Definition
congenital malformation of dilated lymphatics
Term
shotty nodes
Definition
small nodes that feel like BBs or buckshot under the skin
Term
fluctuant nodes
Definition
wavelike motion that is felt when the node is palpated
suggest suppuration from infection
Term
matted nodes
Definition
group of nodes that feel connected and seem to move as a unit
Term
are cancerous nodes usually tender?
Definition
no; malignant nodes are usually harder than expected and contralateral nodes are asymmetric
Term
infections of the ear usually drain to which nodes?
Definition
preauricular, retropharyngeal and deep cervical nodes
Term
which nodes are usually affected in TB and what do they feel like?
Definition
cervical chain nodes
are usually "cold", soft, matted and not tender or painful
Term
where are the supraclavicular nodes felt (during disease states)?
Definition
anterior to the sternocleidomastoid muscle and above the clavical
Term
Virchow nodes
Definition
firm, palpable supraclavicular nodes (usually on the left); known as a "signal node"
if on the left = may be a sign of either abdominal or thoracic malignancy
Term
which nodes drain the lungs?
Definition
mediastinal collecting ducts
Term
immunizations (BCG and smallpox) can cause temporary enlargement of which nodes?
Definition
axillary nodes
Term
where are epitrochlear nodes found?
Definition
proximal and slighly anterior to the medial epicondyle of the humerus in the groove between between the triceps and biceps muscles
Term
which nodes lie close to the surface over the inguinal canals?
Definition
superior superficial inguinal (femoral) nodes
Term
to where do the vulva and lower 1/3 of the vagina drain?
Definition
the inguinal nodes
**enlargement of these nodes suggest infection or metastatic carcinoma
Term
which nodes may be readily visible in very thin children?
Definition
inguinal nodes
Term
what is the usual shape of normal nodes (often seen in children)?
Definition
globular or ovoid, sometimes flatter or more cylindrical
Term
epidemic parotiditis
Definition
mumps
painful swelling of the parotid glands unilaterally or bilaterally
Term
mumps vs. cervical adenitis
Definition
cervical adenitis does not ordinarily obscure the angle of the jaw and mumps will
Term
which diseases often present with obvious cervical nodes, usually posterior rather than anterior?
Definition
common childhood diseases: rubella, rubeola, and varicella
also Hep A and B and infectious mononucleosis
Term
Acute lymphangitis
Definition
inflammation of one or more lymphatic vessels
causes = pathogenic organism
S/O data = enlarge lymph nodes, pain, mailaise, possible fever, minor trauma to the skin distal to the area of infection, red streak in skin following course of lymphatic collecting duct, sometimes indurated and palpable to gentle touch
Term
Acute suppurative lymphadenitis
Definition
infection and inflammation of a lymph node; may affect a single or localized group of nodes
causes = group A beta-hemolytic streptococci and coagulase-positive staphylococci (most common), actinomycotic adenitis (from dental disease), mycobacteria (in presence of TB infection), pasteruella multocida infection (from dog or cat bite), systemic viral infections
S/O data = enlarged lymph nodes may be firm, tender and painful, overlying skin appears red within 72 hours
Term
mycobacterial adenitis
Definition
characterized by inflammation without warmth that may or may not be slightly tender (from TB infection)
Term
Lymphedema (pathophys, S/O data)
Definition
edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage
causes:
primary = hypoplasia and maldevelopment of lympatic system (more common in females)
secondary = acquired damage to regional lymph nodes (tumors, scar tissue, surgical removal of lymph nodes), filariasis (parasite)
S/O data = painless swelling of limb, gradual onset, may or may not pit, skin thickens and feels tougher than normal
Term
Grading of lymphedema
Definition
Stage 0 = latent or subclinical
Stage I = pitting may occur; early accumulation of fluid relatively high in protein content, subsides with limb elevation
Stage II = tissue fibrosis present; limb elevation does not relieve it; pitting may be present
Stage III = pitting is absent; trophic skin changes are present (acanthosis, fat deposits and warty overgrowths)
Term
Lymphangioma/cystic hygroma
Definition
congenital malformation of dilated lymphatics
cause = failure of complete development of lymphatic system
S/O data = commonly found in neck, painless cystic mass, usually seen in 1st year of life (enlarged after URI), asymptomatic when in the back but can cause decreased respiratory function when in the front; compressible spongy fluid-containing mass without discrete margins
Term
Lymphatic filariasis (elephantiasis)
Definition
massive accumulation of lymphedema throughout the body; most common cause of secondary lymphedema worldwide
causes = filarial worms (wucheria bancrofti and grugia malayi = transmitted by mosquitoes)
S/O data = swelling of limb or body area, may be asymptomatic or may see fever, chronic pulmonary infection and progressive lymphedema
Term
Non-Hodgkin Lymphoma
Definition
malignant neoplasm of the lymphatic system and reticuloendothelial tissues
occur most commonly in lymph nodes of chest, neck, abdomen, tonsils, and skin
most arise in B-cell; rest occur in T-cells
S/O data = painless enlarged lymph nodes, fever, weight loss, night sweats, abdominal pain or fullness, family hx common, nodes may be matted in posterior cervical triangle, nodes usually well defined and solid
**cannot distinguish these condition from those of Hodgkins disease through PE alone
Term
Hodgkin Disease
Definition
Malignant lymphoma
causes = unknown etiology; EBV most likely involved
spreads to other lymph nodes, spleen, liver and bone marrow
occurs often in the yong and in people older than 50 y old (more common in males)
Most often stars in B-cells located in lymph nodes in the neck area
S/O data = painless enlarged cervical lymph nodes in post triangle (matted and firm, almost rubbery), abdominal pain, sometimes fever, hx of mono, usually asymmetric, nodal size may be fluctuate
Term
Epstein-Barr Virus Mononucelosis
Definition
infectious mononuecleosis
incubation period = 30-50 days
S/O data = malaise, fatigue, acute or prolonged fever, headache, sore throat, nausea, abdominal pain and myalgia
prodromal period = 1-2 weeks
generalized lymphadenopahty (epitrochlear nodes are especially suggestive of mono), hepatomegaly, splenomegaly (2-3cm below costal margin), pharyngitis with tonsilar enlargement, petechiae at junction of the hard and soft palate
Term
Toxoplasmosis
Definition
zoonosis, caused by parasite Toxoplasma gondii
causes = ingestion or inhalation of oocysts in soil/fomites, undercooked meat or raw eggs, cat feces or litter
infection persists for life without signs of disease, can cause neuologic disease in immunocompromised pt and congenital infection in pregnant women
S/O data = no significant symptoms, single node is chronically enlarged and nontender (usually in the post cervical chain)
Term
Roseola infantum (HHV-6)
Definition
infection by human herpes virus 6
common in infancy with peak age of acquisition at 2 years
virus present in saliva and passed to children; can stay dormant and produce recurrent infections
S/O data = fever (usually high grade over 3-4 days), sometimes associated with respiratory illness and lymphadenopathy (with tenderness = involves occipital and postauricular chains), when fever diminishes = morbilliform fine maculopapular rash occurs (spreads from trunk to extremities)
Term
Herpes Simplex (HSV)
Definition
infection of human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2)
HSV-1 = transmitted by oral secretions; predilection for oropharyngeal infection
HSV-2 = transmitted by genital secretions and causes mainly genital infection
HSV causes lytic infection of fibroblasts and epithelial cells, and establishes latent infection in neurons
S/O data = burning, itching lesions, may have enlargement of the anterior cervical and submandibular nodes (movable and tender)
Term
Cat scratch disease
Definition
A common cause of subacute or chronic lymphadenitis in children
caused by Baronella henselae (most common) and B. quintana or Afipia felis; usually following a bite or scratch from a kitten or cat
S/O data = inoculation lesion (papule or pustule lasts 3-5 days then becomes vasicular and crusts in 2-3 days); painful enlarged lymph nodes; nodes large, tender, red and occasionally suppurate (pus forming)
Term
HIV/AIDS
Definition
S/O data = enlarged lymph nodes (generalized lymphadenopathy), more prolonged clinical latent period in children
Term
Serum Sickness (Type III hypersensitivity reaction)
Definition
serum sickness is an immune complex disease
causes = antigen
S/O data = enlarged lymph nodes, pain pruritus and erythematous swelling at the injection site, urticaria, rash, joint pain, fever and facial edema
medication that cause it = Beta-lactam antibiotics, sulfonamide, antibiotics, minocycline
symptoms become apparent 7-10 days following administration of substance, symptoms subside slowly, recurring at times over several weeks
Term
Latex Allergy Type IV dematitis (delayed hypersensitivity)
Definition
Allergic contact dermatitis caused by latex products
S/O data = allergy to cross-sensitizing foods (banana, avocado, potato, tomato, kiwi); skin reaction usually begins 24-48 hours after contact, vesicular lesions, erythema, rxn may progress to oozing skin blisters
Term
Latex Allergy Type I Reaction
Definition
true allergic reaction to latex
caused by protein antibodies (IgE) to latex
S/O data = allergy to cross-sensitizing foods; local urticaria, generalized urticaria with angioedema, asthma, eye/nose itching and GI symptoms, anaphylaxis
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