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Lymphatics
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104
Medical
Professional
09/07/2013
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Term
blood vessels and lymphatic system
common embryologic network
T or F
 Definition
T
Term
blood vessels and lymphatic system
Separate during development
T or F
 Definition
T
Term
2 main functions of lymphatics
 Definition
maintain homeostasis
immunologic role
Term
role of blood vessels
 Definition
deliver nutrients and immune cells to tissue
Term
role of lymphatic system
 Definition
collect extravasted fluid
filter lymph
return it to circulation
Term
how lymphatic system maintains homeostasis
 Definition
assist CV with fluid ( 2 L/day), transport fats from SI to veins
Term
Immunologic role of Lymphatic systems
 Definition
filter, develop/deliver antibodies
reduce/ eliminate foreign agents
Term
the path of lymph from intestines to liver
 Definition
via thoracic duct--> veins-> liver
Term
lacteals
 Definition
lymphatic vessels found in the intestine
Term
chyle
 Definition
lymph fluid
Term
Primary lymph organs (2)
 Definition
red bone marrow (mostly flat bones)
thymus
Term
Secondary Lymph organs (3)
 Definition
Lymph nodes
Spleen
Lymphatic nodules ( pharyngeal Tonsils)
Term
Lymph system
 Definition
thin walled endothermic cells
from small to big, form large vessels
1* have one way valves
Term
primary lymph valves
one way or two way?
 Definition
one way valves
Term
lymphatic vessels consist of (2)
 Definition
endothelium and smooth muscle
Term
collecting lymphatics are similar top
 Definition
small veins
Term
larger vessels one valve or two valves?
why?
 Definition
have secondary valves
restrict retrogate movement of lymph
Term
where are lymphatic nodes located?
 Definition
along the path of collecting lymphatics
Term
large lymphatic vessels ultimately drain into what?
 Definition
right and left subclavian vein
Term
the pathway of the lymph
 Definition
lymphatic capillaries-> collecting channels->Pre-nodal collecting vessel->lymph node-> post-nodal collecting vessel-> lymphatic ducts-> venous system
Term
Lymphatic capillaries are also known as
 Definition
terminal or primary lymphatics
Term
post-nodal collecting vessel is also known as
 Definition
effrent trunk
Term
pre-nodal collecting vessel is also known as
 Definition
afferent trunk
Term
trunks of collecting vessels return lymph into
 Definition
venous system
Term
Superficial Lymph System drains what? (2)
 Definition
skin (not epidermis)
musculoskeletal structures
located in groups
Term
Superficial Lymph System travel tough what to reach muscle
 Definition
fascia
Term
Deep Lymph System drains what? (4)
 Definition
thorax
abdomen
pelvis
perineum
Term
How does the movement of the lymph progresses?
hint: similar to venous system
 Definition
form peripheral tissues ->
midline of the body->toward
the cervicothoracic junction
Term
How does interstitial fluid get into the lymph capillary?
 Definition
“Complex and not well understood”
Term
How does interstitial fluid get into the lymph capillary?
 Definition
hydrostatic gradient
oncotic gradient
mechanical forces
Term
hydrostatic gradient
 Definition
due to water
Term
oncotic gradient
 Definition
a form of osmotic pressure exerted by proteins
Term
mechanical forces (5)
 Definition
*Local arterial pulsations
*vasomotion
*alveolar expansionns
*musculoskeletal compressions upon lymph vessels
*passive motion of the extremities
Term
Role of the respiratory diaphragm on
lymph fluid flow
 Definition
Breath in-> diaphragm descends
into the abdominal cavity increasing the
pressure in the intra-abdominal space
causing the interstitial fluid to flow into the
terminal vessel
Term
diaphragm works similar to a p _ _ _ _ _ _
 Definition
Piston :)
Term
Role of the respiratory diaphragm on
lymph fluid flow on a alveolar level
 Definition
upon inhaliation alveolar sacs are
expanded causing external mechanical
pressure on surrounding pleural lymph
nodes
Term
% of lymph fluid derived from abdominopelvic fluid
 Definition
50%
Term
KNOW THIS!
 Definition
PROPER RESPIRATORY FUNCTION
IMPROVES EFFICIENCY OF
LYMPHATIC SYSTEM!!
Term
lymph fluid is composed of (4)
 Definition
f.a.
fats
chyle
immune cells
Term
Lymph Capillary cells
 Definition
•Single layer of non-fenestrated (no
window in cell) endothelial cells, overlap
•Incomplete basement membrane
•Lack tight junctions – therefore are
permeable to large particles and
proteins
• Lack smooth muscle
Term
One way permeability of lymphatic capillaries
 Definition
fluid goes in but not out
Term
Collecting Vessel is also known
 Definition
Lymphangion
Term
Initial or terminal lymphatic ends at the
 Definition
first bicuspid valve
marks the beginning of lymphagion or prenodal collecting vessel
Term
Pre-nodal collecting vessels
 Definition
– Drain superficial capillary network
– Transport lymph to regional nodes
(via afferent vessels)
Term
lymph capillaries (primary) don't have, and
pre-nodal (secondary) collecting vessels have
 Definition
smooth muscle
Term
smooth muscle in pre-nodal collecting vessels allows for what?
 Definition
intrinsic contractile properties
and coordinated flow
Term
3 phases that pre-nodal collecting vessels go trough
 Definition
Filling Phase (8 sec); Contraction
Phase (1 sec); Refractory Period (1
sec)
Term
lymphatic Fluid Influx is also known as
 Definition
Expansion Phase
Term
Lymphatic Fluid Propulsion is also known as
 Definition
Compression Phase
Term
Events happening during Expansion Phase
 Definition
Hydrostatic P in the interstitium >> P inside initial lymphatic
Result: microvalves open, fluid enters
Term
Events happening during Compression Phase
 Definition
P inside initial lymphatic>> Hydrostatic P in the interstitium
Result: microvalves close, secondary lyphtaic valves open, fluid goes downstream
Term
Lymph nodes act as filters or traps for
foreign particles such as
 Definition
– Bacteria
– Viruses
– Cancer cells
Term
Lymph nodes have these 3 structures
 Definition
Afferent Lymph Vessels
Efferent Lymph Vessels
Cortex
Term
Cortex of a lymph node
 Definition
is a Fibrous Capsule Extends inward to form trabeculae
also has
Germinal Center
Inner Medulla
Term
Afferent Lymph Vessels of a lymph node
 Definition
Enter the cortex thru the
capsule, bring lymph to the node
Term
Efferent Lymph Vessels of a lymph node
 Definition
Exit at the Hilum with the
artery and veins, drains the lymph down
Term
Cysterna Chyli is known as
 Definition
Collecting “reservoir”
Term
Cysterna Chyli Drains into
 Definition
the Thoracic Duct
Term
Cysterna Chyli is located
 Definition
the level of second lumbar vertebrae (L2)
Term
Cysterna Chyli Collects lymph from
 Definition
Intestinal and Lumbar Trunks
from the lower body; perineum and
abdominal cavity
Term
Lymphatic Ducts (2)
 Definition
Thoracic Duct
Right Lymphatic Duct
Term
Properties of Lymphatic Ducts
 Definition
-thin walled
-have smooth muscle
-secondary vessels
-have organized lymphangions
-demonstrated to be under SNS control
Term
Thoracic Duct drains lymph from (L)
 Definition
• Left head and neck
• Left arm
• Left thorax (partial left lung)
• cysterna chyli
Term
Thoracic Duct empties lymph into
 Definition
left internal jugular and subclavian
veins (variations)
Term
Right Lymphatic Duct Drains lymph from
 Definition
from the right upper
extremity, right side of head, neck
and chest, right lung
Term
Right Lymphatic Returns lymph into
 Definition
the veins at the right subclavian vein
Term
Movement of Lymph Rate
 Definition
10 mm/sec
Term
Movement of Lymph Dependent upon
 Definition
– Local interstitial hydrostatic pressures and extracellular membrane strain
– Intraluminal and interstitial oncotic pressures
– Iintrinsic cc of lymphangion smooth muscle
– External compressive forces
Term
Causes of Flow disturbance (Local)
 Definition
Interstitial fluid
pressures
– ECM strain
Term
Causes of Flow disturbance (Systemic)
 Definition
– Intrinsic
• Contraction of the
lymphangion smooth
muscles
– Extrinsic
• External forces acting on
the lymph vessels
– Local cardiopulmonary
pressures
– Venous stasis
Term
superficial nodes of the neck and head
 Definition
Preauricular
Posterior auricular
Occipital
Submandibular
Submental
Superficial Cervical
Anterior Cervical
Posterior Cervical
Deep Cervical
Supraclavicular
Term
amount of lymph pass through
Thoracic Duct per day
 Definition
2-5 L
Term
liters plasma leak per day
 Definition
20-30 L that beocmes ISF

 2 – 5 L of lymph pass through
Thoracic Duct per day
Term
% of ISF reabsorbed by veins ___, and lymph
 Definition
90% veins
10% lymph capillaries
Term
Lymph Capillaries no smooth muscle so to pump
 Definition
no intrinsic propulsion
Depend on extrinsic forces for propulsion
Term
Collecting vessels fun facts
 Definition
Unidirectional flow
From periphery to the central vascular
system
funnelshaped valves
Lymphangion
Term
Thoracic Duct
 Definition
Largest lymph vessel
Begins at approx. L2
Passes thru diaphragm
within the aortic hiatus
Empties into venous system
at the juncture of the left
internal jugular vein and the
left subclavian vein
Term
Right Lymphatic Duct drains
 Definition
 Right head
 Right neck
 Right chest and lung
 Right upper extremity
 Drains lymph back to the CV
system at juncture of the right
internal jugular vein and the right
subclavian vein
Term
Specialized Lymph organs
 Definition
Pharyngeal tonsils
Thymus
Spleen
Term
Tissues WITHOUT Lymphatics
 Definition
All vascularized tissue except:
 Central Nervous System/Brain
 Bone
 Bone Marrow
 Maternal Placenta
 Endomyceum around m. fibers
Term
how brains get lymphatic drainage
 Definition
Tracers injected into grey matter:
Vessel pulsations: driving force for the lymphatic drainage along artery walls
Term
Tissues WITHOUT Lymphatics
 Definition
NON-Vascularized Tissues do not have
lymphatics:
Cartilage
Lens of the eye
Cornea of the eye
Epidermis
Inner portion of the wall of blood
vessels
Term
Tissues WITHOUT Lymphatics (5)
 Definition
NON-Vascularized Tissues do not have
lymphatics:
Cartilage
Lens of the eye
Cornea of the eye
Epidermis
Inner portion of the wall of blood
vessels
Term
Crura tendon of the diaphragm
 Definition
Act as pump for cysterna chylie
may obstruct flow when tense
Term
Diaphragm as Sponge absorbs fluid from (
 Definition
peritoneal/ pelvic cavity
pleurar cavity
pericardial cavity
posterior body wall lower extremity
lower extremity
Term
stomata of the diaphragm
 Definition
little holes inside the diaphragm, helps to absorb fluid
NO gas regulates their opening
possibly drain to thoracic duct cysterne chyle
Term
Lymphatics of the lung (conflicting findings)
 Definition
there are no lymph vessels deep in the pulmonary artery , other studies suggest that there might be ...
Term
GI track Lymphatics
 Definition
lymphoid tissue, found in lamina along GI
Gut associated lymphoid tissue
mucosa-associated lymphoid tissue)
Term
GI: Colon Lymph Drainage
 Definition
Cisterna Chyle-> Thoracic duct
Term
Clinical Considerations - IBD
 Definition
lymph obstruction and/or dysfunction
Term
Gentiourinary (GU) System/ Reproductive Organs
 Definition
external and internal iliac nodes-> lumbar/ aortic acsending vessles to cyterne chyle
Term
Urinary Tract
 Definition
the kidney-> hilium of k.->renal vein->*upper ureters (lumbar/aortic nodes)
>*lower ureters-> internal/external iliac nodes-> aortic/lumbar nodes
all to Csiterna Chyle and Thoracic duct
Term
Pancreas and Spleen
 Definition
from collecting vessles to Splenic, Celiac, Superior mesenteric
Term
Pancreatitis
 Definition
evidence of fibrosis w/ obliteration of lymphatics
Term
Functional Cells of Lymph System
 Definition
T cells (recognize non-self)
B cells (recognize non-self)
NK cells
Term
Exercise Effect on Lymphatic System
 Definition
increase T and B cells
increase natural killer cells
risk of cancer goes down
Term
Lymphedema
 Definition
lymphatic obstruction
localized fluid retention
tissue swelling
lymph accumulates in the IT
usually affects legs
Term
Primary vs Secondary
Lymphedema
 Definition
Primary
-genbetic
Secondary
-acquired, caused by compressed lymphatics
Term
Stages of Lymphedema (3)
 Definition
Stage 1:
Pressing the swollen limb leaves a pit
Described as “pitting edema”
Can be reversible as there is only small amount of fibrosis
Elevation of extremity can reduce swelling
Stage 2:
Edema does not pit upon manual pressure
Elevation of extremity does not help
Can become fibrotic
Stage 3:
Also called: Elephantiasis
Typically the lower extremities
Irreversible
Term
What are the consequences of edema? (4)
 Definition
Compression of tissues
Neural
Vascular lymphatic
Compromised nutrition
Changes in tissue and organ function
Changes in medical management
Term
Other conditions that contribute to secondary lymphedema
Mechanical Conditions
 Definition
Kyphoscoliosis
Poor posture
Gravity
Decreased respiration
Abdominal or thoracic surgery
Pregnancy
Term
Peripheral Pump Manipulation for lymphatic movement (5)
 Definition
Direct pressure (massage; fascial release)
Body movements (exercise)
Diaphragmatic movement (restore breathing mechanics)
Anti-Gravity (elevate extremity)
Osteopathic Manipulation
Term
How does manipulation facilitate lymph drainage and healing?(7)
 Definition
Releases mechanical barriers
Increases fluid reabsorption, relieve congestions
Decreases proteins in the interstitium
Increases circulation
Improves respiration and diaphragm mechanics
PH changes with increased oxygenation
Improve visceral response to stress
Term
Sequence of Treatment
Techniques - Lab
 Definition
1) Superior Thoracic Inlets
2) 2 – 3 Thoracic Techniques
3) 2 – 3 Abdominal Techniques
4) 2 – 3 Extremity Techniques
5) Entire Cervical Sequence of
Techniques
6) Repeat 2 Thoracic Techniques
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