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Chapter 9
Lymphatic System
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Lymphatic System
• The lymphatic system is examined region
by region during the examination of the
other body systems and by palpating the
spleen, an integral part of the system.
• Sometimes you may examine the entire
lymphatic system at once, exploring all the
areas in which the nodes are accessible.
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Lymphatic System
• Inspect the visible nodes and surrounding area for the
following characteristics:
– Edema
– Erythema
– Red streaks
• Palpate the superficial lymph nodes and compare side to
side for the following:
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–
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Size
Consistency
Mobility
Discrete borders or matting
Tenderness
Warmth
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Anatomy and Physiology
• Lymphatic system consists of:
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Lymph fluid/collecting ducts
Lymph nodes
Spleen
Thymus
Tonsils and adenoids
Peyer patches
• Lymph tissue located in multiple body
systems, including the mucosa of the
stomach, appendix, bone marrow, and lungs
– Exceptions: placenta and CNS
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Anatomy and Physiology (Cont.)
Figure 9-01. Lymphatic System (Lymphoreticular System).
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Immune System
• Function
– Protects body from antigenic substances
– Removes damaged cells
– Partial barrier to malignant cell maturation
• When it functions well, the individual is
immunocompetent
– Tissue rejection of transplanted organs
• When it fails, immunoincompetence can lead to a
variety of illnesses
– Allergic
– Immunodeficient
– Autoimmune
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Immunologic and Metabolic
Processes
•
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Movement of lymph fluid in a closed circuit
Production of lymphocytes
Production of antibodies
Phagocytosis
Absorption of fat and fat-soluble substances
Manufacture of blood when primary sources
compromised
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Lymph
• Composition
–
–
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Clear fluid
Mostly white blood cells (WBCs)
Occasional red blood cells (RBCs)
Proteins
• Drainage
– Moves from bloodstream to interstitial spaces
• No built-in pumping mechanism
– Collected by tubules/ducts
– Carried to lymph nodes
– Moved to venous system
• Subclavian veins
– Closed but porous circulation
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Lymph Nodes
• Discrete structures surrounded by a
capsule composed of connective tissue
and a few elastic fibrils
• Usually occur in groups
• Receive lymph from the collecting ducts
• Usually occur in groups
• Receive lymph from the collecting ducts
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Lymphocytes
• Central to body response to antigens
• B-lymphocytes produce antibodies
• T-lymphocytes have important role in controlling
immune responses brought about by Blymphocytes
• Two types of immunity
– Humoral
– Cellular
• Increased presence in blood indicates systemic
response to most viral and some bacterial
infections
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Thymus
• Located in the superior mediastinum,
extending upward into the lower neck
• Primary function in infancy and childhood
– Little or no demonstrated function in adult
• Essential to the development of the
protective immune function
• Site for T-cell production
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Spleen
• Situated in the left upper quadrant of the
abdominal cavity
• Blood-forming organ early in life
• Site for red corpuscle storage
• Contains blood-filtering macrophages
• Immune response to bloodborne antigens;
usually has its origins in the spleen
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Tonsils and Adenoids
• Palatine tonsils
– Commonly referred to as the “tonsils”
• Pharyngeal tonsils
– Commonly referred to as the “adenoids”
• Lingual tonsils
– Located at the base of the tongue
• Defensive responses to inhaled and
intranasal antigens are activated in these
tissues
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Infants and Children
• Antibody production is immature at birth.
• Thymus is at its largest relative to the rest
of the body shortly after birth.
• Tonsils are larger in early childhood.
• Lymph node distribution is same as in
adults.
• Lymphatic system gradually reaches adult
competency during childhood.
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Pregnant Women
• Pregnancy is a state of altered immune
function
– Implantation and fetal development
• Enhancement of certain immune
mechanisms and suppression of others
• Leukocyte count increases
• Embryo is an in utero foreign body.
– Mother’s hormones and the products of the
fetal trophoblast create a unique environment.
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Older Adults
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•
•
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Number of lymph nodes may diminish.
Size of lymph nodes may decrease.
Some of the lymphoid elements are lost.
Nodes of older patients are more likely to
be fibrotic and fatty.
– Impaired ability to resist infection
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History of Present Illness
• Enlarged node(s)
– Character
– Associated local symptoms
– Associated systemic symptoms
– Predisposing factors
– Medications
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History of Present Illness
(Cont.)
• Swelling of extremity
– Unilateral or bilateral, intermittent, duration
– Predisposing factors
– Associated symptoms
– Efforts at treatment and effect
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Past Medical History
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Chest radiographs
Tuberculosis and other skin testing
Blood transfusions
Chronic illness
Surgery
Recurrent infections
Autoimmune disorders
Allergies
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Family History
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Malignancy
Anemia
Recent infections
Tuberculosis
Immune disorders
Hemophilia
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Personal and Social History
• Travel, especially to Asia, Africa, the
Western Pacific, India, the Philippines
• Use of recreational drugs, especially
injected
• Use of alcohol
• Sexual history (risk factors for HIV
exposure)
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Infants and Children
• Recurrent infections
• Present or recent infections or trauma
distal to nodes
• Poor growth, failure to thrive
• Loss of interest in play or eating
• Immunization history
• Maternal HIV infection
• Hemophilia
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Pregnant Women
• Weeks of gestation
• Exposure to rubella and other infections
• Presence of pets in household
– Exposure to cat feces or litter
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Older Adults
• Presence of an autoimmune disease
• Present or recent infection or trauma distal
to nodes
• Delayed healing
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Equipment
• Centimeter ruler
• Marking (skin) pencil
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Inspection
• Lymph nodes
– Lymphadenopathy
• Edema
– Lymphedema
• Erythema
• Red streaks
– Lymphagenitis
• Skin lesions
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Palpation
• Detect and note
– Enlargement
– Consistency
– Mobility
– Tenderness
– Size
– Warmth
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Palpation (Cont.)
• Node characteristics
– The harder the node, the more likely the
malignancy
– The more tender the node, the more likely
inflammation
– Nodes do not pulsate; arteries do
– A palpable supraclavicular node on the left is
a clue to abdominal or thoracic malignancy
• Virchow node
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Head and Neck
• Head sequence
– Occipital nodes at skull base
– Postauricular nodes over mastoid
– Preauricular node in front of ear
– Parotid/tonsillar nodes at mandible angle
– Submandibular nodes between angle and
tip of mandible
– Submental nodes behind mandible tip
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Head and Neck (Cont.)
• Neck sequence
– Superficial cervical nodes at
sternocleidomastoid
– Posterior cervical nodes along anterior
trapezius
– Cervical nodes deep to sternocleidomastoid
– Supraclavicular areas in angle of clavicle and
sternocleidomastoid
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Other Areas
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Axillae
Epitrochlear lymph nodes
Inguinal and popliteal lymph nodes
Spleen
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Infants and Children
• Technique of examination is similar for all ages.
• Enlarged lymph nodes are common.
– Enlarged postauricular/occipital not unusual in
children younger than age 2
– Enlarged cervical/submandibular less frequent in
children younger than age 1, much more frequent in
children older than age 1
– Enlarged tonsils common, not necessarily abnormal
• Enlargement may not be associated with illness.
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Abnormalities
• Acute lymphangitis
– Inflammation of one or more lymphatic
vessels
• Acute suppurative lymphadenitis
– Infection and inflammation of a lymph node
– May affect a single or localized group of
nodes
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Abnormalities (Cont.)
• Lymphedema
– Edematous swelling due to excess
accumulation of lymph fluid in tissues caused
by inadequate lymph drainage
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Abnormalities (Cont.)
• Lymphatic filariasis (elephantiasis)
– Massive accumulation of lymphedema
throughout the body
– Most common cause of secondary
lymphedema worldwide
• Epstein-Barr virus mononucleosis
– Infectious mononucleosis
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Abnormalities (Cont.)
• Non-Hodgkin lymphoma (NHL)
– Malignant neoplasm of the lymphatic system
and the reticuloendothelial tissues
• Hodgkin disease
– Malignant lymphoma
• Herpes simplex (HSV)
– Infection by human herpes virus 1 (HSV-1) or
human herpes virus 2 (HSV-2)
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Abnormalities (Cont.)
• Cat scratch disease
– Among the most common causes of subacute
or chronic lymphadenitis in children
• AIDS (acquired immune deficiency
syndrome)
– Dysfunction of cell-mediated immunity
• Latex allergy type I reaction
– True allergic reaction caused by protein
antibodies
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