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Download Chapter 9 Lymphatic System The lymphatic system is examined
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Chapter 9 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. Physical Examination Preview 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: Size Consistency Mobility Discrete borders or matting Tenderness Warmth Anatomy and Physiology Lymphatic system consists of: 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 Anatomy and Physiology (Cont.) 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 Immunologic and Metabolic Processes 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 Lymph Composition Clear fluid Mostly white blood cells (WBCs) Occasional red blood cells (RBCs) Proteins Lymph (Cont.) 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 Lymph (Cont.) 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 Located superficially and deep in body Superficial nodes accessible to inspection and palpation 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 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 Thymus (Cont.) Essential to the development of the protective immune function Site for T-cell production 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 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 Peyer Patches Small, raised areas of lymph tissue on the mucosa of the small intestine Consist of many clustered lymphoid nodules Serve the intestinal tract 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. 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 Pregnant Women (Cont.) Embryo is an in utero foreign body. Mother’s hormones and the products of the fetal trophoblast create a unique environment. Older Adults 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 History of Present Illness History of Present Illness Enlarged node(s) Character Associated local symptoms Associated systemic symptoms Predisposing factors Medications History of Present Illness (Cont.) Swelling of extremity Unilateral or bilateral, intermittent, duration Predisposing factors Associated symptoms Efforts at treatment and effect Past Medical History Chest radiographs Tuberculosis and other skin testing Blood transfusions Chronic illness Surgery Recurrent infections Autoimmune disorders Allergies Family History Malignancy Anemia Recent infections Tuberculosis Immune disorders Hemophilia 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) 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 Pregnant Women Weeks of gestation Exposure to rubella and other infections Presence of pets in household Exposure to cat feces or litter Older Adults Presence of an autoimmune disease Present or recent infection or trauma distal to nodes Delayed healing Examination and Findings Equipment Centimeter ruler Marking (skin) pencil Inspection and Palpation Disorders of the lymph system have three physical signs: Enlarged lymph nodes (lymphadenopathy) Red streaks in the skin (lymphangitis) Lymphedema Inspection Lymph nodes Edema Erythema Red streaks Skin lesions Palpation Detect and note Enlargement Consistency Mobility Tenderness Size Warmth 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 Head and Neck Head sequence Occipital nodes at skull base Postauricular nodes over mastoid Head and Neck (Cont.) Head sequence (Cont.) 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 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 Other Areas Axillae Epitrochlear lymph nodes Inguinal and popliteal lymph nodes Spleen 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. Abnormalities 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 Abnormalities (Cont.) Lymphedema Edematous swelling due to excess accumulation of lymph fluid in tissues caused by inadequate lymph drainage Abnormalities (Cont.) Lymphangioma/cystic hygroma Congenital malformation of dilated lymphatics Lymphatic filariasis (elephantiasis) Massive accumulation of lymphedema throughout the body Most common cause of secondary lymphedema worldwide Epstein-Barr virus mononucleosis Infectious mononucleosis Abnormalities (Cont.) Non-Hodgkin lymphoma (NHL) Malignant neoplasm of the lymphatic system and the reticuloendothelial tissues Hodgkin disease Malignant lymphoma Toxoplasmosis Zoonosis, caused by the parasite Toxoplasma gondii Abnormalities (Cont.) Roseola infantum (HHV-6) Infection by human herpes virus-6 Herpes simplex (HSV) Infection by human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2) 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 Serum sickness (type III hypersensitivity reaction) Immune complex disease Abnormalities (Cont.) Latex allergy type IV dermatitis (delayed hypersensitivity) Allergic contact dermatitis that involves the immune system and is caused by the chemicals used in latex products Latex allergy type I reaction True allergic reaction caused by protein antibodies Question 1 Which of the following is the function of the thymus in early life and young children? A. Protective immune function B. Drain lymph from the chest C. Destroying old white blood cells D. Filtering mechanism for white blood cells Question 2 Which of the following organs does NOT have lymphatic vessels? A. Brain B. Kidneys C. Liver D. Lungs Question 3 Small, clustered lymphoid nodules that are raised areas of lymph tissue are called: A. Adenoids B. Thymus C. Peyer patches D. Spleen Question 4 Lymph ducts merge into the venous system at the: A. Portal vein B. Pulmonic vein C. Subclavian veins D. Vena cava Question 5 Enlarged, painful lymph nodes, firm and tender, with mild edema, caused by group A betahemolytic streptococci is: A. Acute suppurative lymphadenitis B. Lymphatic filariasis C. Lymphangioma D. Lymphedema