Download Chapter 9 Lymphatic System The lymphatic system is examined

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