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Questions and Answers
When assessing a patient for lymphatic system impairment, which region is often referred to as the 'thoracic inlet'?
When assessing a patient for lymphatic system impairment, which region is often referred to as the 'thoracic inlet'?
What is the primary goal of clear treatment objectives in a patient with SD affecting the lymphatic system?
What is the primary goal of clear treatment objectives in a patient with SD affecting the lymphatic system?
Which structures may be affected by SD, leading to reduced biomechanical efficiency and increased tension?
Which structures may be affected by SD, leading to reduced biomechanical efficiency and increased tension?
What is the purpose of palpating additional regional and local tissues after assessing terminal lymphatic drainage sites?
What is the purpose of palpating additional regional and local tissues after assessing terminal lymphatic drainage sites?
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What is the result of reduced biomechanical efficiency and increased tension in the corresponding muscular and connective tissue structures caused by SDs?
What is the result of reduced biomechanical efficiency and increased tension in the corresponding muscular and connective tissue structures caused by SDs?
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What is the term used to describe the region that includes the tentorium cerebelli?
What is the term used to describe the region that includes the tentorium cerebelli?
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What is the primary focus of treatment principles for SD affecting the lymphatic system?
What is the primary focus of treatment principles for SD affecting the lymphatic system?
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What is the purpose of assessing terminal lymphatic drainage sites?
What is the purpose of assessing terminal lymphatic drainage sites?
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Which structures are palpated to assess the presence of congestion and excess fluid in the interstitial tissues?
Which structures are palpated to assess the presence of congestion and excess fluid in the interstitial tissues?
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What are clear treatment objectives the foundation of in a patient with SD affecting the lymphatic system?
What are clear treatment objectives the foundation of in a patient with SD affecting the lymphatic system?
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Study Notes
Lymphatic Circulation
- Lymph is transported along the system of vessels by muscle contractions and valves prevent lymph from flowing backward.
- The lymphatic vessels are punctuated at intervals by small masses of lymph tissue called lymph nodes, which remove foreign materials such as infectious microorganisms from the lymph filtering through them.
Lymphatic Trunks
- There are two large lymphatic trunks: the right lymphatic duct and the thoracic duct.
- The right lymphatic duct drains the upper right portion of the body, returning lymph to the bloodstream via the right subclavian vein.
- The thoracic duct drains the rest of the body into the left subclavian vein.
Lymphatic Vessels
- Lymph capillaries:
- Have one-way mini-valves allowing excess fluid to enter but not leave.
- Pick up bacteria and viruses as well as proteins, electrolytes, and fluid.
- Are absent in bones, bone marrow, teeth, and CNS.
- Lymphatic collecting vessels:
- Are similar to blood vessels (3 layers), but thin and delicate.
- Superficial ones in skin travel with superficial veins.
- Deep ones (in trunk and digestive viscera) travel with deep arteries.
- Drain into superficial and deep lymph nodes.
Thymus Gland
- Has an asymmetrical flat shape, with a lobular structure.
- The lobules are comprised of a series of follicles, which have a medullary and cortical component.
- Cortical portion:
- Located peripherally within each follicle.
- Largely composed of lymphocytes, supported epithelial reticular cells.
- Medullary portion:
- Located centrally within each follicle.
- Contains fewer lymphocytes than the cortex, and an increased number of epithelial cells.
- Hassall's corpuscles:
- Are present in the medullary portion.
- Are concentric arrangements of epithelial reticular cells.
- Their function is unclear.
Blood Supply and Vein Drainage of the Thymus Gland
- The arterial supply to the thymus gland is via the anterior intercostal arteries and small branches from the internal thoracic arteries.
- Venous blood drains into the left brachiocephalic and internal thoracic veins.
Spleen
- Is an organ located in the upper left abdomen and is roughly the size of a clenched fist.
- Functions mainly as a blood filter, removing old red blood cells.
- Also plays a role in both cell-mediated and humoral immune responses.
- Is located in the upper left quadrant/left hypochondriac region of the abdomen, under cover of the diaphragm and the ribcage, and therefore cannot normally be palpated on clinical examination (except when enlarged).
Blood Supply and Vein Drainage of the Spleen
- Arterial supply to the lingual tonsil is largely via the lingual artery, with contributions from the tonsillar branch of the facial artery and the ascending pharyngeal artery.
- Venous drainage is via the dorsal lingual branch of the lingual vein.
Pharyngeal Tonsil
- Refers to a collection of lymphoid tissue within the mucosa of the roof of the nasopharynx.
- When enlarged, it is also known as the adenoids.
- Is located in the midline of the nasopharynx and forms the superior aspect of Waldeyer's Ring.
Blood Supply and Vein Drainage of the Pharyngeal Tonsil
- Receives arterial supply from several vessels:
- Ascending palatine artery
- Ascending pharyngeal artery (external carotid)
- Pharyngeal branch of the maxillary artery
- Tonsillar branch of the facial artery
- Venous drainage is via numerous small veins which pierce the superior constrictor muscle to empty into the pharyngeal plexus.
Tubal Tonsils
- Refer to lymphoid tissue around the opening of the Eustachian tube in the lateral wall of the nasopharynx.
- Form the lateral aspect of Waldeyer's Ring.
- Arterial supply is chiefly via the ascending pharyngeal artery and venous drainage is to the pharyngeal plexus.
Palatine Tonsils
- Are commonly referred to as "the tonsils".
- Are located within the tonsillar bed of the lateral oropharynx wall.
- Form the lateral part of Waldeyer's Ring.
Indications and Contraindications
- Indications:
- Upper respiratory infections
- Sinusitis
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Atelectasis
- Pneumonia
- Bronchitis
- Otitis
- Pharyngitis
- Gastrointestinal infections
- Crohn's disease
- Colitis
- Liver cirrhosis
- Chronic hepatitis
- Nephrotic syndromes
- Pancreatitis
- Uterine fibromas
- Uterine contractions
- Premenstrual syndrome
- Endometriosis
- Cystitis
- Contraindications:
- Anuria (if the patient is not receiving dialysis)
- Necrotizing fasciitis (localized inflammation in the affected area)
- Uncooperative or unwilling patients
- Acute asthma exacerbation
- Unstable cardiac conditions
- Cancer (immune system activation vs. suppression)
Diagnostic Principles
- Fluid pumps ascertain whether any of these muscular, fascial, and/or membranous regions have restricted physiologic motion.
- The regions assessed include:
- The supraclavicular fossa region (often referred to by DOs as the "thoracic inlet")
- The thoracoabdominal diaphragm
- The pelvic diaphragm
- The cranial dura membranes, particularly the tentorium cerebelli (which DOs consider to be a "cranial diaphragm")
Treatment Principles
- Clear treatment objectives are the foundation of an efficient and successful treatment plan for SD that impairs optimal lymphatic system function.
- These therapeutic objectives will direct the practitioner toward the best course of action for each patient, including the application of OMT to support optimal lymphatic system function.
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Description
This quiz covers the circulation of lymph through the lymphatic system, including the formation of lymphatic trunks and their connection to veins. Topics include the right lymphatic duct and thoracic duct.
