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The Lymphatic System B&S CHAPTER 16.

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1 The Lymphatic System B&S CHAPTER 16

2 The Lymphatic System Can be considered a supplement to the circulatory system The lymphatic system is different from the circulatory system in that it has no muscular pump or heart (just like the veins) and lymph fluid travels in only one direction: from the body organs to the heart. Lymph fluid does not flow continually through vessels forming a closed circular route The Lymphatic system contains lymph, lymph vessels, lymph nodes, tonsils, Thymus, and spleen

3 Remember in circulation…
Blood travels throughout the body and returns to the heart via the inferior and superior vena cava The blood carries nutrients, water, waste, O2, electrolytes and bunches of other stuff As the blood flows around the body, it drops off waste to be filtered out of the kidneys and liver (through the hepatic portal system), it continues to carry “stuff” to cells also, that lie in tissues. Tissues get juicy and full of liquid and “stuff” Another system carries fluids out of the tissues through the filtering lymph nodes and on out to a large vein that dumps into the heart

4 Functions of the Lymph System
1. Drains protein containing tissue fluid (interstitial fluid) back to the heart 2. Transports fats from lacteals digestive tract and eventually through the heart which will flow out of the heart and to the blood 3. Produce lymphocytes – (needed for fighting infection) 4. Develops immunities

5 Lymphatic System Lymphatic capillaries – these tiny vessels are in addition to blood carrying capillaries, they drain excess fluid that doesn’t return to the blood, but it goes directly to the heart Remember, tissue gets juicy and filled with nutrients but what will help get rid of all of the liquid so the person doesn’t get too edematous? The lymph system  The lymphatic system is sort of its own fluid and waste carrying system separate from the veins and arteries, but it makes it’s exchange of fluids and wastes initially, in the capillary exchange area


7 A Straw… There are no ends of the lymph system that actually attach to the veins or arteries therefore… Waste and nutrients just float on over from capillaries into the surrounding tissue where they get juicy and the closed ended lymph vessels pick up all of the juice and nutrients and carry it away

8 Lymph fluid Is straw colored fluid, similar in composition to blood plasma Lymph fluid bathes the surrounding spaces between tissue cells and it is referred to as interstitial fluid or tissue fluid Lymph fluid is made up of water, lymphocytes, granulocytes, O2, digested nutrients, hormones, salts, CO2 and urea

9 Lymph Fluid is… Collected from body tissues, lymph seeps into lymphatic vessels across the vessel’s thin walls Lymph acts as an intermediary between the blood in the capillaries and the tissues. It carries digested food, O2 and hormones to cells It carries metabolic waste products like CO2 and urea wastes away from the cells and back into capillaries for excretion

10 Lymph Before the lymph reaches veins near the right side of the heart, it flows near through a series of filters called the lymph nodes where bacteria and other foreign particles are trapped and destroyed It’s sort of a system like the hepatic portal system, stuff makes its way through theses vessels to get filtered and then continues back to the heart

11 Lymphatic Circulation
One-way system Begins in tissues Ends in veins near the heart

12 How does the Lymph System work as a pump
Contractions of skeletal muscles against lymph vessels cause the lymph to surge forward into larger vessels The breathing movements of the body also cause lymph to flow Valves located along the lymph vessels prevent backward lymph flow

13 What do lymphatic capillaries look like
They are made up of one layer of flattened (squamous) epithelial cells, this allows for easy passage of soluble materials and water There are gaps between these endothelial cells in the lymphatic capillaries that are larger than those of the blood capillaries to allow for easier entrance of proteins and other relatively large suspended particles

14 Lymphatic Capillaries
Begin “blindly” meaning they are closed at one end and DO NOT serve to bridge two larger vessels One end lies within a lake of tissue fluid and the other end communicates with a larger lymphatic vessel that transports the lymph toward the vein that leads to the heart

15 Lacteals We learned about lacteals in digestion
Lacteals are specialized lymphatic capillaries which act as a pathway for the transfer of digested fats into the bloodstream just like the villi act as a pathway for nutrients into the blood



18 Location Lymphatic vessels lie superficial or deep
They are named according to their location:

19 Names Mammary lymphatic vessels: located in the breast
Femoral lymphatic vessels: located in the thigh Tibial lymphatic vessels: located in the legs

20 Upper extremities All lymphatic vessels form networks and at certain points, they carry lymph into the regional nodes closest to where the node originates from For example: all lymph from the upper extremities and breast pass through the axillary lymph nodes and all of the lower extremities pass through the inguinal nodes

21 2 terminal vessels Lymphatic vessels carry lymph away from the regional nodes and eventually drain into one of two terminal vessels: Right lymphatic duct Thoracic duct Receives lymph from the drains the rest of Right side of the head, neck, the body thorax, right extremity, it Enters into the right subclavian


23 Right Lymphatic Duct This duct receives only lymph that comes from the upper right quadrant of the body such as: right side of head, neck and thorax as well as the right extremity These all drain into the right subclavian

24 Thoracic Duct Is larger than the right lymphatic duct because it drains the whole rest of the body’s lymph juice from the: Left head, chest, abdomen, pelvis and both legs

25 Thoracic Duct Is attached to part of the diaphragm
The 1st part of the duct is enlarged to form a “cistern” or temporary storage pouch called the “cisterna Chyli” CHYLE – (kile) is a milky fluid formed by a combo of fat and lymph that comes from the intestinal lacteals

26 Chyle Passes through intestinal lymphatic vessels and lymph nodes of the mesentary and finally goes to its holding place known as the cisterna chyle All of the lymph juice below the diaphragm enters into the cisterna chyle by way of various clusters of lymph nodes and then makes its way to the thoracic duct and into the heart

27 To get all of the lymph fluid from the upper body down to the heart, the jugular lymphatic vessels from the head and neck, left subcalvian vessels and other vessels in the thorax enter into the left subclavian vein


29 Movement of lymph fluid
Remember, there is no pump to push this fluid back to the heart. It works the same way as the veins to get blood back to the heart Valves keep it going one way, muscles contract to push fluid, pressure in the thorax from breathing pushes the fluid too

30 Lymph Tissue and Lymph Nodes
Our body is filled with lymph tissue that makes up specialized organs of the lymph system (tonsils, thymus, spleen)

31 Lymph tissue’s functions:
Removes impurities like Carbon particles, cancer cells, dead blood cells and pathogenic organisms This junk is sent to the lymph nodes where phagocytosis from macrophages, destroy the junk The making of lymphocytes is done in lymph tissue, this is needed to make antibodies to combat infection and other foreign invaders

32 Lymph Nodes Lymph nodes may be compared to the oil filter in an automobile

33 Lymph Nodes They are designed to filter the lymph once it is drained from the tissues Lymph nodes are small, rounded masses varying from pinhead size up to 1 inch Lymph nodes have fibrous connective tissue capsules

34 Lymph Nodes Are usually massed together in groups varying from 2 or 3
to over 100 Some of these grps. of nodes are super-ficial and some are deep

35 Inside the lymph node There are masses of lymphatic tissue which contain: Lymphocytes Macrophages WBC’s active in immunity


37 Hilus Serves as an exit for lymphatic vessels carrying lymph fluid out of the node At the hilus, blood vessels and nerves connect with the node

38 Main Groups of Nodes In the Body
Cervical Nodes: located deep in the neck, these drain various parts of the head and neck. These often become enlarged during upper resp. infections Axillary Nodes: located in the armpits, may become enlarges after infections of the upper extremities and the breasts. Cancer cells from the breast often metastasize (spread) to axillary nodes


40 Main Groups of Nodes In the Body
Tracheobronchial: nodes are found near the trachea and around the larger bronchial tubes. People living in highly polluted areas have these nodes that are filled with carbon particles that are solid black masses resembling pieces of coal

41 Main Groups of Nodes In the Body
Mesenteric Nodes: these are found between 2 layers of peritoneum that form the membrane around the intestines called the mesentary. There are 100 to 150 of these nodes

42 Main Groups of Nodes In the Body
Inguinal Nodes: located in the groin region, these receive lymph drainage from the lower extremities and from the external genital organs. When they are enlarged, they are referred to as “buboes” (bu-bose), from which Bubonic plague got its name

43 Biopsy or removal Any lymph node can be biopsied or removed if necessary

44 The Tonsils These are masses of lymphoid tissue that are oval shaped and are located at each side of the soft palate These are also called “palatine tonsils” In adults, removal of tonsils causes lots of bleeding and leads to hemoptysis


46 Pharyngeal tonsil (Adenoids)
Commonly called adenoids, means “glandlike” These are located behind the nose on the back wall of the upper pharynx These can be removed also (adenoidectomy)

47 Infection of the tonsils
Either of these tonsils can become loaded with bacteria and they may be removed (tonsillectomy) Drs. Believe that strep throat of at least 5xs in one season calls for the removal of the tonsils


49 Tonsils and immunity Tonsils function in immunity during childhood. They filter tissue fluid and they produce lymphocytes and monocytes and contain macrophages that eat up pathogens that get through Drs. Try and not remove them if possible Tonsils in children are bigger than in adults d/t body size

50 T&A If a pt is having their tonsils out, they will probably have their adenoids out as well, this is referred to as a T&A This can be done out-patient unless pt has sleep apnea, pt stays overnight to watch for swelling and complete closure of airway What pieces of equip. are needed for this pt?

51 The Thymus Located in the upper thorax beneath the sternum
The thymus plays a key role in the development of the immune system before birth the 1st few months of infancy


53 The Thymus Produces a hormone called Thymosin that helps with the development and maturation of lymphocytes called “T-cell lymphocytes” T-cell lymphocytes promote the growth and activity of lymphocytes to fight infection The thymus is most active during early life After puberty, the thymus shrinks in size and is replaced with connective tissue and fat.

54 The Spleen The spleen is designed to filter blood and hold RBC’s as a storage unit The spleen is located in the upper left hypochondriac region of the abdomen high up under the dome of the diaphragm

55 The spleen Is protected by the lower part of the rib cage
The spleen is soft and purple and somewhat flat measuring about 5-6 inches long and 2-3 inches wide The spleen has an elastic capsule which contains involuntary muscle which allows the spleen to contract and to withstand some swelling

56 The spleen Has an unusually large blood supply
The spleen is filled with large pulp so it can filter out worn-out RBC’s The spleen houses phagocytes to engulf bacteria and other foreign invaders The spleen contains prominent masses of lymphoid tissue

57 101 things the spleen can do…
Cleanses the blood by filtration and phagocytosis Destroys old worn-out RBC’s Produces RBC’s before birth Serves as a reservoir for blood which can later be returned to the bloodstream in case of hemorrhage or other emergency

58 Splenectomy To surgically remove the spleen
Usually is well tolerated by pts The spleen is the largest of the lymph tissues, once removed, other lymph tissue can take over its function The body has thousands of lymphoid units and when one unit is removed, this in not a problem for the body

59 Reticuloendothelial System
This system contains cells throughout the body that remove impurities This system is concerned with the destruction of worn-out blood cells, bacteria, cancer cells and other harmful substances

60 The WBC’s The WBCs included in this reticuloendothelial system are the monocytes These are very big WBC’s that are formed in the bone marrow and circulate into the bloodstream and to various other parts of the body

61 When WBC’s enter into tissue…
They develop into macrophages which mean “big eaters” Other WBC’s and macrophages are given other names…

62 Kupffer’s Cells Are found in the lining of the liver in blood channels
Other cells are found in spleen, bone marrow, lymph nodes, brain, and in the lungs. The ones in the lungs care called “dust cells” because they ingest solid particles that enter the lungs

63 Other names for this widely distributed protective system are:
Tissue macrophage system Mononuclear phagocytic system Monocyte-macrophage system These names describe the types of cells found in this system

64 Disorders of the Lymphatic System and Lymphoid Tissue
Lymphangitis - inflammation of the lymph vessels Usually begins in the region of an infected and neglected injury and is seen as red streaks extending along an extremity This type of sign indicates that bacteria have spread into the lymphatic system

65 Lymphangitis – (vessel)

66 Septicemia If the lymph nodes are not able to stop the infection, pathogens may enter the blood stream and cause this blood poisoning. Usually the bug is streptococci

67 Lymphadenitis This is inflammation of lymph nodes, they become enlarged and tender This condition reflects the body’s attempt to combat infection There are several types of lymphadenitis…

68 Types of lymphadenitis
1. Cervical lymphadenitis - d/t measles, scarlet fever, septic sore throat, diptheria and the common cold 2. Chronic Lymphadenitis – may be d/t the bacillus that causes TB 3. Infections of the upper extremity - cancer of the mammary glands can cause enlarged axillary nodes. Infections of external genitals can cause enlarged inguinal lymph nodes.

69 Lymphedema Edema d/t obstruction of lymphatics or the lymph system
Or after a mastectomy

70 Lymphadenopathy This is the term meaning disease of the lymph nodes
Enlarged lymph nodes are seen as an early sign of infection especially with HIV (human immunodeficiency syndrome)

71 Infectious Mononucleosis
Is an acute viral infection which has a classic symptom of having enlarged cervical lymph nodes Mono is seen in college students Lymph nodes are commonly referred to as “glands”…people say they have swollen glands TRUTH: they DO NOT produce secretions and therefore, they are not glands

72 Splenomegaly Enlargement of the spleen Seen in scarlet fever, typhus
fever, typhoid fever and syphilis Many tropical parasitic diseases cause splenomegaly Blood flukes seen in Japan and Asia cause splenomegaly

73 Splenic Anemia Characterized by: enlargement of the spleen
Hemorrhages from the stomach Accumulation of fluid in the abdomen Usually, a splenectomy is the cure for such problems above

74 Lymphoma Any benign or malignant tumor that occurs in lymph tissue
There are 2 examples: Hodgkin’s Disease Non-Hodgkin’s Disease

75 Hodgkin’s Disease Chronic, malignant disorder
Seen in men more than women Characterized by enlarged lymph nodes of the neck, armpit, thorax and groin The spleen becomes enlarged as well Chemo and radiation is the treatment Prognosis is usually good because the Dr. knows what kind of Lymphoma it is

76 Non-Hodgkin’s Lymphoma
Is more common than Hodgkin’s Seen more in older adults Enlarged cervical lymph nodes is an early sign They don’t know what type of Hodgkin’s it is and the prognosis is usually poor and runs rampant, pt dies quickly

77 Elephantiasis Is a GREAT enlargement of the lower extremities resulting from blockage of lymphatic vessels by small worms called “filariae” (fi-LA-re-e) Filariae are parasites carried by insects such as flies and mosquitoes that invade the tissues as embryos or immature forms They then grow in the lymph channels and block the flow Such edema causes swelling of the scrotum, legs causing the victim to become incapacitated Thid disease is seen in Asia and some of the Pacific islands NO CURE IS KNOWN

78 Elephantiasis

79 The End

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