The Lymphatic and Immune Systems

The Lymphatic and Immune Systems
Chapter 6

Overview Lymph – lmyph/o Lymphatic Vessels and Ducts – lymphangi/o
Lymph Nodes – lymphaden/o Tonsils and Adenoids – tonsill/o, adenoid/o Spleen – splen/o Bone Marrow – myel/o Lymphocytes – lymphocyt/o Thymus – thym/o Immune System – immun/o

Objectives Identify the medical specialist who treat disorders of the lymphatic and immune systems Describe the major functions and structures of the lymphatic and immune systems Recognize, define, spell, and pronounce the major terms related to the pathology, diagnostic and treatment procedures of the lymphatic and immune systems Recognize, define, spell and pronounce terms related to oncology

Introduction The lymphatic and immune systems work hand in hand to protect and maintain the health of the body Roles and functions can are performed by specialized or shared structures; additional roles are played by other body systems

Medical Specialties

Allergist – specializes in diagnosing and treating conditions of altered immunologic reactivity, such as allergic reactions Immunologist – specializes in dx and tx disorders of the immune system Oncologist – a physician who specializes in dx and tx malignant disorders such as tumors and cancer

Functions of the Lymphatic System

Performs 3 primary functions in cooperation with other body systems
Absorbing fats and fat-soluble vitamins from the small intestine Removing waste from tissues Providing aid to the immune system

Absorption of Fats and Fat-Soluble Vitamins
Food is digested in the small intestine and from here nutrients, fat, and fat-soluble vitamins are absorbed Villi (small finger-like projections) contain blood vessels that absorb most of the nutrients from the digested food directly into the blood stream. Fats and fat-soluble vitamins that cannot be absorbed are transported by the lymphatic system

Waste Removal from the Tissues
The lymphatic system removed waste products and excess fluids created by the cells Also destroys pathogens and takes away foreign substances that are present in the tissues

Cooperating with the Immune System
Lymph nodes play an active role in cooperation with the immune system to protect the body against invading microorganisms and disease.

Structures of the Lymphatic System

Lymphatic Circulation
Lymphatic Circulation – transports lymph from tissues throughout the body and eventually returns the fluid to venous circulation Differences in the two systems: Lymph flows in 1 direction; from point of origin to venous circulation in the region of the neck Lymph – clear, watery fluid that transports waste products and proteins out of the spaces between the cells of the body tissues; also destroys pathogens Lymph stays in lymphatic circulation until it goes into venous blood flow Lymphatic system doesn’t have a pumping mechanism to it Lymph vessels are closely aligned with those of the CVS, so it’s sometimes called the secondary circulatory system Lymph is clear Lymph is filtered by lymph nodes, not the kidneys

Interstitial Fluid and Lymph Creation
Interstitial fluid – intercellular or tissue fluid; is plasma from arterial blood that flows out of the capillaries and into the spaces between the cells; transports food, oxygen and hormones to cells About 90% of this fluid is reabsorbed, the 10% that is not becomes lymph

Lymphatic Capillaries Microscopic, blind-ended tubes located near the surface of the body; one cell in thickness allowing lymph to enter the capillary Lymphatic Vessels and Ducts Lymph flows from lymphatic capillaries to larger lymphatic vessels Right Lymphatic Duct – collects lymph from the R side of the head and neck, the upper R quad and the R arm. Empties into the R subclavian vein Thoracic Duct – the largest lymphatic vessel; collects from the L side of the face and neck, upper L quad, L arm and the entire lower trunk and both legs. Empties into the L subclavian vein

Lymph Nodes Small, bean-shaped nodes that are specialized lymphocytes that are capable of destroying pathogens There are between 400 and 700 lymph nodes located along the larder lymphatic vessels; appox ½ are in the abdomen Cervical Lymph Nodes – located along side the neck Axillary Lymph Nodes – located under the arms in the area known as the armpits Inguinal Lymph Nodes – located in the inguinal (groin) area of the lower abdomen

Additional Structures of the Lymphatic System
Lymphoid – pertaining to the lymphatic system The Tonsils – three masses of lymphoid tissue that form a protective ring around the back of the nose and upper throat Adenoids – nasopharyngeal tonsils; located in the nasopharynx Palatine Tonsils – located on the L and R sides of the throat in the area that is visible through the mouth Lingual Tonsils – located at the base of the tongue

The Thymus – located superior to the heart; made up of lymphoid tissue, it’s an endocrine gland that assists the immune system Peyer’s Patches and the Vermiform Appendix – work with the immune system to protect against the entry of pathogens Peyer’s Patches are located in the ileum (sm intestine) Vermiform Appendix hangs from the lower portion of the cecum (lg intestine)

The Spleen – a sac-like mass of lymphoid tissue located in the L upper quad, inf to the diaphragm and post to the stomach Filters microorganisms from the blood Forms lymphocytes and monocytes (specialized WBCs) Hemolytic – destroys worn-out RBCs; releases the hemoglobin for reuse Stores extra RBCs; maintains balance between RBCs and plasma

Pathology and Diagnostic Procedures of the Lymphatic System
Lymphadenitis – swollen glands; inflammation of the lymph nodes Lymphadenopathy – any disease process affecting a lymph node or nodes Lymphangioma – a benign tumor found by an abnormal collection of lymphatic vessels due to a congenital malformation of the lymphatic system

Splenomegaly – an abnormal enlargement of the spleen Splenorrhagia – bleeding from the spleen Lymphoscintigraphy – diagnostic test that is performed to detect damage or malformations of the lymphatic vessels

Lymphedema – swelling due to an abnormal accumulation of lymph fluid within the tissues Primary Lymphedema – a hereditary disorder due to malformation of the lymphatic system. Secondary Lymphedema – caused by damage to the lymphatic system that most commonly produces swelling in the limb nearest to the damaged vessels

Functions and Structures of the Immune System

Functions of the Immune System
The primary function of the immune system is to maintain good health and to protect the body from harmful substances including: Pathogens – disease-producing microorganisms Allergens – substances that produce allergic reactions Toxins – poisonous or harmful substances Malignant Cells – potentially life-threatening cancer cells Structures of the Immune System Unlike other body systems, the immune system is not contained within a singe set of organs or vessels. Its function depends on structures from several other body systems

The First Lines of Defense
Intact Skin – wraps the body in a physical barrier that prevents invading organisms from entering Respiratory System – traps breathed in matter with nose hairs and the moist mucous membrane lining or the resp system. The tonsils forma protective ring around the throat, and coughing and sneezing help expel the matter that gets through Digestive System – acids and enzymes produced by the stomach destroy invaders Lymphatic System – their structures and specialized WBCs work together to attack and destroy pathogens

The Antigen-Antibody Reaction
The immune reaction; involves binding antigens to antibodies The reaction labels potentially dangerous antigens so they can be recognized and destroyed Antigen – any substance the body regards as foreign Viruses, bacteria, toxins, transplanted tissue, etc. Allergen – a substance that produces an allergic reaction Antibody – a disease-fighting protein created by the immune system in response to the presence of a specific antigen; created specifically to destroy and specific antigen

The Antigen-Antibody Reaction
Immunoglobulins - bind with specific antigens. Produced by plasma cells (specialized WBCs that produce antibodies coded to destroy specific antigens) 5 Types Immunoglobulin G – most abundant; fight bacteria, fungi, viruses and foreign particles Immunoglobulin A – fight ingested antigens; found in saliva, sweat or tears and prevent antigens from attaching to the epithelial surfaces that line organs Immunoglobulin M – found in circulating body fluids; 1st responders Immunoglobulin E – produced in the lungs, skin and mucous membranes; responsible for allergic reactions Immunoglobulin D – found on the surface of B cells

Specialized Cells of the Antigen-Antibody Reaction
Lymphocytes – WBCs that are formed in bone marrow as stem cells Mature and differentiate into lymphoid tissues throughout the body B cells – B lymphocytes; specialized lymphocytes that produce and secrete antibodies Most effective against viruses and bacteria circulating in the blood When a B cell meets an antigen it is to destroy, to transforms into a plasma B cell, capable of producing a secreting antibodies that are coded to destroy specific antigens

Dendritic Cells – specialized WBCs that patrol the body searching for antigens that produce infection Grab, swallow and internally break apart the antigen Project off, like tentacles, the broken antigen to alert and activate the T cells to protect against that antigen

T cells – T lymphocytes; small lymphocytes that mature in the thymus Kill infected cells on contact Interferon – a family of proteins who fight viruses by slowing or stopping their multiplication Lymphokines – direct the antigen-antibody response by signaling between the cells of the immune system; they attract macrophages to the infection site Macrophage – the WBCs responsible for surrounding and killing invading cells Phagocyte – the large WBCs that destroy substnaces like debris, dust, pollen and pathogens by phagocytosis; surrounding and swallowing them!

Compliment A group of proteins that normally circulate in the blood in an inactive form Foreign cells, bacteria and antigens activate it It marks the invaders and attracts phagocytes to destroy them

Immunity The state of being resistant to a specific disease
Natural Immunity – passed from mother to fetus before birth Passive Immunity – passed from mother to child after birth through breast milk Acquired Immunity – Active Immunity; the production of antibodies by contracting an infectious disease or by vaccination against a disease (chicken pox vs HBV) Vaccination – immunization; provides protection for susceptible individuals from communicable diseases Done via vaccines – a prep containing an antigen; either whole or part of the dead or weakened antigen

Pathology and Diagnostic Procedures of the Immune System
A person’s immunity depends on 3 things: General health – poor health = compromised immune system Age – older individuals have more acquired immunity, but their immune systems tend to respond less quickly and effectively. Babies don’t have much acquired immunity. Heredity – genes and genetic disorders may affect the functioning of one’s immune system

Allergic Reactions Occur when the body’s immune system reacts to a harmless allergen as if it were a dangerous invader Allergy – hypersensitivity; an overreaction to a particular antigen Localized Allergic Response – cellular response; redness, itching and burning at contact site (think poison ivy) Systemic Reaction – Anaphylaxis; anaphylactic shock; a severe response to an allergen. Symptoms develop quickly and without medication, the patient can die within minutes

Allergic Reactions (cont’d) Scratch Test – a dx text to ID common allergens Antihistamine – medications to relieve or prevent the symptoms of hay fever, the common allergy to wind borne pollens, and other types of allergies work by preventing the effects of histamine, the substance that causes itching, sneezing, runny nose and watery eyes

Autoimmune Disorders Autoimmune disease ; any of a large group of diseases characterized by a condition in which the immune system produces antibodies against its own tissues

Immunodeficiency Disorders Occur when the immune system is compromised (weakened, absent, reduced or not functioning properly)

The Human Immunodeficiency Virus HIV; a bloodborne infection in which the virus damages the cells of the immune system, causing it to progressively fail; leaving the body at risk of developing many life-threatening opportunistic infections Opportunistic Infection – caused by a pathogen that does not normally produce an illness in healthy humans Acquired Immunodeficiency Syndrome – AIDS; most advanced, and fatal, stage of an HIV infection Kaposi’s Sarcoma – an ex of an opportunistic infection. A cancer causing patches of abnormal tissue to grown on the lining of the mouth, nose and throat

The Human Immunodeficiency Virus HIV ELISA – enzyme-linked immunosorbent assay; the blood test used to screen for the HIV antibodies Western Blot Test – produces more accurate test results than ELISA Done to confirm test results when ELISA is positive (ELISA can give a false-positive)

Treatment of the Immune System
Immunotherapy Disease tx that involves either stimulating or repressing the immune response Cancer – we would want to ?????? Allergies, autoimmune diseases we’d ?????

Antibody Therapy Synthetic Immunoglobulins – immune serum; used as post-exposure preventative measures against certain viruses Synthetic Interferon – used in the tx of multiple sclerosis, HCV, and some cancers Monoclonal Antibodies – any class of antibodies produced in the lab by identical offspring of a clone of specific cells

Immunosuppression – tx to repress or interfere with the ability of the immune system to respond to stimulation by antigens Immunosuppressant – a substance that prevents or reduces the body’s normal immune response Corticosteroid Drug – a hormone-like preparation administered primarily as an anti-inflammatory and as an immunosuppressant Cytotoxic Drug – a medication that kills or damages cells

Pathogenic Organisms

Bacteria They are one-celled microscopic organisms; most are not harmful to humans Bacilli – rod-shaped spore-forming bacteria Tetanus; cuts, open wounds Rickettsia – small bacterium that lives in lice, ticks, and mites Rocky Mountain Spotted Fever; infected ticks Spirochetes – spiral-shaped bacteria that have flexible walls and are capable of movement Lyme Disease; transmitted by an infected deer tick

Bacteria Staphyloccoci – a group of about 30 species of bacteria that form irregular groups or clusters resembling grapes Most are harmless and live normally on the skin and mucous membranes of humans Staphylococcus Aureus – a form of staphyloccoci that commonly infects wounds and causes serious problems such as toxic shock syndrome or produces food poisoning Streptococci – bacteria that form a chain Most are harmless; some can cause strep throat, meningitis, endocarditis, and necrotizing fasciitis

Bacteria Septic Shock A serious condition that occurs when an overwhelming bacterial infection affects the body Antibiotic Resistant Bacteria Antibiotic Resistant Bacteria – superbugs; develop when an antibiotic fails to kill all of the bacteria it targets The surviving bacteria become resistant to the particular drug (which is why we tell patients to FINISH THEIR PRESCRIPTION!!!) Methicillin-resistant Staphylococcus Aureus – MRSA; resistant to most antibiotics. The infection is serious, difficult to treat and may be fatal

Fungus, Yeast and Parasites
Fungus – a simple parasitic organism Tinea Pedis – athlete’s foot is a fungal infection commonly found on the feet and between the toes Yeast – a type of fungus Candidiasis – yeast infection or thrush; infections found on the skin or mucous membranes Parasite – a plant or animal that lives on, or within, another living organism at the expense of that organism Malaria – a disease caused by a parasite that lived in certain mosquitoes and is transferred to humans by the bite of an infected mosquitoe S&S: 7-14 days post bite, fever, shaking chills, HA, m aches and tiredness

Fungus, Yeast and Parasites
Toxoplasmosis – most commonly transmitted from animals (pets) to humans by contact with contaminated feces. Dangerous for pregnant women; abnormal child development. Pregnant women should not clean litter boxes or other animal feces

Viruses Very small infectious agents that live only by invading other cells; Invade cell, reproduces, then breaks free out the cell wall to infect other cells Viral Infections Herpes Zoster – shingles; an acute viral infection characterized by painful skin eruptions that follow an underlying route of an inflamed nerve Occurs when the dormant varicella (chickenpox) virus is reactivated later in life Infectious Mononucleosis – mono; caused by the Epstein- Barr virus. Characterized by fever, sore throat, and enlarged lymph nodes; splenomegaly or hepatomegaly may develop

Viruses Measles – a acute, highly contageous infection transmitted by respiratory droplets Causes high fever, runny nose, coughing, photophobia and a red, itchy rash over the entire body Mumps – an acute viral disease characterized by the swelling of the parotid glands (the salivary glands located just in front of the ears) Rubella – German measles or 3-day measles; a viral infection characterized by a low-grade fever, swollen glands, inflamed eyes and a fine pink rash Not long lasting or severe, could be dangerous to women in early pregnancy Measles, mumps and rubella vaccination (MMR) can prevent all three

Viruses Rabies – an acute viral infection that is most commonly transmitted to humans by the bite of saliva of an infected animal S&S usually show p the bite; Once symptoms develop, rabies is almost always fatal Varicella – chickenpox; caused by the herpese virus Varicella Zoster and is highly contagious Characterized by fever and a rash consisting of hundreds of itchy, fluid-filled blisters that burst and form crusts West Nile Virus – spread to humans by the bite of an infected mosquito. Mild form has flu-like symptoms, more severe can spread to the spinal cord and brain

Viruses Cytomegalovirus
A member of the herpesvirus family and causes a variety of diseases CMV is found in most bodily fluids and can be present as a silent infection (NO S&S!) Can potentially cause serious illness Can be transmitted from mother to unborn child causing serious congenital disabilities

Medication to Control Infections
Antibiotics – meds that are capable of inhibiting growth, or killing pathogenic bacterial microorganisms Bacteriocide – a substance that causes the deaath of bacteria Bacteriostatic – an agent that slows or stops the growth of bacteria Antifungal – an agent that destroys of inhibits the growth of fungi Antiviral Drug – used to treat viral infections or to provide temporary immunity

Oncology The study of the prevention, causes and tx of tumors and cancer

Tumors aka neoplasms; a growth that forms an abnormal mass
Can be either benign or malignant Benign Tumor – noncancerous growth Malignant Tumor – harmful, capable of spreading to distant body sites including other body systems, can become progressively worse and progressively life-threatening

Tumors Angiogenesis – the process through which the tumor supports its growth by creating its own blood supply (angi/o = vessel; – genesis = reproduction) Antiangiogenesis – a form of tx that disrupts this blood supply to the tumor

Cancer Cancer – a class of diseases characterized by the uncontrolled division of cells and the ability of these cells to invade other tissues, either by invasion through direct growth into adjacent tissue or by spreading into distant cites by metastasizing Metastasize – the process by which cancer spreads from one place to another Metastasis – a new cancer site that results from the spreading process

Cancer Carcinomas – a malignant tumor that occurs in the epithelial tissue (epithelial, if you forgot, is the protective lining for all internal and external surfaces of the body) Tend to infiltrate and produce metastases that can affect any organ or part of the body Carcinoma in Situ – describes a malignant tumor in its original position that has not yet disturbed the surrounding tissues

Cancer Sarcoma – malignant tumor that arises from connective tissues, including hard tissues, soft tissues and liquid tissues Hard Tissue Sarcomas – arise from bone or crtilage Soft Tissue Sarcomas – arise from tissues such as muscle, connective tissues such as tendons, blood and lymphatic vessels, nerves and fat Liquid Tissues Sarcomas – arise from blood and lymph

Hard Tissue (osteosarcoma) Soft Tissue

Staging The process of classifying how far the disease has progressed, the potential for its responding to therapy and the patent’s prognosis

Lymphomas Lmyphoma – a general term applied to malignancies affecting lymphoid tissues Hodgkin’s Lymphoma – Hodgkin’s disease; distinguishable from other lymphomas by the presence of large, cancerous lymphocytes known as Reed-sternberg cells Non-Hodgkin’s Lymphoma – the term used to describe all lymphomas other than Hodgkin’s lymphoma

Breast Cancer A carcinoma that develops from the cells of the breast and can spread to adjacent lymph nodes and other body sites Ductal Carcinoma in Situ – breast cancer at its earliest stage before the cancer has broken through the wall of the milk duct (nearly 100% curable at this stage) Infiltrating Ductal Carcinoma – starts in the milk duct, breaks through the wall of that duct and invades the fatty breast tissue

Breast Cancer Infiltrating Lobular Carcinoma – cancer that starts in the milk glands (lobules), breaks through the wall of the gland and invades the fatty tissue of the breast Inflammatory Breast Cancer (IBC) – the most aggressive and least common form of breast cancer. Grows rapidly and symptoms include pain, rapid increase in the breast size, redness or rash on the breast and the swelling of nearby lymph nodes. Male Breast Cancer – can occur in the small amount of breast tissue that is normally present in men Similar types to those occurring in women

Breast Cancer Detection of Breast Cancer
Breast Self-examination – an essential self- care procedure for the early detection of breast cancer Checking for any new lump or changes in existing lump, shape of the nipple, or the skin covering the breast Professional Palpation of the Breast – performed to feel texture, size and consistency of the breast Mammography – a radiographic examination of the breasts to detect the presence of tumors or precancerous cells

Breast Cancer Detection of Breast Cancer
Surgical Biopsy – the removal of a small piece of tissue for examination to confirm or establish a diagnosis Needle Breast Biopsy – a technique in which an x-ray- guided needle is used to remove a small sample of tissue from the breast Sentinel-node Biopsy – [sentinal node is the 1st lymph node to come in contact with cancer cells as they leave the organ of origination]; after the sentinel lymph node has been identified, only this and the other affected nodes are removed for biopsy Lymph Node Dissection – a surgical procedure in which all of the lymph nodes in a major group are removed to determine or slow the spread of cancer

Breast Cancer Surgical Treatment of Breast Cancer
Lumpectomy – the surgical removal of only the cancerous tissue and a surrounding margin of normal tissue Mastectomy – the surgical removal of the entire breast and nipple Often includes the removal of axillary lymph nodes under the adjacent arm Modified Radical Mastectomy – the surgical removal of the entire breast and all of the axillary lymph nodes under the adjacent arm Radical Mastectomy – the surgical removal of an entire breast and many of the surrounding tissues

Cancer Treatments Surgery – removing the malignancy plus a margin of normal surrounding tissue May also remove one or more nearby lymph nodes to detect whether the cancer has started to spread Chemotherapy – the use of chemical agents and drugs in combinations selected to destroy malignant cells and tissues Chemoprevention – the use of natural or synthetic substances such as drugs or vitamins to reduce the risk of developing cancer or to reduce recurrence Antineoplastic – medication that blocks the development, growth or proliferation of malignant cells

Cancer Treatments Radiation Therapy – used in the tx of some cancers with the goal of destroying the cancer while sparing healthy tissues Brachytherapy – the use of radioactive materials in contact c, or implanted into, the tissues to be treated Teletherapy – radiation therapy administered at a distance from the body Additional Therapies Adjuvant Therapy – used after the primary treatments have been completed to decrease the chance that cancer will recur Targeted Therapy – a developing form of anti-cancer drug therapy that uses drugs or other substances to ID and attack specific can cells w/o harming normal cells

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