Term
| if you have a sympathetic reaction that causes vasoconstriction in the vasculature, will this also affect the lymphatics? |
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Definition
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Term
| what might happen with chronic sympathetic constriction of the lymphatics? |
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Definition
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Term
| what is the lowest pressure system? |
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Definition
| lymphatics - much more easily restricted |
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Term
| why does constriction of the lymphatics bode poorly for chronic inflammation? |
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Definition
| lymphatics carry large proteins, high molecular weight waste products that are pro-inflammatory and if they stay around that area has much greater chance to become inflamed or have deleterious effects |
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Term
| what was hippocrates (460 BC) contribution to this topic? |
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Definition
| hippocrates described the ebb and flow of the blood through the veins and arteries |
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Term
| what was galens (129-216 AD) contribution to this topic? |
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Definition
| galens promoted the theory of blood flowing though pores in the heart |
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Term
| what was harvey's (1578-1657) contribution to this topic? |
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Definition
| harvey solved the mystery of blood flow via experiments w/deer |
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Term
| why is atherosclerosis not usually seen in pulmonary circulation? what might lead to this? |
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Definition
| the lung arterial system is a low pressure circuit. mitral stenosis and L->R shunts can lead to this condition |
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Term
| what kind of murmur is mitral stenosis? |
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Definition
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Term
| what kind of murmur is mitral regurgitation? |
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Definition
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Term
| how much smooth muscle do true capillaries have? |
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Definition
| none - they have no way to control excess pressure other than a small muscle - the precapillary sphincter |
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Term
| what does high capillary pressure result in? |
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Definition
| edema - fluid passes out of the capillaries and into the interstitial space. capillaries are fragile and damaged easily, generally they are the reason bruises form |
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Term
| what is raynaud's syndrome? |
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Definition
| a severe change in peripheral circulation of the hands/feet etc. it involves some sypathetic stimulation (peripherally mediated), but is mainly a *vasospastic disorder of the digital vessels* |
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Term
| how should people with raynauds be treated? |
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Definition
| you want to make sure that they have a good range of motion in the upper throacics, that their thoracic inlet is open, lympatic drainage is OK, and that tissue texture changes are taken care of |
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Term
| what is the color change in raynaud's? |
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Definition
| progressive color change from white to blue to red |
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Term
| what syndrome can raynauds be a part of? |
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Definition
| progressive systemic sclerosis (PSS/scleroedema), which used to be called CREST syndrome (Calcinosis, Raynauds, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) |
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Term
| what are the 2 designations of raynauds? |
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Definition
| primary (vasomotor, female, stress, all digits, no edemea/ischemia) and secondary (M/F, later onset, no stress, no ischema, common edema, no other vasomotor syndromes) |
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Term
| are there cardiac and skin effects associated with sclerodema? |
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Definition
| yes, cardiac: conduction defects, supra-ventricular arrhythmias, skin: progressive fibrosis |
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Term
| what are radiographic findings for pulmonary scleroedema? how would this appear on a CXR? |
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Definition
| prominent at lung base, fine/coarse reticulations, diffuse interstitial infiltrates, formation of subpleural fibrocystic spaces (honeycombing, progressive volume loss, and lack of pleural involvement) - vital capacity changes (less excursion of the rib cage - so do techniques that may improve costal excursion patterns/range of motion). on a CXR, this would appear as flattening/thickening of periphery |
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Term
| what is scleroderma defined as? |
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Definition
| a chronic autoimmune disease characterized by fibrosis (or hardening), vascular alterations, and autoantibodies |
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Term
| where is the sympathetic innervation coming from that controls vasoconstriction? |
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Definition
| T2-7 in the upper extremities, T9-L3 in the lower extremities |
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Term
| how would a pt with hypersympathetic tone in one leg appear on a IR scan? |
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Definition
| hypersympathetic leg - cooler |
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Term
| if for example a SD was named F SRRR, what side will the real dysfunction be on? |
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Definition
| the L side, b/c SDs are named for the direction they are free in |
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Term
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Definition
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Term
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Definition
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Term
| where is sympathetic innervation for the heart? |
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Definition
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Term
| what is one essential function of the lymphatics beyond the immune system? |
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Definition
| its ability to carry large proteins/particulate matter away from tissue spaces (neither of which can be removed by absorption directly into the blood capillary) - we would die w/in 24 hrs w/out this |
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Term
| what does the RIGHT lymphatic duct drain? the LEFT (thoracic)? |
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Definition
| RIGHT lymphatic duct: the head, R arm, heart and lungs. the LEFT (thoracic): everything else |
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Term
| what is the mnemonic for the vessels at the hip? |
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Definition
| NAVEL (nerve, artery, vein, empty space, lymphatics) |
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Term
| if someone has lymphedema in their legs, where are places to look in terms of tx? |
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Definition
| the NAVEL area, involving the psoas muscle and the popliteal fossa, involving the upper portion of the gastrocnemius muscle down to the talar tibial area |
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Term
| what are the causes of primary lymphedema? |
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Definition
| inherited problem with development of lymph vessels (usually affects women in the legs), milroy's disease (congenital malformation of the lymph nodes), meige disease (lack of backflow valves), and late-onset lymphedema (after age 35) |
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Term
| what are causes of secondary lymphedema? |
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Definition
| sx, radiation tx, CA (if cells block lymph), infection (via infiltration or parasites), and injury (damage to nodes or vessels) |
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Term
| how do mud frogs hibernate? |
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Definition
| their heart stops, but they have a lymph pump that keeps going |
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Term
| how much of total body weight does the lymphatic system comprise? what is this divided into? |
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Definition
| 3% this is divided into lymph tissues, collecting ducts, and the lymph fluid |
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Term
| what are the first, second and third circulatory systems? |
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Definition
| first- CV, second- lymph, third- CSF = all blend in venous return |
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Term
| what are the 2 systems for fluid (and accompanying RBCs, HCO3, metabolites, toxins, and proteins) removal? what happens if these systems don't function correctly? |
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Definition
| 2 systems: venous and lymphatic - if they cease to work - you can get a very pro-inflammatory situation, where the HMW proteins are in the interstitial space, pulling the fluid out of the central space and into the 3rd space |
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Term
| what is *normal interstital fluid pressure? |
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Definition
| -6.5mm HG (if increased to 0mm Hg, fluid flow increases 20x) |
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Term
| what is the extracellular matrix surrounded by? |
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Definition
| interstitial fluid, in what is known as the 3rd space |
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Term
| what does the loose ECM support? what if there are collagenous or fibrotic changes? |
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Definition
| lymphatics; if changes - the lymph flow can be disrupted |
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Term
| how does the single cell overlap of the terminal/collecting lymph vessels support their function? |
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Definition
| the cells overlap with the ability to open to either direction, depending on the vessel vs interstitial pressure ratio |
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Term
| if someone has low fluid pressure in their vasculature, what might be low on bloodwork? |
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Definition
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Term
| what are the anchoring filaments? |
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Definition
| these pull/hold the fenestrations open when the capillary is not full - and as fluid pressure accumulates - the fenestrations close |
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Term
| can lymphatic stimulation help with pts post mastectomy/radiation? |
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Definition
| yes - this should improve collateralization |
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Term
| what does the right lymphatic duct drain? |
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Definition
| the R side of the head and neck, the R arm, the R chest -> heart and lung |
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Term
| what is the R lymphatic duct composed of? |
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Definition
| a merger of the R jugular trunk of the R subclavian and the R transverse cervical trunks - usually 2-3 separate openings (only one duct in 20% of pts) |
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Term
| what does the left lymphatic duct drain? |
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Definition
| the L side of the head and neck, the L arm, the L thorax, and the rest of the body bilaterally |
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Term
| where does the L lymphatic duct terminate? |
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Definition
| at the junction between the L subclavian and the L brachiocephalic veins |
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Term
| what is the function of the lymphatic system? |
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Definition
| maintaing fluid balance in the body, purification and cleansing of the tissues, nutrition, and defense |
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Term
| what % of the plasma proteins and salts return to circulation via the lymphatics? why is this so important? |
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Definition
| 50% - they may bind with important nutrients needed in other areas |
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Term
| what is the "lymph of the brain"? |
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Definition
| CSF - which communicates with lymph |
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Term
| what is the total flow of lymph through the body in one day? |
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Definition
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Term
| what does diffusion through the cell walls to the intra-cellular matrix depend on? |
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Definition
| the hydrostatic pressure gradient at the cell membrane, the osmolar gradients in the intra and extracellular fluid, the molecular weight of diffusable materials, and the intra/extracellular electrical potentials |
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Term
| what are the goals of OMM lymphatic treatment? |
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Definition
| activate fluid circulation, drain toxins, assist tissue regeneration, stimulate immune function, and diminish sympathetic tone |
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