Berkowitz

Front 1

Name the four parts of lymphatic functional anatomy.

Back 1

1. Lymphatic capillaries
2. Collecting tubules
3. Lymphatic trunks
4. Collecting ducts

Front 2

3 features of lymphatic capillaries

Back 2

1. blind endothelial tubes
2. fibers runfrom endo. cells into extracellular matrix, preventing collapse of leaky vessels
3. large pores pass proteins

Front 3

name the 7 lymphatic trunks

Back 3

Intercostal, Mediastinal, Jugular, Gastric, Subclavian, External iliac, Internal iliac, (I'M Just Gay, or So Everyone Insists!)

Front 4

Chest wall and pleura drained by?

Back 4

Intercostal

Front 5

thoracic viscera drained by?

Back 5

Mediastinal

Front 6

Head and neck drained by?

Back 6

jugular

Front 7

arms drained by?

Back 7

subclavian

Front 8

legs drained by?

Back 8

external iliac

Front 9

Pelvis drainewd by?

Back 9

internal iliac

Front 10

liver, spleen, stomach, pancreas drained by?

Back 10

gastric

Front 11

name a dilated saccule at the beginning of the thoracic duct

Back 11

cysterna Chyli

Front 12

cysterna chyli drains all lymphatic fluid from?

Back 12

lower extremeties, pelvis, abdomen

Front 13

what does the thoracic duct drain?

Back 13

cysterna chyli, left head and neck, left arm, and left lung

Front 14

the right thoracic duct drains what?

Back 14

right head and neck, right arm, right thorax, heart and pericardium

Front 15

largest lymphatic in the body?

Back 15

thoracic duct

Front 16

what prevents backflow in the lymphatics?

Back 16

valves

Front 17

what regulates the peristalisis of the larger lymphatics ducts?

Back 17

layer of smooth muscle innnervated by the sympathetic nervous system

Front 18

On which side of the aorta is the thoracic duct?

Back 18

right, from the aortic hiatus to the level of T4

Front 19

what happens to the thoracic ducts at the T4 level?

Back 19

It crosses to the left side of the spine and ascends thru the aortic arch

Front 20

where does the thoracic duct exit the thorax and join the venous circulation?

Back 20

exits thru the superior thoracic aperature, makes a U-turn to venous circulation

Front 21

where does the thoracic duct join the venous circulation?

Back 21

at the jucntion of the jugular and subclavian veins

Front 22

what fasica does the thoracic duct traverse?

Back 22

Sibson's fascia

Front 23

what part of the body lacks lymphatics?

Back 23

CNS

Front 24

what does the CNS have in place of lymphatics?

Back 24

endothelial tubes that empty directly into the cerebrospinal fluid of the subarachnoid space, then draining into the cerebral sinuses

Front 25

4 functions of the lymph system?

Back 25

1. maintain fluid balance
2. purification and cleansing of tissues
3. defense
4. nutrition

Front 26

what % of plasma proteins diffusing from the vasculature are returned via the lymph?

Back 26

50%

Front 27

How much fluid leaks out of capillaries daily? How much is not resorbed and returned by the vasculature?

Back 27

30 liters, 10% or 3 liters

Front 28

what is extracellular space cleansed of what 3 things by lymph?

Back 28

1. particulate matter
2. exudates
3. bacteria

Front 29

lymph nodes act as what?

Back 29

purifying filters for removal of waste

Front 30

what is the first line of defense to invading organisms inside the skin?

Back 30

lymph, you dumb ass!

Front 31

cellular defense (T-lymphocytes) or Humeral defense (B-lymphocytes and hence, immunoglobulins) in lymph?

Back 31

both

Front 32

proteins absorbed from the interstitium absorb many essetial nutrients from where?

Back 32

the gut

Front 33

after a fatty meal how much fat is in the lymph from th small intestine?

Back 33

2%

Front 34

fatty lymph is called what?

Back 34

chyle

Front 35

what are the small lymphatics of the villi of the small intestine called?

Back 35

lacteals

Front 36

what do lacteals absorb?

Back 36

long chain fats, chylomicrons, cholesterol

Front 37

5 mechanisms of flow?

Back 37

1. interstitial pressure
2. peristalic action
3. arterial pulsation
4. muscle contraction
5. "Lymph heart"

Front 38

normal interstitial pressure?

Back 38

negative 6.3 mmHg

Front 39

increasing interstitial pressure increases/decreases flow into lymph vessels

Back 39

increases

Front 40

normal flow rate of interstitial fluoid into lymph vessels?

Back 40

120 ml/hr

Front 41

increasing pressure from -6.3 to O mmHg increases flow how much?

Back 41

twenty fold

Front 42

above what level of pressure does lymphatic flow stop? Why?

Back 42

0 mmHg, the lymph capillary walls collapse

Front 43

4 ways to increase interstitial pressure?

Back 43

1. increase arterial capillary pressure
2. decrease plasma colloidal pressure (ex. cirrhosis of liver)
3. increased interstitial fluid protein (or plasma hypoalbuminemia as in starvation)
4. increased capilllary permeability (toxins from rattlesnake venom)

Front 44

mechanism for pumping lymph from one segment to another?

Back 44

lymphatic distension causes causes smooth muscle to contract propelling lymph to next section (past valve)

Front 45

How do lymphatic capillaries contract?

Back 45

via contractile myoendothelial fibrils in the endothelial cells, relaxation causes a slight suction and draws in more fluid

Front 46

cyclic rate of peristalsis of lymph vessels?

Back 46

6-8s/cycle, equal to the cranial rhythmic impulse or CRI

Front 47

CRI has been recently demonstrated to be synchronous with the _____ wave in blood pressure recordings

Back 47

Traub-Hering

Front 48

Peristaltic gut motion is synchronized by ?

Back 48

pacemakers in gut wall called interstitial cells of Cajal

Front 49

what demonstrates sympathetic innervation?

Back 49

hypersympathecotonia causing lymphoconstriction and decreased flow

Front 50

arterial pulsation increases/decrease lymphatic flow?

Back 50

increases, includes thoracic duct adjacent to aorta and spine

Front 51

light/forceful skeletal muscle contraction increases lymph flow?

Back 51

increases

Front 52

light/forceful skeletal muscle contraction collapses lymphatic vessels?

Back 52

forceful

Front 53

sedentary may have_______, due to decreased lymph flow

Back 53

peripheral edema

Front 54

what is the "lymph heart?"

Back 54

diaphragmatic crura exert a pumping action on cysterna chyli, each breath squeezes the sponge

Front 55

what structure possesses specialized giant lymphatic vessels on its inferior surface to absorb large amounts of peritoneal fluid produce by abdominal viscera?

Back 55

diaphragm

Front 56

Fuzzy-wuzzy wuz a bear,
Fuzzy-wuzzy had no hair,
Fuzzy-wuzzy wuzn't fuzzy,
wuz he?

Back 56

Nope.

Front 57

What do you call 6 blonds standing ear-to-ear?

Back 57

a wind tunnel

Front 58

What do blonds wear to keep their ears warm?

Back 58

Their socks

Front 59

The diaphragm generates ____pressure in the thorax and _____pressure in the abdomen with contraction.

Back 59

negative pressure in thorax, positive pressure in abdomen with diaphragmatic contraction

Front 60

5 things that decrease diaphragmatic excursion?

Back 60

1. asthma
2. emphysema
3. kyphosis
4. lordosis
5. scoliosis

Front 61

what can increase lymphatic flow 15-20x?

Back 61

vigorous exercise

Front 62

5 diaphragms?

Back 62

1.tentorium cerebelli and diaphragm sella
2. Sibson's fasciaa aka throacic inlet
3. diaphragm
4. pelvic floor
5. arches of the feet

Front 63

how do the diaphragms move?

Back 63

synchronously

Front 64

______in any diaphragm will impair all of the others

Back 64

restriction

Front 65

restrictor of tentorium cerebelli?

Back 65

cranial somatic dysfunction

Front 66

4 restrictors of thoracic inlet motion? as in diaphragmatic pump action restriction

Back 66

1. T1 and R1 dysfunction (think scalen muscles and head posture)
2. manubrio-sternal dys
3. clavicular dys
4. contracture of Sibson's fascia

Front 67

4 restrictors of respiratory diaphragm?

Back 67

1. somatic dys L1-3
2. somatic dys R6-12
3. somatic dys xiphisternal joint (rare)
4. somatosomatic reflex (c3-5 via phrenic nerve causes hypertonicity)

Front 68

4 restrictors of pelvic floor diaphragm?

Back 68

1. innominate dys
2. sacral and coccygeal dys
3. pubic symphysis dys
4. scarring from childbirth, and perineal surgery

Front 69

3 restrictors of arches of feet diaphragm?

Back 69

1. arch collapse
2. dys in bones of ft
3. somatosomatic reflexes from the lumbar spine and SI joints

Front 70

Unclog the ___ pipes before you try to pump the ______ ones

Back 70

big, smaller

Front 71

3 steps to correct respiratory diaphragm?

Back 71

1. correct spinal curvature
2. correct somatic dys (C3-5 for phrenic, L1-3 for dia. crura, R6-12 diaphragm to ribs)
3. redome diaphragm

Front 72

4 steps to correct pelvic floor?

Back 72

correct:
1. innominate dys
2. sacral dys
3. pubic symphysis
4. ischiorectal fossa release on hypertonic/scarred musculature

Front 73

indications for lymphatic treatment?

Back 73

any site of edema or infection

Front 74

CI to lymphatic techniques?

Back 74

acute osseous fracture (fat embolism), bacterial infection with fever over 102F, certain stages of cancer (risk of metastasis), kidney failure (increases GFR, may precipitate CHF and Pulmonary edema),
uncompensated heart failure(pulmonary edema)

Front 75

Lymphatic approach to OMT

Back 75

1. remove obstruction to flow
2. free all diaphragms
3. apply external lymphatic pump techniques