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61 Cards in this Set
- Front
- Back
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how much fluid drains into the interstitial fluid faily? how uch is drained to lymphatics and how much to bllood?
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30L
90% bleed, 10% lymph |
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what can happen to healing when lymph is blocked? why?
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it can slow or cause adhesions or fibrosis because the immune mediators and cells are lingering there and prolonging inflammation
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where is the lymph system absent
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CNS, bone marrow, cartilage, lens, placenta, epidermis, and inner large blood vessels
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7 steps of where the lymph goes and drains
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where exactly does lymph drain in the veins?
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in the corner between the internal jugular and the subclavian
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how are the initial lymphatics arranged cellularly?
two things present in arterioles that the lymphatics don't hae? |
overlapping one cell layers to prevent backflow
no tight junctions or SM |
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what are anchoring filaments and what are they good for?
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anchor the initial lymphatics to the tissue to prevent collapse when lymph is empty
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what are some features of the collecting lymph vesse;ls? 2 describe each
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valves- bicuspid
smooth muscle- progressively thicker |
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what are the prenodal and post nodal vessels?
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the collecting vessels before and after the lymph nodes
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what happens to aid drainage in the lymph npodes? name the exact site?
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hydrostatic water movement from sinusoids of lymph nodes to the veins
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What is the 2 main functions of the lymph nodes?
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filtratioon and generation of antigens to foreign substances
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wwhere do the efferent lymphatic vessels like to head towards?
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the follow the fascial planes toward the midline up to the cervico-thoracic junction (where the jugular meets the subclavian)
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why are the lymphatics so vulnerable to backing up?
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since they run in the fascia and those are also vulnerable to tightness
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what are the two main dranage ducts called?
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right lymphatic
left thoracic |
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what parts of the body does the right lymphatic duct drain?
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right half of head and neck, arm, lung, breast, and thorax (all RUQ of head/thorax)
also the heart |
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what happens to the interstitium with failure of the lymphatics?
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it swells with water, metabolic waste, and proteins that get backed up there
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what is the formation phase?
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when extracellular fluid moves into the lymph capillaries
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what kind of gradient exists between the lymph capillaies and the interstitium? Why?
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it is uphill going from the interstitium to the lymph because you are usually draining upwards
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what kinds of things will help lymph flow against this upward stack of fluid? 3
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skeeletal muscle contraction, tissue compression (pump/compression stockings), and arterial pulse
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What is the vascular phase?
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when the lymph moves through the vessels
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what is the role of the SM in the vessels?
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they have intrinsic perotalsis to help move the fluid forward
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what regular movememtns of ours helps with the vascular phase?4
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skeletal muscle movement, arterial pulse, visceral motions like peritalsis, respiration
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what innervates the lymphatics? what other technique does this match up with?
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sympathetics- chapman;s
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what kind of stuff should you say when performing a technique in the practical?
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some indications and counterindications and explain it in general (they will not prompt you)
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where is sibson's fascia?
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the thoracic inlet area
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where do you want to start opening up lymph channels from?
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from central (thracic inlet then diaphragm) to outward and peripheral
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What is the terminal stage?
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when the lymph coleccts into the regional collecting sites
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should you push on a swollen lmph node? why>
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no because it is swollen for a reason- there is no where to for it to drain
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how do ou do disphragmatic doming?
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put thumbs into the diaphragm from the costal margin.
dig thumb up with exhale resisst diaphragm with inhale |
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how do you dx with popliteal fossa?
tx? |
put fingers on medial and lateral of the popliteal fossa
motion test up down, and sisde to side to find restriction treat toward restricition |
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how do you do thoracic pump? how many pumps?
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put hands on upper chest with thumb around neck. push down on exhalation and resist with inhalation
3-5 times |
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how do you do pedal pump? for how long?
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push on their toes flexed for a couple minutes (but like 030 seccs for lab)
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How do you do effleurage?
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raise the leg up
work from proximal to distal with both hands pushing deep and in a wringing motion like you are pushing lymph up. |
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where is sibson' fascia?
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above the calvicle on either side there the thoracic/lymphatic ducxt goes in
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where is the superior thoracic inlet?
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around the sternum
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What does the Zinc model say? what is it?
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the respiratory-circulatory model
35-60% of thoracic duct flow is produced by respiration |
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what happens to the throacic diaphragm when it gets tight?
breathing and lymph consequence? |
it will flatten- harder to create pressure gradients to breath and will kink off lymph vessels going to the thorax
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what two muscles go through the diaphragm here?
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psoas and uadratus lumborum
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main mechanism by which respiration help lymph flow?
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pressure differences
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what is the goal of lymphatic treatment?
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remove the key tissue stresses interfereing with flow of body fluids
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what is reciprical inhibition?
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when you contract the anatagonist to relax a muscle reciprically just by reflex
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what is the order of regions you should treat if the obstruction is in the feet?
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thoracic inlet
diaphragm pelvic floor popliteal fossa |
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6 ways you can open up channels?
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what are the two main things you are doing in order to release lymph?
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1. open up channels
2. move the lymph |
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What 4 techniques will help to open up the channels?
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1. thoracic inlet/outlet steering wheel
2. pectoral traction 3. doming of diaphragm 4. popliteal fossa release |
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What 4 techniques will help to pump the lymph?
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1. miller thoracic pumps
2. pedal pump 3. rib raising 4. effleurage/petrissage |
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what fascia is involved in the sterring wheel release?
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sibson's fascia
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how many times does the thoracic duct pass through the sibson's fascia before dumping into the veins?
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twice
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where does the respiratory diaphragm attach to bones?
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L1-3
transverse process of T12-L1 12th rib |
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what muscles is the diaphragm associated with?
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quadratus lumbortum, psoa, and transversus abdominus
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follow the path of fluid from inhalation and exhalation from the abdomen to the brachiocephalic vein.
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inhale- pulls fluid into chest from abdomen
exhalae- fluid pulled into the neck inhale- fluid pulled into brachiocephaic vein |
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what is the freq of a lyphatic pump?
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2/sec
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what is another name for the thoracic pump?
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the miller thoracic pump
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2 types of miller thoracic pumps?
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the normal one and the exaggerated respiration one
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how do ou do the exaggerated respiration version?
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have hands on pt
have them take 3 quick breaths while resisiting them but on the last breath, you let go so the chest expands really quickly |
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what is 1 counter indication to the miller thoracic pump and why?
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COPD because you can pop blebs this way.
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difference between effleurage and petrissage?
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petrissage is deeper
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what is the point of rib raising?
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to stimulate the sympathetic innervation to the lymphatics
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WHat are a couple indications for lymphatic technique?
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sprains, strains, CHF, inflammation, pregnancy, infection, lymphatic/venous stasis, edema
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What are 2 absolute counterindications to lymphatic technique?
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anuria and necrotiing fascitis
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