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Similar to BSC nursing - LYMPHATIC SYSTEM notes.pptx
BSC nursing - LYMPHATIC SYSTEM notes.pptx
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- 2. CONTENTS 1. FORMATION ANDCOMPOSITION OF LYMPH 2. LYMPH VESSELS 3. LYMPH FLOW- FACTORS AFFECTING LYMPH FLOW 4. LYMPHATIC ORGANS 5. LYMPH NODES 6. LYMPHATIC DRAINAGE 7. SPLEEN 8. THYMUS GLAND 9. DISEASES OF LYMPHATIC SYSTEM 10. DISEASES OF LYMPH NODES 11. MALIGNANT TUMOURS OF LYMPHOID TISSUE
- 3. FORMATION AND COMPOSITIONOF LYMPH LYMPHATIC SYSTEM IS AN ACCESSORY COMPONENT OF THE CIRCULATORY SYSTEM. THE FLUID FLOWING THROUGH THIS SYSTEM IS TERMED – LYMPH LYMPH IS – A CLEAR, WATERY FLUID (except LYMPH FROM THE LACTEALS OF INTESTINAL VILLI – IS MILKY- CALLED CHYLE) LMYPH- IS A TISSUE FLUID- THAT DRAINS INTO THE BLOOD VIA THORACIC DUCT AND RIGHT LYMPHATIC DUCT LYMPH- CONTAINS -- LYMPHOCYTES LYMPH IS LIKE PLASMA- BUT HAS LESS PROTEIN
- 4. COMPONENTS OF LYMPHATICSYSTEM LYMPH VESSELS LYMPH ORGANS- LYMPHATIC SYSTEM IS PRESENT IN ALL ORGANS- EXCEPT CENTRAL NERVOUS SYSTEM AND CORNEA OF THE EYE
- 5. LYMPHATIC CAPILLARIES Commence asblind sacs in tissue spaces- they are larger in size than blood capillaries, more irregular and endothelium is more permeable. LYMPH from lymph capillaries enters- LARGE LYMPHATIC VESSELS
- 6. LYMPH CAPILLARIES Lymphatic capillariesare formed by a one cell-thick layer of endothelial cells , allowing interstitial fluid from outside to flow into them via overlapping cells. When interstitial pressure is low, the endothelial flaps close to prevent “backflow “ or leaking out of lymph the lymph capillaries As interstitial pressure outside increases, the spaces between the cells open up, allowing the fluid to enter in.
- 8. COMPOSITION OF LYMPH LYMPH- CONTAINS – LYMPHOCYTES ALL OTHER SUBSTANCES PRESENT IN PLASMA ARE PRESENT IN LYMPH-
- 9. LYMPH VESSELS CENTRAL: PERIPHERAL : LYMPHATIC CAPILLARIES Commence as blind sacs in tissue spaces- they are larger in size than blood capillaries, more irregular and endothelium is more permeable. LYMPH from lymph capillaries enters- LARGE LYMPHATIC VESSELS LARGE LYMPHATIC VESSELS – are like veins but have many valves – they pour lymph into regional lymph nodes- that drain a particular area- LYMPH NODES- filter the Lymph and propel it forward through larger lymphatic vessels to the main lymphatic trunk ( THORACIC DUCT AND LYMPHATIC DUCT )
- 10. LYMPHATIC VESSELS THORACICDUCT The thoracic duct is the largest lymphatic vessel in the human body. Around 75% of the lymph from the entire body EXCEPT- (the right upper limb, right breast, right lung and right side of the head and neck,) ORIGIN : starts at upper end of a lymphatic sac- CISTERNA CHYLI- at L1 vertebrae- it receives right and left lumbar trunks and intestinal trunks COURSE – enters thorax through diaphragm – it ascends up behind arch of aorta- above clavicle and opens at junction of left subclavian and internal jugular veins
- 11. Rate of lymphflow 120ml/hour 2- 3 litres of lymph is drained into blood everyday Factors- affecting lymph flow Greater interstitial fluid pressure Lymphatic pump- stretching of smooth muscles when lymph accumulates External compression- muscles, movemnet Increased permeability- more toxins, less oxygen, increase in temperature
- 12. Blood capillaries Lymph capillaries Lymp h vesse ls Lymp h nodes Lymph vessels and ducts and ducts JUNCTIONOF INTERNAL JUGULR AND SUBCLAVIAN VEIN
- 14. LYMPHATIC ORGANS THELYMPHATIC ORGANS ARE A PART OF MONONULCEAR PHAGOCYTES SYSTEM – PREVIOUSLY CALLED AS RETICULOENDOTHELIAL SYSTEM THEY CONTAIN AGGREGATES OF LYMPHOCYTES, MACROPHAGES AND PLASMA CELLS.
- 16. BONE MARROW ITIS a gelatinous tissue that fills the medullary cavity of the long bones- and spaces between traberculae – there are 2 types of bone marrow RED – also called myeloid tissue YELLOW – fatty tissue Red bonemarrow, gets it red colour from the haemoglobin in red blood cells. It is present throughout the skeleton at foetal life and birth but is gradually replaced by yellow bone marrow. In adult life red bone marrow remains only in vertebrae ,ribs, sternum, clavicle,scapula,hip bones and upper end of humerus and femur. Red bone marrow contains blood forming HAEMATOPOIETIC- STEM CELLS – that produce RBC,WBC,PLATELETS. YELLOW BONE MARROW – contains MESENCHYMAL STEM cells – that produce- FAT CARTILAGE AND BONE.
- 17. LYMPH NODES SMALLOVAL BODIES- situated along the course of lymph vessels – they form groups or chains in close association with blood vessels . MICROSCOPIC STRUCTURE CAPSULE- Surrounds the node and divides it- CORTEX- PERIPHERAL PART - which contains lymphocytes and forms lymphatic follicles – the follicles develop central germinal center- which produce B lymphocytes in response to antigen MEDULLA –inner part –has lymphocytes (B and T) macrophages and plasma cells.
- 18. FUNCTION OF THELYMPH NODE FILTER THE LYMPH- SEPARATE particles like carbon, caner cells, worn out cells PHAGOCYTOSIS- of the particles TRAP AND PRESENT – antigen to lymphocytes for interaction PRODUCE- LYMPHOCYTES at germinal centre IMMUNITY – CELLULAR- T LYMPHOCYTES HUMORAL –B LYMPHOCYTES
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- 21. REGIONAL NODES SUPERFICIALNODES – CAN BE PALPATED when enlarged – as they are present in superficial fascia along the veins DEEP NODES – arranged along deeper vessels- may be difficult to palpate
- 22. Lymph node- localpolice station
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- 25. LYMPHATIC DRAINAGE OF HEAD ANDNECK SUPERFICIAL LYMPH NODES of the head and neck drain into the DEEP CERVICAL NODES- that lie along carotid sheath. The deep cervical nodes drain deeper parts- larynx, pharynx and thyroid gland and form JUGULAR LYMPHATIC TRUNKS. Left jugular trunk join THORACIC DUCT Right jugular trunk joins RIGHT LYMPHATIC DUCT
- 26. LYMPHATIC DRAINAGE OF UPPERLIMB AXILLARY LYPMH NODES – drain upper limb and the breasts SUPERFICIAL- SUPRATROCHLE AR AND INFRACLAVICUL AR DRAIN INTO AXILLARY NODES DEEP- AXILLARY LYPMH NODES – drain upper limb and the breasts ( anterior nodes, lateral,posterior, central and apical) join to form SUBCLAVIAN TRUNK-
- 27. LYMPHATIC DRAINAGE OFLOWER LIMB INGUINAL LYPMH NODES – SUPERFICIAL INGUINAL- which has an upper group- above inguinal ligament (drains gluteal area, anterior abdominal wall below umbulicus) Lower group- arranged along saphenous vein- drains- lower limb DEEP- INGUINAL NODES – lie medial to femoral vein receive from superficial inguinal nodes- and deeper tissues of lower limb and glans penis/clitoris. POPLITEAL – drain lateral part of foot and knee joint and send efferents to deep inguinal nodes
- 28. RIGHT SIDE- SCALP,FACENECK LEFT SIDE- SCALP, FACE NECK DEEP CERVICAL. L. NODE DEEP CERVICAL L. NODE LEFT JUGULAR TRUNK RIGHT- JUGULAR TRUNK LEFT UPPER LIMB AXILLARY LYMPH NODE RIGHT UPPER LIMB AXILLARY LYMPH NODE SUB CLAVIAN TRUNK SUBCLAVIAN TRUNK RIGHT- POPLITEAL NODES LEFT POPLITEAL NODES INGUINAL NODES ILIAC NODES PARA-AORTIC NODES PARA-AORTIC NODES ILIAC NODES RIGHT- LUMBAR TRUNK LEFT – LUMBAR TRUNK INGUINAL NODES PRE-AORTIC NODES INTESTINAL TRUNK CISTERNA CHYLI BRONCHOMEDIASTINAL TRUNK BRONCHOMEDIASTINAL TRUNK MEDIASTINALNODES MEDIASTINALNODES V V RIGHT LYMPHATI C DUCT THORACIC DUCT
- 29. LYMPHATIC DRAINAGE OF PELVIS EXTERNAL ILIAC NODES –receive lymph from deep inguinal nodes INTERNAL ILIAC NODES – drain pelvic viscera and gluteal region SACRAL NODES – drain prostrate, seminal vesicle, rectum, cervix and drain into internal iliac nodes COMMON ILIAC NODES – receive efferents from external and internal iliac nodes and send their efferents to PARA- AORTIC NODES
- 30. LYMPHATIC DRAINAGE OFABDOMEN PREAORTIC NODES – lie IN FRONT OF AORTA drain GI tract, liver, gall bladder, spleen, pancreas - their efferents form INTESTINAL TRUNKSwhich join the cisterna chyli . -COELIAC, SUPERIOR MESENTERIC, INFERIOR MESENTERIC NODES PARA-AORTIC NODES – lie on the side of the aorta They drain the kidneys, gonads, ureters, suprarenals, posterior abdominal wall –Drain pelvic viscera- as they are receiving lymph from common iliac nodes -The efferents of para aortic nodes form right and left LUMBAR TRUNKS which join CISTERNA CHYLI
- 33. LYMPHATIC DRAINAGE OFCHEST CHEST The superficial lymphatic vessels converge in the subcutaneous space and take lymph back to the AXILLARY LYMPH NODES The deep lymphatic system, on the other hand, drain to the intercostal nodes, as well as to the parasternal and diaphragmatic nodes.
- 34. LYMPHATIC DRAINAGE OF THORAX (P.A.I.D- MED) WALL OF THORAX DRAIN INTO ( P.A.I.D) P-PARASTERNAL NODES- ALONG INTERNAL THORACIC VESSEL A-AXILLARY NODES- IN AXILLA I-INTERCOSTAL – ON POSTERIOR END OF INTERCOSTAL SPACES D-DIAPHRAGMATIC NODES- ON UPPER SURFACE OF DIAPHRAGM THE THORACIC VISCERA DRAIN INTO ( MED) the MEDIASTINAL nodes which drain trachea, bronchi, heart . Their efferents form BRONCHOMEDIASTINAL TRUNKS ON EACH SIDE- which opens at the jucntion of internal jugular and subclavian vein of it’s own side. BRONCHO MEDIASTINAL
- 39. SPLEEN LOCATION –LEFT HYPOCHONDRIAC SPLEEN HAS – 2 BORDERS – superior and inferior 2 POLES – posterior and anterior 2 SURFACES – diaphragmatic surface- separating it from left lung Visceral surface – related to stomach, left colic flexure, left kidney BLOOD SUPPLY- SPLENIC ARTERY – AND DRAINED BY SPLENIC VEIN WHICH JOINS SUPERIOR MESENTERIC VEIN TO FORM PORTAL VEIN .
- 40. FUNCTIONS OF SPLEEN PHAGOCYTOSIS – old abnormal cells are destroyed by spleen and breakdown products like bilirubin and iron pass to liver through the splenic or portal vein STORAGE OF BLOOD – about 350 ml of blood is present in the spleen - on sympathetic stimulation , blood from spleen rapidly enters circulation to increase blood volume – is conditions such as bleeding (haemorrhage) IMMUNE RESPONSES – spleen has T and B lymphocytes that are activated in the presence of antigen. Therefore some infections can cause spleenomegaly (enlargement of spleen) ERYTHROPOIESIS –site of red blood cell formation in foetus. the spleen is constantly filtering the BLOOD in order to detect the presence of microorganisms
- 41. White pulp isthe main lymphoid tissue of the spleen. It is the accumulation of lymphocytes around an arterial vessel..it is the first to react if microbes reach the spleen through the bloodstream. .Red pulp consists of splenic venous sinuses and cords (of Billroth), linings of splenic macrophages around the sinuses..
- 42. DISEASES OF THESPLEEN SPLENOMEGALY- SPLEEN IS ENLARGED INFECTIOUS DISEASES- MALARIA, TYHPOID CIRCULATORY DISORDERS –RT SIDED HEART FAILURE BLOOD DISEASES – ABNORMAL RBC- MICROCYTIC ANAEMIA ,HAEMOLYTIC ANAEMIA ANAEMIA –OCCURS DUE TO PREMATURE DESTRUCTION OF RBS, PHAGOCYTOSIS OF WBC AND PLATELETS BY SPLEEN CANCER OF THE SPLEEN
- 43. THYMUS GLAND Thymusis a central organ of Lymphatic system Location- superior mediastinum Relations- Anteriorly- sternum Posteriorly – arch of aorta Laterally- lungs
- 44. THYMUS GLAND Thethymus gland is a pink, lobulated lymphoid organ, located in the thoracic cavity and neck. In the adolescent, it is involved the development of the immune system. After puberty, it decreases in size and is slowly replaced by fat. The gland is mainly located within the thoracic superior mediastinum, posterior to the manubrium of the sternum
- 45. STRUCTURE AND FUNCTIONS- OF THYMUS 2 LOBES EACH LOBES HAS A FIBROUS CAPSULE OUTER CORTEX which is packed with LYMPHOCYTES INNER MEDULLA which has less cells and degenerated epithelial cells arranged in a lamellae- called HASSALL corpuscle
- 46. FUNCTIONS OF THYMUS PRODUCTIONOF MATURE LYMPHOCYTES LYMPHOCYTES originate from pluripotent stem cell of bone marrow. Those that enter THYMUS develop into acitvated T lymphocytes. These leave the thymus and enter blood. The thymus thus produces mature T LYMPHOCYTES that can react with specific foreign antigen. PRODUCTION OF THYMOSIN – hormone secreted by thymus gland .
- 47. In the THYMUS–CELLS MATURE AND DIFFERENTIATE B- LYMPHOCYTES T- LYMPHOCYTES
- 48. MUCOSA ASSOCIATED LYMPHOD TISSUE-MALT- (toremember- P.O.T.A.TO ) P- PEYER’S PATCHES IN ILEUM AND LYMPHATIC FOLLICLES O- LYMPHATICS IN OESOPHAGUS T- LYMPHAIC TISSUE IN TRACHEA, BRONCHI, LUNGS A- APPENDIX- HAS LYMPHATIC TISSUE (called as abdominal tonsil) TO- TONSILS – PALATINE, LINGUAL,TUBAL, PHARYNGEAL MALT –provides- first line of defense FOLLICLES- proved local defense Act as RESERVOIRS of lymphocytes
- 49. DISEASES OF LYMPHVESSELS Because lymph in constantly circulating in the lymph vessels, it can spread a disease ,infections and cancer (malignant disease ) Spread of infectious disease – lymph vessels carry infected material from infected site. Usually at local site – tissue macrophages act as first line of defense- additionaly other cells like neutrophils and monocytes also try to phagocytose the microorganism and prevent spread- it this is not effective, then the germs enters the lymph vessels and is carried to lymph nodes. Here the lymph nodes try to stop the spread but if that fails, the infection enters the blood stream .
- 50. DISEASES OF LYMPHVESSELS SPREAD OF MALIGNANT TUMOUR- THE wall ofthe lymph vessel is eroded by cancer cells (malignant cells) and thus they enter the lymph capillaries- then they reach the local lymph nodes. Wherever they go the malignant cells start multiplying and finally enter blood stream HODGKINS AND NON HODKIN’S LYMPHOMA – ABNORMAL LYMPTPHOCYTES Spread of cancer(malignant) cells is called METASTASIS. INFECTION OF LYMPH VESSELS is called LYMPHANGITIS INFECTION OF LYMPH NODES is called LYMPHADENITIS which can be ACUTE –eg GLANDULAR FEVER Or CHRONIC –eg -TUBERCULOSIS
- 51. FILARIASIS – WHENLYMPHATIC VESSELS ARE AFFECTED – BY A PARASITE WHICH IS BROUGHT BY THE MOSQUIOT BITE
- 52. HODGKIN’S AND NONHODGKIN’S LYMPHOMA (TYPE OF CANCER) - WHEN LYMPHOCYTES MULTIPLY ABNORMALLY SPECIAL –CELLS CALLED REED- STRNBERG CELLS IN HODGKIN’S LYMPHOMA
- 53. IMMUNITY What isImmunity? Immunity is the ability of the body to defend itself against disease-causing organisms
- 55. Types ofImmunity There are two major types of immunity: Innate Immunity or Natural or Non-specific Immunity. The innate immune system provides a general defense against harmful germs and substances, so it’s also called the non-specific immune system. Acquired Immunity or Adaptive Immunity. The adaptive (specific) immune system makes antibodies and uses them to specifically fight certain germs that the body has previously come into contact with. This is also known as an “acquired” (learned) or specific immune response.
- 56. INNATE IMMUNITY PATHOGEN: A disease-causing organism, including bacteria, Innate immunity refers to the body’s defence system. It is quick Non specific
- 57. 4 BARRIERS- INNATEIMMUNITY PHYSICAL barrier These include the skin, body hair, cilia, eyelashes, the respiratory tract, and the gastrointestinal tract. These form the first line of defence. CHEMICAL barriers We know that our stomach uses hydrochloric acid to break down the food molecules. Due to such a strongly acidic environment, most of the germs that enter our body along with the food are killed before the further process is carried on. Saliva in our mouth and tears in our eyes also have the ANTIBIOTIC property that does not allow the growth of pathogens even though they are exposed all day. Cellular barriers : CYTOKINE barriers- Cells Involved In Innate Immunity- MAST CELLS, PHAGOCYTES, EOSINOPHILS, DENDRITIC CELLS etc
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- 59. Acquired immunity- takestime and is specific Acquired Immunity Acquired immunity or adaptive immunity is the immunity that our body acquires or gains over time. Unlike the innate immunity, this is not present by birth. The ability of the immune system to adapt itself to disease and to generate pathogen-specific immunity is termed as acquired immunity. It is also known as adaptive immunity. Humoral Immune Response humoral immune response consists of an antibody produced by the B lymphocytes. Cell-mediated Immune Response Cell-mediated immunity is initiated by the T CELLS- which can be T helper cells (calls other cells into action ) , memory T cells (which remember the antigen for the next attack) and – cytotoxic T cells
- 60. Acquired immunity- humoralimmunity When a B cell encounters an antigen, it is stimulated to mature into a plasma cell or a memory B cell. Plasma cells then release antibodies (also called immunoglobulins, or Ig). There are 5 classes of antibodies— IgM, IgG, IgA, IgE, and IgD. Antibodies protect the body in the following ways: ingest antigens (phagocytes) Inactivating toxic substances produced by bacteria Attacking bacteria and viruses directly Preventing bacteria and viruses from attaching to and invading cells Activating the complement system - which has many immune functions
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- 62. END OF CHAPTER–QUESTIONS What are components of lymphatic system ? Describe importance of Thoracic duct with respect to LYMPH Describe structure of spleen Describe structure of Thymus Lymph node- short notes Cisterna chyli- short notes Lymphatic drainage of upper limb Lymphatic drainage of head and neck Lymphatic drainage of lower limb WHAT IS IMMUNITY- ?innate and acquired ?
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