The lymphatic system includes lymph vessels, lymph nodes, and lymphoid organs that help maintain fluid balance, absorb lipids, filter the blood, and participate in immunity. The lymph vessels carry lymph fluid similar to plasma but without red blood cells or as many proteins. The lymph nodes filter lymph and activate the immune system. The major lymphoid organs are the tonsils, spleen, and thymus, which help the immune system fight pathogens.

1. The Lymphatic System Includes the lymph, lymphatic vessels, lymph nodes, lymphoid organs (tonsils, spleen and thymus) Primary Functions: 1. Maintains fluid homeostasis 2. Absorbs lipids from the GIT 3. Filters blood (spleen) 4. Contains lymphocytes participating in immunity

4. The Lymph Fluid similar to composition as plasma Without RBC and less proteins Special Lymph from the GIT is loaded with fats and is called CHYLE

6. Fig. 14.2

7. The Lymph vessels Carry fluid away from tissues into the venous circulation These are NOT present in the central nervous system, Bone marrow, epidermis and cartilage They resemble vein because they have valves

8. 3 mechanisms of edema formation 1. Decrease oncotic pressure  cirrhosis and kwashiorkor 2. Increased hydrostatic pressure  CHF and prolonged standing 3. Lymphatic obstruction or destruction  filiariasis, lymph node dissection

9. Lymphatic duct 1. Right lymphatic duct- drains the right side of the head and the upper right side of the thorax and the right extremities 2. Thoracic duct- drains the rest of the body

11. The Lymphatic organs 1. Tonsils A. palatine B. pharyngeal C. lingual D. tubal

12. The lymphatic organs 2. Lymph nodes Small round structures of lymphoid tissue Major lymph nodes are the axillary, inguinal and cervical Filters lymph Activates the immune system Removes microorganisms from the blood

13. The lymphoid organs 3. The spleen Reddish, flat organ lying next to the 9 th and 10 th rib in the left upper quadrant Functions: Repository of old RBC Activates the immune system Storage of Blood Sequesters bacteria MOST COMMONLY INJURED in BLUNT abdominal trauma

14. The lymphoid organs 4. Thymus Bilobed organ in the superior mediastinum Lymphocytes from the bone marrow mature and grow as T-lymphocytes Positive selection= T-cells that react to foreign antigen are selected Negative selection= T-cells that do not react to the self-antigen are selected

16. IMMUNITY Innate or Non-specific 1. Mechanical- skin, mucus, saliva, urine 2. Chemical- enzymes, lysozymes 3. Vascular Blood cells- Neutrophils and macrophages 4. Inflammation Specific Immunity 1. Cellular Immunity- T-cell system 2. Humoral Immunity- B-cell system

17. Non-specific Immunity Inflammatory response Reaction of the vacularized living tissues to injury Classic signs: 1. Rubor- redness 2. Calor- heat 3. Tumor- swelling 4. Dolor- pain 5. Functio laesa- loss of function

18. Inflammation Initial reaction  Vasoconstriction! VC  VD  VP (due to HISTAMINE) VD  Redness and Heat VP  Swelling Bradykinin, Prostaglandin, compression of tissues  pain

19. Specific Immunity: T cell T-cells originate in the bone marrow and mature in the thymus 4 types of T-cells 1. Cytotoxic T cells- kill infected cells, cancer cells and transplanted cells 2. Helper T cells- help the humoral immunity 3. Suppressor T cells- suppress that actions of cytotoxic and Helper cells 4. Memory T cells- for recall and specificity

20. Specific Immunity: B cells B cells are produced and mature in the bone marrow B cells  helped by Helper cells  turn into Plasma cells  secrete ANTIBODIES

21. ANTIBODIES Are proteins that can combine with antigens and function for: 1. Opsonization 2. Neutralization 3. Activation of complement system

22. ANTIBODIES types Five classes 1. Ig M- priMary response, pentaMer 2. Ig G- secondary response, most abundant, can cross placenta 3. Ig A- secreted by the body (sIgA) 4. Ig D- receptor for B cells 5. Ig E- allergic and parasitic reactions

23. TYPES OF IMMUNITY 1. Natural Immunity Active natural Passive natural 2. Artificial Immunity Active artificial Passive artificial

24. Fig. 14.18

25. End of Immune System

26. THE RESPIRATORY SYSTEM

27. The Respiratory System Composed of the air conducting system and the respiratory unit (lungs) Major function is RESPIRATION Commonly divided into UPPER RESPIRATORY tract and LOWER RESPIRATORY tract

28. Ventilation and Respiration VENTILATION- movement of air from the atmosphere into the lungs and out of the lungs EXTERNAL RESPIRATION- exchange of gases between the alveoli and the blood INTERNAL RESPIRATION- exchange of gases between the blood and the tissues

29. The Respiratory System Commonly divided into UPPER RESPIRATORY tract and LOWER RESPIRATORY tract

30. The UPPER Respiratory tract The nose, pharynx and larynx

31. The LOWER respiratory tract Composed of The trachea down to the Lungs

32. The NOSE Made up of nasal bones and cartilages The NASAL cavity is made up of bones, cartilages and turbinates or conchae The nostril is the external opening The choanae is the internal opening

33. Functions of the nose 1 . Hairs or vibrissae filter large particles 2. Blood vessels warm the air 3. Mucus serves to humidify the air 4. Phonation

34. The Pharynx Musculo-membranous tube from behind the nasal cavity to the level of the cricoid cartilage (C6)

35. The Pharynx 3 component parts 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx

36. The Larynx Upper expanded portion of the trachea Made up of cartilages 3 Unpaired- Cricoid, Thyroid and Epiglottis ( cUte) 6 Paired- Cuneiform, Corniculate and Arytenoid (pACC) Function: air passageway and phonation

38. The vocal cords 1. False vocal cords 2. True vocal cords 3. Glottis- the space between the true vocal cords and is the narrowest portion of the adult airway

39. Fig. 15.4

40. Lower airway: Trachea Called windpipe Made up of 15-20 C-shaped cartilage 10-11 inches Lined with pseudostratified ciliated epithelium

41. Bronchus RIGHT Bronchus Wider Shorter More vertical Left bronchus Narrower Longer More horizontal

42. Bronchioles Primary bronchus  secondary bronchus  tertiary bronchus  terminal bronchioles Respiratory bronchioles belong to the respiratory unit

43. Respiratory unit Respiratory bronchioles Alveolar ducts Alveolar sacs alveolus

44. The Pleura Surrounds the lungs and provide protection 1. Parietal pleura- in the chest wall 2. Visceral pleura- intimately attached to the lungs 3. Pleural space- in between the two

46. Diaphragm

47. Respiratory Physiology 1. Ventilation and gas exchange 2. Mechanics of breathing 3. Gas transport 4. Pulmonary volumes and capacities 5. Respiratory control

48. Ventilation Ventilation is the movement of air into the lungs Air (oxygen) moves by the process of diffusion from the higher concentration in the alveoli to the pulmonary capillaries

49. Mechanics of breathing

50. Gas exchange Respiratory membrane is thin which facilitates gas exchange Rate of diffusion depends on the thickness of the membrane, surface area and partial pressure of gases

51. Gas transport 1. OXYGEN- majority is transported in the blood loosely bound to hemoglobin- oxyhemoglobin 2. CARBON DIOXIDE- majority is transported in the blood in the RBC as BICARBONATE

52. Fig. 15.8

53. LUNG VOLUMES 1. Tidal volume – TV 2. Inspiratory Reserve Volume- IRV 3. Expiratory Reserve Volume- ERV 4. Residual volume- RV

54. LUNG CAPACITIES Lung volume + another lung volume 1. Inspiratory Capacity- IC 2. Functional Residual Capacity- FRC 3. Vital capacity- VC 4. Total Lung capacity- TLC

57. NOT CLINICALLY measured 1. Residual volume 2. Functional residual volume 3. Total lung capacity

58. Control of Respiration: Central Respiratory center in the medulla Controls the rate and depth of respiration Increased CO2 is the most potent stimulus

59. Control of Respiration: Peripheral 1. Chemoreceptors in the carotid and aortic bodies Sensitive to changes in pH and O2 Decreased O2  increase respiration Decreased pH (acidosis)  increase respiration 2. Herring-Breurer reflex Stretch receptors in the lungs limit the inspiration

60. ASSESSMENT Normal Breathing pattern: 12-21 respiratory rate Active inspiration with contraction of diaphragm Passive expiration with relaxation of diaphragm Steady rhythm and regular rate and size I:E ratio is 1:2

61. Abnormal breathing pattern 1. Cheyne-Stoke’s 2. Biot’s 3. Kussmaul’s 4. Agoral

62. Breathing rates 1. Eupnea- 12-21 2. Bradypnea- 11 and below 3. Tachypnea- 22 and above 4. Dyspnea- difficulty of breathing

63. Breathing Position 1. Platypnea- inability to breath in an upright position 2. Orthopnea- difficulty in breathing in any position except upright

64. Breath sounds: Normal 1. Bronchial or Tracheal- in the sternum 2. Bronchovesicular- in the interscapular area 3. Vesicular- lung periphery

65. Adventitious Breath sounds 1. Rales or crackles 2. Stridor 3. Wheeze 4. Rhonchi 5. Friction rub