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Chapter 9Chapter 9
Lymphatic and Immune Lymphatic and Immune PathologiesPathologies
Mosby’s PATHOLOGYfor Massage Therapists
Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
2Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
2
Lesson 9.1 ObjectivesLesson 9.1 Objectives
Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic processes related to the lymphatic system.processes related to the lymphatic system.
Describe the different types of immunologic Describe the different types of immunologic reactions.reactions.
3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System OverviewLymphatic System Overview
Composed of:Composed of: LymphLymph LymphocytesLymphocytes Lymphatic vesselsLymphatic vessels Lymph nodesLymph nodes Organs and glands Organs and glands
containing lymphoid tissuecontaining lymphoid tissue
From Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology,Anatomy & Physiology, ed 6, ed 6, 2007, St. Louis, Mosby.2007, St. Louis, Mosby.
4Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Lymphatic system functions:Lymphatic system functions: Drains excess interstitial fluidDrains excess interstitial fluid Transports dietary lipids and lipid-soluble vitamins Transports dietary lipids and lipid-soluble vitamins
from digestive tract to the bloodfrom digestive tract to the blood Carries out immune functionsCarries out immune functions
5Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Draining excess interstitial Draining excess interstitial fluidfluid Enters lymphatic capillaries; Enters lymphatic capillaries;
drains into larger vesselsdrains into larger vessels
Lymph nodes situated along lymphatic vessels; these filter out pathogens and debris
Lymph finally drains into subclavian veins
From Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology,Anatomy & Physiology, ed 6, 2007, St. Louis, Mosby. ed 6, 2007, St. Louis, Mosby.
6Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Lymphatic circulation pathwaysLymphatic circulation pathways
From Thibodeau GA, Patton KT: From Thibodeau GA, Patton KT: Anatomy & Physiology,Anatomy & Physiology, ed 6, 2007, St. Louis, Mosby. ed 6, 2007, St. Louis, Mosby.
7Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Immunity – Anatomic and physiologic defense Immunity – Anatomic and physiologic defense reactions to invading organismsreactions to invading organisms
Key components are:Key components are: LymphocytesLymphocytes White blood CellsWhite blood Cells
Structures such as skin and chemicals (i.e., Structures such as skin and chemicals (i.e., digestive enzymes) are also involved digestive enzymes) are also involved
8Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Immunity; two types:Immunity; two types: Natural: nonspecific responses to invading Natural: nonspecific responses to invading
pathogens (i.e., physical barriers of the skin, pathogens (i.e., physical barriers of the skin, chemical barriers of enzymes, fever, and chemical barriers of enzymes, fever, and inflammation)inflammation)
Acquired: diverse but specific responses to invaders Acquired: diverse but specific responses to invaders involving lymphocytes; two typesinvolving lymphocytes; two types of lymphocytesof lymphocytes• B cellsB cells
• T cellsT cells
9Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
T and B cells both form in T and B cells both form in red bone marrowred bone marrow
B cells mature in red bone B cells mature in red bone marrowmarrow
T cells mature in the thymusT cells mature in the thymus Mature T and B cells then Mature T and B cells then
travel to lymphatic tissuestravel to lymphatic tissues
From Salvo S: From Salvo S: Massage therapy: principles and Massage therapy: principles and practice,practice, ed 3, St. Louis, 2007, Saunders. ed 3, St. Louis, 2007, Saunders.
10Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Immune responseImmune response T and B cells activate when they come into contact T and B cells activate when they come into contact
with pathogenswith pathogens T cells leave lymphatic tissue to kill pathogens T cells leave lymphatic tissue to kill pathogens
directlydirectly B cells produce antibodiesB cells produce antibodies
• antibodies leave lymphatic tissue to circulate in body antibodies leave lymphatic tissue to circulate in body fluidsfluids
• antibodies inactivate pathogens as they come across antibodies inactivate pathogens as they come across themthem
11Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
11
Lymphatic System Overview Lymphatic System Overview (cont’d.)(cont’d.)
Immune response (cont’d.)Immune response (cont’d.) Autoimmune diseasesAutoimmune diseases
• T and B cells unable to distinguish body’s own tissues T and B cells unable to distinguish body’s own tissues from something foreign to body from something foreign to body
• T and B cells then attack the tissuesT and B cells then attack the tissues
12Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lesson 9.2 ObjectivesLesson 9.2 Objectives
Define conditions of the lymphatic system Define conditions of the lymphatic system and list appropriate massage considerations.and list appropriate massage considerations.
Identify conditions of the immune system and Identify conditions of the immune system and list appropriate massage considerations.list appropriate massage considerations.
Explain emergency measures for Explain emergency measures for anaphylaxis.anaphylaxis.
13Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
13
Conditions of the Lymphatic Conditions of the Lymphatic SystemSystem
Lymphedema and Edema Lymphedema and Edema Lymphangitis Lymphangitis Lymphadenopathy and LymphadenitisLymphadenopathy and Lymphadenitis
14Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphedema and EdemaLymphedema and Edema LymphedemaLymphedema
Abnormal accumulation of fluids caused by Abnormal accumulation of fluids caused by obstruction in lymph flow causing swellingobstruction in lymph flow causing swelling• Primary: due to lymph vessel or nodal malformation; rarePrimary: due to lymph vessel or nodal malformation; rare
• Secondary: due to a condition or medical procedureSecondary: due to a condition or medical procedure
EdemaEdema Abnormal accumulation of fluids from a sluggish or Abnormal accumulation of fluids from a sluggish or
overloaded lymph transport system causing swellingoverloaded lymph transport system causing swelling
15Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphedema and Edema Lymphedema and Edema (cont'd.)(cont'd.)
Secondary lymphedemaSecondary lymphedema
Primary lymphedemaPrimary lymphedema
From Seidel HM et al: From Seidel HM et al: Mosby’s guide to physical Mosby’s guide to physical examinations,examinations, ed 6, St. Louis, 2006, Mosby. ed 6, St. Louis, 2006, Mosby.
From Seidel HM et al: From Seidel HM et al: Mosby’s guide to physical Mosby’s guide to physical examinations,examinations, ed 6, St. Louis, 2006, Mosby. ed 6, St. Louis, 2006, Mosby.
16Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphedema and Edema Lymphedema and Edema (cont'd.)(cont'd.)
Peripheral edema – Edema of an extremityPeripheral edema – Edema of an extremity Dependent edema – Type of peripheral Dependent edema – Type of peripheral
edema found in gravity-dependant areas of edema found in gravity-dependant areas of the lower extremity the lower extremity
Angioedema – Edema seen in allergic Angioedema – Edema seen in allergic reactionsreactions
Pitting edema – Edema that leaves a pit or Pitting edema – Edema that leaves a pit or dent in skin once compressed and releaseddent in skin once compressed and released
Non-pitting edema – Does not leave a dent Non-pitting edema – Does not leave a dent after skin is compressed and releasedafter skin is compressed and released
17Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphedema and Edema Lymphedema and Edema (cont'd.)(cont'd.)
From Frazier MS, Drzymkowski J: From Frazier MS, Drzymkowski J: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed 3, 2004, St. Louis, Saunders; Callen JP et al: ed 3, 2004, St. Louis, Saunders; Callen JP et al: Color atlas Color atlas of dermatology,of dermatology, ed 2, Philadelphia, 2000, Saunders; and Bloom A, Ireland J: ed 2, Philadelphia, 2000, Saunders; and Bloom A, Ireland J: Color atlas of diabetes,Color atlas of diabetes, ed 2, London, 1992, Mosby-Wolfe. ed 2, London, 1992, Mosby-Wolfe.
18Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphedema and Edema Lymphedema and Edema (cont'd.)(cont'd.)
Avoid vigorous massage in affected areasAvoid vigorous massage in affected areas Avoid all forms of thermotherapy Avoid all forms of thermotherapy During massage, elevate affected areasDuring massage, elevate affected areas Massage proximal to affected areas if located Massage proximal to affected areas if located
on the extremitieson the extremities
19Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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LymphangitisLymphangitis
Infection of Infection of lymphatic vessels; lymphatic vessels; usually an indication usually an indication that a primary that a primary infection is infection is spreading spreading
Local Local contraindicationcontraindication
From Stone DR, Gorbach SL: From Stone DR, Gorbach SL: Atlas of infectious Atlas of infectious diseases,diseases, Philadelphia, 2000, WB Saunders. Philadelphia, 2000, WB Saunders.
20Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Lymphadenopathy and Lymphadenopathy and LymphadenitisLymphadenitis
Lymphadenopathy – Lymphadenopathy – Enlarged lymph nodesEnlarged lymph nodes
Lymphadenitis – Infected Lymphadenitis – Infected lymph nodeslymph nodes
Local contraindication; Local contraindication; absolute contraindication if absolute contraindication if systemic disease is systemic disease is presentpresent
Courtesy Dr. A.R. Kagan, Los Angeles. In Del Regato Courtesy Dr. A.R. Kagan, Los Angeles. In Del Regato JA, Spjut HJ, Cox JD: JA, Spjut HJ, Cox JD: Ackerman and del Regato’s Ackerman and del Regato’s
cancer,cancer, ed 2, St. Louis, 1985, Mosby. ed 2, St. Louis, 1985, Mosby.
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Conditions of Immune SystemConditions of Immune System
AllergyAllergy Chronic fatigue syndromeChronic fatigue syndrome Systemic lupus erythematosusSystemic lupus erythematosus Acquired immunodeficiency syndromeAcquired immunodeficiency syndrome
22Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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AllergyAllergy
Overreaction of immune system to otherwise Overreaction of immune system to otherwise harmless agents; also called a hypersensitivity harmless agents; also called a hypersensitivity reaction Type Ireaction Type I
Anaphylaxis is the least common, but most Anaphylaxis is the least common, but most perilous reactionperilous reaction Caused by insect sting, ingestion of nuts or shellfish, or Caused by insect sting, ingestion of nuts or shellfish, or
drug reaction drug reaction Ascertain and avoid allergens during massage Ascertain and avoid allergens during massage
23Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Emergency Measures for Emergency Measures for AnaphylaxisAnaphylaxis
Call 911Call 911 Calmly reassure the personCalmly reassure the person Check for special medications, such as Check for special medications, such as
injectable epinephrine; administer medicationinjectable epinephrine; administer medication Have person lie flat; elevate feet 12 inchesHave person lie flat; elevate feet 12 inches Cover person with coat or blanket; loosen Cover person with coat or blanket; loosen
tight clothingtight clothing
24Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Emergency Measures for Emergency Measures for AnaphylaxisAnaphylaxis (cont’d.)(cont’d.)
Do not give anything to drinkDo not give anything to drink If person is vomiting or bleeding from mouth, If person is vomiting or bleeding from mouth,
place on side to prevent chokingplace on side to prevent choking Perform CPR if person is not breathing or Perform CPR if person is not breathing or
does not have a pulsedoes not have a pulse
25Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Chronic Fatigue SyndromeChronic Fatigue Syndrome
Disease characterized by prolonged and Disease characterized by prolonged and severe tiredness and disabling fatigue; this severe tiredness and disabling fatigue; this fatigue is not relieved by rest and may fatigue is not relieved by rest and may worsen with physical or mental activityworsen with physical or mental activity
Reduce treatment time and pressure if client Reduce treatment time and pressure if client is overly fatigued is overly fatigued
26Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Systemic Lupus ErythematousSystemic Lupus Erythematous
Chronic inflammatory Chronic inflammatory disease affecting skin, bones disease affecting skin, bones and joints, nervous system, and joints, nervous system, kidneys, lungs, and other kidneys, lungs, and other organs organs
Massage is contraindicated Massage is contraindicated during flare-ups; otherwise, during flare-ups; otherwise, reduce treatment time and reduce treatment time and pressure if client is overly pressure if client is overly fatigued; avoid skin rashesfatigued; avoid skin rashes
A, Courtesy the Department of Dermatology, University of North Carolina at Chapel Hill. In Goldstein A, Courtesy the Department of Dermatology, University of North Carolina at Chapel Hill. In Goldstein BJ, Goldstein AO: BJ, Goldstein AO: Practical dermatology,Practical dermatology, ed 2, St. Louis, 1997, Mosby. B, from Hill MJ: ed 2, St. Louis, 1997, Mosby. B, from Hill MJ: Skin Skin
disorders—Mosby’s clinical nursing series,disorders—Mosby’s clinical nursing series, St. Louis, 1994, Mosby. St. Louis, 1994, Mosby.
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Acquired Immunodeficiency Acquired Immunodeficiency Syndrome (AIDS)Syndrome (AIDS)
Viral disease causing Viral disease causing progressive progressive impairment of immune impairment of immune systemsystem
AIDS is the final stage AIDS is the final stage (Stage IV) of HIV (Stage IV) of HIV infection infection
From Salvo S: From Salvo S: Massage therapy: principles and Massage therapy: principles and practice,practice, ed 2, Philadelphia, 2003, WB Saunders. ed 2, Philadelphia, 2003, WB Saunders.
28Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome (cont’d.)(cont’d.)
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Acquired Immunodeficiency Acquired Immunodeficiency Syndrome Syndrome (cont’d.)(cont’d.)
Reduce treatment time and pressure if client is Reduce treatment time and pressure if client is overly fatiguedoverly fatigued
Inquire about and avoid skins lesions, enlarged Inquire about and avoid skins lesions, enlarged lymph nodes, and area of most recent site of lymph nodes, and area of most recent site of blood workblood work
Avoid or administer joint mobilizations and Avoid or administer joint mobilizations and compressions carefully when condition is compressions carefully when condition is advancedadvanced