Mosbys PATHOLOGY for Massage Therapists Chapter 9 Lymphatic

Lesson 9. 1 Objectives Discuss anatomic structures and physiologic processes related to the lymphatic system. Describe the different types of immunologic reactions. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 2

Lymphatic System Overview Composed of: Lymph Ø Lymphocytes Ø Lymphatic vessels Ø Lymph nodes Ø Organs and glands containing lymphoid tissue Ø From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6, 2007, St. Louis, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 3

Lymphatic System Overview (cont’d. ) Lymphatic system functions: Drains excess interstitial fluid Ø Transports dietary lipids and lipid-soluble vitamins from digestive tract to the blood Ø Carries out immune functions Ø Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 4

Lymphatic System Overview (cont’d. ) Draining excess interstitial fluid Ø Enters lymphatic capillaries; drains into larger vessels Ø Lymph nodes situated along lymphatic vessels; these filter out pathogens and debris Ø Lymph finally drains into subclavian veins From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6, 2007, St. Louis, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 5

Lymphatic System Overview (cont’d. ) Lymphatic circulation pathways From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6, 2007, St. Louis, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 6

Lymphatic System Overview (cont’d. ) Immunity – Anatomic and physiologic defense reactions to invading organisms Key components are: Lymphocytes Ø White blood Cells Ø Structures such as skin and chemicals (i. e. , digestive enzymes) are also involved Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 7

Lymphatic System Overview (cont’d. ) Immunity; two types: Natural: nonspecific responses to invading pathogens (i. e. , physical barriers of the skin, chemical barriers of enzymes, fever, and inflammation) Ø Acquired: diverse but specific responses to invaders involving lymphocytes; two types of lymphocytes • B cells • T cells Ø Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 8

Lymphatic System Overview (cont’d. ) T and B cells both form in red bone marrow B cells mature in red bone marrow T cells mature in the thymus Mature T and B cells then travel to lymphatic tissues From Salvo S: Massage therapy: principles and practice, ed 3, St. Louis, 2007, Saunders. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 9

Lymphatic System Overview (cont’d. ) Immune response T and B cells activate when they come into contact with pathogens Ø T cells leave lymphatic tissue to kill pathogens directly Ø B cells produce antibodies • antibodies leave lymphatic tissue to circulate in body Ø fluids • antibodies inactivate pathogens as they come across them Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 10

Lymphatic System Overview (cont’d. ) Immune response (cont’d. ) Ø Autoimmune diseases • T and B cells unable to distinguish body’s own tissues from something foreign to body • T and B cells then attack the tissues Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 11

Lesson 9. 2 Objectives Define conditions of the lymphatic system and list appropriate massage considerations. Identify conditions of the immune system and list appropriate massage considerations. Explain emergency measures for anaphylaxis. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 12

Conditions of the Lymphatic System Lymphedema and Edema Lymphangitis Lymphadenopathy and Lymphadenitis Copyright ©

Lymphedema and Edema Lymphedema Ø Abnormal accumulation of fluids caused by obstruction in lymph flow causing swelling • Primary: due to lymph vessel or nodal malformation; rare • Secondary: due to a condition or medical procedure Edema Ø Abnormal accumulation of fluids from a sluggish or overloaded lymph transport system causing swelling Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 14

Lymphedema and Edema (cont'd. ) Primary lymphedema From Seidel HM et al: Mosby’s guide to physical examinations, ed 6, St. Louis, 2006, Mosby. Secondary lymphedema From Seidel HM et al: Mosby’s guide to physical examinations, ed 6, St. Louis, 2006, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 15

Lymphedema and Edema (cont'd. ) Peripheral edema – Edema of an extremity Dependent edema – Type of peripheral edema found in gravity-dependant areas of the lower extremity Angioedema – Edema seen in allergic reactions Pitting edema – Edema that leaves a pit or dent in skin once compressed and released Non-pitting edema – Does not leave a dent after skin is compressed and released Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 16

Lymphedema and Edema (cont'd. ) From Frazier MS, Drzymkowski J: Essentials of human diseases and conditions, ed 3, 2004, St. Louis, Saunders; Callen JP et al: Color atlas of dermatology, ed 2, Philadelphia, 2000, Saunders; and Bloom A, Ireland J: Color atlas of diabetes, ed 2, London, 1992, Mosby-Wolfe. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 17

Lymphedema and Edema (cont'd. ) Avoid vigorous massage in affected areas Avoid all forms of thermotherapy During massage, elevate affected areas Massage proximal to affected areas if located on the extremities Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 18

Lymphangitis Infection of lymphatic vessels; usually an indication that a primary infection is spreading Local contraindication From Stone DR, Gorbach SL: Atlas of infectious diseases, Philadelphia, 2000, WB Saunders. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 19

Lymphadenopathy and Lymphadenitis Lymphadenopathy – Enlarged lymph nodes Lymphadenitis – Infected lymph nodes Local contraindication; absolute contraindication if systemic disease is present Courtesy Dr. A. R. Kagan, Los Angeles. In Del Regato JA, Spjut HJ, Cox JD: Ackerman and del Regato’s cancer, ed 2, St. Louis, 1985, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 20

Conditions of Immune System Allergy Chronic fatigue syndrome Systemic lupus erythematosus Acquired immunodeficiency syndrome Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 21

Allergy Overreaction of immune system to otherwise harmless agents; also called a hypersensitivity reaction Type I Anaphylaxis is the least common, but most perilous reaction Ø Caused by insect sting, ingestion of nuts or shellfish, or drug reaction Ascertain and avoid allergens during massage Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 22

Emergency Measures for Anaphylaxis Call 911 Calmly reassure the person Check for special medications, such as injectable epinephrine; administer medication Have person lie flat; elevate feet 12 inches Cover person with coat or blanket; loosen tight clothing Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 23

Emergency Measures for Anaphylaxis (cont’d. ) Do not give anything to drink If person is vomiting or bleeding from mouth, place on side to prevent choking Perform CPR if person is not breathing or does not have a pulse Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 24

Chronic Fatigue Syndrome Disease characterized by prolonged and severe tiredness and disabling fatigue; this fatigue is not relieved by rest and may worsen with physical or mental activity Reduce treatment time and pressure if client is overly fatigued Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 25

Systemic Lupus Erythematous Chronic inflammatory disease affecting skin, bones and joints, nervous system, kidneys, lungs, and other organs Massage is contraindicated during flare-ups; otherwise, reduce treatment time and pressure if client is overly fatigued; avoid skin rashes A, Courtesy the Department of Dermatology, University of North Carolina at Chapel Hill. In Goldstein BJ, Goldstein AO: Practical dermatology, ed 2, St. Louis, 1997, Mosby. B, from Hill MJ: Skin disorders—Mosby’s clinical nursing series, St. Louis, 1994, Mosby. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 26

Acquired Immunodeficiency Syndrome (AIDS) Viral disease causing progressive impairment of immune system AIDS is the final stage (Stage IV) of HIV infection From Salvo S: Massage therapy: principles and practice, ed 2, Philadelphia, 2003, WB Saunders. Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 27

Acquired Immunodeficiency Syndrome (cont’d. ) Copyright © 2010, 2006 by Mosby, Inc. , an

Acquired Immunodeficiency Syndrome (cont’d. ) Reduce treatment time and pressure if client is overly fatigued Inquire about and avoid skins lesions, enlarged lymph nodes, and area of most recent site of blood work Avoid or administer joint mobilizations and compressions carefully when condition is advanced Copyright © 2010, 2006 by Mosby, Inc. , an affiliate of Elsevier Inc. All rights reserved. 29