Lymphatic System
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Transcript Lymphatic System
Jarvis
Chapter 20
Circulation:
http://www.youtube.com/watch?v=PgI80UeAMo
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 20: Peripheral Vascular System and Lymphatic System
Learning Objectives
1. Relate normal & abnormal findings to the structure
& functions of the arteries & veins.
2. Discuss the lymphatic circulation system & related
organs.
3. Discuss arteriosclerosis & atherosclerosis in the
aging adult.
4. Discuss normal & abnormal subjective and
objective findings when assessing the peripheral
vascular system of an adult.
Chapter 20: Peripheral Vascular System and Lymphatic System
Key Terms
Artery
Arteriosclerosis
Atherosclerosis
Bruit
Capillary refill
Claudication
Deep vein
thrombophlebitis
(DVT)
Doppler ultrasound
Ischemia/ischemic ulcer
Lymph node
Lymphedema
Pitting edema
Perfusion
Pulsus paradoxus
Raynaud’s phenomenon
Varicose veins
Vein
Venous stasis ulcer
Chapter 20: Peripheral Vascular System and Lymphatic System
Peripheral Vascular System
Arteries carry blood away from the heart
Heart pumps freshly oxygenated blood through the arteries to
all body tissues
High pressure system, usually lie deep
Have a pulse accessible in certain areas temporal, carotid,
brachial, femoral, popliteal, medial malleolus (post tibial), &
dorsalis pedis
Veins carry blood back to the heart
Carry deoxygenated blood back to heart & lungs
Low-pressure system depends on skeletal muscle
contraction & one-way intraluminal valves to get blood back
to heart
Do not pulsate, usually lie closer to surface
Chapter 20: Peripheral Vascular System and Lymphatic System
Arteries in the Peripheral Vascular
System
Arteries in the head &
neck
Temporal artery
Carotid artery
Arteries in the arm
Brachial
Ulnar
Radial
Arteries in the leg
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
Slide 20-5
Chapter 20: Peripheral Vascular System and Lymphatic System
Veins in the Peripheral Vascular
System
Veins in the neck
Internal & external
jugular (Ch. 19)
Veins in the arm
Basilic
Cephalic
Median
Veins in the leg
Deep veins
Femoral
Popliteal
Superficial veins
Great saphenous
Small saphenous
Superficial veins can be
resected for BPGs without
compromising leg circulation
if deep veins are healthy
Chapter 20: Peripheral Vascular System and Lymphatic System
Arteries in the Head & Neck
Chapter 20: Peripheral Vascular System and Lymphatic System
Arteries in the Arm
Vessels
of the
Arm
Slide 20-8
Chapter 20: Peripheral Vascular System and Lymphatic System
Vessels in the Leg
Slide 20-9
Chapter 20: Peripheral Vascular System and Lymphatic System
Venous Flow
Drains deoxygenated blood from tissues & returns it
to heart & lungs for reoxygenation
Venous flow back up to heart depends on:
Skeletal muscle contraction
Increased abdominal pressure from inspiration
Intraluminal valves to ensure blood flow up to heart &
prevent back flow
Problems with flow back to heart venous stasis
pitting edema stasis ulcers
Chapter 20: Peripheral Vascular System and Lymphatic System
Venous
Flow
Chapter 20: Peripheral Vascular System and Lymphatic System
Lymphatic System
Completely separate circulation system from the blood
circulation system
Flow is slow compared to blood has one-way valves
& depends on skeletal muscle contraction &
contraction of lymph vessels
Slide 20-12
Chapter 20: Peripheral Vascular System and Lymphatic System
Lymphatic System (cont’d)
Functions:
Drains excess fluid from tissue spaces (prevents edema)
& picks up plasma proteins that leak out of capillaries &
returns both to blood circulation system Right
lymphatic duct empties into right subclavian vein;
thoracic duct empties into left subclavian vein
Forms a major part of the immune system that defends
the body against disease
Absorbs lipids from the intestinal tract
http://www.youtube.com/watch?v=Q9gpDUooVwo
Slide 20-13
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Lymphatic System
• Lymph vessels
• Lymph nodes filter out &
destroy pathogens before returning
collected fluid to blood circulation
•Related organs that aid the
lymphatic system with the immune
function:
•Tonsils
•Thymus
•Spleen
•Peyer’s patches on small
intestines
•Bone marrow
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Lymph Nodes
• Small clumps of
lymphatic tissue
•Filter & destroy
pathogens that may
harm the body
•Superficial nodes
may be palpable;
deep nodes are not
•With local
inflammation,
nodes in that area
become swollen &
tender
Chapter 20: Peripheral Vascular System and Lymphatic System
Changes in the Aging Adult
Arteriosclerosis peripheral blood vessels grow stiff &
less compliant rise in systolic BP
Atherosclerosis fat plaques deposited inside arteries
found in all ages, not just aging adults
Enlargement of calf veins prolonged bedrest or sitting
and heart failure increased risk for deep vein thrombosis
(DVT) and pulmonary embolus (PE)
Loss of lymphatic tissue with fewer lymph nodes &
decreased size of lymph nodes – decreased immune
function
Slide 20-18
Chapter 20: Peripheral Vascular System and Lymphatic System
Subjective Data—
Health History Questions
Leg pain or cramps claudication: leg/calf pain on
walking or climbing stairs; pain resolves with rest
decreased perfusion (blood flow) results in
ischemia (a deficient supply of oxygenated arterial
blood to a tissue) partial blockage creates
insufficient supply w/pain on exercise, when
oxygen needs increase
Skin changes on arm or legs
Edema (Swelling) (hard or pitting)
Lymph node enlargement (tender)
Medications
Chapter 20: Peripheral Vascular System and Lymphatic System
Objective Data—The Physical Exam
Radial pulse
Arms—Inspect and palpate
Skin
Profile sign detects
early clubbing of nails
Capillary refill (<2
sec.)
Symmetry
Edema
Ulnar pulse (not
usually palpable)
Brachial pulse
Modified Allen test
(evaluates adequacy
of collateral
circulation before
cannulating the
radial artery)
Slide 20-20
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Objective Data—The Physical Exam (cont.)
Legs—Inspect and palpate
Skin and hair
Symmetry
Temperature
Calf muscle
Inguinal lymph nodes
Pitting edema grade
on scale of 1+ (mild) to
4+ (severe)
Lymphedema (hard,
nonpitting)
Capillary refill (<2 sec.)
Peripheral pulses (scale of
0-3+)
Femoral pulse
Popliteal pulse
Posterior tibial pulse (PT)
Dorsalis pedis pulse (DP)
Additional techniques
Color changes
Doppler ultrasonic
stethoscope
Femoral bruit
Slide 20-22
Chapter 20: Peripheral Vascular System and Lymphatic System
4+ Pitting Edema
© Pat Thomas, 2006.
Slide 20-23
Chapter 20: Peripheral Vascular System and Lymphatic System
Abnormal Findings
Variations in Arterial Pulse
Weak, “thready” pulse – 1+
** Normal peripheral pulses are 2+
Full, bounding pulse – 3+
Pulsus paradoxus Beats have weaker amplitude
with inspiration, stronger with expiration. Best
determined during BP measurement reading
decreases >10mm/Hg during inspiration &
increases with expiration.
Slide 20-24
Chapter 20: Peripheral Vascular System and Lymphatic System
Doppler Ultrasound (US)
Stethoscope
•Used to detect
weak peripheral
pulse
•Pulse identified
by swishing,
whooshing sound
Slide 20-25
Chapter 20: Peripheral Vascular System and Lymphatic System
Abnormal Findings
Peripheral Vascular Disease (PVD)
Arms
Raynaud’s Phenomenon
Lymphedema (also often seen in legs)
Legs
Arteriosclerosis—ischemic ulcer
Venous (stasis) ulcer
Superficial varicose veins
Deep vein thrombophlebitis (DVT)
Lymphedema
Occlusions
Aneurysms
Slide 20-26
Chapter 20: Peripheral Vascular System and Lymphatic System
Manifestations (S/Sx) of PVD
Arterial Insufficiency
Pain, cramps, or numbness &
tingling in lower extremity,
usually calf muscle
Onset with exertion (walking
or climbing stairs) or with
elevation (severe)
Relieved by rest or dangling
(severe)
Pale, cool skin
Weak or absent pulse
Foot or ankle ulcer
Venous Insufficiency
Feeling of fullness, aching in
lower leg
Discomfort increases at end of
day
Prolonged sitting or standing
exacerbates discomfort
Elevation, lying or walking
relieves
Edema, varicosities, weeping
ulcers (stasis ulcers) at ankles
Chapter 20: Peripheral Vascular System and Lymphatic System
2 Presentations of Raynaud’s Phenomenon
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Arterial Ischemic Ulcers
Slide 20-30
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Manifestations of Venous Stasis with Ulcer
•Edema (hard or
pitting)
•Tan/brown
discoloration to
lower leg
•Wet, draining
ulcer
Slide 20-33
Chapter 20: Peripheral Vascular System and Lymphatic System
Venous Stasis Ulcers
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Chapter 20: Peripheral Vascular System and Lymphatic System
Sample Charting
Slide 20-39