PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
3. ● The lymphatic system and immunity are major protectors from disease.
● Lymphocytes are specialized leukocytes.
● Organs and glands containing lymphoid tissue include bone marrow, the
thymus and spleen, and areas in the intestinal mucosae. The latter is
collectively called mucosal associated lymphoid tissue or M.A.L.T.
● The image on the slide located in the lower left hand corner features the
areas drained by the two main lymphatic trunks. These are the thoracic duct
(blue area) and the right lymphatic duct (green area).
● The lymphatic system and immunity are major protectors from disease.
● Lymphocytes are specialized leukocytes.
● Organs and glands containing lymphoid tissue include bone marrow, the
thymus and spleen, and areas in the intestinal mucosae. The latter is
collectively called mucosal associated lymphoid tissue or M.A.L.T.
● The image on the slide located in the lower left hand corner features the
areas drained by the two main lymphatic trunks. These are the thoracic duct
(blue area) and the right lymphatic duct (green area).
6. Lipids and lipid-soluble vitamins are too large to fit into blood capillaries. Thus
when they are absorbed from the digestive tract, they move into the largerdiameter lymphatic capillaries instead, entering the blood when lymph drains
back into the bloodstream.
Lymph system function
What moves lymph?
Gravity
Muscle contraction
Alternating hot and cold
Breathing
Massage
Deep, light
8. ● This fluid is then transported to progressively larger lymphatic vessels,
culminating in the right lymphatic duct (for lymph from the right upper body)
and the thoracic duct (for the rest of the body). These ducts drain into the
circulatory system at the right and left subclavian veins.
● Lymphatic flow is maintained by contraction of skeletal muscles and by
intrinsic contraction mechanisms within the larger collection vessels.
9. Immunology is studied in the lymphatic system because lymphoid tissue is the
anatomical component of the immune system.
10. Natural immunity protects a person from a wide range of pathogens.
Defenses that qualify as part of the body’s natural immunity include the
physical barriers of skin, mucosa and cilia; the chemical barriers of digestive
enzymes, perspiration, vaginal secretions, and the skin’s acid mantel;
complement proteins found in blood that attack foreign agents; phagocytes
such as neutrophils and macrophages; fever; and inflammation.
● What is acquired immunity?
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
Acquired immunity develops in response to the activation of the lymphatic
system after pathogens penetrate the body’s natural immunity defenses.
Once the immune system is able to recognize a specific pathogen, white
blood cells develop the ability to recognize and destroy that pathogen.
12. In order for T cells and B cells to mount an immune response, they need to
come in contact with the pathogen. What are the three ways in which this
can happen?
The pathogen can travel through the lymph into a lymph node; the
pathogen can travel through the blood to the lymphatic tissue in the spleen;
or the pathogen can come into contact with the embedded lymphatic
nodules in the mucous membranes.
● The large-scale cloning of the B cells and T cells accounts for the presence of
swollen lymph nodes when the body is fighting off an infection.
13. ● What are some common autoimmune diseases?
Arthritis, lupus, multiple sclerosis, psoriasis, scleroderma, and type 1 diabetes
are all examples of autoimmune disorders. Autoimmune disorders result when
the immune system attacks the body’s own cells, mistaking them for
pathogens.
14. Box 9-1 on page 263 for general manifestations of lymphatic and
immunologic diseases.
15. ● The lymphatic system involved in all inflammatory, circulatory, and
neoplastic diseases. There are few diseases limited to just the lymphatic
system.
● Discussions of lymphoma, a type of cancer, is located in Chapter 14.
16. ● Lymphedema and edema are conditions that involve swelling, but they
have very different causes.
● What are some of the possible causes of lymphedema and edema?
Some possible causes include the following: inflammation, obstruction of
lymph flow, removal of lymph channels, physical trauma, high blood
pressure, or damaged blood vessels. Edema can be aggravated by
pregnancy, obesity, and prolonged standing.
Signs and Symptoms
Depends on source, duration, affected area
Soft, puffy, boggy texture
Hot with recent injury, infection
Cool if longstanding, from poor circulation
Pitting edema: Fig. 6.2
Massage
Most types contraindicate massage, especially pitting edema
Lymphatic work appropriate with care, no infection
17. Edemas that contraindicate circulatory massage
Heart problems
Kidney problems
Liver problems
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
Local infection
Blockage
Indicated edemas
Post acute musculoskeletal injury
Some cases of immobility
Some cases of immobility are mediated by Risk of blood clots,
deep vein thrombosis (DVT )
20. ● In this slide, the child was born with the lymphatic vessel malformation,
which caused left leg swelling.
● The woman on the slide had a surgical procedure to remove her right breast.
The procedure included removal of her axillary lymph nodes. This caused
swelling in her right arm.
21. ● These are terms used when describing both lymphedema and edema.
● Pitting edema is more common in lymphedema than edema. Non-pitting is
more common in edema.
22. ● Which three kinds of edema are shown in this slide?
Dependant edema, angioedema, and pitting edema.
● Edema distribution is often linked to its cause; edema of lower extremities is
typical of heart failure; edema of the abdomen is typical of liver cirrhosis;
edema that is diffuse is typical of kidney failure. Be sure to consider these and
other medical conditions in the treatment plan.
23. ● Why is vigorous massage contraindicated? Because this may cause
inflammation, which contributes to the closing of dysfunctional vessels, which
in turn worsens swelling.
● Gentle superficial gliding strokes applied centripetally are beneficial. The
edematous limb should be supported and elevated during the massage.
● Therapists trained in advanced techniques of manual lymphatic drainage
may follow appropriate protocols.
24. Treatment
Antibiotic therapy ASAP
Massage
Contraindicates massage
Take good care of hands to prevent picking up infection
25. ● What are the symptoms of lymphangitis?
Some symptoms of lymphangitis include enlarged local lymph nodes along
with red streaks extending from the infected area. The person usually has
chills, fever, fatigue, loss of appetite, and headaches.
● Because of comparable local signs and symptoms, lymphangitis of the lower
extremity may be confused with thrombophlebitis.
26. ● Lymphadenitis denotes infection within the lymph nodes.
Lymphadenopathy may be indicative of an underlying disease, while
lymphadenitis is caused by bacteria, virus, parasites, or protozoa.
● What are the symptoms of lymphadenopathy?
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
Some symptoms of lymphadenopathy include the following: enlargement of
lymph nodes with possible bilateral involvement; lymph nodes feel hard; skin
may be red or hot and edema may be present; there may be symptoms of
systemic infection such as fever; chills; fatigue; loss of appetite; and
headaches.
● If enlarged lymph nodes accompany a systemic disease, massage is
postponed until the disease has resolved OR until medical clearance is
obtained.
27. Conditions of Immune System
● Immune disorders are usually a malfunction of immune system.
● These malfunctions may generate hypersensitive reactions, autoimmune
diseases, or immunodeficiency disorders.
●
Scleroderma is discussed with dermatologic pathologies and multiple
myeloma is discussed with types of cancer.
28. ● Table 9-1 on page 267 discusses types of hypersensitivities. Note that SLE is
classified as Type III.
● The term allergy was originally used to denoted both aspects of the immune
response, immunity (which is beneficial) and hypersensitivity (which is
harmful). Now, the term allergy is used to denote harmful effects of the
immune system, and immunity is the term to indicate its protective effects.
● An allergen is a substance that promotes allergic reactions. What are some
examples?
Pet dander, lubricants that contain nut oils, and latex gloves are all possible
allergens. The therapist should ask clients with known allergies to review the
ingredients list before applying a massage lubricant.
● Massage can be performed as long as the client is not experiencing any
acute allergic reaction and/or difficulty breathing.
30. ● What are the symptoms of anaphylaxis?
Choking, wheezing and shortness of breath, rapid pulse, dizziness, and loss of
consciousness are all symptoms of anaphylaxis.
● Anaphylaxis
- Acute, severe, systemic
- Massive histamine release
Drop in blood pressure; edema; can interfere with breathing
- Triggers: antibiotics, blood products, diagnostic imaging dye; latex,
wasp stings, ants, honeybees; nuts
- First exposure may not cause significant reaction; repeated
exposures cause more antibody activity
- Occurs at site of exposure and systemically; can be medical
emergency (500 deaths/year)
31. Box 9-2 on page 268 discusses these emergency measures.
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
32. ● CFS is often accompanied by flulike symptoms such as low-grade fever,
sore throat, headaches, unexplained muscle soreness, joint pain, and lymph
node tenderness.
● Depression is a frequent complaint.
● What type of massage is indicated for clients with chronic fatigue syndrome?
A gentle massage is best as it can soothe the nervous system, relieve muscle
and joint pain, and give the client a chance to rest. Because the client’s
symptoms vary daily, it is important to ask about current symptoms and adjust
the massage accordingly. It is also helpful to ask how the client responded to
the previous massage, making appropriate treatment modifications.
33. ● There are three main types of lupus, with systemic lupus erythematosus
being the most common. The two other types are discoid lupus
erythematosus and drug-induced.
● Skin rash is present in SLE. The photographs here show the butterfly rash and a
skin rash on sun exposed areas of skin.
● Box 9-2 on page 272 features disease manifestations of SLE.
● During periods of remission, what sort of massage is indicated?
A gentle full body massage is indicated. Special care should be exercised
when performing stretches and joint mobilizations. Be sure to treat enlarged
lymph nodes as a local contraindication.
35. ● The person is considered HIV-positive when blood test positive for viral
antibodies. The same person has AIDS when the immune system has
weakened to the point where he or she has had at least three opportunistic
diseases, or T cell blood count below 200 (normal range is between 6001000).
● Box 9-3 on p. 273 of the textbook lists the staging criteria for HIV infection.
(Review box in class.)
● The person is considered HIV-positive when blood test positive for viral
antibodies. The same person has AIDS when the immune system has
weakened to the point where he or she has had at least three opportunistic
diseases, or T cell blood count below 200 (normal range is between 6001000).
● Box 9-3 on p. 273 of the textbook lists the staging criteria for HIV infection.
(Review box in class.)
36. 40% new infections from sexual activity between men
26% from shared needles
4% from some combination of homosexual activity and shared needle use
28% from heterosexual activity
2% from no identified risk
37. ● Antibodies against HIV appear rapidly after infection through blood
(within 2-10 weeks). When the virus is transmitted by sexual activity,
antibodies may not appear for 6-14 months. The time period between
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
infection and the appearance of antibodies is called the window. This
creates an opportunity of an infected person to transmit the virus
unknowingly. The presence of antibodies helps determine diagnosis.
● Clinical stage 1 marks a period of asymptomatic infection, which can last
from 2 wks to 20 yrs. During this period, the virus is replicating in lymph nodes.
During clinical stage 2 and 3, the person presents more general symptoms of
HIV infection such as unexplained weight loss, diarrhea, fatigue, night sweats,
and enlarged lymph nodes.
● As the disease progresses, immunodeficiency is more evident and marked by
frequent, or opportunistic, infections (any listed in the image on the prior
slide). T cell count plummets; the person enters the final stage of infection
called AIDS.
Progression
Phase 1
New infection; pools in WBCs
Tests are negative, no symptoms
Communicable
Lasts 3 weeks to 6 months for sexually transmitted infections
Phase 2
Acute primary HIV: antibodies become detectable
70% have fatigue, swollen glands, fever; looks like flu or mono
Phase 3
Asymptomatic period
Virus replicates; immune system keeps up
Medication works to prolong this phase
1–20+ years; average is 10 years
Phase 4
HIV+ → AIDS
T cells drop < 200 cells/mL of blood (normal is 800–1,000)
Opportunistic diseases develop
HIV Resistance
Long-term nonprogressors: three major factors
Host resistance
Fewer CD4 sites; harder for virus to attach
Immune system response
Immune system is more aggressive, responsive to viral signals
Virulence of the virus
Virus may be weakened by other factors
39. ● When massaging a client who is HIV+ or who has AIDS, inquire about the
client’s activities of daily living before every massage. When appropriate,
reduce treatment time to 30 minutes and use lighter pressure. In general,
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PATHOLOGY OF THE IMMUNE AND LYMPHATIC SYSTEM
ROBERTA L. WOLFF
COMMENTARY ON LYMPHATIC/IMMUNE POWERPOINT/ADOBE PRESENTATION
individuals who are HIV+ can typically tolerate a more vigorous massage,
and individuals with AIDS cannot.
● Because the immune system of the HIV-infected client is not fully functional,
the client is more susceptible to contacting infections through simple
exposure. The therapist is a greater health hazard to the HIV-infected client
than the infected client is to the therapist.
40. HL mostly 15–34 years old or >55
NHL mostly 60–70 years old
20,500 deaths/year
19,000 NHL
1,500 HL
Types of lymphoma
Hodgkin lymphoma
B cells mutate into large, malignant multinucleate Reed Sternberg cells
Usually submandibular nodes, can be axillary, inguinal
Growths metastasize to liver, bone marrow
Progress is usually organized, predictable
Non-Hodgkin lymphoma
Mutation of lymphocytes into indolent or aggressive cancer cells
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