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Chapter 21 Lymphatic and Immune Systems. Maintains fluid balance Protect body from infection and disease. Lymphatic Vessels Within Capillary Network. Lymphatic capillaries weave through blood capillaries. 2 Major Functions of Lymphatic System. 1.) Fluid recovery

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Chapter 21 Lymphatic and Immune Systems

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Chapter 21 lymphatic and immune systems l.jpg

Chapter 21Lymphatic and Immune Systems

  • Maintains fluid balance

  • Protect body from infection and disease


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Lymphatic Vessels Within Capillary Network

  • Lymphatic capillaries weave through blood capillaries.


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2 Major Functions of Lymphatic System

  • 1.) Fluid recovery

    • absorbs plasma proteins and fluid from tissues and returns it to the bloodstream

      • interference with lymphatic drainage leads to severe edema

    • lipid absorption

      • Lacteals in small intestine absorb dietary lipids

  • 2.) Immunity

    • fluids from all capillary beds are filtered

    • immune cells stand ready to respond to foreign cells


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Lymphatic Obstruction

Elephantiasis- mosquito-borne infection effect the skin to cause it to thicken. Also, the scrotum of men and breasts of women are similarly effected.


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Lymph and Lymphatic Tissue

  • Lymph

    • clear, colorless fluid, similar to plasma

  • Lymph is like blood in the vascular system

  • This fluid flows within lymphatic vessels

  • Lymphatic tissue is specialized connective tissue that contains lymphocytes


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Route of Lymph Flow

  • Lymphatic vessels are vein-like, have valves and go along the course with arteries and veins

  • Lymphatic vessels permits interstitial fluid to flow in and out

  • The flow- Lymphatic capillaries to:

  • Lymphatic vessels to:

  • Lymph nodes.

  • So lymphatic vessels, unlike blood circulation, don’t have arteries but start with capillaries.


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Valve in a Lymphatic Vessel

  • Why valves?


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Lymphatic Drainage


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Lymphatic Drainage of Mammary and Axillary Regions

  • Drainage of Right side of the body:

  • Right lymphatic duct to:

  • Right subclavian


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Drainage of Thorax

  • Drainage of the Left side of the body:

  • Cisterna Chyli (sis-turn-a ki-lay) to Thoracic Duct to Left Subclavian vein.


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4 Mechanisms of Lymph Flow

  • 1.) Moved along by rhythmic contractions of lymphatic vessels and Cisterna Chyli (“Heart for the lymph”)

  • 2.) Flow aided by skeletal muscle pump

  • 3.) Thoracic pump aids flow from abdominal to thoracic cavity

    • Valves prevent backward flow

  • 4.) Rapidly flowing bloodstream in subclavian veins, draws lymph into it

    • Exercise significantly increases lymphatic return


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Lymphatic Cells

  • T lymphocytes

    • Mature in Thymus

  • B lymphocytes

    • Mature in Bone marrow

  • Secondary lymphatic organs- sites where the B and T cells carry out the immune response

    • Lymph nodes

    • Spleen


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Lymphatic Organs

  • At well defined anatomical sites.

  • Lymph nodes

    • cervical, axillary and inguinal regions close to surface

    • thoracic, abdominal and pelvic groups deep in cavities

  • Tonsils

    • guard entrance to pharynx

  • Spleen

    • inferior to diaphragm on the left

  • Thymus

    • behind sternum


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Thymus Gland

  • Thymus gland is located posterior to the sternal angle

  • Thymus gland produces T cells

  • The thymus may not become atrophied as we age


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Lymph Node

  • Lymph Nodes- approximately 600 bean shaped nodes in the body

  • Lymph nodes - only organs that filter lymph

    • reticular tissue cells (like a network of cotton fibers), macrophages phagocytize foreign matter

    • lymphocytes respond to antigens

    • lymphatic nodules-germinal centers for B cell activation


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Lymph Node


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Lymphadenopathy

  • Collective term for all lymph node diseases

  • Lymphadenitis

    • swollen, painful node responding to foreign antigen

  • Lymph nodes are common sites for metastatic cancer

    • swollen, firm and usually painless


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Swollen Lymph nodes

  • Lymph nodes filter lymph

  • Foreign substance are trapped

  • Macrophages destroy by using phagocytosis

  • Examination of swollen glands:

    • Neck- sweep from clavicle on SCM to ear

    • Axilla- place hand at apex, lower arm

    • Groin- palpate just below pubic bone by femoral artery


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CANCER

Firm, hard

Non-movable

No fever

Not painful

Diagnosis- neoplasm

INFECTION

Soft

Movable

Fever

Painful

Diagnosis- swollen lymph nodes

Differential Diagnosis of Nodes


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“Don’t Yank Me!”

  • Tonsils- aggregation of lymphatic tissue at the ring of the throat

  • The tonsils, are strategically positioned to participate in immune response against foreign substances that are inhaled or ingested.

  • Research shows that tonsillectomy is related to respiratory problems

  • Appendix- Lymphoid tissue that assists in ______ _________


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Spleen

  • Largest mass of lymphatic tissue, 5 inch long

  • 3 Functions-

    • Immune function: assists red bone marrow and liver

    • Clears blood from RBCs and WBCs

    • Blood storage, platelets are stored

  • The spleen- “Mean, bloody and clean”


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Resistance to Disease

  • Resistance- your body’s ability to ward off disease

    • Two Types:

    • 1.) Nonspecific

      • General defense such as skin, mucous membranes, acidity of the stomach

    • 2.) Specific (also called Immunity)

      • Specific defense, produces specific cells (lymphocytes) that combat particular bugs

      • results from prior exposure, protects against only a particular pathogen

      • immune system

  • Susceptibility- the body’s lack of resistance


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Nonspecific Resistance to Disease- External

  • Immediate protection against a wide range of pathogens, general not a specific response

  • External resistance to disease- passive defense (Barrier- like castle walls, moat- flow)

    • Barrier: the skin

      • toughness of keratin

      • dry and nutrient-poor

      • defensins: peptides, from neutrophils attack microbes

      • lactic acid (acid mantle) is a component of perspiration barrier

    • Barrier: gastrointestinal barrier

      • Leaky gut syndrome is a break in this barrier

    • Flow: mucous

      • stickiness of mucus

      • lysozyme: enzyme destroys bacterial cell wall

    • Flow: cilia, tears, saliva, urine, defecation, vomit, diarrhea, sebum, perspiration, gastric juice, vaginal secretions


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Natural Killer Cells and Phagocytes

  • Natural killer cells are lymphocytes that kill microbes and tumor cells

    • It can mess with the membrane of the bug causing cytolysis or it can bind to the cell and never get off it’s back

  • Phagocytes- ingest microbes by 5 processes:

    • Chemotaxis- chemical from infection attract phagocytes

    • Adherence- jumps on the bugs back

    • Ingestion- pseudopods “hug” the bug

    • Digestion- from enzymes and lethal oxidants,

    • Killing

  • Two major phagocytes are: Neutrophils, Macrophages


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Inflammation

  • Defense response from cell damage due to bugs, physical trauma or chemical agents such as diet

    • suffix -itis denotes inflammation of specific organs

  • Cardinal signs

    • paincaused by inflammatory chemicals (bradykinin, prostaglandins) secreted by damaged cells, pressure on nerves

    • heatcaused by hyperemia

    • redness(erythema) caused by hyperemia ( blood flow)

    • swelling(edema) caused by  capillary permeability and filtration

    • “Pa, He Read Swell”

  • Diet loaded with refined foods, hydrogenated oils, dairy products can cause subclinical inflammation and disease


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Tissue Repair

  • Facilitated by hyperemia that provides materials needed and heat that increases metabolism

  • Fibrin clot may provide a scaffold for repair

  • Painis your normal friend, it tells you to attend!

    • it limits use of body part allowing for repair


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Fever

  • Elevation of core temperature

  • Most common cause is infection

  • Defense mechanism: Up to a point fever is beneficial

    • promotes interferon activity and phagocytosis

    • accelerating metabolic rate and tissue repair

    • inhibiting pathogen reproduction

  • How high is too high? Coma and death occurs at 111F- 115F, practically 104-5 degrees is the limit


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Specific Immunity

  • Immunity is the bodies ability to defend against specific invaders such as viruses, toxins, bacteria

  • This system is Antigen (Ags) based- substances that are recognized as foreign and provoke an immune response

  • Immunology- study of the immune response

  • Immune system principal components- Thymus, Red Bone Marrow


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Antigens (Bad Guys)

  • Antigen means Antibody Generator- these guys stimulate antibodies production, like pollen to an allergic person, usually made of protein

  • Two important characteristics:

  • 1.) Immunogenicity- the ability to provoke an antibody reaction

  • 2.) Reactivity- the ability to react with the antibody it provoked


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Of Bs and Ts

  • The cells that develop immunocompetence, the ability to carry out an immune response are B and T cells.

  • Both start mostly in the bone marrow, Bs mature in the bone marrow but Ts leave home and go to the thymus to mature

  • Both cells acquire antigen receptors that can detect antigens.


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T Cell Doing What It Does Best…


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…Destruction of Cancer Cell


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Immunological Memory

  • A hallmark of the immune response is memory, this memory is for the antigen that triggered the response in the past

  • Long lasting antibodies “embody” this memory

  • When you recover from an infection without taking antibiotic drugs, if at a later time you are infected again by the same bug the response will be swift, so swift that you may not know you were infected

  • Vaccination work on the theory that man can induce immunological memory this is called: artificial active immunity


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Vacinations- Pros and Cons

  • Pro- Small Pox

  • Con- Black Death that swept through Europe in the 14th century killing more than 25 million people, a third of the European population

  • Con- Polio vaccine

  • http://www.hrsa.gov/vaccinecompensation/table.htm


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Antibody Classes

  • Immuno globulins- glycoprotein antibodies

  • IgA: Stress decreases, less protection for mucous membrAnes against bacteria and viruses

    • Exercise raises levels of Ig A

  • IgD: Minor antibody

  • IgE: Protects against parasites, involved in allErgy

  • IgG: The Great antibody, most abundant and protests against bacteria and viruses

  • IgM: Antibody in blood plasMa (creates ABO blood type)

  • In acute infection- IgM, Chronic infection- IgG


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Hypersensitivity (Allergy)

  • Excessive immune reaction against antigens that most people can tolerate called allergens

  • Hypersensitivity- Acute (most common)

    • anaphylaxis: IgE (allErgy) mediated, mucus hypersecretion, congestion; hives, watery eyes, runny nose

  • Asthma (most common chronic illness in children)

    • inhaled allergens, bronchiole constriction

  • Anaphylactic shock: bronchiolar constriction, dyspnea, vasodilation, shock, death; treatment- epinephrine


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Immunodeficiency Diseases

  • Severe Combined Immunodeficiency Disease

    • hereditary lack of T and B cells

    • vulnerability to opportunistic infection


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Immunodeficiency Diseases

  • AIDS

    • HIV structure

    • invades helper T cells, macrophages and dendritic cells by “tricking” them to internalize viruses by receptor mediated endocytosis

    • reverse transcriptase (retrovirus), uses viral RNA as template to synthesize DNA, new DNA inserted into host cell DNA, may be dormant for months to years


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HIV Structure

Comparing cells to bacteria to viruses- If a typical cells was about 2 feet a bacteria would be a speck, if a bacteria was 2 feet the virus would be a speck.


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AIDS

  • Signs and symptoms

    • early symptoms: flulike chills and fever

    • progresses to night sweats, fatigue, headache, extreme weight loss, lymphadenitis

    • normal T cell count is 600 to 1,200 of blood but in AIDS it is < 200

    • thrush: white patches on mucous membranes may appear

    • Kaposi sarcoma: cancer originates in endothelial cells of blood vessels causes purple lesions in skin


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HIV Transmission

  • Through blood, semen, vaginal secretions, breast milk, or across the placenta

  • Most common means of transmission

    • sexual intercourse (vaginal, anal, oral)

    • contaminated blood products

    • contaminated needles

  • Not transmitted by casual contact

  • Undamaged latex condom is an effective barrier to HIV especially with the spermicide nonoxynol-9


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