chapter 9 lymphatic and immune pathologies mosby’s pathology for massage therapists copyright ©...

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.

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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.


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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.


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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


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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.


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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.


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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


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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


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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.


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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


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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


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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.


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Conditions of the Lymphatic Conditions of the Lymphatic SystemSystem

Lymphedema and Edema Lymphedema and Edema Lymphangitis Lymphangitis Lymphadenopathy and LymphadenitisLymphadenopathy and Lymphadenitis


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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


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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.


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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


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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.


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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


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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.


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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


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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


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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


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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


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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


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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.


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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

chapter 9 lymphatic and immune pathologies mosby’s pathology for massage therapists copyright ©...

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lymphatic system functions

lymphatic capillaries

lymphatic tissues

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pathogens t cells

lymphatic circulation

red bone marrow b cells