UNIVERSITY OF LA SALETTE

COLLEGE OF NURSING Santiago City

A CASE STUDY IN

CERVICAL

LYMPHADENOPATHY
PRESENTED BY: GROUP D

Balot, Jr,, German M. Eustaquio, Anna Kathreen Joy A. Fletchetero, Julius Caezar G. Garcia, Cesar A. Gervacio, Cyrhex Jay C. Gumpal, April Joy B. Laron, Cherry C. Manalay, Mardylle B. Mangahas, Raff Angelo S. Mayandoc, Ma. Lolita D. Mercado, Jhoanna Marie F. Santiago, Predison D.

PRESENTED TO:

Mrs.Bernadette Asuncion, RN Mr. Jonard Fernandez, RN Mrs. Theresa Bermusa, RN Mrs. Pinky Bolos, RN

TABLE OF CONTENTS

I. Introduction

A. Case Description II. Demographic Data

Nursing History A. B. C. Present Health History Past Medical History Family History

Gordons Functional Pattern

A. B. C. D. E. F. G. H. I. J. K.

Health Perception Nutrition Pattern Sleep and Rest Activity and Exercise Elimination Pattern Self Perception Cognitive and Perception Pattern Role and Relationship Pattern Sexuality Pattern Coping of Stress Pattern Value and Belief Pattern

III. Course in the Ward IV. Physical Assessment V. Laboratory Result VI. Anatomy and Physiology VII. Pathophysiology VIII. Nursing Care Plan IX. Drug Study

Introduction
Cervical lymphadenopathy is an enlargement of the cervical lymph nodes. Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, autoimmune disease, or malignancy. Inflammation of a lymph node is called lymphadenitis. In practice, the distinction between lymphadenopathy and lymphadenitis is rarely made. (Inflammation of lymph channels is calledlymphangitis.)

Types:
 Localized lymphadenopathy : due to localized spot of infection e.g. an infected spot on the scalp will cause lymph nodes in the neck on that same side to swell up  Generalized lymphadenopathy : due to generalized infection all over the body e.g. influenza  persistent generalized lymphadenopathy (PGL) : persisting for a long time, possibly without an apparent cause  Dermatopathic lymphadenopathy : lymphadenopathy associated with skin disease.

Tangier disease (ABCA1 deficiency) may also cause this

Causes:
Enlarged lymph nodes are a common symptom in a number of infectious and malignant diseases. It is a recognized symptom of very many diseases, of which some are as follows:  Reactive: acute infection (e.g. bacterial, or viral), or chronic infections (tuberculous lymphadenitis, cat-scratch disease).  The most distinctive symptom of bubonic plague is extreme swelling of one or more lymph nodes that bulge out of the skin as "buboes." The buboes often become necrotic and may even rupture.  Infectious mononucleosis is an acute viral infection, the hallmark of which is marked enlargement of the cervical lymph nodes.  It is also a symptom of cutaneous anthrax, measles and Human African trypanosomiasis, the latter two giving lymphadenopathy in lymph nodes in the neck.  Toxoplasmosis, a parasitic disease, gives a generalized lymphadenopathy (Piringer-Kuchinka lymphadenopathy).[4]   Plasma cell variant of Castleman's disease - associated with HHV-8 infection and HIV infection. Mesenteric lymphadenitis after viral systemic infection (particularly in the GALT in the appendix) can commonly present like appendicitis.  Tumoral:  Primary: Hodgkin lymphoma, non-Hodgkin lymphoma, hairy cell leukemia, give lymphadenopathy in all or a few lymph nodes. 
[4]

Secondary: metastasis, Virchow's Node, Neuroblastoma.

Autoimmune etiology: systemic lupus erythematosus, rheumatoid arthritis all giving a generalized lymphadenopathy.

Immunocompromised etiology: AIDS. Generalized lymphadenopathy is an early sign of infection with human immunodeficiency virus(HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). "Lymphadenopathy syndrome" has been used to describe the first symptomatic stage of HIV progression, preceding a diagnosis of AIDS.

Bites from certain venomous snakes, most notably the black mamba, kraits, Australian brown snakes, coral snakes, tiger snakes,taipans, death adders, and some of the more toxic species of cobra.

Unknown etiology: Kikuchi disease, progressive transformation of germinal centres, sarcoidosis, hyaline-vascular variant of Castleman's disease, Rosai-Dorfman disease, Kawasaki disease

DEMOGRAPHIC DATA

NAME: Mrs .Lympha AGE: 37 Y/o SEX: Female RELIGION: Roman Catholic CIVIL STATUS: Married NATIONALITY: Filpino ADDRESS: P1 Carulay Echague Isabela BIRTH DATE: August 29, 1973 DATE OF ADMISSION: August 21, 2011 TIME OF ADMISSION: 2:45 pm ATTENDING PHYSICIAN: Dr. Jade Malvar CHIEF COMPLAINT: Submandibular Mass ADMITTING DIAGNOSIS: Thyroductal Cysts FINAL DIAGNOSIS: Cervical Lymph Adenopathy SURGICAL PROCEDURE: THYROD

Nursing History
Present Medical History 1 month PTA, the patient observed that she has a palpable mass on her submandibular midline tsaka parang namamaga as verbalized by the patient. She asked for consultation immediately at De Vera Medical Hospital at EENT department and they advised her to take sultamicillin 750mg BID for three(3) weeks after 3 weeks of taking it, she noticed that it slightly become response but didnt disappear SO she sought for a second option under Dr. Malvar and the Dr. suggested to undergo ultrasound and they found out that it is a cyst (3cm) where in it need emergency excision. 1 day PTA, the patient decided to undergo operation and called Dr. Malvar to inform it.

Past Medical History According to the patient she doesnt experience yet any serious health problem. She was just hospitalized at Ilagan District Hospital twice because she undergone Cesarean Section by the year 2000 on her 1st baby and last 2001on her 2nd child. She also has an allergy to sea foods such as seashells and fish Daing. According to the patient she also experienced cough and cold and she managed it by taking Neozep 500mg.

Family History

HPN Paternal Maternal

ASTHMA

DM

TB 

CA

Gordons Functional Health Pattern

HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN Before hospitalization: Health is important to her too. napaka health conscious ko as verbalized by the patient. Ang kalusugan ang pinakamahalaga sa bawat tao lalo na sa gaya kong nagtratrabaho at naghahanap buhay patient adds. She immediately consult and go out for further check up if she observed something unusual to her so that she will be aware of any health problem shes suffering and to avoid any problem so it wont lead to a more hard and serious one. According to her 5 years ago her health rating is 10 but as of now her health rating is 8 and 5 years from now her heath rating then is 6 because habang tumatanda ang tao mas lalong nagiging prone sa sakit she says. During hospitalization: I learned that its a good idea to be always aware when it comes to our health. Health seems to be really important to her because she immediately decided to undergo operation. When it comes to her ADL she says sa awa ng diyos hindi naman naapektohan ang pang araw araw kong gawain. She drinks occasionally but doesnt smoke. She complies properly with management and treatment by taking medicine and cooperating with the health care team. NUTRITIONAL-METABOLIC PATTERN Before hospitalization: Few days after she noticed her palpable mass,everytime she eat,she observed feeling of fullness on her throat whenever she swallow.Parang hindi bumababa ang mga kinakain koshe said. She eat three times a day.Her breakfast usually comprises of fried rice and egg and sometimes frozen products such as tocino.Her lunch and dinner usually comprises of vegetables such as pinakbet and meat such as adobong manok and baboy.She consumes 2-3 cups of rice per meal and drinks 5-8 glasses of water per day.She is also a fond of eating street foods such as kwek kwek and fishball,this served already as her snacks according to her.She as an allergy to seafoods suchs as seashell and daing. During hospitalization: She is in a DAT diet but prior to surgery,she is in NPO status as ordered. ELIMINATION PATTERN Before hospitalization:

Our clients bowel habit was, she defecates every morning,brown in color,cylindrical in shape and consistency was formed and moist.Her bladder habit was,she urinates 6-8 times per day.This are all normal base on her pattern,according to her.She is also experiencing constipation and diarrhea and she managed it by water therapy alone. During hospitalization: Shes bowel and bladder habits was the same regardless when shes in NPO status,she never defacate that day(on the day of surgery). No known problems on bowel and bladder habits such as incontinence,hematuria,retention and nocturia.No known history of laxatives and anti diarrhreals used. ACTIVITY-EXERCISE PATTERN Before hospitalization: Our client is a working mom.She used her time wisely.To wake up early in the morning to prepare the needs of her kids,send them to school,and go to her office everyday as a secretary to a pharmaceutical company became her daily routine.This served already as her daily activities according to her. During hospitalization: She can still perform activities of daily living such as grooming and eating,she is ambulatory and can move freely.When shes in a post operative status,she can do the same thing with a little bit adjustments and needs assistance with her SO. SLEEP-REST PATTERN Before hospitalization: She sleeps at 9pm and awakes at 5am.She has no difficulty in falling asleep and remaining asleep. During hospitalization: She cannot sleep in a normal pattern because of unfamiliarity to environment and due to hospital routines such as giving medications and vital signs monitoring.

COGNITIVE PERCEPTUAL PATTERN Before hospitalization: Our client is a college graduate in a degree of Bachelor of Science in Elementary Education but she failed to pass the board exam. She cant fairly understand how she can manage and cure her submandibular mass.She doesnt even know how does she acquired such condition. During hospitalization: She already understand the course of her condition on how does she acquired and the approach to removed as explained by her physician. ROLE RELATIONSHIP PATTERN Before hospitalization: She has a good and strong relationship with her family despite of being a working mom. She always make a point to have time for their family bonding.They were blessed with

two kids , an 11 years old boy and and a 9 years old girl. His husband is a hard working farmer. Their primary dialect is Ilocano. During hospitalization: She cant find enough time for their family bonding since her children are going to school. Unless if theres an available time for her kids to visit .His husband is also spending most of his time in the farm and visits her seldom. kinakabahan kasi ang mister ko pagdating sa mga ganitong bagay lalo pa at ooperahan akoas verbalized by the patient when we asked where his husband is prior to operation. Since we noticed his husband is not around ,only the S.O assisted her. SELF-PERCEPTION-SELF CONCEPT PATTERN Before hospitalization: She viewed herself as a supportive and loving mother .She find her kids to be the source of her pride and joy especially when life gets too chaotic. She cant imagine life and what life would be if without the presence of her loved ones that catches her every time that life gets difficult, according to her. She also considered her husband as one of the greatest blessing she had. He is the reason why I am happy with my life [Laughing] she added.

During hospitalization: Self-perception-self concept pattern was the same but this time, she proved again that whatever life gives, her loved ones will always be there that cares and supports. This increases her self-esteem and self-worth, accdg. to her.

SEXUALLY AND REPRODUCTIVE PATTERN Our clients menarche is when she was 13y/o, she was second year H.S that time. She got married when she was 25y/o, now, shes married for 12 years, they were blessed with two lovely kids. Obstetrical data include:T-2,P-O,A-0,L-2.(G2P2).Now that she is 37y/o, she is still sexually active, they used withdrawal method as a form of control .Previously ,they almost tried all the methods of birth control such as pills, condoms and depo., according to her. No known history of previous gynecologic disorders. COPING-STRESS TOLERANCE PATTERN Whenever she is stress, she simply diverts her attention by having fun with her kids and sometimes social get together with her officemates .Being alone and reflecting in silence nor listening to old songs is also beneficial for her. VALUE-BELIEF PATTERN Their family are a Roman Catholic devotee.She believed that God is the source of our strength and health.They go to church every Sunday.They do not believe to any quack doctors and superstitious beliefs.Only God can cure all the ailments,accdg.to her. .

REVIEW OF SYSTEMS August 21, 2011 (PRE OP) General( ) Weight loss or gain ( ) Flashing lights ( ) Specks ( ) Glaucoma ( ) Cataracts ( ) Last eye exam -----------------------------------------------------Nose( ) Stuffiness ( ) Discharge ( ) Itching ( ) Hay fever ( ) Nosebleeds ( ) Sinus pain -----------------------------------------------------Throat( ) Teeth ( ) Gums ( ) Bleeding ( ) Dentures ( ) Sore tongue ( ) Dry mouth ( ) Sore throat ( / ) Hoarseness ( ) Thrush ( ) Non-healing sores ( ) Last dental exam -----------------------------------------------------Neck( / ) Lumps

( ) Fatigue ( ) Fever or chills ( ) Weakness ( / )Trouble sleeping -----------------------------------------------------Skin( ) Rashes ( ) Lumps ( ) Itching

( ) Dryness ( ) Color changes ( ) Hair and nail changes -----------------------------------------------------Head( ) Headache ( ) Head injury -----------------------------------------------------Ears( ) Decreased hearing ( ) Ringing in ears (tinnitus) ( ) Earache ( ) Drainage -----------------------------------------------------Eyes( ) Vision ( ) Glasses or contacts ( ) Pain ( ) Redness ( ) Blurry or double vision

( ) Swollen glands ( ) Pain ( ) Stiffness -----------------------------------------------------Breasts( ) Lumps ( ) Pain ( ) Discharge ( ) Self-exams ( ) Breast-feeding -----------------------------------------------------Respiratory( ) Cough (dry or wet, productive) ( ) Sputum (color and amount) ( ) Coughing up blood (hemoptysis) ( ) Shortness of breath (dyspnea) ( ) Wheezing ( ) Painful breathingCardiovascular( ) Chest pain or discomfort ( ) Tightness ( ) Palpitations ( ) Shortness of breath with activity (dyspnea) ( ) Difficulty breathing lying down (orthopnea) ( ) Swelling (edema) ( ) Sudden awakening from sleep with shortness of breath (Paroxysmal

Nocturnal Dyspnea) -----------------------------------------------------Gastrointestinal( / ) Swallowing difficulties ( ) Heartburn ( ) Change in appetite ( ) Nausea ( ) Change in bowel habits ( ) Rectal bleeding ( ) Constipation ( ) Diarrhea ( ) Yellow eyes or skin (jaundice) -----------------------------------------------------Urinary( ) Frequency ( ) Urgency ( ) Burning or pain ( ) Blood in urine (hematuria) ( ) Incontinence ( ) Change in urinary strength -----------------------------------------------------GenitalMale( ) Pain with sex ( ) Hernia ( ) Penile discharge ( ) Sores ( ) Masses or pain ( ) Erectile dysfunction ( ) STDs Female-

( ) Pain with sex ( ) Vaginal dryness ( ) Hot flashes ( ) Vaginal discharge ( ) Itching or rash ( ) STDs -----------------------------------------------------Vascular( ) Calf pain with walking (Claudication) ( ) Leg cramping -----------------------------------------------------Musculoskeletal( ) Muscle or joint pain ( ) Stiffness ( ) Back pain ( ) Redness of joints ( ) Swelling of joints ( ) Trauma -----------------------------------------------------Neurologic( ) Dizziness ( ) Fainting

( ) Seizures ( ) Weakness ( ) Numbness ( ) Tingling ( ) Tremor -----------------------------------------------------Hematologic( ) Ease of bruising ( ) Ease of bleeding -----------------------------------------------------Endocrine( ) Heat or cold intolerance ( ) Sweating ( ) Frequent urination (polyuria) ( ) Thirst (polydypsia) ( ) Change in appetite (polyphagia) -----------------------------------------------------Psychiatric( / ) Nervousness ( ) Depression ( ) Memory loss ( ) Stress

Physical Assessment
GENERAL APPEARANCE:

Received sitting on bed with IVF of D5LR 1L regulated at 32 gtts/min patent and infusing well on her right hand. V/S: Bp> 110/70 mmHg Temp> 36.9oC RR>20 cpm PR>70 bpm

Date: August 22, 2011 (PRE-OP) BODY PARTS SKIN METHOD USED Inspection Palpation FINDINGS Light brown in color Uniform (warm and dry); smooth to touch Normocephalic Symmetrical Smooth; firm Evenly distributed hair Symmetrical Symmetrical Skin intact; symmetrically aligned Symmetrical; Evenly distributed; curled slightly outward Symmetrical; Skin intact Symmetrical; Pinkish Symmetrical; White in color Symmetrical; Transparent PERRLA Aligned with outer canthus of the eye Mobile; firm; pinna recoils after it folded Dry cerumen Symmetric and straight Pinkish White shiny tooth enamel INTERPRETA TION Normal Normal

HEAD Scalp Hair FACIAL FEATURES EYES Eyebrows

Inspection Inspection Palpation Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal Normal Normal

Eyelashes

Inspection

Normal

Eyelids Conjunctiva Sclera Cornea Pupils EARS Auricles

Inspection Inspection Inspection Inspection Inspection Inspection

Normal
Normal Normal

Normal Normal Normal

Palpation

Normal

External ear canal NOSE LIPS Teeth

Inspection Inspection Inspection Inspection

Normal Normal Normal Normal

Gums Tongue NECK Neck muscles

Inspection Inspection Inspection

Pink
Pink color; moves freely

Normal
Normal

Muscles equal in size; head centered

Normal

Lymph nodes  Cervical o Submandibular o Superficial anterior o Posterior o Supraclavicuar  Axillary  Inguinal Trachea Chest

Palpation Palpation Palpation Palpation Palpation Palpation Palpation Auscultation

Heart Abdomen

Auscultation Inspection Auscultation Percussion Palpation Inspection Inspection

UPPER EXTREMITIES NAILS

LOWER EXTREMITIES

Inspection

Palpable; enlarged; tender Not palpable Not palpable Not palpable Not palpable Not palpable Central placement in midline of neck Vesicular and bronchovesicular breath sound irregular heart beat Flat; uniform in color Hyperactive (22 BS) Dull Relaxed abdomen Moves freely Pinkish nail bed; Blanch test (2-3 seconds) Moves freely

d/t inflammation Normal Normal Normal Normal Normal Normal Normal

d/t tension Normal d/t diet as ordered (NPO) Normal Normal Normal Normal

Normal

REVIEW OF SYSTEM
August 23, 2011 (POST OP) General ( ) Weight loss or gain ( ) Fatigue ( ) Fever or chills ( ) Weakness ( / )Trouble sleeping ---------------------------------------------------------Skin( ) Rashes ( ) Lumps ( ) Itching ( ) Dryness ( ) Color changes ( ) Hair and nail changes ---------------------------------------------------------Head( ) Headache ( ) Head injury ---------------------------------------------------------Ears( ) Decreased hearing ( ) Ringing in ears (tinnitus) ( ) Earache ( ) Drainage ---------------------------------------------------------Eyes( ) Vision ( ) Glasses or contacts ( ) Pain ( ) Redness ( ) Blurry or double vision ( ) Flashing lights ( ) Specks ( ) Glaucoma ( ) Cataracts ( ) Last eye exam ---------------------------------------------------------Nose( ) Stuffiness ( ) Discharge ( ) Itching ( ) Hay fever ( ) Nosebleeds ( ) Sinus pain ---------------------------------------------------------Throat( ) Teeth ( ) Gums ( ) Bleeding ( ) Dentures ( ) Sore tongue ( ) Dry mouth ( ) Sore throat ( / ) Hoarseness ( ) Thrush ( ) Non-healing sores ( ) Last dental exam

---------------------------------------------------------Neck( ) Lumps ( ) Swollen glands ( / ) Pain ( / ) Stiffness ---------------------------------------------------------Breasts( ) Lumps ( ) Pain ( ) Discharge ( ) Self-exams ( ) Breast-feeding ---------------------------------------------------------Respiratory( ) Cough (dry or wet, productive) ( ) Sputum (color and amount) ( ) Coughing up blood (hemoptysis) ( ) Shortness of breath (dyspnea) ( ) Wheezing ( ) Painful breathingCardiovascular( ) Chest pain or discomfort ( ) Tightness ( ) Palpitations ( ) Shortness of breath with activity (dyspnea) ( ) Difficulty breathing lying down (orthopnea)

( ) Swelling (edema) ( ) Sudden awakening from sleep with shortness of breath (Paroxysmal Nocturnal Dyspnea) ---------------------------------------------------------Gastrointestinal( / ) Swallowing difficulties ( ) Heartburn ( ) Change in appetite ( ) Nausea ( ) Change in bowel habits ( ) Rectal bleeding ( ) Constipation ( ) Diarrhea ( ) Yellow eyes or skin (jaundice) ---------------------------------------------------------Urinary( ) Frequency ( ) Urgency ( ) Burning or pain ( ) Blood in urine (hematuria) ( ) Incontinence ( ) Change in urinary strength ---------------------------------------------------------GenitalMale( ) Pain with sex ( ) Hernia ( ) Penile discharge

( ) Sores ( ) Masses or pain ( ) Erectile dysfunction ( ) STD s Female( ) Pain with sex ( ) Vaginal dryness ( ) Hot flashes ( ) Vaginal discharge ( ) Itching or rash ( ) STD s ---------------------------------------------------------Vascular( ) Calf pain with walking (Claudication) ( ) Leg cramping ---------------------------------------------------------Musculoskeletal( ) Muscle or joint pain ( ) Stiffness ( ) Back pain ( ) Redness of joints ( ) Swelling of joints ( ) Trauma ----------------------------------------------------------

Neurologic( ) Dizziness ( ) Fainting ( ) Seizures ( ) Weakness ( ) Numbness ( ) Tingling ( ) Tremor ---------------------------------------------------------Hematologic( ) Ease of bruising ( ) Ease of bleeding ---------------------------------------------------------Endocrine( ) Heat or cold intolerance ( ) Sweating ( ) Frequent urination (polyuria) ( ) Thirst (polydypsia) ( ) Change in appetite (polyphagia) ---------------------------------------------------------Psychiatric( ) Nervousness ( ) Depression ( ) Memory loss ( ) Stress

Physical assessment

GENERAL APPEARANCE: Received lying on bed awake with ongoing IVF of D5LR 1L regulated @ KVO rate patent and infusing well on her right hand.

V/S: Bp>100/70 mmHg Temp> 36.4oC RR>20 cpm PR>68 bpm

Date: August 23, 2011 (POST-OP) BODY PARTS SKIN METHOD USED Inspection Palpation FINDINGS Light brown in color Uniform (warm and dry); smooth to touch Normocephalic Symmetrical Smooth; firm Evenly distributed hair Symmetrical Symmetrical Skin intact; symmetrically aligned Symmetrical; Evenly distributed; curled slightly outward Symmetrical; Skin intact Symmetrical; Pinkish Symmetrical; White in color Symmetrical; Transparent PERRLA Aligned with outer canthus of the eye Mobile; firm; pinna recoils after it folded Dry cerumen Symmetric and straight Pinkish White shiny tooth enamel Pink
Pink color; moves freely

INTERPRETATION Normal Normal

HEAD Scalp Hair FACIAL FEATURES EYES Eyebrows

Inspection Inspection Palpation Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal Normal Normal

Eyelashes

Inspection

Normal

Eyelids Conjunctiva Sclera Cornea Pupils EARS Auricles

Inspection Inspection Inspection Inspection Inspection Inspection

Normal
Normal Normal

Normal Normal Normal

Palpation

Normal

External ear canal NOSE LIPS Teeth Gums Tongue NECK

Inspection Inspection Inspection Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal

Normal

Neck muscles

Inspection

(+) incision in the submandiblar (2 inches) Muscles equal in size; head

d\t removal of the cyst

Normal

centered Lymph nodes  Cervical o Submandibular

Palpation

Not palpable

o Superficial anterior o Posterior o Supraclavicuar  Axillary  Inguinal Trachea

Palpation Palpation Palpation Palpation Palpation Palpation

Chest

Auscultation

Heart Abdomen

Auscultation Inspection Auscultation Percussion Palpation

UPPER EXTREMITIES NAILS

Inspection Inspection

LOWER EXTREMITIES

Inspection

Not palpable Not palpable Not palpable Not palpable Not palpable Central placement in midline of neck Vesicular and bronchovesicul ar breath sound irregular heart beat Flat; uniform in color Hyperactive (22 BS) Dull Relaxed abdomen Moves freely Pinkish nail bed; Blanch test (2-3 seconds) Moves freely

Normal d\t removal of the cyst Normal Normal Normal Normal Normal Normal

Normal

d/t tension Normal d/t diet as ordered (NPO) Normal Normal Normal Normal

Normal

ANATOMY & PHYSIOLOGY Of LYMPHATIC SYSTEM

Lymphatic System
Composition: Lymph - Lymphocytes - Lymph vessels - Lymph nodes - Tonsils - Spleen Thymus gland Function 1) Maintains fluid balance 30 liters of plasma pass out of capillaries each day - 27 liters get resorbed at capillary - 3 liter left in tissue spaces get resorbed into lymph vessels 2) Fat absorption from gastrointestinal tract - lacteals in small intestine - lymph + fat = chyle (a milky white fluid) 3) Body defense system - lymph nodes filter lymph contains lymphocytes - spleen filters blood Lymph Vessels Carry lymph away from tissues - begins at lymph capillaries (simple squamous epithelium) - lymph capillaries join together to form vein-like lymph vessels - lymph vessel contain valves to prevent retrograde flow y contraction of skeletal muscle y smooth muscle in lymph vessel wall y pressure changes in thorax during breathing 1) Right Lymphatic Duct (RLD) drains lymph from - right upper limb - vessels from right halve of head, neck, & chest form the RLD which empties into the right subclavian vein. 2) Thoracic Duct The rest of the body drains into the Thoracic Duct which empties into the left subclavian vein. Lymph Organs - Contain lymphatic tissue composed of lymphocytes, macrophages, & other cells.- Lymphocytes originate from red bone marrow, and are carried by the blood to lymph organs. - Microorganisms stimulate lymphocyte cell division in germinal centers of lymph nodes. This is called

Immune System Activation 1) Tonsils

Protects body against pathogens entering at the nose and mouth. a.palatine posterior oral cavity b.pharyngeal nasal cavity, adenoids c.lingual posterior tongue 2) Lymph Nodes - Small, round structures along lymph vessels. - Lymph passes through at least one node before emptying into vein. - Superficial aggregation Inguinal in groin Axillary Cervical The function of a node is to filter lymph and produce lymphocytes. -activation of the immune system (lymphocyte cell division) -phagocytosis of pathogens by macrophages

3) Spleen Located in the left upper abdominal cavity Function: Filters blood of pathogens and old RBCs Activation of immune system Blood reservoir Easily traumatized 4) Thymus Located in the superior mediastinum Function: Maturation of lymphcytes

Stem cells (red bone marrow)

Overview of the Lymphatic System Lacteals in the small

Lymphatic capillaries

Remove fluid from tissues Lymphocytes (pre-B & pre-T cells) thoracic duct Fluid become lymph Chyle Lymph flows through lymphatic vessels

Pre-B cells

Pre-T cells

Red bone marrow

Lymph nodes filter lymph

Mature B-cells

Lymph enters thoracic duct or right Or right lymphatic duct

Venous circulation Heart Arterial Circulation Spleen Blood Circulation

Pre- T cells Mature B-cells Thymus Mature T-cells Enters and multilply in all lymphatic tissues Return to blood circulation

INFLAMMATORY PROCESS
Bacteria enter tissue

Tissue damage Release of chemical mediators

Increase blood flow

Chemotaxis

increase vascular permeability

Increase number of WBC and chemical mediators At the site of tissue affected/damaged

Bacteria are contained, destroyed and phagocytized

Bacteria gone

Bacteria remain

Tissue repair

additional chemical mediators activated

 Antibodies or Immunoglobulin y Are specific glycoprotein produced by B-Lymphocytes and plasma cells in response To a specific antigen and capable of reacting with that antigen.

y y y

1. IgG Binds to macrophage and neutrophils for enhaced phagocytosis. The only class of antibody that can cross placenta and enter the fetal circulation. High levels of IgG feedback to B-lymphocytes to prevent their activation in order to Turn-off antibody production. 2. IgA 6% of the antibodies Found mainly in body secretions ( saliva, mucous, tears, colostrums and milk) 94% --SECRETORY IgA , where it protects internal body surfaces exposed to the environment By blocking the attachment of bacteria and viruses to mucous membranes. 3. IgM The 1st antibody produced during an immune response. Activates complement and acts as an antigen-binding receptor on the surface of B-cells. 4. IgE Stimulates inflammatory response Enables IgG, complement proteins,and leukocytes to enter tissues Major defense against parasitic worms 5. IgD Activates basophil and mast cells to produce anti-microbial factors Serves as antigen receptor for the activation of B-cells Monovalent

y y y

y y

y y y

y y y

EFFECTS OF ANTIBODIES

1. Inactivates the antigen

 An antibody binds to an antigen and inactivates it.

2. Binds antigen together

 Antibodies bind several antigens together.

3. Activates the Complement cascade

 An antigen binds to an antibody, as a result, the antibody can activate complement proteins Which can produce inflammation, chemotaxis and lysis.  Opsonization

4. Initiates the release of inflammatory chemicals

 Antibody binds to a mast cell or basophil. It triggers a release of chemicals that cause inflammation.

5. Facilitates phagocytosis
 Antibody binds to an antigen and to a macrophage, which phagocytizes the antibody and antigen.

Lymphatic Circulation

Lymph

Afferent lymphatic vessels

PSEUDOPODS of macrophages

Medullary sinuses converges at the hilum

Lymph leaves via efferent lymphatic vessel

PATHOPHYSIOLOGY
Entry of antigen

Lymphocytic recognizes an antigen thru memory cell

Activation of B-cell

Formation of germinal center in the cortex

B-cell migrates to germinal centers

Formation of antibody-producing plasma cells

Stimulation of the AB-PPC by antigen

Accelerates migration of AB-PPC to the medullary cords to about 10 times

INFLAMMATION/ SWELLING