2. LYMPHATIC SYSTEM The body has a second transportation system, which consists of a network of lymphatic vessels and lymphoid organs. Called the lymphatic system, it has two major functions. First, it ensures that blood volume stays the same. Each day, some 51 pints (24 liters) of fluid leave the blood as it passes through the tissues. Most returns to capillaries, but some 6- 8 pints (3-4 liters) remains.

3. This surplus, now called lymph, drains into lymphatic vessels and is emptied back into the bloodstream. Second it plays a major part in body defense. It contains cells, also found in the blood, called lymphocytes and macrophages, which form the immune system the body’s most powerful defense against disease.

5. LYMPHATIC SYSTEM Functions: LYMPH – fluid that goes between capillary blood and tissues. LYMPH VESSELS – transport excess tissue fluid back into circulatory system. LYMPH NODES – produce lymphocytes, filter out harmful bacteria. SPLEEN – produces lymphocytes and monocytes, blood reservoir, recycles old red cells. Thymus gland – produces T-LYMPHOCYTES

7. LYMPH Straw-colored fluid (similar to plasma) INTERSTITIAL FLUID or tissue fluid because it is in the spaces between cells Composed of H2O, lymphocytes, some granulocytes, O2, digested nutrients, hormones, salts, CO2 and urea. NO red blood cells or protein molecules (too large) Carries digested food, O2 and hormones to cells Carries wastes back to capillaries for excretion Since the lymphatic system has no pump, skeletal muscle action squeezes lymph along Valves prevent backward flow

9. LYMPH VESSELS Closely parallel veins Located in almost all tissues and organs that have blood vessels Transport lymph

10. Tissue lymph enters small lymph vessels which drain into larger vessels called lymphatics they flow into one of two large, main lymphatics – the THORACIC DUCT and right lymphatic duct.

11. THORACIC DUCT gets lymph from left side of chest, head and neck, abdominal area and lower limbs  left subclavian vein  superior vena cava  heart. Lymph flows only in one direction – from body organs to the heart.

12. 2.03 Remember the stuctures of the lymphatic system Structures of the lymphatic system 12 Lymph vessels parallel to blood vessels

13. 2.03 Remember the stuctures of the lymphatic system Structures of the lymphatic system 13 Lymph vessels Lacteals Specialized lymph vessels in the small intestines

15. LYMPH CAPILLARIES The smallest vessels in the lymphatic system, lymph capillaries form a branching network of dead-end tubes that, like blood capillaries, pass between tissue cells. The thin walls of the lymph capillaries have tiny flaps that act like one-way swinging doors letting in excess tissue fluid – which has passed out of, but not returned to, blood capillaries – but not allowing it to flow back out into the tissues. This clear, watery fluid, now called lymph, is carried onward into the larger lymphatic vessels

17. 2.03 Remember the stuctures of the lymphatic system Structures of the lymphatic system 17 Lymph nodes Where are lymph nodes located? Why are there so many?

18. LYMPH NODES Tiny, oval shaped - size of pinhead to size of almond Located alone or grouped Site for lymphocyte production and filter for screening out harmful substances If substance can’t be destroyed, node becomes inflamed To protect us from infection/harmful substances

20. Occur along lymph vessels like beads on a string. Lymph nodes filter lymph as it passes through them. Surrounded by a tough capsule, the spaces, or network of fibers that support macrophages and lymphocytes. These fibers slow the flow of lymph passing through while macrophages engulf and destroy bacteria, cancer cells, and debris, and lymphocytes launch their immune defenses. During infections, lymph nodes may swell up and become tender, a condition known as “swollen glands”

22. TONSILS Masses of lymphatic tissue that produce lymphocytes and filter bacteria – they get smaller in size as person gets older

23. 2.03 Remember the stuctures of the lymphatic system 23 Tonsils 3 pairs 1.Palatine tonsils sides of throat 2.Adenoids upper throat 3.Lingual tonsils back of tongue

24. A ring of five tonsils (2 at the back of mouth, 2 at the back of tongue, & one in the upper throat) protect the entrance to the digestive & respiratory systems from bacteria carried in food and air. Bacteria migrate into the tonsils where they are trapped inside deep “crypts” & destroyed by lymphoctyes.

25. 2.03 Remember the stuctures of the lymphatic system Structures of the lymphatic system 25 Say “aahhh” Why this is helpful?

26. SPLEEN Sac-like mass of lymphatic tissue Largest lymphatic structure Upper left abdominal cavity, just below diaphragm Forms lymphocytes and monocytes Filters blood Stores large amounts of RBCs – contracts during vigorous exercise or loss of blood, to release RBCs Destroys or removes old or fragile RBCs

28. THYMUS GLAND Upper, anterior thorax, above the heart

29. 2.03 Remember the stuctures of the lymphatic system Structures of the lymphatic system 29 Thymus gland What is unique about the thymus gland?

30. Begins to disappear at puberty Also, classified as an endocrine gland Produces T-Lymphocytes 2.03 Remember the stuctures of the lymphatic system 30

31. The two lobed thymus gland carries out its most important functions in the early years of life. It trains lymphoctyes to be effective as part of the body’s immune system. Unspecialized lymphocytes arrive in the blood from bone marrow. They mature in the thymus, becoming capable of attacking specific pathogen, then leave as T-cells (thymus-dependent) to be sent to lymphoid organs, blood and lymph

32. The Lymphatic System What are the functions of the lymphatic system? 1 2 3 4 2.04 Understand the functions and disorders of the lymphatic system 32

33. The Lymphatic System What are the functions of the lymphatic system ? 1 Fluid Balance 2 Lymphocyte Production 3 Filtration 4 Immunity 2.04 Understand the functions and disorders of the lymphatic system 33

34. 2.04 Understand the functions and disorders of the lymphatic system 34 http://www.youtube.com/watch?v=Kh- XdNnTZUo

35. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Fluid balance Why is this important? What happens during this process? What is the relevance to health? 35 ____ Fluid IN ____ Fluid OUT

36. Lymph vessels transport excess fluid from body tissues back into the circulatory system. The fluid acts as an intermediary between the blood in the capillaries and the tissues. It carries digested food, oxygen and hormones into the cells. It carries metabolic waste out of the cells. 2.04 Understand the functions and disorders of the lymphatic system 36

37. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Lymphocyte production What are lymphocytes? What do they do? What is their relevance to health? 37

38. They are a kind of agranulocyte WBC. They help the body by making and releasing antibody molecules they also help prevent the formation of some cancer cells. 2.04 Understand the functions and disorders of the lymphatic system 38

39. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Filtration What does a filter do? How do filters relate to the lymphatic system? 39

40. Lymph nodes filter out harmful bacteria 2.04 Understand the functions and disorders of the lymphatic system 40

41. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Immunity What is immunity? Think about how sneezing relates to immunity. 41

42. Immunity The body’s ability to resist bacterial invasion and disease. 2 general types – natural and acquired.

43. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Natural immunity We have this at birth. It is inherited and permanent. It includes: Unbroken skin, mucus, tears, phagocytes (white blood cells) and local inflammation. 43

44. NATURAL IMMUNITY – at birth, inherited and permanent. Includes: Unbroken skin sweat together with sebum produced by sebaceous glands, protects the skin. Both substances have antiseptic properties Mucus and tears tears produced by glands in the eyelids wash away dirt & contain an antiseptic substance

45. Blood phagocytes WBC that engulf & destroy invading organisms. Two types: neutrophils & macrophages. Neutrophils circulate in the blood before being transferred to the tissues, where they seek out organisms. Macrophages also start in the bloodstream, where they are known as monocytes, before moving to the tissues where they become macrophages. Some macrophages stay in one place; others travel around looking for invading organisms. All phagocytes flow around organisms, wrapping them within a membrane that fuses with granules called lysosomes. These granules contain strong chemicals that digest the organisms, producing harmless substances that pass out through the cells’ membrane.

46. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Natural immunity Discuss the body’s natural immune processes seen in this picture. 46

47. Local inflammation This is the familiar warm, reddish, tender swelling that appears after an injury. At the site of the damage, tissue cells release histamine & other chemicals. They make the blood vessels wider, so that extra blood arrives, and more leaky, so that fluid passes into the tissues, aiding repair and making the area, swollen, and warm. These chemicals also attract phagocytes that destroy pathogens.

49. 2.04 Understand the functions and disorders of the lymphatic system The Lymphatic System Acquired immunity: Passive Discuss passive acquired immunity 49

50. ACQUIRED IMMUNITY – body’s reaction to invaders PASSIVE ACQUIRED IMMUNITY Acquired artificially by injecting antibodies to protect from a specific disease Immediate immunity Lasts 3-5 weeks Used when someone exposed to measures, tetanus, infectious hepatitis Mother provides newborn with some passive immunity

51. ACTIVE ACQUIRED IMMUNITY Lasts longer, two types NATURAL ACQUIRED IMMUNITY – result of having had and recovered from a disease. For example, a child who had measles will usually not get it again – child’s body has manufactured antibodies.

52. ARTIFICIAL ACQUIRED IMMUNITY – comes from being vaccinated – provides artificial active immunity IMMUNIZATION – artificial resistance to a particular infection by artificial means Antigen injected into a person to stimulate production of antibodies

53. 2.04 Understand the functions and disorders of the lymphatic system 53 The Lymphatic System Acquired immunity Active Artificial Should immunizations be required? Why or why not?

54. The Lymphatic System Tonsillitis What are the symptoms? What are the usual treatments? Why would you have your tonsils removed? 2.04 Understand the functions and disorders of the lymphatic system 54

55. 2.04 Understand the functions and disorders of the lymphatic system 55  In childhood, the tonsils may become infected, enlarged, and cause difficulty swallowing  Swollen glands, fever. Sore throat, drainage.  Treat the symptoms.  If strep occurs > 5 times in a year or if tonsils are cryptic, they need to come out

56. The Lymphatic System Lymphadenitis What is it? Lymph aden itis What are the symptoms? How is it treated? 2.04 Understand the functions and disorders of the lymphatic system 56

57. LYMPHADENITIS enlargement of the lymph nodes occurs when infection is present and body is attempting to fight off the infection. Tx. with antibiotics

58. The Lymphatic System Lymphedema What is it? What causes it? How is it treated? 2.04 Understand the functions and disorders of the lymphatic system 58 Photo used with written permission by the Mayo Clinic.

59. 2.04 Understand the functions and disorders of the lymphatic system 59 Lymphedema is a swelling that is caused by lymphatic fluid that has been blocked from draining into the circulatory system. TX: with light (gentle) exercises, compression and massage. There is no cure.

60. The Lymphatic System Scleroderma What is it? What causes it? What are some complications of scleroderma? How is it treated? 2.04 Understand the functions and disorders of the lymphatic system 60

61. 2.04 Understand the functions and disorders of the lymphatic system 61 A thickening of the skin and blood vessels. It is a type of autoimmune disorder, (a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue) It involves changes in the skin, blood vessels, muscles, and internal organs. Difficulty moving, breathing, stiffening of skin TX: with anti-inflammatories, immunosuppressants. No cure.

62. The Lymphatic System Hodgkin’s disease What is Hodgkin’s disease? What are the symptoms? How is it treated? Who is most likely to develop Hodgkin’s disease? 2.04 Understand the functions and disorders of the lymphatic system 62

63. 2.04 Understand the functions and disorders of the lymphatic system 63 Hodgkin’s disease is a cancer of the lymph nodes. The most common early symptom of the disease is painless swelling of the lymph nodes. It is treated with chemotherapy and radiation. People who have had mono or people that have AIDS are more likely to develop Hodgkin’s.

64. HODGKIN’S DISEASE

65. The Lymphatic System Infectious mononucleosis What is mononucleosis most often called? What causes it? How is it treated? 2.04 Understand the functions and disorders of the lymphatic system 65

66. INFECTIOUS MONONUCLEOSIS Caused by the Epstein Barr virus Frequently in young adults and children Spread by oral contact (kissing) Known as the “kissing disease”

67. Symptoms – enlarged lymph nodes, fever, physical and mental fatigue,  leukocytes Rx – bedrest

68. The Lymphatic System Lupus erythematosus What is the classic symptom of lupus? What other symptoms might present? How is lupus managed? What is the prognosis? 2.04 Understand the functions and disorders of the lymphatic system 68

69. 2.04 Understand the functions and disorders of the lymphatic system 69 Systemic lupus erythematosus (SLE) is an autoimmune disease, which means the body's immune system mistakenly attacks healthy tissue. This leads to long-term (chronic) inflammation. Almost everyone with SLE has joint pain and swelling

70. 2.04 Understand the functions and disorders of the lymphatic system 70 Other SX: Chest pain when taking a deep breath, Fatigue, Fever with no other cause, General discomfort, uneasiness, or ill feeling (malaise), Hair loss, Mouth sores, Sensitivity to sunlight, Skin rash -- a "butterfly" rash over the cheeks and bridge of the nose affects about half of people with SLE. The rash gets worse in sunlight. The rash may also be widespread, Swollen lymph nodes There is no cure for SLE. The goal of treatment is to control symptoms

71. HYPERSENSITIVITY When the body’s immune system fails to protect itself against foreign material, and instead, the antibodies formed irritate certain body cells. An abnormal response to a drug or allergen.

72. An ALLERGEN is an antigen that causes allergic responses. (Examples of allergens – ragweed, penicillin, bee stings, foods, etc.)

73. ANAPHYLAXIS severe, sometimes fatal allergic reaction Antigen-antibody reaction stimulates a massive secretion of histamine Symptoms – breathing problems, headache, facial swelling, falling blood pressure, stomach cramps, and vomiting Rx – adrenaline, epipen

75. The Lymphatic System AIDS How is it diagnosed? What do these terms mean? HIV ARC AIDS 2.04 Understand the functions and disorders of the lymphatic system 75

76. AIDS/HIV Acquired Immunodeficiency Syndrome Caused by HTLV-III (human T- lymphotrophic virus type III) Commonly caused HIV or Human immunodeficiency virus. Affects not only homosexual males but all populations The patient with AIDS cannot fight off cancers and most infections.

77. Between October 1980 and May 1981, five young, previously healthy homosexual men were treated for a pneumonia caused by a parasite, Pneumocystis carinii. Before this, P. carnii pneumonia occurred only in immunosuppressed patients, especially those receiving cancer therapy. At the same time, a rare and unusual blood vessel malignancy called Kaposi’s sarcoma was being diagnosed with increasing frequency in young homosexual males.

78. In 1981, twenty-six cases of Kaposi’s sarcoma had been diagnosed in young homosexual males. These cases were an early indication of an epidemic of a previously unknown disease. Later, it was called the Acquired Immunodeficiency Syndrome. (AIDS). It is said to be the third leading cause of death in young people.

79. Three responses to HIV infection: AIDS ARC (AIDS-related complex) Asymptomatic infection Screening tests for HIV/AIDS are available

80. Screening tests Blood tests for presence of antibodies does not reach detectable levels until 1-3 months after infection Tests: ELISA- enzyme linked immunosorbent assay (detects antibodies but not the virus itself) Western Blot confirms the ELISA results

81. AIDS Most severe type of HIV infection Subject to OPPORTUNISTIC INFECTIONS – a healthy person would fight off these infections, but a person with AIDS has a compromised immune response.

82. Opportunistic infections Kaposi sarcoma Cervical cancer Parasitic infections (some pneumonias) Fungal infection – candidiasis Viral infections – herpes simplex, hepatitis B Higher risk for TB & syphilis

83. Symptoms of AIDS 1.Prolonged fatigue 2.Persistent fevers or night sweats 3.Persistent, unexplained cough 4.Thick coating in throat or on tongue 5. Easy bruising, unexplained bleeding

84. 6.Appearance of purple lesions on mucous membranes or skin that don’t go away 7.Chronic diarrhea 8.Shortness of breath 9.Unexplained lymphadenopathy 10. Unexplained weight loss, 10 pounds or more, in less than 2 months

85. AIDS-RELATED COMPLEX (ARC) Has HIV but not AIDS and develops other conditions such as: Chronic diarrhea Chronic lymphadenopathy Unexplained weight loss

86. If life threatening opportunistic infections develop, then individual is said to have AIDS ASYMPTOMATIC INFECTION - Has HIV but no symptoms. High-Risk Groups for AIDS – EVERYONE who participates in risky behaviors.

88. The AIDS Patient Sometimes treated as outcasts Healthcare worker should be supportive Use of gloves for normal patient contact is not necessary

89. Transmission by: Sex with someone who is HIV positive Sharing needles with infected IV drug users At birth from infected mother

90. Cannot be spread by: 1.Casual contact 2.Through air, feces, food, urine or water 3.Coughing, sneezing, embracing, shaking hands and sharing eating utensils Prevention: 1.Avoid risky behaviors 2.Standard precautions

91. The Lymphatic System Cancer What is cancer? Who gets cancer? Why is it included in the lymphatic system? 2.04 Understand the functions and disorders of the lymphatic system 91

92. Cancer occurs when a cell mutates and begins to divide rapidly, taking up nutrients and oxygen and crowding out normal cells. The normal tissue dies as the cancers progresses. Anyone can get cancer. It is usually caused by multiple exposures to carcinogens over a period of time. 2.04 Understand the functions and disorders of the lymphatic system 92

93. Some cancers, however are opportunistic, which means that a weakened immune system can make a person more susceptible. Some opportunistic cancers are Kaposi’s sarcoma, cervical cancer and cancers of the immune system, known as lymphomas.

94. STANDARD PRECAUTIONS Guidelines to be used in patient care setting Must be used when there is contact with blood, any body fluid (except sweat), mucous membranes and non-intact skin.

95. Handwashing – the single most effective way to prevent infection. Wash hands after touching body fluids, even if gloves are worn. Wash hands immediately after removing gloves, between patient contacts. Use a plain (non-antimicrobial) soap Wash for a minimum of 10 seconds Gloves – worn when touching blood, body fluids, etc. Mask, eye protection, face shield and gown – during patient care activities that may generate splashes or sprays of blood, body fluids, etc. Patient care equipment and linens – handle with care, don’t let it touch your or clothing, clean or discard appropriately.

96. Occupational Health and Bloodbourne Pathogens Beware of needles! Never recap used needles. Dispose of all needles and sharp objects in SHARPS container.

97. Use mouthpieces, resuscitation bags, or other ventilation devices as alternative to mouth-to-mouth resuscitation. A patient who contaminates the environment should be in a private room or relatively isolated area.