Lymph

 

Lymphatic vessels flow in the body just like blood vessels. Lymphatic fluid is inside a lymphatic vessel. These vessels flow through a series of nodes, where lymph is cleaned and lymphocytes are built. The lymphatic system is important in the body’s defence and transport.

Lymphatic tissue is made up of reticular connective tissue, which is fine mesh and contains reticulum cells.

Reticulum cells produce reticulum fibres and fulfil defensive tasks like large macrophages.

Lymphatic system consists of:

Lymph vessels Lymph nodes Spleen Thymus Lymphatic pharynx Appendix Lymphoid tissue in gut

Lymphatic system tasks are:

Defence: lymphocytes play a main role here, as well as in the reticular connective tissue that lymphatic organs are made up of.

Transport: Substances which cannot enter the blood capillaries because of their size can be absorbed by the lymphatic system. 10% is transported by the lymphatic system. Lymph also transports fatty acids, absorbed in the colon.

Lymphatic Fluid

Lymph is clear. But when the body is infected, it can change into light yellow because of an increase in proteins. After the lymph passes through the colon, it looks milky white because of the fatty substances it consumes. This milky white lymph is called Chylus.

Composition of Lymph

Lymph is essentially interstitial fluid and is made up of blood plasma that has made its way into the intracellular space. The lymphatic capillaries take in the blood plasma where it enters a lymphatic vessel and becomes lymph.

Lymph is made up of nutrients, waste, proteins, 70% lymphocytes and no red corpuscles.

Blood on the other hand has the same except it contains red corpuscles and 5% lymphocytes.

This is how 2 litres of lymph is produced daily. Lymph capillaries can absorb substances via diffusion and active transport carrier mediums. They can take on large protein particles. If they can’t then they are stuck in the intracellular space and become lymphatic edema.

Lymph capillaries only absorb. They don’t release. One way only.

So the lymphatic system transports water, protein, fat and cells away from the intracellular space.

Lymphatic Vessels

Lymph capillaries flow inside lymph venules then into larger vessels similar to veins. Finally the vessels reach the two lymph ducts.

Lymph vessels are made up of 3 layers like a blood vessel:

Intima: endothelium on a basement membrane Media: smooth muscle Externa: connective tissue

Pressure inside the lymph vessels is much lower than in the veins, and so the muscle layer is much thinner than in a vein.

Lymph Pump

Lymph vessels contain valves, just like veins, which prevent the backflow of lymph. Lymph moves forward in the lymphatic system thanks to:

Lymphangion Motor: which helps the lymph to contract Fluidic Pressure in Interstitium: similar to a heart beat concept Arterial Pulsation: Lymph vessels lie against arteries and use the arterial pulse to move Physical Movement: The joint and muscle pumps can make the lymph stream 10-15 times more powerful. It is also influenced by respiration and visceral movement.

The lymphatic system is part of the circulatory system but is not a closed system.

Lymph Ducts

Thoracic Duct

The lymph moves through capillaries, vessels and nodes before flowing into the thoracic duct and the right lymphatic duct.

It contains the milky white lymph that comes from the colon due to the high fat content absorbed there.

The thoracic duct, otherwise known as the left lymphatic duct, is the largest duct in the body. It collects almost all of the lymph, which flows back into the blood stream. The duct is about 16 inches long and located in the mediastinum. Here it drains lymph from everywhere except the upper right quarter of the body above the diaphragm and below the midline.

The entrance of the thoracic duct is very small and springs from the cisterna chyli between the 2nd and 10th thoracic vertebrae.

It extends into the abdominal area, meets the aorta and passes through the diaphragm into the mediastinum. Here it joins the venous circulatory system.

The cisterna chyli is the collection point of all lymph. There is also the thoracic duct, the right lumbar trunk, the intestinal trunk and the left lumbar trunk.

The cisterna chyli receives the collective flow of both lymph trunks and the intestinal trunk. The intestinal lymph trunk originates out of the colon. The two lumbar lymph trunks transport lymph out of the legs and pelvic region into the cisterna chyli.

Right lymphatic duct is the shorter lymph duct, at about 1.25 cm. It runs the lymph out of the upper right part of the body, particularly the right arm, rib cage, throat and head. It is located near the neck base.

The right lymphatic duct and thoracic duct merge into the venous system. This merging builds the right and left venous arch and has the combined flow of the subclavian and jugular veins.

Lymph is made up of interstitial fluid. It enters the lymph vessels via the lymph capillaries. It flows into the regional lymph nodes and through node clusters. Finally it reaches the lymph ducts, flowing either into the right lymph duct or the cisterna chyli. Lastly, it empties into the right and left venous arches and merges with venous blood.

Lymph nodes are everywhere in the lymphatic system and are as large as a bean. They are not equally distributed. About half of them are in the throat-larynx region and fight against germs which can enter the body via food or air.

There are also nodes around the rump. The lymph cleans the extremities before reaching the rump. Lymph nodes are also found in the breast and pelvic regions.

Nodes can be either superificially or deeply positioned in tissue.

Superficial: head, groin, armpits Deep: stomach and breast Superficial and deep: throat-l

There are two types of lymph nodes: regional and collective.

Regional: each organ has its own lymph nodes. When lymph moves out of an organ, it passes through regional lymph nodes and is cleaned off cancer cells, pathogens and excess protein.

Collective: these nodes take the lymph out of the regional nodes. They are found in the throat and along the abdominal aorta.

Nodes cannot be felt in healthy persons. During infection, nodes are large, movable, painful and can be felt. After infection, they return to normal.

Lymph nodes play an important role in the body when fighting cancer. They break the cells down in the lymph. If the lymph is overrun it will start to metastasise. During palpation, the nodes can be felt, are large, painfree and unmovable.

The nodes have two tasks: to clean the lymph and to increase and store B and T lymphocytes. The nodes can clean out pathogens and also harmful particles in pulmonary tissue.

Lymph nodes have more afferent lymph vessels than efferent. It is encased in hard connective tissue and contains septum walls. There is an inner marrow and outer shell. The marrow is a canal system where the lymph is cleaned and purified. The cortice or shell contains lymph follicles, and B and T lymphocytes are spread out. The lymph flows slowly through the nodes to ensure enough time to purify and clean the lymph.

Spleen

The spleen is attached to the circulatory system and not the lymphatic system. Its the only lymph organ that is. It lies intraperitoneally in the back left upper abdomen, under the diaphragm. Its neighbours are the stomach, pancreatic tail, colon and left kidney. It weighs about 200 grams, and is 11 cm long.

The spleen arteries and veins enter and exit the spleen hilum.

The spleen is surrounded by rough connective tissue and has two types of pulpa.

Red pulpa: small arterioles and spleen sinusoids White pulpa: lymphatic tissue where B and T lymphocytes spread out

Task of the spleen is to:

Purify blood: reticulum cells in the spleen sinusoids clean blood, digest old erythrocytes, blood platelets and cell fragments Increase B and T lymphocytes in white pulpa Store thrombocytes Small thromboses interception Storage of iron when old erythrocytes are broken down Blood production until 5th fetal month

The body constantly regenerates blood. Old erythrocytes are broken down, and reused to build new cells (erythropoese). The spleen tests if the erythrocytes are old or not, by forcing them through a tight mesh. Young cells can do this, but old can’t.

Erythrocytes are renewed every 120 days in the spleen, liver and bone marrow. They are made out of hemaglobin. When digested they are separated into hem and globin. Bilirubin in hem is sent to the liver so it can be flushed out. Iron is stored by the liver. Globin is metabolised.

The celiac artery is the first branch of the abdominal aorta. Out of the celiac artery, the spleen arteries feed into the spleen hilum. From here they branch into arterioles. Surrounding these are white pulpa. The lymphocytes in the white pulpa are released into spleen sinusoids. It is here where erythrocytes are digested and blood purification occurs. Blood is then transported to spleen venules, which run into spleen veins, exits the spleen through the hilum again, and finally makes its way to the liver via the portal vein.

Thymus is responsible for differentiation of lymphocytes into T lymphocytes. It was once thought to be a gland, as it produces hormone similar substances, like thymosin and thymopoetin.

The thymus is found in the mediastinum (middle chest cavity) between the two pulmonary lobes behind the breast bone in front of the cardiac sac. The heart and thymus are in the mediastinum and the trachea, esophagus, aorta, inferior vena cava, thoracic duct, vagus nerve and diaphragm nerve pass through the mediastinum.

The thymus is quite large and grows right up to puberty. Then it starts to put on fat. Conventional medicine teaches that the thymus starts to regress and has no purpose.

The thymus has two layers which are further divided into layers. There is a dark outer made up of densely packed lymphocytes and a light inner made up of thymus corpuscles, also known as Hassall bodies.

Task of the thymus is the differentiation of T lymphocytes. The lymphocytes created in the red bone marrow are converted into T lymphocytes in the thymus. They populate secondary lymphatic organs such as nodes, tonsils and spleen, where cell division occurs.

The thymus also produces thymus factors which are hormone like substances. These substances influence the T lymphocyte differentiation.

Waldeyer tonsillar ring or lymphatic pharynx

This is a ring formed bundle of lymphatic tissue in the pharynx region. It is made up of adenoid tonsil, tubal tonsil, palatine tonsil and lingual tonsil.

Task is to defend against pathogens entering the body via food or air. It also increases lymphocytes, especially B type, as they can identify pathogens and kickstart antibody production. These antibodies are immune globulin class A or mucous antibodies. They lie in wait inside mucous and slaughter the pathogens before they spread throughout the body.

It has a padding of 1-2 cm thick lymphatic tissue surrounded by reticular connective tissue. The tonsils are covered by a connective tissue capsule.

Pharyngeal tonsil (1): on roof of nasal-pharynx space. Large in children, small in adults. In kids they can block the eustachian tube or nasal opening. This is because of the increase in lymphatic tissue. Palatal tonsil (2): on tonsillar bed. Large in kids, small in adults. Lingual tonsil (1): at root of tongue, only possible to see using a laryngoscope. Tubal tonsil (2): at opening of eustachian tubes. Lymphatic tissue continues as salpginopalatine folds. If large in kids, it can close eustachian tube.

When pathogens attack, tonsils become inflamed, enlargens and can cause pain and pressure. If palatal tonsils are affected, lymph nodes in lower jaw swell (tonsilitis).

Angina is any infection that narrows the throat region. Caused by streptcococca or Epstein Barr virus.

Tonsils that were large and ulcerated were once removed. Today, tonsils are seen as important because of B lymphocyte source, which identify pathogens and produce antibodies. From the tonsils, infection can spread, that is why in continuously infected tonsils, they are removed. Streptococca can attack the heart valve or kidneys, etc.

Finding the cause of infection is a common natural medicine strategy.

Intestinal Lymphatic Tissue

This is the lymphatic tissue in the mucous membrane of the small intestines. It is not equally distributed. In the duodenum there is no lymphatic tissue. In the jejunum there are solitary follicles (small collections of lymphatic tissue). In the ileum there are a lot of solitary follicles named after Peyer Plaques, who discovered them.

On top of and underneath the intestinal epithelium is lymphatic tissue. Between the epithelium cells are M cells which receive antigens and pass them onto the lymphocytes. The lymphocytes then decide to fight or produce an antibody. If they produce an antibody, they share it with the rest of the body via the mucous membrane. The intestines are therefore critical to defense and immunity.

Illnesses of the Lymphatic System

Angina is anything that has a tight feeling. When used alone it refers to throat infection. Can be caused by any kind of pathogen. Tonsilitis is a special form of angina, and is limited to the tonsils.

Mostly kids and teenagers are affected and mostly in winter. Localised to palatal, lingual, and pharyngeal tonsils, as well as the salpingopalatine folds which can cause pharyngitis.

Caused by streptococca, staphylococca, Epstein Barr virus, and fungal infection.

Spread by droplet.

Symptoms include: throat infection, pain while swallowing and in the ear, fever, muffled speech, swelling and pain in the lymph nodes of the lower jaw

Types of Angina:

Angina catarrhalis: reddening and swelling of tonsils Angina follicularis: lymph follicles infected by streptococca Angina lacunaris: pus inside crypt opening, caused by streptococca (bacteria) Angina membranacea: caused by bacteria or virus, area build up by dead tissue, fibrin and pathogens. Angina ulcerosa: ulcers on the tonsils that penetrate mucous membrane. Tonsil hyperplasia: harmless change, small kids

Plaut Vincent Angina

One sided infection of tonsils together with angina ulcerosa and angina membranacea. Caused by spirochaete or fusobacteria. Affects young adults 20-40 years of age. Not many complaints. Detected through another illness. Can last 1-2 weeks. Problems swallowing, coldness, light rise in temp.

Conventional medicine treats this with penicillin and astringents.

Streptococcal Angina

Is wide spread in throat-pharynx of kids. Group A type streptococcal infection. If infected with a virus, can develop into erythogenic toxin and scarlet fever.

Symptoms: fever 39.5, throat pain, lymph nodes in lower jaw swollen, muffled speech.

Streptococcal angina can develop into angina catarrhis, then into lacunaris and sometimes follicularis.

Difference between scarlet fever and streptococcal angina are scarlet fever has angina and skin rash, with raspberry tongue, flaking on hand and soles, as well as perioral dermatitis. Streptococcal angina only has angina and fever symptoms.

Complications can include: middle ear infection, sepsis, tonsil abscess, rheumatic fever, kidney infection, heart infection.

Antibiotics are usually given by a doctor. No compulsory registration needed. For the HP, there is a treatment ban. If the angina is caused by group A streptococca, then the patient must be sent to a doctor.

Tonsil abscess

Pus on tonsil tissue, mostly one sided, accompanied by recurring tonsilitis, which prevents lymph flowing. Can develop into a primary illness. Can also occur during and after tonsilitis.

Symptoms include: fever, shivering, throat pain, lock jaw

Reddening and swelling of tonsil which can force the uvula aside. Send to a doctor for antibiotics.

Spleen disease

If pathogens are found in the blood, then the spleen is infected too, as its main job is to fight blood pathogens. It can swell and change size.

Can also cause increased spleen digestion of erythrocytes, leucocytes and thrombocytes. If this is the case, reticular cytosis will be found in the blood and more reticulocytes.

Splenomeglia is when the spleen swells too much and limits the stretch capacity of the spleen. It can go from 150 grams to kilos. Felt in left lower stomach.

Causes: leucemia, malignant lymphoma, hemalytic anema, congested spleen, spleen tumor, collagen vascular disease, iron storage disease, copper storage disease, malaria, syphilis, typhus, hepatitis and other acute infections.

Spleen lies in the lower left rib cage. Healthy spleen is soft and cannot be felt. If it swells you can touch it. Patient should lie on right side.

Lymphangitis

Inflammation of lymph vessels from localised infection, such as skin injury, ulcus, boils, fungi and panaritis or any kind of skin infection where pathogens can enter the body.

Caused by streptococca and staphylococca.

Symptoms: narrow red stripes at infection site. These are infected lymph vessels. Lymph nodes can be enlarged and painful. High temperature.

Complications include sepsis and secondary lymph edema.

The infection can spread from the infection site throughout the body via the lymph nodes. If the finger is injured, it can spread to the elbow, then the whole arm. This is dangerous and the spread should be brought under control. If these infected lymph vessels reach the blood stream via the venous flow, it can lead to blood poisoning.

Lymphangitis is an inflamed lymph vessel and is different to blood poisoning. But there is the same danger as sepsis if the infection spreads to the blood.

Therapy: treat beginning with moist compresses, such as quark or betonite. The red streaks stop spreading. Affected extremities are supplied. High doses of anti inflammatory enzymes also possible. Severe cases should be sent to a doctor.

Erysipel

Pathogens enter the body via small skin injuries and infect the sclera and lymph tract.

Caused by streptococca and staphylococca. Infection sites are usually the face and lower legs. Symptoms can be acute and include: shivering, fever, nausea, vomiting, headache, swelling of regional lymph nodes and flame shaped reddening with swelling, heat and pain.

Complications include relapsing and secondary lymph edema. In rare cases, there can be sepsis, glomerulo nephritis and meningitis.

Therapy includes prescriptive medication by a doctor. Depends on how severe the disease is.

Lymph Edema

Lymph cannot flow away from tissue and remains. Can see and touch the swelling and collection of lymph. Two types:

Primary: congenital disorder prevents lymph being transported because of valve failure, missing lymph vessels, or fibrosed lymph nodes. Young girls and women affected. Secondary: happens after the removal of a node, especially in breast cancer. If occurs some time after operation then can be new cancer developing in nodes. Check the sentinel node in the armpit, which is responsible for lymph outflow out of the breast tissue. If it is free of metastasis then the others will also be free. Can affect either sides of the body, mostly over age of 40 years.

Course of disease:

  1. Latent stage: insufficiency, no visible edema
  2. Reversible stage: soft touchable edema, which goes away at night. Depression left behind when touch applied. Edema is a protein rich fluid which binds with intracellular space.
  3. Irreversible stage: edema doesnt go away at night, increase in fibrosis and hardening. No depression left behind when touch applied.
  4. Elephantitis stage: extreme edema, skin changes, strong impairment, elephantitis.

Lipohypertrophy vs Lipedema

Lipohypertrophy: increase and spread of fatty tissue in extremities, noticeable in women. Weight reduction necessary. Pain free. Lipedema: next stage, increased fatty tissue increases mechanical compression, leads to vessel permeability, and venous related edema (too much pressure on small veins). Tension and pressure pain, also movement pain. Manual lymphatic drainage necessary, physical movement, compression and venous pumps.

Differential diagnosis: differentiate from heart, kidney and venous edema. Lift skin fold around toes. If you can do this, then no lymph edema.

Symptoms: heaviness, tension, pale skin, edema feels doughy or solid. Tissue swelling from arch of foot to shin or toes. Do not inject or take a blood test from extremity affected with lymph edema.

Therapy includes lymph drainage, body movement, compression bandage. Also possible to use anti inflammatory enzyme therapy, blood letting, etc.

Lymphogranulomatosis Maligna

Cancer of lymphatic tissue, granulomes (inflamed knots of connective tissue) builds up. Called Hodgkin cells.

Mostly young people but people over 60 at risk.

Symptoms: painfree lymph node swelling in one side of throat. Nodes in armpit, stomach and groin can also be affected. Nodes feel like potatoes in a sack. If the disease starts in the abdominal and pelvic regions, then it may go unrecognised. Many alcoholics are affected and the pain can be alcohol related.

Spleen and liver can swell and become hard, there is also tiredness, low performance, night sweats and fever. Fever with changing temperature is Pel Epstein fever. The reason for the change is the ongoing inflamed infection caused by immune weakness as a result of affected lymph nodes breaking down. This may move beyond illness to death. May also spread to other lymph nodes. Metastasis can take up residence in the liver, bone marrow and lungs.

Consequences: infected immune system and overall weakness.

Unclear, painfree lymph node enlargements must be treated by a doctor. Tissue examination necessary.

Conventional medicine treats this like any other cancer related illness, with operation, radiation and cytostatics.

Non Hodgkin Lymphoma

This is an umbrella term for any malignant lymphoma which have no Hodgkin cells. This is particularly nasty, mostly found in AIDS patients. May be difficult to differentiate.

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