Chapter 20
The Lymphatic System and Lymphoid Organs and Tissues
763
2.
A friend tells you that she has tender, swollen “glands” along
the leF side of the front of her neck. You notice that she has a
bandage on her leF cheek that is not fully hiding a large infected
cut there. Exactly what are her swollen “glands,” and how did they
become swollen?
3.
Once almost a rite of childhood, tonsillectomy (surgical removal
of the tonsils) is now rarely performed. Similarly, while ruptured
spleens were once routinely removed, they are now conserved
whenever possible. Why should these lymphoid organs be
preserved when possible?
Critical Thinking
and Clinical Application
Questions
1.
Mrs. Jackson, a 59-year-old woman, has undergone a leF radical
mastectomy (removal of the leF breast and leF axillary lymph
nodes and vessels). Her leF arm is severely swollen and painful,
and she is unable to raise it to more than shoulder height. (a)
Explain her signs and symptoms. (b) Can she expect to have relief
from these symptoms in time? How so?
Related Clinical Terms
Elephantiasis
(el
0
lĕ-fan-ti
9
ah-sis) Typically a tropical disease in
which the lymphatics (particularly those of the lower limbs
and scrotum) become clogged with parasitic roundworms, an
infectious condition called filariasis. Swelling (due to edema)
reaches enormous proportions.
Hodgkin’s lymphoma
A malignancy of lymphoid tissue; symptoms
include swollen, nonpainful lymph nodes, fatigue, and oFen
intermittent fever and night sweats. Characterized by presence
of giant malignantly transformed B cells called Reed-Sternberg
cells. Infection with Epstein-Barr virus (see mononucleosis
below) and genetic susceptibility appear to be predisposing
factors. Treated with chemotherapy and radiation; high cure rate.
Lymphadenopathy
(lim-fad
0
ĕ-nop
9
ah-the;
adeno
5
a gland;
pathy
5
disease) Any disease of the lymph nodes.
Lymphangiography
(lim-fan
0
je-og
9
rah-fe) Diagnostic procedure in
which the lymphatic vessels are injected with radiopaque dye
and then visualized with X rays.
Lymphoma
Any neoplasm (tumor) of the lymphoid tissue, whether
benign or malignant.
Mononucleosis
A viral disease common in adolescents and young
adults; symptoms include fatigue, fever, sore throat, and swollen
lymph nodes. Caused by the Epstein-Barr virus, which is
transmitted in saliva (“kissing disease”) and specifically attacks
B lymphocytes. ±is attack leads to a massive activation of T
lymphocytes, which in turn attack the virus-infected B cells.
Large numbers of oversized T lymphocytes circulate in the
bloodstream. (±ese lymphocytes were originally misidentified
as monocytes:
mononucleosis
5
a condition of monocytes.)
Usually lasts four to six weeks.
Non-Hodgkin’s lymphoma
Includes all cancers of lymphoid
tissues except Hodgkin’s lymphoma. Involves uncontrolled
multiplication and metastasis of undifferentiated lymphocytes,
with swelling of the lymph nodes, spleen, and Peyer’s patches;
other organs may eventually become involved. ±e seventh
most common cancer. A rapidly progressing type, which
primarily affects young people, grows quickly but responds to
chemotherapy; up to a 75% remission rate. A slowly progressing
type, which affects the elderly, resists chemotherapy and so is
oFen fatal.
Sentinel node
±e first node that receives lymph drainage from a
body area suspected of being cancerous. When examined for
presence of cancer cells, this node gives the best indication of
whether metastasis through the lymphatic vessels has occurred.
Splenomegaly
(sple
0
no-meg
9
ah-le;
mega
5
big) Enlargement of
the spleen due to accumulation of infectious microorganisms;
typically caused by septicemia, mononucleosis, malaria, or
leukemia.
Tonsillitis
(ton
0
sĭ-li
9
tis;
itis
5
inflammation) Inflammation of the
tonsils, typically due to bacterial infection. Tonsils become red,
swollen, and sore.
AT T H E C L I N I C
Back to following the progress of
Mr. Hutchinson, we learn that the
routine complete blood count (CBC)
performed on admission reveals that
his leukocyte count is dangerously low and follow-up lab tests
show that his lymphocytes are deficient. One day postsurgery, he
complains of pain in his right ring finger (that hand had a crush
injury). When examined, the affected finger and the dorsum of
the right hand are edematous, and red streaks radiate superiorly
on his right forearm. Higher-than-normal doses of antibiotics are
prescribed, and a sling is applied to the affected arm. Nurses are
instructed to wear gloves and gown when giving Mr. Hutchinson
his care.
Relative to these observations:
1.
What do the red streaks emanating from the bruised finger
indicate? What would you conclude his problem was if there
were no red streaks but the right arm was very edematous?
2.
Why is it important that Mr. Hutchinson not move the affected
arm excessively (i.e., why was the sling ordered)?
3.
How might the low lymphocyte count, megadoses of
antibiotics, and orders for additional clinical staff protection be
related?
4.
Do you predict that Mr. Hutchinson’s recovery will be uneventful
or problematic? Why?
(Answers in Appendix H)
Lymphatic System/Immunity
Case Study
20
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