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The Lymphatic System
The Lymphatic SystemIncludes the lymph, lymphatic vessels, lymph nodes, lymphoid organs (tonsils, spleen and thymus)
Primary Functions:1. Maintains fluid homeostasis2. Absorbs lipids from the GIT3. Filters blood (spleen)4. Contains lymphocytes participating in immunity
The LymphFluid similar to composition as plasmaWithout RBC and less proteinsSpecial Lymph from the GIT is loaded with fats and is called CHYLE
Fig. 14.2
The Lymph vesselsCarry fluid away from tissues into the venous circulationThese are NOT present in the central nervous system, Bone marrow, epidermis and cartilageThey resemble vein because they have valves
3 mechanisms of edema formation
1. Decrease oncotic pressure cirrhosis and kwashiorkor2. Increased hydrostatic pressure CHF and prolonged standing3. Lymphatic obstruction or destruction filiariasis, lymph node dissection
Lymphatic duct1. Right lymphatic duct- drains the right side of the head and the upper right side of the thorax and the right extremities2. Thoracic duct- drains the rest of the body
The Lymphatic organs1. Tonsils
A. palatineB. pharyngealC. lingualD. tubal
The lymphatic organs2. Lymph nodes
Small round structures of lymphoid tissueMajor lymph nodes are the axillary,
inguinal and cervicalFilters lymphActivates the immune systemRemoves microorganisms from the blood
The lymphoid organs3. The spleen
Reddish, flat organ lying next to the 9th and 10th rib in the left upper quadrantFunctions:
Repository of old RBCActivates the immune systemStorage of BloodSequesters bacteriaMOST COMMONLY INJURED
in BLUNT abdominal trauma
The lymphoid organs4. Thymus
Bilobed organ in the superior mediastinumLymphocytes from the bone marrow mature and grow as T-lymphocytesPositive selection= T-cells that react to foreign antigen are selectedNegative selection= T-cells that do not react to the self-antigen are selected
IMMUNITYInnate or Non-specific
1. Mechanical- skin, mucus, saliva, urine2. Chemical- enzymes, lysozymes3. Vascular Blood cells- Neutrophils and macrophages4. Inflammation
Specific Immunity1. Cellular Immunity- T-cell system2. Humoral Immunity- B-cell system
Non-specific ImmunityInflammatory responseReaction of the vacularized living tissues to injury
Classic signs:1. Rubor- redness2. Calor- heat3. Tumor- swelling4. Dolor- pain5. Functio laesa- loss of function
InflammationInitial reaction Vasoconstriction!VC VD VP (due to HISTAMINE)VD Redness and HeatVP SwellingBradykinin, Prostaglandin, compression of tissues pain
Specific Immunity: T cellT-cells originate in the bone marrow and mature in the thymus
4 types of T-cells1. Cytotoxic T cells- kill infected cells, cancer cells and transplanted cells2. Helper T cells- help the humoral immunity3. Suppressor T cells- suppress that actions of cytotoxic and Helper cells4. Memory T cells- for recall and specificity
Specific Immunity: B cellsB cells are produced and mature in the bone marrowB cells helped by Helper cells turn into Plasma cells secrete ANTIBODIES
ANTIBODIESAre proteins that can combine with antigens and function for:1. Opsonization2. Neutralization3. Activation of complement system
ANTIBODIES typesFive classes
1. Ig M- priMary response, pentaMer2. Ig G- secondary response, most abundant, can cross placenta3. Ig A- secreted by the body (sIgA)4. Ig D- receptor for B cells5. Ig E- allergic and parasitic reactions
TYPES OF IMMUNITY1. Natural Immunity
Active naturalPassive natural
2. Artificial ImmunityActive artificialPassive artificial
Fig. 14.18
End of Immune System
THE RESPIRATORY SYSTEM
The Respiratory SystemComposed of the air conducting system and the respiratory unit (lungs)Major function is RESPIRATIONCommonly divided into UPPER RESPIRATORY tract and LOWER RESPIRATORY tract
Ventilation and Respiration
VENTILATION- movement of air from the atmosphere into the lungs and out of the lungsEXTERNAL RESPIRATION- exchange of gases between the alveoli and the bloodINTERNAL RESPIRATION- exchange of gases between the blood and the tissues
The Respiratory SystemCommonly divided into UPPER RESPIRATORY tract
andLOWER RESPIRATORY tract
The UPPER Respiratory tract
The nose, pharynx and larynx
The LOWER respiratory tract
Composed of The trachea down to the Lungs
The NOSEMade up of nasal bones and cartilagesThe NASAL cavity is made up of bones, cartilages and turbinates or conchaeThe nostril is the external openingThe choanae is the internal opening
Functions of the nose1. Hairs or vibrissae filter large particles2. Blood vessels warm the air3. Mucus serves to humidify the air4. Phonation
The PharynxMusculo-membranous tube from behind the nasal cavity to the level of the cricoid cartilage (C6)
The Pharynx3 component parts
1. Nasopharynx2. Oropharynx3. Laryngopharynx
The LarynxUpper expanded portion of the tracheaMade up of cartilages
3 Unpaired- Cricoid, Thyroid and Epiglottis ( cUte)6 Paired- Cuneiform, Corniculate and Arytenoid (pACC)
Function: air passageway and phonation
The vocal cords1. False vocal cords2. True vocal cords3. Glottis- the space between the true vocal cords and is the narrowest portion of the adult airway
Fig. 15.4
Lower airway: TracheaCalled windpipeMade up of 15-20 C-shaped cartilage10-11 inchesLined with pseudostratified
ciliated epithelium
BronchusRIGHT BronchusWiderShorterMore vertical
Left bronchusNarrowerLongerMore horizontal
BronchiolesPrimary bronchussecondary bronchustertiary bronchus terminal bronchioles
Respiratory bronchioles belong to the respiratory unit
Respiratory unitRespiratory bronchiolesAlveolar ductsAlveolar sacsalveolus
The PleuraSurrounds the lungs and provide protection1. Parietal pleura- in the chest wall2. Visceral pleura- intimately attached to the lungs3. Pleural space- in between the two
Diaphragm
Respiratory Physiology1. Ventilation and gas exchange2. Mechanics of breathing3. Gas transport4. Pulmonary volumes and capacities5. Respiratory control
VentilationVentilation is the movement of air into the lungsAir (oxygen) moves by the process of diffusion from the higher concentration in the alveoli to the pulmonary capillaries
Mechanics of breathing
Gas exchangeRespiratory membrane is thin which facilitates gas exchangeRate of diffusion depends on the thickness of the membrane, surface area and partial pressure of gases
Gas transport1. OXYGEN- majority is transported in the blood loosely bound to hemoglobin- oxyhemoglobin2. CARBON DIOXIDE- majority is transported in the blood in the RBC as BICARBONATE
Fig. 15.8
LUNG VOLUMES1. Tidal volume – TV2. Inspiratory Reserve Volume- IRV3. Expiratory Reserve Volume- ERV4. Residual volume- RV
LUNG CAPACITIESLung volume + another lung volume1. Inspiratory Capacity- IC2. Functional Residual Capacity- FRC3. Vital capacity- VC4. Total Lung capacity- TLC
NOT CLINICALLY measured1. Residual volume2. Functional residual volume3. Total lung capacity
Control of Respiration: Central
Respiratory center in the medullaControls the rate and depth of respirationIncreased CO2 is the most potent stimulus
Control of Respiration: Peripheral
1. Chemoreceptors in the carotid and aortic bodies
Sensitive to changes in pH and O2Decreased O2 increase respirationDecreased pH (acidosis) increase respiration
2. Herring-Breurer reflexStretch receptors in the lungs limit the inspiration
ASSESSMENTNormal Breathing pattern:
12-21 respiratory rateActive inspiration with contraction of diaphragmPassive expiration with relaxation of diaphragm Steady rhythm and regular rate and sizeI:E ratio is 1:2
Abnormal breathing pattern
1. Cheyne-Stoke’s2. Biot’s3. Kussmaul’s4. Agoral
Breathing rates1. Eupnea- 12-212. Bradypnea- 11 and below3. Tachypnea- 22 and above4. Dyspnea- difficulty of breathing
Breathing Position1. Platypnea- inability to breath in an upright position2. Orthopnea- difficulty in breathing in any position except upright
Breath sounds: Normal1. Bronchial or Tracheal- in the sternum2. Bronchovesicular- in the interscapular area3. Vesicular- lung periphery
Adventitious Breath sounds
1. Rales or crackles2. Stridor3. Wheeze4. Rhonchi5. Friction rub