Describe lymphatic system in a more simple way

1. Disorders of the lymphatic system
• Lymphatic obstruction
• Lymphadenitis
• Lymphomas- HL and NHL
• Role of the lymphatic system in the spread of
diseases

2. Lymphatic obstruction
• Lymphatic obstruction is a blockage of the lymph vessels that drain
fluid from tissues throughout the body and allow immune cells to
travel where they are needed.
• Lymphatic obstruction may cause lymphedema, i.e
swelling(accumulation of lymph distal to the blockage) due to a
blockage of the lymph passages
Causes
• Common…tumors and surgical removal of lymph
• Causes of lymphatic obstruction include:
• Infections with parasites such as filariasis
• Injury
• Radiation therapy
• Skin infections such as cellulitis (more common in obese patients)
• Surgery
• Tumors

3. Lymphatic obstruction
Symptoms
• The main symptom is persistent (chronic) swelling,
usually of the arm or leg.
Dx
Based on
• Physical exam and hx
• Investigations-
– CT or MRI scan
– Lymphangiography
– Lymphoscintigraphy

4. lymphadenitis
• Lymphadenitis is an infection of the lymph nodes/glands . The
nodes swell due to inflamation trigered by the infection.
• It is common complication of certain bacterial infections
although it can also be due to some viral or fungal infetions
Causes
– Mainly Bacteria infections- e.g wound infections, skin infections
with streptococcus or staphylococcus, tuberculosis, syphilis,
typhoid, cat-scratch fever (BARTONELLA) etc
– viruses, esp infectious mononucleosis(glandular fever),,
measles,
– or fungi-
• In bold-shows causes of more serious lymphadenitis
• The swollen glands are usually found near the site of an
infection, tumor, or inflammation.

5. lymphadenitis
Symptoms:
– Red, tender skin over lymph node
– Swollen, tender, or hard lymph nodes
– Lymph nodes may feel rubbery if an abscess has formed
Treatment:
• Lymphadenitis may spread within hours. Treatment
should begin promptly. This includes :
– Analgesics (painkillers) to control pain
– Antibiotics to treat any infection..if prompt complete
recovery tho swelling may persist for some time.
– Anti-inflammatory medications to reduce inflammation
– Cool compresses to reduce inflammation and pain
– Surgery may be needed to drain an abscess.

6. lymphadenitis
Complications:
– Abscess formation
– Cellulitis (a skin infection)
– Fistulas (seen in lymphadenitis that is due to
tuberculosis)
– Sepsis (bloodstream infection)

7. lymphomas
• Are malignant tumors of the lymphoid tissue. Are two:
– HL
– NHL
HODGKIN’S DISEASE
• It is cancer of the lymphatic system mainly distinguished by
the presence of Reed-Sternberg cells.
• This cells make it different from all the other forms of
lymphoma.
• HD is more prevalent in men than in women and occurs most
often in young adults ages 15 to 40 and pple older than 55
years
• Of all the lymphomas, HD is the most curable type, even
when the disease is widely spread at the time of diagnosis.

8. Hodgkin’s l.
• Pathophysiology
• Lymph nodes are made of tightly bound fibers and cells
that serve as filtering devices for the body’s immune
system. Most often, HD begins as a single changed
lymph node, usually in the cervical lymph nodes of the
neck.
• As the disease progresses, the cancer invades the
lymph node chains, node by node. The path of cancer
infiltration is usually the same as of the path for lymph
fluid flow. Left untreated, other lymphoid tissues such
as the spleen become infiltrated with HD.
• The major organs eventually become involved with
Hodgkin’s disease.

9. Hodgkin’s l.
• A tentative diagnosis
– of HD is based on one or more painlessly enlarged nodes
in the cervical, axillary, or inguinal areas.
– A biopsy of several of the enlarged nodes shows
presence of RSCs
Cause
• Unknown..common in:
– Viral dccs esp in pts with hx of mononucleosis.
– genetic link.
– Patients with impaired immune function, such as those
with acquired AIDs or on immunosuppressive therapy.

10. Hodgkin’s l.
Signs and symptoms
• of HD is based on one or more painlessly enlarged
nodes in the cervical, axillary, or inguinal areas
• persistent low grade fever, night sweats, fatigue, weight
loss, and malaise
• In late-stage disease there is edema of the neck and
face, possible jaundice, nerve pain, enlargement of the
retroperitoneal nodes, and infiltration of the spleen;
liver and bones may also be involved.
• Press on adjacent organs hence DIB..stridor,Diff in
swallowing etc
Invetigagions:CBC- low or high WBC count, low RBCs

11. Hodgkin’s l.
Staging according to Ann Arbor Clinical:
• Stage I disease is limited to a single lymph node or site.
• In stage II disease, two or more nodes are involved on
the same side of the diaphragm. Limited organ
involvement may or may not be present.
• Stage III disease is characterized by nodes on both sides
of the diaphragm, with or without organ involvement.
• Stage IV, the most serious form of the disease and the
least curable, includes widely disseminated disease in
several organs or tissues with or without associated
lymph node involvement.

12. Hodgkin’s l.
TX
• Radiation
• Chemotherapy
• NB: Combinations of chemotherapy and radiation
therapy are used for patients with stage III and
stage IV

13. NON–HODGKIN’S LYMPHOMAS
• Refers to all other lymphomas that don’t have the RSCs.
• NHLs arise from the T and B lymphocytes
– E.g Burkitt’s lymphoma…B lymphocytes
– Multiple myeloma…..plasma cells
• Most cases of NHL are of B-cell origin.
• NHL is more aggressive and rapid in progress than HL. It is
very common and prognosis is poor
• Common in elderly (except Burkit’s---children)
Etiology
• Unknown—associtad with
– viruses, such as Epstein-Barr virus(Burkitt’s lymphoma) and
herpes virus
– Immunosuppression
– Exposure to nuclear and toxic substances

14. NON–HODGKIN’S LYMPHOMAS
Signs and Symptoms
• Clinical features of malignant lymphomas are same
e.g.
– enlarged, painless, rubbery nodes in the cervical and
supraclavicular areas; enlarged tonsils and adenoids;
– occasional symptoms of dyspnea and cough.
– As the disease progresses, the patient may report
fatigue, malaise, weight loss, and night sweats, similar to
Hodgkin’s disease.

15. NON–HODGKIN’S LYMPHOMAS
Dx
• Biopsy of lymphoid tissues is confirmatory of type
of cells involved
Rx
Combination of several therapies:
• Chemotherapy
• Radiation therapy in advanced stages
• Stem cell transplant in advanced stages