Lymphatic System Disorders

1. Lymphatic System Disorders HLTAP501A Analyse Health Information

2. Lymphatic System Disorders • Disorders of immunity • Allergies • Immediate response • Related to antibody response to an allergen • Histamine causes small blood vessels in the area to become dilated and more permeable leading to oedema or increased secretion of mucus • Anaphylactic shock • Whole body allergic response • Medical emergency • Delayed response • Lymphokines not histamine released • Eg. Contact dermatitis

4. Hypersensitivity Reactions • Type I – Allergy • IgE bound to mast cells; release of histamine and chemical mediators • Immediate effects: eg. Hay fever, anaphylaxis • Type II – cytotoxic • IgG or IgM reacts with antigen on cell – complement activated • Cell lysis and phagocytosis: ABO compatability • Immune complex • Antigen-antibody complex deposits in tissue-complement activated • Inflammation, vasculitis: SLE, glomerulonephritis • Cell-mediated or delayed • Antigen binds to T-lymphocytes; sensitised lymphocyte releases lymphokines • Delayed inflammation: contact dermatitis, transplant rejection

5. Anaphylaxis

6. Effects of anaphylaxis Second or subsequent exposure to antigen eg. penicillin Antigen binds with IgE antibodies Mast cell releases large amount of histamine into general circulation Cardiovascular Vasodilation & Increased capillary permeability Skin Nerve ending irritated Lungs Constriction of bronchioles; release of mucus itching Decreased blood pressure, faint, weak Airways obstructed; cough, dyspnoea Severe oxygen deficit to the brain

7. Emergency treatmentanaphylaxis – a medical emergency • Epinephrine should be injected immediately • Highly allergic people advised to carry EpiPen with them • Oxygen • Injectable antihistamine • Treat for shock: keep warm • Summon help, ambulance, hospital • CPR may be necessary

8. Immunodeficiencies • Congenital • Severe combined immune deficiency (SCID) • Caused by disruption of stem cell development • ‘bubble children’ • Acquired • Acquired immunodeficiency disease (AIDS) • Attacks helper T cell – cripples the immune system

9. Autoimmune diseases • When body loses ability to recognize its own cells and produces antibodies against them. • Multiple sclerosis (MS) • Myasthenia gravis • Grave’s disease • Juvenile diabetes mellitus • Systemic lupus erythematosus (SLE) • Glomerulonephritis • Rheumatoid arthritis (RA)

10. SLE • An inflammatory multi-system disorder characterised by widespread vasculitis affecting capillaries, arterioles and venules • Peak age of onset 20-40 years – women more than men • Aetiology unknown • Predisposing factors • Hereditary • Genetics • Environmental triggers

11. SLE

12. SLE • Clinical manifestations • Joints and muscles • Skin • Lungs • Heart and cardiovascular system • Renal • Nervous system • Eyes • Gastrointestinal system

13. SLE • Investigations • Blood • Histology • Diagnostic imaging • Management • Recurs and remits • Medications to manage symptoms eg. NSAIDs • Corticosteroids

14. Lymphoedema • Accumulation of lymph in the soft tissues due to obstruction to the flow of lymph through the lymphatic system. • Inflammation and fibrosis occurs if untreated. • Primary lymphoedema • Structural problems with lymphatic system • May be congenital • Secondary lymphoedema • Caused by the obstruction of the lymphatic system • Due to surgery, radiation therapy, trauma, parasites, neoplasms, and allergic reactions

15. Lymphoedema http://www.lymphoedemasupport.com/lymphoedema.php

16. Lymphoedema clinical manifestations • Affected area feels heavy • Skin feels tight and close to bursting point • Skin is hotter than other areas of the body • Aches • Numbness • Pins and needles • Darting pains • Painful joints • Swelling

17. Lymphoedematreatment • Complex physical therapy • Compression bandages • Lymphatic drainage massage • Special exercises • Medications • Massage • Low level laser therapy • Surgery

18. Lymphoedemanursing care • Maintain skin hygiene • Avoid local heat to area • Maintain CPT program • Handle limb carefully • Avoid restrictive clothing • Don’t take blood pressure on affected limb • Observe for signs of injury or infections

19. Lymphoma • Malignant neoplasms involving lymphocyte proliferation in the lymph nodes • Hodgkin’s lymphoma • Occurs primarily in adults 20-40 years • Involves single node at first then spreads to others • S&S • Lymph node – enlarged, nontender • Splenomegaly • General signs of cancer – weight loss, anaemia, low-grade fever and night sweats, and fatigue • Generalised pruritus • Recurrent infection • Treatment • Radiation, chemotherapy, surgery

20. Non-Hodgkin’s lymphoma • Incidence increasing • Initial manifestation is enlarged, painless lymph nodes. • Clinical symptoms similar to Hodgkin’s • Distinguished by multiple node involvement scattered throughout the body and widespread metastases

21. Multiple myeloma • Neoplastic disease of unknown aetiology occurs in older adults (involves plasma cells – B lymphocytes) • Malignant plasma cells replace the bone marrow and erode the bone • Blood cell production is impaired as well as production of antibodies • Multiple tumours • Treatment is chemotherapy – prognosis – survival 3 years

22. Lymphadenopathy • Lymph nodes abnormal size, consistency or number • Generalised • Enlarged in two or more non contiguous areas • Localised • Lymph nodes usually become enlarged when there is infection or neoplasm involvement