Lymphatic System Disorders

HLTAP501A

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Lymphatic System DisordersDisorders of immunityAllergies

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

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Hypersensitivity ReactionsType I – Allergy IgE bound to mast cells; release of histamine and

chemical mediatorsImmediate effects: eg. Hay fever, anaphylaxis

Type II – cytotoxic IgG or IgM reacts with antigen on cell – complement

activatedCell lysis and phagocytosis: ABO compatability

Immune complexAntigen-antibody complex deposits in tissue-complement

activatedInflammation, vasculitis: SLE, glomerulonephritis

Cell-mediated or delayedAntigen binds to T-lymphocytes; sensitised lymphocyte

releases lymphokines Delayed inflammation: contact dermatitis, transplant rejection

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Anaphylaxis

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Second or subsequent exposure to antigen eg. penicillin

Antigen binds with IgE antibodies

Mast cell releases large amount of histamine into general circulation

CardiovascularVasodilation &

Increased capillarypermeability

SkinNerve ending irritated

LungsConstriction of

bronchioles; release ofmucus

Decreased blood pressure, faint, weak

itching Airways obstructed; cough, dyspnoea

Severe oxygen deficit to the brain

Effects of anaphylaxis

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Emergency treatmentanaphylaxis – a medical emergency

Epinephrine should be injected immediately

Highly allergic people advised to carry EpiPen with them

Oxygen Injectable antihistamineTreat for shock: keep warmSummon help, ambulance, hospitalCPR may be necessary

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Immunodeficiencies

CongenitalSevere 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

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Autoimmune diseases

When body loses ability to recognize its own cells and produces antibodies against them.Multiple sclerosis (MS)Myasthenia gravisGrave’s diseaseJuvenile diabetes mellitusSystemic lupus erythematosus (SLE)GlomerulonephritisRheumatoid arthritis (RA)

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SLEAn 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 unknownPredisposing factors

HereditaryGeneticsEnvironmental triggers

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SLE

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SLE

Clinical manifestationsJoints and musclesSkinLungsHeart and cardiovascular systemRenalNervous systemEyesGastrointestinal system

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SLE

InvestigationsBloodHistologyDiagnostic imaging

ManagementRecurs and remitsMedications to manage symptoms eg. NSAIDs

Corticosteroids

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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 systemMay be congenital

Secondary lymphoedemaCaused by the obstruction of the lymphatic systemDue to surgery, radiation therapy, trauma, parasites,

neoplasms, and allergic reactions

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Lymphoedema

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

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Lymphoedema clinical manifestations

Affected area feels heavySkin feels tight and close to bursting pointSkin is hotter than other areas of the bodyAchesNumbnessPins and needlesDarting painsPainful jointsSwelling

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Lymphoedematreatment

Complex physical therapyCompression bandagesLymphatic drainage massageSpecial exercisesMedicationsMassageLow level laser therapySurgery

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Lymphoedemanursing care

Maintain skin hygieneAvoid local heat to areaMaintain CPT programHandle limb carefullyAvoid restrictive clothingDon’t take blood pressure on affected limb

Observe for signs of injury or infections

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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

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Non-Hodgkin’s lymphoma

Incidence increasingInitial manifestation is enlarged, painless lymph nodes.

Clinical symptoms similar to Hodgkin’sDistinguished by multiple node involvement scattered throughout the body and widespread metastases

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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 tumoursTreatment is chemotherapy – prognosis – survival 3 years

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Lymphadenopathy

Lymph nodes abnormal size, consistency or numberGeneralisedEnlarged in two or more non contiguous areas

Localised Lymph nodes usually become enlarged when there is infection or neoplasm involvement