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Respiratory System Diseases and Disorders 197
5. What behavior puts an individual at highest risk for pulmonary disease?
6. What is the difference between hypoxia and hypoxemia?
7. What is the difference between apnea and tachypnea?
Matching
8. Match the term on the left with the correct descriptive clause on the right.
_____ Asthma
_____ Pneumothorax
a. Inflammation of the mucous membranes of the
sinuses
b. High-risk behavior for developing respiratory
_____ COPD disease
_____ Hemothorax
c. Best preventive behavior against respiratory
infections
_____ TB
d. Hypersensitivity reaction, causing constriction of
_____ Sinusitis
the bronchie
e. Bacterial infection, causing a primary lesion in
_____ Cor pulmonale
the lung
_____ COVID 19
f. Collapse of part of the lung with blood in the
space
_____ Handwashing
g. Group of chronic pulmonary diseases
_____ Smoking
h. Right-sided heart failure
i. Collection of air in the pleural cavit
j. Caused by a coronavirus
Case Studies
■ Ms. Petrie is a second grade teacher. She realizes influenza season is about to begin and that flu shots are
given at her school by the school nurse and the local health department. She has never bothered to get a flu shot
and feels it is unnecessary. She also thinks she might get the flu from the flu shot. She asks you what you think
about it. What would be a good response to her question? Can she get the flu from the shot? What are some
other tips you can tell her to help her prevent getting the flu this season?
■ Mr. Loftin is a 78-year-old man who has been diagnosed with severe emphysema. He has been a heavy
smoker since age 12 and continues to smoke. He complains about his shortness of breath, stating he cannot do
much more than walk across the room without gasping for air. He has been cautioned about the effects of his
continued smoking, but he responds with statements such as, “What difference does it make if I quit now? I’ve
smoked all my life and you can’t go back and change that.” How would you respond to this statement? Is it too
late for him to quit and receive some benefit of that behavioral change? Is any of the damage from smoking
reversible? How can you explain this to Mr. Loftin?
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10
Lymphatic
System Diseases
and Disorders
Key Terms
Lymph (p. 200)
Lymphadenitis (p. 201)
Lymphadenopathy
(p. 201)
Lymphangiography
(p. 201)
Lymphangiopathy
(p. 201)
Lymphangitis (p. 202)
Lymphedema (p. 202)
Lymphocytes (p. 201)
Lymphocytopenia
(p. 201)
Lymphocytosis
(p. 201)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define the terminology common to the lymphatic
system and the disorders of the system.
2. Discuss the basic anatomy and physiology of the
lymphatic system.
3. Identify the important signs and symptoms
associated with common lymphatic system disorders.
4. Describe the common diagnostics used to determine
the type and cause of lymphatic system disorders.
5. Identify common disorders of the lymphatic
system.
6. Describe the typical course and management of
the common lymphatic system disorders.
7. Describe the effects of aging on the lymphatic
system and the common disorders associated with
aging of the system.
Overview
T
he lymphatic system is the infection-fighting system of the body. It works with the immune system to
play an important role in preventing infection and maintaining one’s immunity. The lymphatic sys
tem includes the lymph nodes, lymph vessels, and fluid lymph. It is a special vascular system that picks up
excess tissue fluid and returns it to the blood. Disorders of the system include inflammatory conditions and
neoplasms. The lymphatic system is so closely related to the immune system, the blood and blood-forming
organs, and the cardiovascular system that many of the concepts and diseases of the system have already
been discussed. Refer to these chapters for additional information on the lymphatic system. ■
199
Anatomy and Physiology
The lymphatic system includes lymph vessels, ducts,
and nodes (Figure 10-1). It is important in protecting
the body from infection and filters bacterial and non-
bacterial products resulting from the inflammatory
process. The goal of the system is to prevent these waste
products from entering the general circulation, but this
activity can cause some inflammation of the node filter
ing the waste products, causing swelling and redness of
the involved node.
The lymphatic system depends, to some extent,
on the vascular system because the lymphatic system
returns its fluids and other materials to the vascular sys
tem. There is diffusion of fluid between the lymphatic
vessels, the interstitial spaces, and the blood capillaries.
The fluid in the lymphatic system is called lymph,
a clear liquid similar to plasma that contains many
white cells. The conducting vessels of the lymphatic
system include the capillaries, the smallest vessels, and
the larger lymph vessels, which have valves much like
the veins in the cardiovascular system. In the lymph
vessels, the direction of flow is toward the thoracic cav
ity. The vessels meet in the right lymphatic duct or the
left lymphatic duct, which drain into the venous system.
The right lymphatic duct drains the lymph from the
right half of the head, upper torso, and right arm. The
rest of the lymph vessels in the body drain into the left
lymphatic duct, also called the thoracic duct.
The lymph vessels have other functions besides the
transportation of lymph. They also return important
nutrients such as proteins and large particulate matter
that have leaked out into the capillaries to the blood
vessels (Figure 10-2). In the course of a day, approxi
mately 3 liters of extra fluid are leaked into the tissue
and not picked up by the venous system. The lymphatic
Right subclavian vein
Intestinal lymph nodes
Inguinal lymph nodes
Right lymphatic duct
* Largest lymph
Figure 10-1 The lymphatic system.
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Lymphatic System Diseases and Disorders 201
lymph
capillary
Figure 10-2 Exchange of fluids between the lymph and
blood vessels.
system picks up this extra fluid and returns it to the
blood. In addition, the lymph vessels transport toxic
substances to the nodes for filtration. In the digestive
process, the vessels are important in the absorption of
fats. The nodes are important in the filtering process,
but they also produce lymphocytes and protect the
body by developing immunity to some diseases.
Organs related to the lymph system are the ton
sils, thymus gland, and spleen. These organs also play a
part in the body’s immunity and protection system. See
Chapter 5, “Immune System Diseases and Disorders,”
for a discussion on immunity.
Consider This...
In 1652, Thomas Bartholin, a Danish phy
sician, published the first article correctly
describing the lymphatic system.
Common Signs and Symptoms
Enlargement of the lymph glands or nodes is common
and is usually due to infection somewhere in the body.
Infection stimulates activity of the nodes and glands to
produce more lymphocytes (white cells created in the
lymphatic system). Fever, fatigue, and weight loss are
common with lymphatic diseases.
Most disorders of the lymphatic system are related
to diseases of other systems. Lymphocytosis (lympho
5 lymph, cyto 5 cell, osis 5 increase or an abnormal
increase in lymphocytes) and lymphocytopenia (lym
phocyte 5 lymph cell, penia 5 decrease or an abnor
mal decrease in lymphocytes) in blood and tissue can
accompany diseases of the immune system as well as of
the lymphatic system.
Diagnostic Tests
A complete blood count with white cell differential can
assist in determination of inflammation or infectious
diseases of the lymphatic system.
Lymphangiography (lim-FAN-jee-OG-rah-fee;
lymph 5 lymph, angio 5 vessel, graphy 5 procedure)
consists of injecting a contrast dye and taking X-rays.
This procedure can be helpful in diagnosing vessel con
ditions. Magnetic resonance imaging (MRI) and com
puterized tomography (CT) can also be used.
Biopsy of lymph glands and nodes can assist in
determination of lymphoma. A special connective tis
sue cell called a Reed-Sternberg cell confirms a diagno
sis of Hodgkin’s disease.
Common Diseases of the
Lymphatic System
Diseases of the lymphatic system commonly include
inflammatory conditions. Often, diseases of this sys
tem are the result of disease in another system. Dis
eases of lymph glands can be collectively called
lymphadenopathy (lim-FAD-eh-NOP-ah-thee;
lymph 5 lymph, adeno 5 gland, opathy 5 disease).
Lymphangiopathy (lim-FAN-jee-OP-ah-thee; lymph
5 lymph, angio 5 vessel, opathy 5 disease) is a general
term to describe any disease of the lymph vessels.
Lymphadenitis
■ Description. Lymphadenitis (lim-FAD-eh-NIGH-tis;
lymph 5 lymph, adeno 5 gland, itis 5 inflammation) is
characterized by swelling of the lymph gland, nodes, or
both.
■ Etiology. Lymphadenitis is usually caused by
infection somewhere in the body. Drainage of bac
teria or toxic substances can cause the swelling. The
location of the affected nodes can assist in determi
nation of cause.
202 Chapter 10
Pharmacology
Highlight
Common Drugs for Lymphatic Disorders
Category Examples of Medications
Analgesics and Antipyretics
Drugs used for pain or fever Acetaminophen, ketoprophen, ibuprofen,
or naproxen
Antibiotics
Drugs used to prevent or stop
bacterial infections
Adriamycin, ampicillin, ciprofloxacin, doxycycline,
erythromycin, penicillin, or tetracycline
Antineoplastics
Drugs used to treat cancer
Alkylating agents Chlorambucil, cyclophosphamide, or lomustine
Antimetabolites 5-Flourauracil, mercaptopurine, or methotrexate
Antitumor antibiotics Mitomycin or streptozocin vincristine
Immunotherapy Bortezomib, brentuximab, panobinostat,
rentuximab, rituximab, or thalidomide
Other substances
l-asparaginase, paclitaxel, carboplatin, cisplatin,
or etoposide
Diuretics
Drugs used to reduce
excessive fluid
Amiloride, chlorothiazide, furosemide,
spironolactone, or trimterene
■ Symptoms. Swelling, pain, and tenderness of the
gland or node are common.
■ Diagnosis. A physical examination revealing swollen
lymph nodes is indicative of lymphadenitis. A blood cul
ture can be performed to determine spread of infection
to the bloodstream. A biopsy confirms the diagnosis.
■ Treatment. Antibiotic treatment is helpful with bac
terial infections.
■ Prevention. Maintaining good general health is help
ful in preventing any infection.
Lymphangitis
■ Description. Lymphangitis (lymph 5 lymph, angi 5
vessel, itis 5 inflammation) is a condition of swelling of
the lymph vessel due to inflammation.
■ Etiology. This inflammation is commonly caused by
infection with streptococcal bacteria following a trauma.
■ Symptoms. Lymphangitis is often characterized by a
red streak at the site of bacterial entry that extends to
the area lymph nodes. Other symptoms include fever,
chills, and malaise. Cellulitis (inflammation of cellular or
connective tissue) and leukocytosis can also be present.
■ Diagnosis. Diagnosis is immediate based on the high
fever and the primary symptom of red streaks just below
the skin surface. A blood culture can be completed to
determine whether bacteria have entered the blood
stream. A biopsy can determine the type of bacteria
causing the infection.
■ Treatment. Lymphangitis is commonly treated with
antibiotics. Warm, moist packs and elevation of the
affected area are also helpful.
■ Prevention. Good hygiene and maintaining good
general health are preventive activities.
Lymphedema
■ Description. Lymphedema (lymph 5 lymph, edema
5 swelling) is an abnormal collection of lymph fluid,
usually observed in the extremities (Figure 10-3).
■ Etiology. The most common causes are:
■ Surgery or radiation treatments for cancer, espe
cially breast and testicular surgeries. Breast cancer
surgery (mastectomy) and radiation can lead to a
chronic lymphedema of the arm on the affected
side. About 30% of all post-mastectomy patients
are affected by lymphedema.
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Lymphatic System Diseases and Disorders 203
Figure 10-3 Lymphedema.
■ Surgery on blood vessels of the arms or legs.
■ Other surgical procedures, such as liposuction.
■ Other causes such as pregnancy, burns, and trauma.
■ Symptoms. Symptoms occur in the arms and legs and
include swelling and heaviness. Swelling can also extend
into the fingers and toes, causing tight-fitting rings and
shoes.
■ Diagnosis. History and physical examination of the
affected area along with CT and MRI scans confirm the
diagnosis.
■ Treatment. Treatment is dependent on the cause.
Antibiotics might be needed to treat infections that
worsen with lymphedema. Placing the affected arm
or leg above heart level, while resting, and exercise
to increase lymph flow can decrease the edema. Pro
cedures such as obtaining blood pressure and draw
ing blood samples should not be performed on the
affected side because affected tissue is more prone to
infection.
Pregnancy and constrictive clothing often cause an
increase in venous pressure, resulting in an accumula
tion of fluid in the ankles and feet. Decreasing venous
pressure in these cases will relieve lymphedema. To
reduce venous pressure in the pregnant female, lying
on the left side helps improve venous flow because the
inferior vena cava is to the right of midline. Constrictive
clothing should be removed or loosened when lymph
edema is observed.
Compression therapy might be needed tempo
rarily or lifelong, depending on the cause of the con
dition. Compression aids in pushing the excessive
fluid back into the venous or lymphatic system. Com
pression also aids in venous return or return flow of
both the lymphatic and venous system. Compression
gloves, arm wraps, and leg stockings are available for
this purpose.
Surgery might be needed to remove excess tissue
if the affected limb becomes so large and heavy that it
interferes with the ability to move and walk.
■ Prevention. Activities to reduce the risk of lymph
edema include protecting the affected extremity (arm
or leg), elevating the area while at rest, avoiding heat
directly on the area, avoiding tight clothing, and keep
ing the extremity clean to prevent infection.
Complementary and Alternative Therapy
Acupuncture for
Lymphedema
Treatment
M
anual lymphatic drainage is commonly used to treat lymphedema and has been
shown to be effective for temporary relief. However, an alternative or additional
treatment for lymphedema following breast cancer treatment is acupuncture. A research
study conducted at Memorial Sloan Kettering Cancer Center found that acupuncture
may reduce some of the swelling that occurs in this condition. This study found that
acupuncture is also a very safe and a well-tolerated procedure. Further research is
planned to prove that acupuncture is an effective auxiliary treatment that can benefit the
patient after breast cancer treatment suffering from lymphedema.
Source: Memorial Sloan Kettering Cancer Center (2020)
204 Chapter 10
Lymphoma
Lymphoma refers to several types of neoplasms that
affect lymphoid tissue (lymph nodes, tonsils, spleen,
and lymph fluid). There are many types of lymphoma,
but all affect normal lymphocyte production, leading
to an impaired immunity. Lymphoma is the most
common type of blood cancer in the United States.
Lymphoma is discussed in more detail in Chapter 7,
“Blood and Blood-Forming Organs Diseases and Dis
orders,” under the heading, “Disorders of White Blood
Cells.”
Mononucleosis
Mononucleosis is a viral infection that affects primar
ily children and young adults. It is somewhat conta
gious and is commonly called the “kissing disease.”
This disease is discussed in more detail in Chapter 20,
Childhood Diseases and Disorders, under the heading
“Infectious Diseases.”
Consider This...
Massage lowers blood pressure and assists
in the movement of lymph through the lym
phatic system.
Rare Diseases
Kawasaki Disease
This disorder is also called mucocutaneous lymph node
syndrome. It is an acute febrile disease found mostly in
children and causes cervical lymphadenopathy. It resem
bles scarlet fever because the individual develops a rash
and some edema of the hands and feet. Other symptoms
include lethargy, congestion, irritability, fever, dry skin,
and reddened lips, tongue, and mucous membranes.
Treatment is supportive because the disease does not
respond to antibiotic therapy. This disease is rarely fatal
in the acute stage, but children can die quite suddenly
some years later due to coronary artery disease.
Effects of Aging on the System
As the individual ages, there is decreased ability to produce
antibodies, leading to decreases in the normal immune
response, which interferes with the normal ability to ward
off infections. If other chronic diseases are also present,
the individual can be at an even higher risk for poor heal
ing and development of infections. In addition, as the
immune response becomes less effective, the individual
is more susceptible to autoimmune disorders. Many dis
eases of the older adult have some direct relationship to
the decreased immune response. Because the lymphatic
system depends, for some of its functions, on the vascular
system, additional problems arise in the older person who
has impaired circulation or other vascular system diseases.
Summary
T
he lymphatic system plays an important role in the body’s ability to fight infection and maintain immunity. The sys
tem is composed of lymph, lymph nodes, and vessels to transport the lymph. The lymphatic system also transports
fluid that has leaked into the interstitial areas between the blood vessels. Diseases of the system are usually caused by
infections or neoplasms and can range from mild to severe. Treatment varies with the particular type of disease. Com
mon symptoms include fever, fatigue, weight loss, and enlarged lymph nodes.
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Lymphatic System Diseases and Disorders 205
Review Questions
Short Answer
1. What are the three main functions of the lymphatic system?
2. Name the four signs and symptoms associated with common lymphatic system disorders.
3. Which diagnostic tests are most commonly used to determine the type and cause of lymphatic system disorders?
True or False
4. T F Diseases of the lymphatic system commonly include inflammatory conditions.
5. T F Lymphangiography is a biopsy of a lymph node or several nodes.
6. T F Lymphadenitis is characterized by a swelling of the lymph nodes.
7. T F Lymphangitis is a condition of swelling of lymph vessels due to inflammation.
8. T F Lymphedema is always caused by obstruction of a lymphatic vessel.
9. T F Mononucleosis is a bacterial infection that usually affects children and young adults.
10. T F Lymphoma affects lymphocyte production and impairs immunity.
Fill in the Blank
11. An abnormal collection of lymph fluid, usually in the extremities is ___________ .
12. A type of neoplasm that affects lymph tissue is _________ .
Case Studies
■ Mrs. Talik s 78-years-old and has been hospitalized frequently for repeated respiratory infections. Until the
past two years, she has been relatively healthy. She has not been diagnosed with any serious chronic diseases
but does have some osteoporosis. Based on your knowledge of the aging process and lymphatic system changes,
what might be contributing to the development of these repeated respiratory infections? What can she do to
decrease her risk and improve her immunity to infections?
■ Mrs. Smithson is a 55-year-old woman who has had a mastectomy for breast cancer. She has severe lymph
edema in her right arm. She had talked to her physician about treatments for this, and he recommended using
compression wraps and keeping the arm elevated. Are there any other recommendations you could make to
her? How would you explain the cause of her lymphedema to her?
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