Chapter 20 The Lymphatic System and Lymphoid Organs and Tissues

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1) A mother takes her son to the doctor and describes the following symptoms that she has observed. The child is running a fever, has flu-like symptoms, and his lymph glands are very swollen and sore to the touch. Of what significance are the swollen and sore lymph glands?

Answer:
When tissues are inflamed, such as due to a bacterial infection, lymphatic capillaries develop openings that permit the uptake of the pathogens. The inflammation and pain indicate lymph nodes infected by microorganisms.

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2) A woman had a mastectomy that included the removal of axillary lymph nodes on her left side. What can she expect regarding her left arm and why?

Answer:
Removal of the axillary lymph nodes results in severe localized edema because the lymphatic vessels are also lost. She can expect chronic edema along the arm, although some lymphatic drainage is eventually reestablished by regrowth of the vessels.

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3) A man involved in a traffic accident is rushed to the emergency room of a hospital with severe internal bleeding. Examination reveals a ruptured spleen. What is the treatment of choice and what is the likely long-term outcome (prognosis)?

Answer:
Splenectomy is not as necessary as once believed, and is now performed less frequently. If the spleen does need to be removed, the prognosis is very good, as the functions of the spleen are taken over by the liver and bone marrow.

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4) While passing through a village on safari you notice a man with one enormous leg and one normal-sized leg. What could have caused the increased size of the swollen leg?

Answer:
The man has elephantiasis, which is caused by parasitic worms that get in the lymph system and reproduce to proportions that block the vessels. The swelling is due to edema.

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5) Lymphedema may occur as a complication after a radical mastectomy, in which lymph nodes have been removed. Explain why it might occur.

Answer:
Anything that prevents the normal return of lymph to the blood, such as blockage of the lymphatics by tumors or removal of lymphatics during surgery, results in severe localized edema (lymphedema).

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6) A nurse palpated enlarged lymph nodes. Describe signs and symptoms that help to distinguish cancerous lymph nodes from infected lymph nodes.

Answer:
Tender nodes are usually due to inflammation, whereas hard, fixed nodes are suggestive of malignancy.

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7) Describe why the prognosis of cancer is best when there is no detectable spread from the region of the primary tumor to the lymph nodes.

Answer:
The lymphatic system consists of a meandering network of lymphatic vessels. Cancer cells that break free from the primary tumor can metastasize via the lymph system.

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8) As the human immunodeficiency virus (HIV) progresses, some individuals develop persistent generalized lymphadenopathy. Explain why this may occur.

Answer:
This may occur because lymph nodes are overwhelmed by a large number of virus particles trapped in the nodes.

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