Anatomy & Physiology - Lecture

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 17

LESSON TITLE: LYMPHATIC SYSTEM AND IMMUNITY Materials:

LEARNING OUTCOMES: Book, pen and notebook
Upon completion of this lesson, you can:
1. List the functions of lymphatic system;
2. Describe each component of lymphatic system structures;
3. State the processes performed by the lymphatic system;
4. Describe the innate immunity and each mechanism involved in
its response;
5. Identify the characteristics of adaptive immunity & its
relationship to antigens;
6. Define lymphocytes with its origin, development, activation &
multiplication;
7. Describe the categories of adaptive immunity with structural &
functional features of each of components;
8. Identify the ways that adaptive immunity can be acquired;
9. Recognize the major interactions & responses of innate &
adaptive immunity to an antigen;
10. Define immunotherapy with examples; Reference:
11. Identify the different diseases & disorders associated with
lymphatic system with its description; and, VanPutte, C., Regan, J., & Russo, A. (2019). Seeley’s
12. Enumerate the effects of aging on lymphatic system and essentials of anatomy & physiology (10th ed.).
immunity. New York, NY: McGraw-Hill Education.

LESSON REVIEW/PREVIEW
You must answer the questions below before starting the main lesson. This is your review from the previous session.
Do this without looking at your notes and compare it to the correct answers. Enjoy!
1. Enumerate the major points at which the pulse can be monitored/felt.
▪ Temporal Pulse ▪ Femoral Pulse
▪ Carotid Pulse ▪ Popliteal Pulse
▪ Apical Pulse ▪ Posterior Tibial Pulse
▪ Brachial Pulse ▪ Dorsalis Pedis Pulse
▪ Radial Pulse ▪ Ulnar Pulse

2. How does the nervous mechanisms regulate the control of blood flow? Illustrate.

The cardiovascular centers of the medulla oblongata are responsible for the neurological control of blood pressure and flow.
This group of neurons reacts to changes in blood pressure, oxygen, carbon dioxide, and other variables including pH.

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MAIN LESSON
You must read & study the concepts and refer to figures/tables in Chapter 14 of the book.

Functions of the Lymphatic System:

1. Fluid balance in tissues
2. Lipid absorption from small intestines
3. Defense against pathogens

Lymphatic System – carries fluid from tissues to circulatory system; does not circulate to or from tissues;
includes lymph, lymphocytes, lymphatic vessels, lymph nodes, tonsils, spleen, and thymus. (Refer to
process figure 14.7, page 387)

Lymph – fluid that flows within lymphatic system; this occurs when some fluid that moves from blood capillaries
into tissue spaces (most of fluid returns to blood) moves from tissue spaces into lymphatic capillaries (See figure
14.2)

Lymphatic Capillaries – tiny, closed-ended vessels; more permeable than blood capillaries & fluid moves easily
into; contain valves from overlapping squamous cells in the walls that prevent the backflow of fluid
▪ Superficial group collects excess interstitial fluids from dermis & subcutaneous tissues
▪ Deep group collects from muscle, the viscera, & other deep structures
▪ CNS, bone marrow, & tissues lacking blood vessels (epidermis & cartilage) do not have lymphatic
capillaries

Lymphatic Vessels – where lymphatic capillaries join; resemble small veins that have a beaded appearance;
valves prevent backward & cause forward movement through vessels when compressed, caused by factors:
1. Contraction of skeletal muscle due to activity
2. Periodic contraction of smooth muscle
3. Pressure changes in the thorax during breathing

Two Ducts where Lymphatic Vessels Empty into the Blood: (See figure 14.1)
▪ Right Lymphatic Duct – formed by vessels from the right upper limb and right half of head, neck, chest;
empties into right subclavian vein
▪ Thoracic Duct – where the rest of the body enters which empties into the left subclavian vein

Lymphatic Tissue – characterized by housing many lymphocytes & other defense cells (macrophages); has
very fine reticular fibers that trap microorganisms & other items in fluid

Tonsils – form a protective ring of lymphatic tissue around openings between nasal & oral cavities and pharynx;
protect against pathogens entering from nose & mouth; has three groups: (See figure 14.3)
▪ Palatine Tonsils – paired; located on each side of posterior opening of oral cavity; may become
chronically infected & must be removed surgically through tonsillectomy
▪ Pharyngeal Tonsil – located near internal opening of nasal cavity; when enlarged (adenoid), can
interfere with normal breathing; can be surgically removed through adenoidectomy
▪ Lingual Tonsil – on posterior surface of tongue; less often infected & more difficult to remove

Lymph Nodes – rounded structures distributed along lymphatic vessels & has 3 superficial aggregations on each
side of body: inguinal nodes in groin, axillary nodes in armpit, & cervical nodes in neck (See figure 14.4)
▪ Capsule – surrounds each node; extensions are called trabeculae, that subdivide the node into
compartments:
o Lymphatic Nodules: dense aggregations of tissue formed by lymphocytes & other cells;
contain rapidly dividing lymphocytes called germinal centers
o Lymphatic Sinuses: spaces between the lymphatic tissue that contain macrophages
▪ as lymph moves through these nodes, two functions are performed:
o (1) activation of immune system, and (2) removal of pathogens from lymph through macrophages

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Spleen – located in left, superior corner of abdominal cavity; filters blood instead of lymph & serves as blood
reservoir; has two specialized types of lymphatic tissue: (See figure 14.5)
▪ White Pulp – surrounding the arteries within the spleen
▪ Red Pulp – associated with veins; filled with macrophages that remove foreign substances & worn- out
RBCs through phagocytosis
Splenectomy – surgical removal of spleen

Thymus – bilobed gland roughly triangular in shape; site for the maturation of T cell lymphocytes; located in
superior mediastinum that contains: (See figure 14.6)
▪ Cortex – dark-staining areas formed by numerous lymphocytes
▪ Medulla – lighter-staining, central portion of lobules that has fewer lymphocytes

Immunity – ability to resist damage from pathogens, harmful chemicals, & internal threats, making a person
immune in second exposure before any symptoms develop; categorized into innate immunity & adaptive
immunity (See table 14.1); intimately linked as illustrated in Figure 14.18

Innate Immunity / Nonspecific Resistance – present at birth; the body recognizes & destroys certain
pathogens, but the response is the same each time the body is exposed; mechanisms of this immunity include:

1. Physical Barriers – prevent pathogens & chemicals from entering the body in two ways:
▪ skin & mucous membranes that prevent the entry
▪ tears, saliva, & urine that wash substances from body surfaces

2. Chemical Mediators – molecules which include:

▪ Lysozyme: found in tears & saliva that kills certain bacteria
▪ Mucus: in mucous membrane, prevents entry of some pathogens
▪ Complement: group of more than 20 plasma proteins that are activated once exposed to
pathogens and promote inflammation, phagocytosis, & can directly lyse bacterial cells
▪ Interferons: proteins that protect against viral infections by stimulating surrounding cells to
produce antiviral proteins
▪ Histamine, Prostaglandins, & Leukotrienes: promote inflammation by causing vasodilation,
increase vascular permeability & stimulate phagocytosis

3. White Blood Cells – move towards chemicals released from pathogens or damaged tissues (chemotaxis)
▪ Phagocytic Cells: ingest & destroys pathogens
o Neutrophils – first to respond but die quickly
o Macrophage – large monocytes that leave blood & enter tissues; responsible for most of
phagocytic activity in late stages of infection (Kupffer cells in liver, dust cells in lungs, &
microglia in CNS)
▪ Cells of Inflammation: produce inflammatory response to fight against pathogens
o Basophils – motile WBC that can leave blood & enter infected tissues
o Mast Cells – located at points where pathogens may enter the body such as skin, lungs,
gastrointestinal tract, & urogenital tract.
o Eosinophils – participate in inflammation associated with allergies & asthma
▪ Natural Killer (NK) Cells – a lymphocyte that recognize class of cells such as tumor cells or virus
infected cells; kill target cells by releasing chemicals that damage cell membranes & cause cell lysis

4. Inflammatory Response - stimulates release of chemical mediators; the amount of mediators & phagocytes
increase until the cause of inflammation if destroyed; mediators produce several effects: (See figure 14.8)
▪ vasodilation increases blood flow & brings phagocytes & other WBC to area
▪ phagocytes leave the blood & enter the tissue
▪ increased vascular permeability allows fibrinogen & complement to enter the tissue from blood

Local Inflammation – inflammatory response confined to a specific area of body; produces redness, heat,
swelling, pain, & loss of function

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 Systemic Inflammation – response that is generally distributed throughout the body; produces local
symptoms & three additional features: increased neutrophils, fever (presence of pyrogens), & decreased
blood volume (shock)

Adaptive Immunity / Specific Immunity – body recognized & destroys pathogens, but the response
improves each time the pathogen is encountered due to two certain characteristics:
▪ Specificity – ability to recognize a particular substance
▪ Memory – ability to remember previous encounters resulting to faster, stronger, & longer- lasting
response
Antigens – substances that stimulate adaptive immune responses; exposure to these increases the
effectiveness of successive exposure; divided into two groups:
▪ Foreign Antigens – introduced from outside the body (ex: drugs causing allergic reactions)
▪ Self-Antigens – produced by body that stimulates immune system response (ex: autoimmune
disease)

Lymphocytes – responsible for the responses of adaptive immunity; develop from stem cells that give rise to:
▪ Pre-T cells – migrate through blood to thymus to divide & processed into T cells
▪ Pre-B cells – processed in red bone marrow into B cells

Two Events of Lymphocytes in Adaptive Immunity:

▪ Antigen Recognition
o B & T cells have antigen receptors on surfaces. Clones are lymphocytes with the same antigen
receptor. Each receptor binds with only specific antigen that activates lymphocytes & adaptive
immunity begins.
o Major Histocompatibility Complex (MHC) Molecules – glycoproteins that have binding
sites specific for certain antigens; functions as “serving tray” that hold & present a processed
antigen on outer surface of cell membrane (See figure 14.10, steps 1 to 3)
✔ the first signal necessary to produce a response from a B cell or T cell
✔ costimulation by second signal is also required; achieved by cytokines
▪ Lymphocyte Proliferation – important process that generates the needed defense cells to protect the
body
o Process of proliferation differs for each lymphocyte class
o Number of helper T cells must be greatly increased because they are necessary in activation of
most T cells and B cells (See figure 14.10, steps 4 to 7)
o B cell proliferation begins when a B cell takes in the same kind of antigen that stimulated the
helper T cell (See figure 14.11)

Categories of Adaptive Immunity:

1. Antibody-Mediated Immunity – involves a group of B cell lymphocytes & proteins called antibodies;
effective against extracellular antigens (bacteria, viruses, & toxins) & in certain allergic reactions

Antibodies – produced by plasma cells and bind to the antigen; are Y-shaped molecules consisting of:
(See figure 14.12)
▪ Variable Region – at the end of each arm that functions as an antigen-binding site (lock-and-key
model)
▪ Constant Region – activate complement or bind to other immune cells (macrophages, basophils &
mast cells)
Gamma Globulins – other term of antibody since they are found mostly in gamma globulin part of plasma
Immunoglobulin (Ig) – another term for antibody since they are globulin proteins involved in immunity (See
table 14.2)

Effects of Antibodies: (See figure 14.13)

▪ Inactivate antigen ▪ Initiate release of inflammatory chemicals
▪ Bind antigens together ▪ Facilitate phagocytosis
▪ Active complement cascades

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Antibody Production: (See figure 14.14)
▪ Primary Response – results from 1st exposure of B cell to an antigen; person usually develops disease
symptoms because the antigen has time to cause tissue damage
▪ Secondary Response / Memory Response – initiated by memory B cells to quickly form plasma
cells; responsible for formation of new memory cells

2. Cell-Mediated Immunity – involves the actions of T cells; most effective against microorganisms that live
inside body cells; also functions in:
✔ allergic reactions, control of tumors, & graft rejections
✔ essential in fighting viral infections by destroying virally infected cells (See figure 14.15 & 14,16)

Types of T Cells:
▪ Cytotoxic T Cells – responsible for immediate immune response; has two main effects:
o release cytokines that activate additional components of immune system (cells for
phagocytosis & inflammatory response) & also activate additional cytotoxic T cells
o bind to antigen on surfaces of these cells (viral antigen, tumor antigen, & foreign antigen)
& kill them
▪ Helper T Cells – promote or inhibit the activities of both adaptive immunities; promote production of
cytotoxic T cells & activate macrophages
▪ Memory T Cells – provide a secondary response & long-lasting immunity

Four Ways to Acquire Adaptive Immunity: (Refer to figure 14.17, page 400)

Immunotherapy – treats disease by altering immune system function or by directly attacking harmful cells
✔ administer cytokines to promote inflammation & activate immune cells or blocks the expression of MHC
molecules that display self-antigens
✔ vaccination that can prevent many diseases
✔ monoclonal antibodies can be used to deliver radioactive isotopes, drugs, toxins, or enzymes for treating
tumors

Diseases and Disorders of Lymphatic System:

Condition Description
autoimmune disease in which immune system treats self-antigens as foreign, destroying the
Multiple Sclerosis
myelin that covers axons
Systemic Lupus
a disease in which tissues & cells are damaged by immune system; no cure
Erythematosus (SLE)
For the listed conditions below, refer to Table 14.3, page 402 of the book for description:
▪ Lymphatic System (Lymphedema & Lymphoma)
▪ Immune System (Immediate Allergic Reactions, Asthma, Anaphylaxis & Delayed Allergic Reactions)
▪ Immunodeficiencies (Severe Combined Immunodeficiency & AIDS)

Effects of Aging on the Lymphatic System and Immunity:

▪ Aging has a little effect on the ability to remove fluid from tissues, absorb lipids from the digestive tract,
or remove defective RBCs from blood.
▪ Decreased helper T cell proliferation results in decreased antibody-mediated & cell-mediated immune
responses.
▪ The primary & secondary antibody responses decrease with age.
▪ The ability to resist intracellular pathogens also decreases with age.

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CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given
to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your
answer/ratio is not allowed. You are given 20 minutes for this activity.

Multiple Choice

1. The lymphatic system plays a role in maintaining fluid balance within the body by:
a. adding lymph to GI tract secretions. d. carrying excess fluid to the kidneys to be
b. returning interstitial fluid to the plasma. excreted.
c. transporting lymph from tissues to the liver. e. actively absorbing fluid from the blood.
ANSWER: B
RATIO: By collecting excess fluid and particle matter from tissues and depositing them in the circulation, the lymphatic system aids in
maintaining fluid balance in the body. It also aids in the body's defense against infection by providing disease-fighting lymphocytes.

2. Germinal centers are the sites of:

a. increased blood flow to the lymph nodes. d. entrance of lymph into lymph nodes.
b. fluid production. e. proliferation of lymphocytes in the lymph
c. increased flow of lymph from infected nodes.
tissues.
ANSWER: E
RATIO: The germinal center (GC) is a specialized microstructure found in secondary lymphoid tissues that produces long-lived
antibody-secreting plasma cells and memory B cells that can defend against reinfection.

3. Which of the following is the molecule that displays an antigen on the surface of cells?
a. Antigen c. Antigen receptor
b. Antibody d. Major histocompatibility complex molecule
ANSWER: D
RATIO: The purpose of MHC molecules is to bind pathogen-derived peptide fragments and display them on the cell surface for
identification by T lymphocytes.

4. What is the nonspecific lymphocyte that kills tumor cells and virus infected cells?
a. Macrophages c. Eosinophils
b. Natural killer cells d. Basophils
ANSWER: B
RATIO: Natural Killer cells are well recognized for their ability to destroy virally infected cells as well as identify and suppress early
cancer symptoms. Specialized NK cells are present in the placenta and may play an essential function in pregnancy in addition to
guarding against illness.

5. Which of the following occur during the inflammation? (Select all that apply)
a. Chemical mediators cause vasodilation d. Fibrin walls off the infected area
b. Blood flow is decreased to the area e. Complement attracts phagocytes to the area
c. Vascular permeability is decreased
ANSWER: A, D, E
RATIO: Options A, D, and E occur during the inflammation. Chemical mediators released chemical mediators which includse
vasoactive amines such as histamine and serotonin, peptide, and eicosanoids.

6. Which is the proper order of events in cell-mediated immunity?

(1) Cloning of cytotoxic T cells and memory T cells
(2) Antigen presented to T lymphocyte
(3) Activation of T lymphocytes

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 (4) Cytotoxic T cells attack target cells a.
2, 3, 4, 1 d. 3, 2, 4, 1
b. 1, 4, 2, 3 e. 1, 2, 3, 4
c. 2, 3, 1, 4
ANSWER: C
RATIO: Antigen presented to T lymphocytes > Activation of T lymphocytes > Cloning of cytotoxic T cells and memory T cells >
Cytotoxic T cells attack target cells. This is the proper order of events in cell-mediated immunity.

7. Which of the following is correctly matched?

a. IgA - found in saliva and tears d. IgM - antigen-binding receptor on B cells
b. IgD - can cross the placenta e. IgE - transfusion reactions
c. IgG - first to challenge the antigen
ANSWER: A
RATIO: Tears, saliva, perspiration, colostrum, and secretions from the genitourinary tract, gastrointestinal system, prostate, and
respiratory epithelium all include sIgA, which is the primary immunoglobulin present in mucous secretions. It's also present in blood in
trace levels.

8. Active natural immunity occurs when:

a. antibodies pass from a pregnant mother to her c. an individual develops a disease.
fetus. d. a person is vaccinated.
b. antibodies are injected into a host. e. antibodies are passed in breast milk
ANSWER: C
RATIO: When a person is exposed to a live pathogen, gets the disease, and becomes immune as a result of the main immune response,
this is known as naturally acquired active immunity. When a microorganism penetrates the skin, mucous membranes, or other basic
defenses of the body, it comes into contact with the immune system.

9. Cytotoxic T cells attack:

a. viruses. d. cells that display normal proteins on the
b. bacteria. surface.
c. cells that display foreign proteins on the e. viruses and bacteria
surface.
ANSWER: C
RATIO: Cytotoxic T cells are effector cells that kill virus-infected cells, tumor cells, and tissue transplants in the cytosol, or nuclear
compartment next to the nucleus.

10. Pepper is experiencing difficulty swallowing and inflamed tonsils. Which of the following signs will be
associated with her condition? (Select all that apply)
a. pain c. loss of appetite
b. paleness d. swelling
ANSWER: A, C, D
RATIO: All of the options are true concerning the signs of difficulty swallowing and inflamed tonsils except paleness.

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER:
RATIO:

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10. ANSWER:
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to
help you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: FORMATIVE ASSESSMENT

This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions,
as honestly as possible, based on your own understanding.

1. What specific part of the Main Lesson for this session do you find the most confusing?
About the Diseases and Disorders of Lymphatic System.

2. What makes your answer in #1 confusing? What is the question in your mind?

Does Hypothyroid and Hyperthyroid have direct relationship in the diseases or disorders regarding
Lymphatic System?

3. Since that is your most confusing lesson, what are the interventions that you must do to
understand the topic?

I read some topics related to the condition so that I can gain more facts.

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