ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING

CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024

The Lymphatic System

 Consists of two semi-independent parts:
1. Lymphatic vessels
2. Lymphoid tissues and organs
 Lymphatic system functions
 Transports escaped fluids from the cardiovascular
system back to the blood
 Plays essential roles in body defense and resistance
to disease
Lymphatic Vessels
 Lymph consists of excess tissue fluid and plasma
proteins carried by lymphatic vessels
 If fluids are not picked up, edema occurs as fluid
accumulates in tissues
 Lymphatic vessels (lymphatics) pick up excess
fluid (lymph) and return it to the blood  Lymphatic collecting vessels
 Collect lymph from lymph capillaries
 Carry lymph to and away from lymph nodes
 Return fluid to circulatory veins near the heart
 Right lymphatic duct drains the lymph from
the right arm and the right side of the head and
thorax
 Thoracic duct drains lymph from rest of body

 Lymphatic vessels (lymphatics)

 Form a one-way system
 Lymph flows only toward the heart
 Lymph capillaries
 Weave between tissue cells and blood capillaries
 Walls overlap to form flaplike minivalves
 Fluid leaks into lymph capillaries
 Capillaries are anchored to connective tissue by
filaments
 Higher pressure on the inside closes minivalves
 Fluid is forced along the vessel
 Lymphatic vessels are similar to veins of the
cardiovascular system
 Thin-walled
 Larger vessels have valves
 Low-pressure, pumpless system
 Lymph transport is aided by:
 Milking action of skeletal muscles
 Pressure changes in thorax during breathing
 Smooth muscle in walls of lymphatics
Lymph Nodes
 Lymph nodes filter lymph before it is returned to
the blood
 Harmful materials that are filtered
 Bacteria
 Viruses
 Cancer cells
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 Cell debris
 Defense cells within lymph nodes
 Macrophages—engulf and destroy bacteria, viruses,
and other foreign substances in lymph
 Lymphocytes—respond to foreign substances in
lymph
 Most lymph nodes are kidney-shaped, less than
1 inch long, and buried in connective tissue
 Surrounded by a capsule
 Divided into compartments by trabeculae
 Cortex (outer part)
 Contains follicles—collections of lymphocytes
 Germinal centers enlarge when antibodies are
released by plasma cells
 Medulla (inner part)
 Contains phagocytic macrophages
 Flow of lymph through nodes
 Lymph enters the convex side through afferent
lymphatic vessels
 Lymph flows through a number of sinuses inside the
node
 Lymph exits through efferent lymphatic vessels
 Because there are fewer efferent than afferent
vessels, flow is slowed
Other Lymphoid Organs
 Several other lymphoid organs contribute to
lymphatic function (in addition to the lymph
nodes)
 Spleen
 Thymus
 Tonsils
 Peyer’s patches
 Appendix
 Spleen
 Located on the left side of the abdomen
 Filters and cleans blood of bacteria, viruses, debris
 Provides a site for lymphocyte proliferation and
immune surveillance
 Destroys worn-out blood cells
 Forms blood cells in the fetus
 Acts as a blood reservoir
 Thymus
 Found overlying the heart
 Functions at peak levels only during youth
 Tonsils
 Small masses of lymphoid tissue deep to the mucosa
surrounding the pharynx (throat)
 Trap and remove bacteria and other foreign
pathogens
 Tonsillitis results when the tonsils become
congested with bacteria
 Peyer’s patches
 Found in the wall of the small intestine
 Similar lymphoid follicles are found in the appendix
 Macrophages capture and destroy bacteria in the
Intestine
 Mucosa-associated lymphoid tissue (MALT)
 Includes:
 Peyer’s patches
 Tonsils
 Appendix
 Acts as a sentinel to protect respiratory and
digestive
tracts
Part II: Body Defenses
 Two mechanisms that make up the immune system
defend us from foreign materials
1. Innate (nonspecific) defense system
2. Adaptive (specific) defense system
 Immunity—specific resistance to disease
 Immune system is a functional system rather than
an organ system in an anatomical sense
Body Defenses
 Innate (nonspecific) defense system
 Mechanisms protect against a variety of invaders
 Responds immediately to protect body from foreign
materials
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
Surface Membrane Barriers
 Adaptive (specific) defense system  Surface membrane barriers, such as the skin and
 Fights invaders that get past the innate system mucous membranes, provide the first line of
 Specific defense is required for each type of invader defense against the invasion of microorganisms
 The highly specific resistance to disease is immunity  Protective secretions produced by these membranes
 Acidic skin secretions inhibit bacterial growth
Innate (Nonspecific) Body Defenses Sebum is toxic to bacteria
 Innate body defenses are mechanical barriers to Mucus traps microorganisms
pathogens (harmful or disease-causing Gastric juices are acidic and kill pathogens
microorganisms) and include: Saliva and tears contain lysozyme (enzyme that
 Body surface coverings destroys bacteria)
 Intact skin Internal Defenses: Cells and Chemicals
 Mucous membranes  Cells and chemicals provide a second line of
 Specialized human cells defense
 Chemicals produced by the body  Natural killer cells and phagocytes
 Table 12.1 provides a more detailed summary  Inflammatory response
 Chemicals that kill pathogens
 Fever
 Natural killer (NK) cells
 Lyse (burst) and kill cancer cells, virus-infected
cells
 Release chemicals called perforin and granzymes to
degrade target cell contents
 Inflammatory response
 Triggered when body tissues are injured
 Four most common indicators (cardinal signs) of
acute inflammation
1. Redness
2. Heat
3. Pain
4. Swelling (edema)

 Damaged cells release inflammatory chemicals

 Histamine
 Kinin
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 These chemicals cause:
 Blood vessels to dilate
 Capillaries to become leaky
 Phagocytes and white blood cells to move into the
area (called positive chemotaxis)
 Functions of the inflammatory response
 Prevents spread of damaging agents
 Disposes of cell debris and pathogens through
phagocytosis
 Sets the stage for repair

 Process of the inflammatory response

1. Neutrophils migrate to the area of inflammation by
rolling along the vessel wall (following the scent of
chemicals from inflammation)
2. Neutrophils squeeze through the capillary walls by
diapedesis to sites of inflammation
3. Neutrophils gather in the precise site of tissue injury
(positive chemotaxis) and consume any foreign  Antimicrobial proteins
material present  Enhance innate defenses by:
 Attacking microorganisms directly
 Hindering reproduction of microorganisms
 Most important types
 Complement proteins
 Interferon

 Antimicrobial proteins: complement proteins

 Complement refers to a group of at least 20 plasma
proteins that circulate in the plasma
 Complement is activated when these plasma
proteins encounter and attach to cells (known as
complement fixation)
 Membrane attack complexes (MACs), one result of
complement fixation, produce holes or pores in cells
 Pores allow water to rush into the cell
 Cell bursts (lyses)
 Activated complement enhances the inflammatory
response

 Phagocytes
 Cells such as neutrophils and macrophages engulf
foreign material by phagocytosis
 The phagocytic vesicle is fused with a lysosome,
and enzymes digest the cell’s contents

 Antimicrobial proteins: interferons

 Interferons are small proteins secreted by virus-
infected cells
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 Interferons bind to membrane receptors on healthy
cell surfaces to interfere with the ability of viruses to
multiply
 Fever
 Abnormally high body temperature is a systemic
response to invasion by microorganisms
 Hypothalamus regulates body temperature at 37oC
(98.6oF)
 The hypothalamus thermostat can be reset higher by
pyrogens (secreted by white blood cells)
 High temperatures inhibit the release of iron and
zinc (needed by bacteria) from the liver and spleen
 Fever also increases the speed of repair processes
Adaptive Body Defenses
 Adaptive body defenses are the body’s specific
defense system, or the third line of defense
 Immune response is the immune system’s response
to a threat
 Antigens are targeted and destroyed by antibodies
 Three aspects of adaptive defense
 Antigen specific—the adaptive defense system
recognizes and acts against particular foreign
substances
 Systemic—immunity is not restricted to the initial
infection site
 Memory—the adaptive defense system recognizes
and mounts a stronger attack on previously
encountered pathogens
 Two arms of the adaptive defense system
 Humoral immunity = antibody-mediated immunity
 Provided by antibodies present in body fluids
 Cellular immunity = cell-mediated immunity
 Targets virus-infected cells, cancer cells, and cells
of foreign grafts
Antigens
- Antigens are any substance capable of
exciting the immune system and provoking an
immune response
 Examples of common nonself antigens
 Foreign proteins provoke the strongest response
 Nucleic acids
 Large carbohydrates
 Some lipids
 Pollen grains
 Microorganisms (bacteria, fungi, viruses)
 Self-antigens
 Human cells have many protein and carbohydrate
molecules
 Self-antigens do not trigger an immune response in
us
 The presence of our cells in another person’s body
can trigger an immune response because they are
foreign
 Restricts donors for transplants
 Haptens, or incomplete antigens, are not
antigenic by themselves
When they link up with our own proteins, the
immune system may recognize the combination as
foreign and respond with an attack
Found in poison ivy, animal dander, detergents, hair
dyes, cosmetics
Cells of the Adaptive Defense System: An
Overview
 Crucial cells of the adaptive system
1. Lymphocytes—respond to specific antigens
 B lymphocytes (B cells) produce antibodies and
oversee humoral immunity
 T lymphocytes (T cells) constitute the cell-mediated
arm of the adaptive defenses; do not make antibodies
2. Antigen-presenting cells (APCs)—help the
lymphocytes but do not respond to specific antigens
 Lymphocytes
 Arise from hemocytoblasts of bone marrow
 Whether a lymphocyte matures into a B cell or T
cell depends on where it becomes immunocompetent
 Immunocompetence
 The capability to respond to a specific antigen by
binding to it with antigen-specific receptors that appear
on the lymphocyte’s surface
 Lymphocytes (continued)
 T cells develop immunocompetence in the thymus
and oversee cell-mediated immunity
 Identify foreign antigens
 Those that bind self-antigens are destroyed
 Self-tolerance is important part of lymphocyte
“education”
 B cells develop immunocompetence in bone marrow
and provide humoral immunity
 Immunocompetent T and B lymphocytes migrate
to the lymph nodes and spleen, where encounters with
antigens occur
 Differentiation from naïve cells into mature
lymphocytes is complete when they bind with
recognized antigens
 Mature lymphocytes (especially T cells) circulate
continuously throughout the body
 Antigen-presenting cells (APCs)
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 Engulf antigens and then present fragments of them
on their own surfaces, where they can be recognized
by T cells
 Major types of cells behaving as APCs
 Dendritic cells
 Macrophages
 B lymphocytes
 When they present antigens, dendritic cells and
macrophages activate T cells, which release chemicals
Humoral (Antibody-Mediated) Immune
Response
 B lymphocytes with specific receptors bind to a
specific antigen
 The binding event sensitizes, or activates, the
lymphocyte to undergo clonal selection
 A large number of clones is produced (primary
humoral response)
Humoral (Antibody-Mediated) Immune
 Most of the B cell clone members (descendants)
Response
become plasma cells
 Active immunity Occurs when B cells encounter
 Produce antibodies to destroy antigens
antigens and produce antibodies
 Activity lasts for 4 or 5 days
 Active immunity can be:
 Plasma cells begin to die
 Naturally acquired during bacterial and viral
 Some B cells become long-lived memory cells
infections
capable of mounting a rapid attack against the same
 Artificially acquired from vaccines
antigen in subsequent meetings (secondary humoral
response)
 Passive immunityOccurs when antibodies are
 These cells provide immunological memory
obtained from someone else
 Naturally acquired from a mother to her fetus
or in the breast milk
 Artificially acquired from immune serum or
gamma globulin (donated antibodies)
 Immunological memory does not occur
 Protection is short-lived (2–3 weeks)
 Monoclonal antibodies
 Antibodies prepared for clinical testing for
diagnostic services
 Produced from descendants of a single cell line
 Exhibit specificity for only one antigen
 Examples of uses for monoclonal antibodies
 Cancer treatment
 Diagnosis of pregnancy
 Treatment after exposure to hepatitis and
rabies

 Antibodies (immunoglobulins, Igs)

 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 Constitute gamma globulin part of blood 4. IgG—can cross the placental barrier and fix
proteins complement; most abundant antibody in plasma
 Soluble proteins secreted by activated B cells 5. IgE—involved in allergies
(plasma cells)
 Formed in response to a huge number of
antigens

 Antibody structure
 Four polypeptide chains, two heavy and two
light, linked by disulfide bonds to form a T- or Y-
shaped molecule
 Each polypeptide chain has a variable (V)
region and a constant (C) region
> Variable regions form antigen-binding sites, one
on each arm of the T or Y
> Constant regions determine the type of antibody
formed (antibody class)
antigen-antibody complex settles out of solution
 Antibody function
 Antibodies inactivate antigens in a number of
ways
 Complement fixation: chief antibody
ammunition used against cellular antigens
 Neutralization: antibodies bind to specific sites
on bacterial exotoxins or on viruses that can cause
cell injury
 Agglutination: antibody-antigen reaction that
causes clumping of cells
 Precipitation: cross-linking reaction in which

 Antibody classes
 Antibodies of each class have slightly different
roles and differ structurally and functionally
 Five major immunoglobulin classes (MADGE)
1. IgM—can fix complement
2. IgA—found mainly in secretions, such as mucus
or tears
3. IgD—important in activation of B cell
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
Cellular (Cell-Mediated) Immune  Helper T cells
 Recruit other cells to fight invaders
Response  Interact directly with B cells bound to an antigen,
 Main difference between two arms of the adaptive
prodding the B cells into clone production
response
 Release cytokines, chemicals that act directly to rid
 B cells secrete antibodies
the body of antigens
 T cells fight antigens directly
 Regulatory T cells
 Like B cells, immunocompetent T cells are
 Release chemicals to suppress the activity of T and
activated to form a clone by binding with a recognized
B cells
antigen
 Stop the immune response to prevent uncontrolled
 Unlike B cells, T cells are unable to bind to free
activity
antigens
 A few members of each clone are memory cells
 Antigens must be presented by a macrophage,
and double recognition must occur
 APC engulfs and presents the processed
antigen in combination with a protein from the
APC
 Different classes of effector T cells
 Helper T cells
 Cytotoxic T cells
 T cells must recognize nonself and self through
the process of antigen presentation
 Nonself—the antigen fragment presented by APC
 Self—coupling with a specific glycoprotein on the
APC’s surface at the same time

 Cytotoxic (killer) T cells

 Specialize in killing infected cells
 Insert a toxic chemical (perforin or granzyme)
 The perforin enters the foreign cell’s plasma
membrane
 Pores now appear in the target cell’s membrane
 Granzymes (protein-digesting enzymes) enter and
kill the foreign cell
 Cytotoxic T cell detaches and seeks other targets
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
Organ Transplants and Rejection
 Major types of transplants, or grafts
 Autografts—tissue transplanted from one site to
another on the same person
 Isografts—tissue grafts from a genetically identical
person (identical twin)
 Allografts—tissue taken from a person other than an
identical twin (most common type of graft)
 Xenografts—tissue taken from a different animal
species (never successful)
 Blood group and tissue matching is done to
ensure the best match possible
 75% match is needed to attempt a graft
 Organ transplant is followed by
immunosuppressive therapy to prevent rejection
Disorders of Immunity
 The most important disorders of the immune
system
 Allergies
 Autoimmune diseases
 Immunodeficiencies
 Allergies
 Allergies, or hypersensitives, are abnormal, vigorous
immune responses
 The immune system overreacts to an otherwise
harmless antigen, and tissue damage occurs
 Types of allergies
 Immediate (acute) hypersensitivity
 Seen in hives and anaphylaxis
 Due to IgE antibodies and histamine
 Anaphylactic shock is systemic, acute allergic
response and is rare
 Delayed hypersensitivity
 Reflects activity of T cells, macrophages, and
cytokines
 Symptoms usually appear 1–3 days after contact
with antigen
 Allergic contact dermatitis (poison ivy, cosmetics)
 Autoimmune diseases
 Occurs when the body’s self-tolerance breaks down
 The body produces auto-antibodies and sensitized T
lymphocytes that attack its own tissues
 Most forms of autoimmune disease result from the
appearance of formerly hidden self-antigens or
changes in the structure of self-antigens, and
antibodies formed against foreign antigens that
resemble self-antigens
 Examples of autoimmune diseases
 Rheumatoid arthritis—destroys joints
 Myasthenia gravis—impairs communication
between nerves and skeletal muscles
 Multiple sclerosis—white matter of brain and spinal
cord is destroyed
 Graves’ disease—thyroid gland produces excess
thyroxine
 Examples of autoimmune diseases (continued)
 Type I diabetes mellitus—destroys pancreatic beta
cells, resulting in deficient insulin production
 Systemic lupus erythematosus (SLE)—affects
kidney, heart, lung, and skin
 Glomerulonephritis—severe impairment of kidney
function due to acute inflammation
 ANAPHY100: ANATOMY AND PHYSIOLOGY IN NURSING
CRYSTAL A. ARIETA
Professor: Vernel Iam Sendrijas, RN
First Semester | A.Y. 2023-2024
 Immunodeficiencies
 May be congenital or acquired
 Severe combined immunodeficiency disease (SCID)
is a congenital disease
 AIDS (acquired immune deficiency syndrome) is
caused by a virus that attacks and cripples the helper T
cells
 Result from abnormalities in any immune element
 Production or function of immune cells or
complement is abnormal

Part III: Developmental Aspects of the

Lymphatic System and Body Defenses
 Lymphatic vessels form by budding off from veins
 Lymph nodes present by fifth week of development
 The thymus and the spleen are the first lymphoid
organs to appear in the embryo
 Other lymphoid organs are poorly developed before
birth
 The immune response develops around the time of
birth
 The ability of immunocompetent cells to recognize
foreign antigens is genetically determined
 Stress appears to interfere with normal immune
response
 Efficiency of immune response wanes in old age,
and infections, cancer, immunodeficiencies, and
autoimmune diseases become more prevalent