Lymphatic Dysfunction: Case Study of Mr. Atkins, Healthcare Analysis

This case study presents the case of Mr. Atkins, a 56-year-old software engineer, detailing his medical history and the development of symptoms leading to a diagnosis of Hodgkin's Lymphoma. The lymphatic system's function, including its anatomical structure and role in eliminating waste and immune response, is explained. Mr. Atkins's presentation with back and hip pain, fatigue, and a painless swelling lymph node, is described, along with his family history of breast cancer. The diagnosis of Hodgkin's Lymphoma is confirmed, and the characteristics of the disease, including the presence of Reed-Sternberg cells, are discussed. The case study outlines various treatment options, including chemotherapy, radiation therapy, immunotherapy, and bone marrow transplantation, along with the potential side effects. The importance of post-treatment care, including exercise and monitoring for relapse, is also highlighted. The assignment concludes with a list of references used in the case study.

Running head:EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC
DYSFUNCTION
EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
Name of the student
Name of the university
Author note

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
Mr. Atkins, a 56-year-old gentleman, is a software engineer and a hardworking person.
He remained engrossed in his work, and after coming from the office, he visits his shop and
works over there. In addition to this, he has to cook his food and do the household work as
his wife passed away. Due to a lack of time and work pressure, he could not exercise
regularly and control his diet. Recently he felt slight back pain which he thought due to
constantly sitting in one place. However, his past medical history suggests that he received
physical therapy for disc herniation at L4-L5 about 6 years ago and had high cholesterol
which recently within range. Further report of biopsy suggests that he had cervical

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
lymphadenopathy which is now under control. Till now, no problem has been diagnosed in
his lymphatic system. The removal of harmful waste, toxins and other body materials is done
by lymphatic system which is a collection of tissues and organs . The cells that are present in
the body are usually bathed in the interstitial fluid which continuously spills out via
permeable walls of the capillaries of the blood from the bloodstream. Out of all, few tissue
fluid at their venous end returns to the capillaries and the remaining diffuses through the
lymph capillaries ' more permeable walls, forming lymph. Upon returning to the blood,
lymph passes through vessels of varying number of lymph nodes and rising size (Waugh and
Grant, 2014). The anatomical structure of the lymphatic system comprises of :
 Lymph
 Lymph vessels
 Lymph nodes
 Lymph organs, e.g., spleen and thymus
 Diffuse lymphoid tissue, e.g., tonsils
 Bone marrow
Bone marrow and the thymus are the primary lymphoid organs, while the secondary
lymphoid organs are considered as spleen and lymph nodes (Randolph et al. 2017). The
primary lymphoid organs serve as the production site for the B and T cells ' clonal selection
and maturation, whereas the secondary lymphoid organ serves as sites for the maintenance of
mature naive lymphocytes and is also the site where antigen-binding lymphocytes are bound
and thus activated. The lymphatic system is regardes as the first line of defence. This network
of vessels and nodes shuttles and filters bacterial and antibody from lymphocyte-containing
lymph fluids. The lymph gets alter by first contact of the body with these invaders, calling for
this cycle to orchestrate how the cells battling infections prevent disease from invading

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microorganisms. White blood cells and spleen macrophages surround and kill dead tissue,
bacteria and take them out of the blood.
A network of vessels that collect the 2liters of fluid or lymph leaked from the cardiovascular
system is known as the lymphatic system. Lymph is usually a clear watery fluid containing
lymphocytes (defense cells) along with that it collects cell debris and bacteria from damaged
tissues and thus destroyed by lymph nodes. Lymph is produced by accumulating the
interstitial fluid via tiny lymph capillaries that are present all over the whole body. This is
then transferred to lymph nodes via lymph vessels, which clean and flush it out. Before
draining completely into the subclavian right or left vein, the lymph then enters into the
lymphatic ducts, where it combines with blood. The lymph vessels create a network of
branches mainly covering body tissues, and interacting with the veins to return the tissue
fluid. Lymph is gradually pumped into larger vessels until it enters two major outlets, the
lymph ducts in trunk. It returns to the blood after removal of lymph fluid from the veins.
Lymph nodes are branching of vessels into junctions. Immune cells in lymph nodes, such as
bacteria, viruses, or fungi, detect foreign material. About 20 to 40 bean-shaped axillary
lymph nodes are present in the body that drain lymph from the breast, shoulders, upper arms
and lower arm. Supratrochlear nodes are numbered and positioned one or two just above
medial humerus epicondyle, medial to the basilic vein (Suami and Scaglioni, 2018).
Tonsils: There are tonsils to the back of the head. These generate lymphocytes, a white blood
cell type, and antibodies. They are mounted strategically, hanging from a ring surrounding
the intersection between the pharynx and the mouth.
Spleen: Spleen plays an pivotal role in white blood cell by filtering and damaging red blood
cells and platelets.

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
Thymus gland- The thymus gland is a member of the lymphatic system and an endocrine
gland immediately behind the sternum. It secretes hormones and is essential for the
development, maturation, and differentiation of immune T cells.
Bone marrow- Bone marrow is considered part of the lymph system because this is where the
immune system's B cell lymphocytes grow.
The main lymphatic system roles are:
 Elimination of excess fluid from body tissue.
 Generating immune cells (such as antibody-forming lymphocytes, monocytes, and
plasma cells).
 Fatty acid absorption and subsequent conveyance of fat, chyle, to the circulatory
system.
After 5 months, Mr. Atkins arrived in the clinic with low back pain, which has moved to hip
pain along with symptoms of fatigue. He says that due to work pressure, he fails to exercise
daily which has been prescribed by the previous doctor; however, he lost some weight. He
reports that the unbearable pain disallows him to sit comfortably. He is a non-smoker and
reduced having alcohol as it worsens the pain. To decrease the pain, he started light exercises
but no such difference is noticed. Swelling is observed in a lymph node which he said to be
painless. He added his mother passed away a few years back due to breast cancer (Rahman
and Mohammed, 2015).
Summarizing all the points and based on medical screening and testing its was confirmed that
he was diagnosed with Hodgkin’s Lymphoma. Hodgkin's lymphoma is characterized by
Reed-Sternberg cells that are mainly identified through a microscope. Hodgkin lymphoma, or
HL, was sometimes referred to as Hodgkin diseaseIt is a cancer lymph network that is part of
the immune system and consists of a variety of ducts or tubes parallel to the arteries and veins
in the body(Hoppe et al. 2015). These lymph ducts release a milky white fluid that contains

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
by-products of immune response far from areas of infection and as well as inflammation.
Throughout the lymph system, at certain points there are filters, called lymph nodes, which
usually exist in clusters that look like grape. Usually, lymph nodes extract and clears cellular
waste products and contaminants from pathogenic canals. Immune cells neutralize and
destroy the waste in the lymph nodes. Lymphocytes fight bacterial, viral and other infectious
agents that are contained in lymph nodes. HL occurs within a lymph node and spreads to
other lymph nodes in the immediate area via lymph ducts (Padera, Meijer and Munn, 2016).
Cancer gradually propels lymph ducts into other parts of the body and into other lymph
nodes. At the neck, lymphoma begins that will spread on the very same part of the body to
other nodes first. The disease may then transmit lymphatic ducts to nodes in the armpit on the
same side of the neck.
With the tumor burden growing late in the disease, the bloodstream contains HL. This leads
to broader distribution to the organs and bone marrow. Located in one body area, the
treatment of HL is done by chemotherapy or radiation therapy (Specht et al. 2014).Other
treatment includes immunotherapy, steroid therapy, bone marrow transplant. Chemotherapy
involves the use of drugs to kill cancer cells, usually by stopping the cancer cells from
developing, dividing, and building up further. The drugs enter the bloodstream when
chemotherapy is taken by mouth or inserted into a vein or muscle, and can hit cancer cells in
the body (systemic chemotherapy). Radiation therapy is a treatment for cancer that requires
high-energy x-rays or other forms of radiation to destroy or prevent cancer cells developing.
External radiation therapy uses a system outside the body to send radiation into the cancer
region of the body. Total-body irradiation is often offered prior to a stem cell transplant.
Immunotherapy is a cancer-fighting procedure that uses the patient's immune system.
Substances that are created by the body or generated in a laboratory are used to improve,
steer or restore the body's natural cancer defenses. This form of treatment for cancer is also

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
called biotherapy or biological therapy. Immunotherapy with an inhibitor of the immune
regulation level (nivolumab, or pembrolizumab). Bone marrow transplantation, also
recognized as stem cell transplantation, is a procedure to replace your bone marrow with
healthy stem cells to help you develop new bone marrows. Chemotherapy itself, or
chemotherapy accompanied by radiotherapy, are effective therapies for Hodgkin lymphoma.
For a few cases, steroid treatment can be paired with chemotherapy (Ansell, 2015). In
general, surgery is not used to treat the disease, except for the biopsy used to diagnose it.
Though every treatment comes with side effects but it will gradually decrease on cessation of
the treatment. If Hodgkin's lymphoma returns after treatment, a bone marrow transplant may
be an option. Bone marrow transplant increases the risk of getting prone to infections
whereas radiation therapy leads to long term problems and permanent darkening of skin. If
Mr. Atkins relapse, which means if his tumor returns, secondary chemotherapy will be done.
After that Mr. Atkins is recommended to continue with aerobic training, strength and
resistance training.

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EFFECT AND SUBSEQUENT DIAGNOSIS OF LYMPHATIC DYSFUNCTION
References
Ansell, S.M., 2015, November. Hodgkin lymphoma: diagnosis and treatment. In Mayo Clinic
Proceedings (Vol. 90, No. 11, pp. 1574-1583). Elsevier.
Hoppe, R.T., Advani, R.H., Ai, W.Z., Ambinder, R.F., Aoun, P., Bello, C.M., Benitez, C.M.,
Bierman, P.J., Blum, K.A., Chen, R. and Dabaja, B., 2015. Hodgkin lymphoma, version
2.2015. Journal of the National Comprehensive Cancer Network, 13(5), pp.554-586.
Padera, T.P., Meijer, E.F. and Munn, L.L., 2016. The lymphatic system in disease processes
and cancer progression. Annual review of biomedical engineering, 18, pp.125-158.
Rahman, M. and Mohammed, S., 2015. Breast cancer metastasis and the lymphatic
system. Oncology letters, 10(3), pp.1233-1239.
Randolph, G.J., Ivanov, S., Zinselmeyer, B.H. and Scallan, J.P., 2017. The lymphatic system:
integral roles in immunity. Annual review of immunology, 35, pp.31-52.
Specht, L., Yahalom, J., Illidge, T., Berthelsen, A.K., Constine, L.S., Eich, H.T., Girinsky, T.,
Hoppe, R.T., Mauch, P., Mikhaeel, N.G. and Ng, A., 2014. Modern radiation therapy for
Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation
oncology group (ILROG). International Journal of Radiation Oncology* Biology*
Physics, 89(4), pp.854-862.
Suami, H. and Scaglioni, M.F., 2018, February. Anatomy of the lymphatic system and the
lymphosome concept with reference to lymphedema. In Seminars in plastic surgery (Vol. 32,
No. 01, pp. 005-011). Thieme Medical Publishers.
Waugh, A. and Grant, A., 2014. Ross & Wilson Anatomy and physiology in health and
illness E-book. Elsevier Health Sciences.