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LYMPHATIC SYSTEM

GRAY’S ANATOMY

network or mesh composed of lymphatic
vessels and organs
collects and brings back to venous system
tissue fluid in interstitial spaces

I. Terminology
1. Lymphatic Vessels - e.g. Thoracic Duct (biggest)
2. Lymphoid Tissues - e.g. Spleen (biggest), Bone
Marrow, Thymus, and Lymph Nodes


Hydrostatic pressure
 pushes blood (to interstitial spaces) out of
arteries towards the cells.
 Toxins out (product of metabolism);
bacteria, absorbed nutrients)
Colloid Oncotic pressure – brings back
interstitial fluid to circulation.
Virchows node – left side of clavicle
 located at the left supraclavicular area
(because thoracic duct passes on the left)
 becomes enlarged because of the
phagocytes and macrophages engulfing
the cancer cells

Vasa vasorum & Nerve Fibers - drains
and sypply the lymphatic vessels

Pathology: Lymphangitis - acutely
infected lymphatic plexuses or vessels

III. Microscopic Structure

Single layer of endothelium




lacks basal laminae
few intercellular junctions
FILOPODIA

Extracellular filaments for anchoring to
sternum (surrounding stroma)

external connective tissue coat ->
envelopes larger vessels

3 layers seen in larger trunks

tunica inima, tunica media, & tunica
adventitia

more valves (semilunar) than veins

thoracic duct - similar to medium-sized
veins but thicker tunica media.

II. General Structure

LYMPHATIC VESSELS forms
 capillaries plexuses in different regional
groups over the entire body
 wider meshes (compared to veins) ;
begins as dilated tubes with close ends;
cross-sectional appearances are less
regular than blood capillaries; lacks BASAL
LAMINA (layer bet. t. media & t. intima)

Pathology: Once obstructed results to
“OEDEMATOUS APPEARANCE” of a particular area.
 Almost present in all areas of the body
except: EPIDERMIS, HAIR, NAILS, CORNEA,
CARTILAGES, BONE MARROW, CNS

Lymph - mostly clear and colorless
 dense and milky (chyle) in the terminal
vessels (lacteal) of small intestine due to
presence of lipid globules (chylomicrons)

lacteals – milky, conveys chyme to the
intestines
chylomicrons – makes lymph denser than
venous blood
 absorbed in the interstitial villi
through the lacteals.
Pathology of lymph

in general lymph traverses a series of nodes
before reaching a major collecting duct

exception: thyroid gland, esophagus, coronary
and triangular ligaments of liver which passes
directly to the thoracic duct.

Superficial lymphatics of skin - accompanies
superficial veins; few connections with deep
lymphatics

Deep lymphatics trucks - accompanies
arteries or veins emptying into the thoracic duct or
right lymphatic duct then into left and right brachio
cephalic veins

Other Entry Points:
1. Inferior vena cava
2. Renal veins
3. Suprarenal veins
4. Azygos veins
5. Iliac veins

IV. Topography of Lymph nodes and
Vessels

Route of Drainage
1. Unimodal – passes to only one node
2. Multimodal- most common
Primary Node -> Intermediary Node ->
Terminal Nodes (Regional Nodes)
* Primary node – lymph nodes nearest to the
organ.
* Secondary node – lymph nodes nearest to
the heart
-- farthest to the organ.
* Intermediary – bet. primary and secondary
nodes
Topographical Naming:
1. Superficial or deep location - Deep Fascia
2. Related Vasculature
3. Related Organ
4. General Topographical location

EXAMPLES:
A. Vasculature
1. Buccal Node (Facial Vein)
2. Superficial Cervical Node (Ext. Jugular
Vein)
3. Anterior Cervical Node (Anterior Jugular
Vein)
4. Infraclavicular Node (cephalic vein)
5. Supratrochlear node (Basilic vein)
6. Superficial Inguinal Node (Great
Saphenous veins)
7. Aortic, common Iliac, internal iliac,
external iliac node
8. Left gastric, right gastro-epiploic,
hepatic, panoreaticosplenic node
9. Aortic node (aorta)
10. Hepatic node (hepatic vessels)
B. VISCERA
1. Superficial and deep parotid,
submandibular node
2. Pulmonary, bronchopulmonary, inferior
and superior tracheobronchial node
C. General Topography - Palpable
1. Leg - popliteal node, inguinal node

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heart. Thoracic duct -drains all extensive remaining parts of the body. Cervical Lymphovenous Portals ( Cervicolymphovenous portals) • RIGHT PORTAL – 3 Trunks converge to form the RIGHT LYMPHATIC TRUNK 1. -. thyrocervical artery. right of the midline • CISTERNA CHYLI . saccular dilatation at its origin – begins as Abdominal confluence . intestine.I.C7 (lateral of transverse process) -> arches into the neck 3-4 cm above the clavicle then curves anterior to: the vertebral artery and vein.) 3. right bronchi. right diaphragm. tests. pre-auricular. drains lower limbs. Confluence of lymph Trunks .Lumbar trunks and Intestinal Trunks . diaphragm. Bilateral Ascending Thoraric Lymph Trunks -Drains the upper lateral aortic nodes 4. Right Jugular Trunk . Left Jugular trunk . right aortic intercostal arteries. pericardium.vertebral colum. no. and Respiratory Tract = most richly served -.2. vagus nerve and Internal Jugular Vein. Thoracic duct – – 30-45 cm L2 up to the base of the neck Course of Thoracic Duct: – T12 (Superior Pole) -> enters the diaphragm’s aortic opening right of the nidline then ascends the posterior mediastinum between the thoracic aorta (left) and azygots vein (right) – • Relations: Anterior . 3.drains/conveys lymph from the right half of the head and Neck ->Ventral lateral aspect of Int. Left broncho mediastinal trunk .) 2. perineal and infra-umbilical walla. infrahyoid. pancreas. • Finally -> descends anterior to the arched cervical “First part” of the left subclavian artery and ends by opening into the junction of the left subclavian and left Internal Jugular veins • – ORIGINS & TRIBUTONS: Abdominal origin . Right subclavian Trunk . post auricular nodes.Drains the intercostal lymph nodes of the lower 6 or 7 I. Arm .S.diaphragm and esophagus 2.submandibular. medial border of scalenus anterior muscle. accessory hemiazygos and hemiazygos veins.5-7 cm anterolateral to the right of L1 and L2 and right of abdominal aorta – Lumbar Trunks • formed by lateral aortic lymph node • drains lymph from lower limbs. 5. 80% open independently.C. superficial tissues of right hlaf of the thoraco-abdominal wall down to umbilicus (Anterior) and Iliac crest (Posteriorly) -> Along Axillary and SUBCLAVIAN VEINS (loc.also similar to the right trunk 4.C. supraumbilical walls. pelvic. • – – Intestinal Trunks coeliac node (formed by) drains stomach. and esophagus 6.simple. pelvic and perineal area Embryology • In the fetus.loc. paratracheal • 400-500 NODES = Ave. submental.T5 ->inclines to the left and enters the superior mediastinum and then ascends to the thoraic inlet left of the esophagus where it is crossed by the aortic arch and then it runs posterior to the first segment of the left subclavian artery in close contact with the left mediastinal pleura -. • Posterior . Right Bronchomediastinal trunk -conveys lymph from thoracic walls.lower border. Upper Intercostal Trunks (bilateral) -Draws the upper 5 or 8 left I. left sympathetic trunk. Head and Neck . Jugular vein (.T. Bilateral Descending Throracic Lymph Trunks . -. posterior to: left common carotid artery.T12 .20 % converge to become R lymphatic duct • LEFT PORTAL – 4 trunks converge to form the LEFT LYMPHATIC TRUNK 1. the thoracic ducts are a pair of vessels which ascends through the posterior mediastinum on each side of the descending Aorta. right heart. antero-inferior liver • Tributaries of thoracic duct Proper: (as it ascends toward the heart) 1. of lymph nodes in normal young adult • • • limbs and superficial body = least nodes head and neck = 70 nodes G. small drainage from thoracic esophagus -> ascends over the trachea -> the 3 trunks open into the ventral aspect of the right jugular-subclavian veins junction. right trachea. axillary node 3. pelvic viscera. right lung.supratrochlear.mirrors its right fellow 2.formed by lateral aortic lymph nodes.also mirrors its contralateral fellow 3.S. Left Subclavian Trunk 2 .due to GIT is where most infections occur VI. spleen. ovaries. Mediastinal Trunks -Draws the diaphragmatic aspect of Liver.conveys lymph from right upper limb. left phrenic nerve. supraclavicular. kidneys and suprarenals. Left subclavian trunk .

) contractions of neighboring muscles 3.) respiratory movements 5.ant to cricovecal membrane • • A. deep cervical node -. Deep Cervical Lymphatic Nodes 1. Jugular vein -extending into subclavian triangle -drains also to jugular trunk e. God.Teeth . and ratrepharyngeal node. Superior Deep Cervical Nodes -adjoins the upper internal jugular vein -mostly deep to the sternocmastoid muscle -drains to lower group or jugular trunk e.7. submental group.submandibular group. – – node – Pharynx and cervical Esophagus deep cervical node retropharyngeal and paratrocheal Infrahyoid node superficial cervical nodes occipital nodes • – – – – B. retroauricular group. submental. Larynx.g.g. Lord.submandibular & Deep cervical node – Tonsil . intermediary and Terminal (collecting) group of Nodes • – Terminal Group .ant. Trachea and Thyroid Gland – superior and inferior deep cervical node – – • pretrocheal and pretracheal node prelaryngeal node C. • Infrahyoid Nodes . grant A funny half. Lymphatic Drainage of HEAD & NECK • Primary.Median and lateral groups – Lie between pharyngeal and prevertebral fascia • Paratracheal Nodes . SCALP & EAR Superficial parotid nodes retro-auricular nodes submandibular node Parotid Node Retrepharyngeal Node • B.occipital group. nasopharynx and Middle Ear – – – • – – – – A.) filtration pressure 2. To every trail.related to carotid sheath -. prelaryngeal.ant to trachea – Tongue • D. • Draws into deep cervical Nodes or Retropharyngeal.flank both trachea and esophagus along the recurrent laryngeal nerves • Lingual Nodes .) pulsations of neighboring arteries 4. Left Bronchomediastinal Trunk VII. anterior and superficial cervical group. Or right lymphatic trunk -Left -> ends in thoracic duct or Int. • Retropharyngeal Nodes . To thyrohyoid membrane • pre-laryngeal nodes . lingual. grant my sense of humor To be strong To weep a bit – and yet. parotid group.submandibular. Lord. Teeth.farthest to organ that they drain where all lymph of Head & Neck drains JUGULAR TRUNK (EFFERENT TRUNK) -Right ->ends in Jugular subclavian junc. Nasal cavity. Mouth. jugulo digastric group 2. grant there be a Chuckle in each tear. FACE Superficial and deep parotid nodes Submandibular nodes Buccal Nodes Submental Nodes Lymphatic Drainage of Deep Tissues of Head and Neck jhadee O Lord.sup. also related to Int. grant that I may see The joke of things. The little things that Bother now and then. and pretracheal nodes 3 . Pre-tracheal nodes . buccal group NECK . Jugular. Tonsil and Tongue – Mouth . Left Jugular Trunk 8.) sympathetic stimulation of smooth muscles in lymphatic walls • LYMPHATIC DRAINAGE OF SUPERFICIAL TISSUES OF HEAD AND NECK – most drains to local group of nodes which then drains to deep cervical nodes.ext. subclavian veins junction. Deep cervical node •jugulodigastric node HEAD . surface of hyoglosus and between geniogloss. infrahyoid. Jugular-omohyoid ** Mechanisms in propulsion of lymph: 1. To smile again. paratrocheal. Inferior deep cervical Nodes -partly deep to the SCM.