Anatomy of the Lymphatic system - Lecture 7

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1

Describe the general features of lymphatic vessels/nodules and their distribution

Lymphatic vessels

Blind ending tubes in connective tissues which compose a plexus that then acts to form larger vessels

Length: 1-25mm long

Diameter: 2-5mm

  • Can enlarge as a result of infection
  • Thin walled

Lymphatic fluid drains into veins

  • follow vessels as a plexus on their adventitia

NOT FOUND IN:

  • CNS
  • Bone marrow
  • Avascular tissue - cornea, epidermis, cartilage

Lymph nodules

  • Produce lymphocytes
  • Most vessels pass through at least 1 node on their way back into circulation
  • Macrophages
  • Can become blocked and swell in infection

Distribution

  • 300-400 with most concentrated areas being:
    • Neck
    • Thorax
    • Abdomen
    • Pelvis - Able to externally palpate
    • Groin
    • Axilla - Able to externally palpate
2

Describe the functions of lymph vessels

Collection of tissue fluid and its return to the systemic circulation

~20% of Tissue fluid (water, protein, lipids) is returned to systemic circulation via lymphatic vessels

  • Compromise with this return = lymphoedema

Main return

  • jugulosubclavian junction - subclavian and internal jugular
  • IFV
  • Renal
  • Suprarenal
  • Azygous
  • Iliac Veins

Transport of lymphocytes and other cells

Lymphocytes produced in lymph nodes use vessels to distribute themselves to site of infection

Uptake and transport of long chain fatty acids absorbed in the intestine

Absorbed across intestinal villa into lacteals (lymph vessels) --> Thoracic duct and into blood stream

Small chain fatty acids are taken up by blood stream --> portal vein --> liver

3

Outline the relationship between lymph nodes and vessels and list other lymphatic organs

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Lymph nodes ALWAYS along lymph vessels

Lymph nodes NOT ASSOCIATED with: lymph capillaries, smallest lymph vessels, thoracic duct or R.lymphatic duct

Multiple afferent branches - 1 or multiple efferent branches

Lymph fluid lymphocytes, macrophages and plasma cells

Lymphatic organs

  • Thymus
  • Spleen
  • Tonsils
  • Mucosal associate lymphatic tissue (includes GALT)
4

Outline in detail the main pattern of lymphatic drainage of the body with specific detail on the left and the right sides of the body

...

5

Provide an overview of lymph drainage of regions of the body

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Deep cervical group lymph nodes drain from superior clavicle area

Axillary group lymph nodes drain clavicle to umbilicus area

Inguinal group lymph nodes drain from inferior umbilicus area

6

Describe the breast as a type of lymphatic tissue and its changing structure during pregnancy/lactation

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Changing structure

Resting

  • Mainly fibrous and adipose tissue
  • Proportion of fat increases with age
  • Some ducts - few alveoli (secretory part of gland)

Pregnancy/lactation

  • Ducts and alveoli proliferate
  • Fibrous and fatty tissue decreases

Post Lactation

  • Glandular tissue involutes and is replaced by fibrous tissue and fat

Lymphatic drainage

Mainly drain into axillary lymph nodes to drain into the subclavian trunks

Other drain into infraclavicular, parasternal or intercostal nodes

Abdominal nodes can receive some tributaries

If blockage occurs to normal passage lymph can drain into deep cervical nodes or into the contralateral breast

7

Describe the location and role of Inguinal lymph nodes

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2 groups

Superficial

Proximal

  • Along inguinal ligament (horizontal group)
  • Receives vessels from external genitalia: anal region, skin below umbilicus NOT TESTIS
    • Can drain uterus
  • Travel with round ligament

Distal

  • Along termination of great saphenous (vertical group)
  • Receive superficial vessels from lower limb

Deep

  • Deep and medial to femoral vein
  • Superficial --> Deep inguinal nodes -->External and common iliac and aortic nodes -- > lumbar trunks
8

Describe the location of function of the abdominal lymph trunk (intestinal and lumbar)

Intestinal lymph trunk

  • Drains the alimentary abdominal organs
  • Follow major branches of abdominal aorta (Coeliac and superior/inferior mesenteric arteries
    • Pre-aortic nodes
  • --> Cisterna Chyli --> Thoracic trunk

Lumbar lymph trunk

  • Union of iliac vessels and lateral aortic lymph gland efferents
  • Drains urogential organs, posterior body wall and lower limbs
  • Associated nodes: lateral aortic and lumbar
  • Many anastomoses = lymph can drain in a variety of ways
9

Describe the location and function of lymph vessels in the thorax

Lower thoracic vessels --> descending thoracic lymph trunks --> cisterna chyli/thoracic duct

Upper thoracic vessels --> bronchomedistinal lymph trunk --> jugulosubclavian junction

Lungs

  • Deep and superficial (subpleural) plexus
  • Likely at hilus and at the carina
  • --> Bronchomediastinal lymph trunks
10

Provide information on the surface/cross sectional anatomy of the lymphatic system

C7 = highest point of thoracic duct - arch behind internal jugular before entering jugulosubclavian junction posteriorly to the clavicle