Introduction to the Lymphatic System
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| What is the primary function of the lymphatic system? | drains excess fluid from body's tissue and returns it to the bloodstream; also includes tissues and organs that provide immunological responses (thymus gland, spleen, aggregates of lymphatic tissue in respiratory and digestive tract, and lymph nodes)
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| Describe the origin of interstitial fluid and lymph | @ Capillaries: arterial side: hydrostatic pressure exceeds osmotic pressure-->fluid out of vessels; some of it returns at venous end; rest of fluid removed by lymphatic capillaries-->lymphatics
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| Lymphatics conducting lymph into a cluster of lymph nodes are called _____ lymphatics; lymphatics draining lymph from lymph nodes are called _____ lymphatics. | afferent, efferent
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| The lymph reaches the bloodstream at the junctions of the _____ and the _____ veins by way of the ______ duct and the ______ duct. | Internal jugular, subclavian, right lymphatic, thoracic
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| In general terms, the ______ duct drains the head and neck, the right upper limb and the right side of the thorax (including right lung); all the rest of the body is drained by the _____ duct. | right lymphatic; thoracic
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| * Describe the path and location of the thoracic duct | begins as dilated sac (cysterna chili), behind the right of aorta (L1, L2); ascends via aortic hiatus on right of aorta and left of azygous v.; @ T5 crosses to left and reaches left of esophagus at level of sternal angle; empties @ l. SubcV and l. IJV
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| Where does the right lymphatic duct empty? | At the junction of the right internal jugular and the right subclavian veins
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| What nodes do the lymphatic vessels of the upper limbs empty into? | Axillary nodes
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| What nodes do the lymphatics of the lower limbs empty into? | Inguinal nodes
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| The lymphatic vessels from the wall of the thorax and abdomen for the most part drain into the ____ and ____ nodes. Some vessels pierce the body wall to run to deeper nodes, particularly in the anterior wall of the _____. | Axillary and inguinal, thorax
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| Where is the watershed between the inguinal and axillary drainage areas? | A line around the trunk at the level of the umbilicus
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| What are the main vessels carrying lymph from the axilla? Where do they pass? | The subclavian trunk; pass proximally alongside the subclavian artery and vein
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| Where do the efferent vessels from the inguinal nodes pass through? Where do they drain? | Into abdomen; into external iliac nodes
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| Where are the superficial inguinal nodes located? Where do they receive lymph from? | In superficial fascia below inguinal lig.; anterior and posterior surfaces of trunk below umbilicus, perineum including lower 1/2 of anal canal, vagina, and all of externa genitalia of both sexes (not testes), and superficial lymph vessels of lower limb
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| * * Where are the deep inguinal nodes? What structures do they drain? | Receive ALL the lymph from the superficial nodes and from the deep structures of lower limb; efferent vessels ascend via femoral canal and drain into external iliac nodes.
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| Where are the final nodes draining the neck and head located? What is the main vessel draining these nodes? What do they drain (superficial or deep)? | Alongside carotid sheath; known as deep cervical nodes; jugular trunk; drain skin and superficial fascia AND deeper structures
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| Lymph from the lungs, pleura, bronchi, trachea, and heart converge on the _____ lymph nodes. | Bronchomediastinal
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| The efferents unite to form the ____ trunks. | bronchomediastinal
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| Which trunks empty into the thoracic duct? | Left jugular, subclavian, bronchomediastinal trunks
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| Which trunks join the right lymphatic duct? | THE RIGHT JUGULAR, subclavian, bronchomediastinal
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| How are the major lymph node groups in the abdomen arranged? | Along blood vessels; groups include pre-aortic and para-aortic nodes
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| How are the pre-aortic nodes arranged? Where are they? What do they drain? What the efferents from these nodes form? | Along front of aorta in 3 groups: celiac nodes (foregut), superior mesenteric nodes (midgut), inferior mesenteric nodes (hindgut); intestinal trunk (contributes to cysterna chili)
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| How are the para-aortic nodes arranged? Where are they? What do they drain? What the efferents from these nodes form? | Along borders of aorta; drain kidneys, suprarenal glands, gonads; receive efferents from common iliac nodes; upper nodes give rise to lumbar trunks that contribute to cysterna chili
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| What nodes drain the pelvis? | Internal iliac nodes (organs supplied by internal iliac arteries EXCEPT gonads, uterine tube, fundus, upper body of uterus, which drain into para-aortic/lumbar nodes); external iliac nodes-->common iliac nodes-->lumbar nodes
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| Lymph nodes of the axilla receive and filter lymph from the ____ limb and from the ____ and _____ aspects of the trunk as far as the ______ and the _____ crest. | upper; anterior and posterior; umbilicus; iliac
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| How are the axillary nodes typically subdivided? | By the territories they drain and their location
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| What are the five groups of axillary nodes? | Brachial (lateral), subscapular (posterior), pectoral (anterior), central, apical (subclavian)
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| Describe the location and drained region of the brachial group | Lie along medial side of axillary vein; receive most of lymph from upper lymph
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| Describe the location and drained region of the subscapular group | Lie in front of subscapularis muscle; from scapular region and back
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| Describe the location and drained region of the pectoral group | along lower border of pectoralis minor behind pec major; receive from thoracic wall and anterior abdominal wall
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| Describe the location and drained region of the central group | Lie in center of axilla in axillary fat; receive lymph from above three groups (brachial, subscapular, and pectoral)
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| Describe the location and drained region of the apical group | Lie in apex of axilla at lateral border of first rib; receive efferents from other axillary nodes; efferents from apical group form the subclavian lymph trunk
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| Describe Drainage of breast: what node groups drain most of it? | most goes laterally and upward to axillary (mostly pec) nodes and suprascapular and infraclavicular nodes; remaining lymph goes to parasternal (intern. thoracic) along intrnl thoracic vessels; some drains down to upper abdmnl nodes, some to other breast
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| Describe the drainage of the uterus: fundus and body; lower body and cervix (most frequent site of carcinoma) | Few to superficial inguinal nodes, most unite with lymphatics from uterine tube and ovary passing to lumbar (para-aortic) nodes; internal, external, and common iliac nodes, sacral nodes
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| Describe the drainage of the vagina, testes, and ovaries | Upper 3/4s: internal iliac nodes; lower 1/4: superficial inguinal nodes; para-aortic (lumbar) nodes
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