1-70 Anatomy

Question 1

Lympth functions

Answer 1

– Drain excess fluids from body tissues (2-4 liters/day)

– Re-circulate proteins from blood capillaries

– Absorb emulsified fat via lacteals in intestinal villi

– Body defense mechanism. 2 kinds of lymphocytes:

B-cells differentiate into plasma cells for

antibody production (humoral immunity)

and memory cells

T-cells (killer cells) for cell-mediated immunity

(3rd cell type: natural killer (NK) cells)

Question 2

Lymph vessels junctions

Answer 2

Lymphatic vessels in general have little smooth muscle. Junctions between capillary endothelial cells (below right) do not have junctional complexes. Note the absence of a basal lamina.

Question 3

Most lymph enters the blood circulation at the junction of the internal jugular and subclavian veins via:

Answer 3

1. Jugular trunks
2. Subclavian trunks
3. Bronchomediastinal trunks

The thoracic duct from the lower body only goes to the veins on the left.

Question 4

Schematic of left-right lymph drainage

Answer 4

Lymph drainage into the veins of the neck is bi-laterally symmetrical above umbilicus because of the paired trunks.

All lymph below umbilicus goes to the left veins via the thoracic duct.

Exception: deep thoracic body wall drains into thoracic duct; it all ends up on the left

Question 5

Stratification of lympth flow

Answer 5

Question 6

Lympth flow in leg

Answer 6

Superficial lymph flows up to the superficial inguinal Lymph nodes.

Deep lymph follows the large vessels (popliteal, femoral, etc.) to the deep inguinal nodes under the deep or investing fascia at or within the femoral canal.

Lymph Flow from Lateral Foot and Ankle, and Posterior Calf Drain Deep into Popliteal Nodes

Question 7

Superficial inguinal lympth nodes

Answer 7

Nodes are in the superficial fascia around the greater saphenous vein.

Efferents will pierce the deep fascia to go to deep inguinal nodes around the femoral sheath.

Question 8

Femoral sheath

Answer 8

Superficial and deep lymph converge on the femoral sheath enveloping the:

• Femoral artery
• Femoral vein
• Lymphatics

Medial to lateral:

• 1. Lymphatics through the femoral canal
• 2. Femoral vein
• 3. Femoral artery
• (The femoral nerve is outside the sheath.)

The lymphatics pass through the medial femoral canal – the site of femoral hernia.

Question 9

Stratification of lymph flow: anal/rectum

Answer 9

Question 10

Aortic lymphatics recieve lymph from…

Answer 10

The entire lower body!

Question 11

GI lymph flow into…

Answer 11

Aortic lymph vessels

Mesenteries are rich in lymph vessels and nodes because of their proximity to the external environment (intestinal lumen).

Question 12

below the diaphragm, All lower lymph converges on the…

Answer 12

• cysterna chyli and then goes to thoracic duct**
• The thoracic duct drains the thoracic body wall, but not the heart & lungs.
  
  • It joins the veins on the left side of the neck.

** Exception: upper liver drains directly through diaphragm.

Question 13

Arm lymphatics

Answer 13

• Superficial AND deep lymph in the upper extremity flow to the axillary lymph nodes.
• The subclavian trunk drains lymph from the axillary nodes into the veins of the neck on each side.

Question 14

Lymph Drainage from the Heart and Lungs:

Answer 14

Bronchomediastinal Trunks

Note:

– Thoracic duct (1), jugular (2) & subclavian (3) trunks

– Other smaller lymph vessels entering the veins (internal thoracic, etc.)

– Lymph passing to opposite sides

Question 15

Lympth draininage of breast

Answer 15

1. Upper lateral breast –> axillary nodes
2. To opposite breast

EXCEPTIONS to the plan:

3. Parasternal nodes deep to body wall
4. Superficial inguinal nodes.

Question 16

Limbs lymph summary

Answer 16

Question 17

Superficial trunk lymph summary:

Answer 17

Question 18

Odd routes summary:

1. Breast lymph
2. Anterior intercostal lymph
3. Esophogus

Answer 18