3.2 Lymphatic Drainage Of The Head And Neck

Question 1

Where are lymphatics not found?

Answer 1

Eyeball (cornea, lens)
Inner ear
Cartilage

(Used to think CNS too)

Question 2

What makes up the lymphatic system?

Answer 2

Lymphatic tissues and organs eg lymph nodes
Drainage vessels -> Lymphatics
Fluid -> Lymph

Question 3

Describe the pressures at the arterial end in the formation of tissue fluid?

Answer 3

Hydrostatic pressure > Oncotic pressure

Question 4

Describe with pressures at the venue end in the formation of tissue fluid

Answer 4

Oncotic pressure > Hydrostatic pressure

Question 5

What makes up lymph fluid?

Answer 5

Tissue fluid plus..
Small proteins
Damaged cells
Bacteria 
Cancer cells
Lipids (specific to gut lymphatics)

Question 6

How much lymphatic fluid does the body produce a day?

Answer 6

3-4L

Question 7

What do the lymphatic vessels do?

Answer 7

Continuous removal of remaining tissue fluid (and macromolecules like proteins) from the extra cellular space back to the blood circulation via lymph nodes

Question 8

What are some features of flow of the lymphatic system?

Answer 8

One directional flow
Low pressure
No central pump

Question 9

Where is lymph drained to?

Answer 9

Venous circulation

Question 10

What are the two lymphatic ducts called and where do they drain to?

Answer 10

Right lymphatic duct
Thoracic duct

Drain into subclavian veins

Question 11

Define lymphoedema

Answer 11

Abnormal collection of protein-rich fluid causing tissue swelling due to compromised lymphatic system

Question 12

What are some causes of lymphoedema?

Answer 12

Removal or enlargement of lymph nodes
Infections 
Damage to lymphatic system (eg cancer treatments) 
Lack of limb movement 
Congenital

Question 13

Name a congenital cause of lymphoedema

Answer 13

Milroy’s syndrome

Question 14

Describe the connective tissue structure of lymph nodes

Answer 14

Tough fibrous outer capsule

Reticular connective tissue inside

Question 15

Describe how lymph nodes provide defence against infection

Answer 15

All substances in lymph pass through at least one lymph node

Physical filter
Phagocytise filter
Full of lymphocytes

Question 16

How do enlarged lymph nodes in response to infection feel?

Answer 16

Tender

Mobile

Question 17

How to enlarged lymph nodes due to malignancy feel?

Answer 17

Hard, matted

Non-tender

Question 18

What should be done if an enlarged lymph node is found?

Answer 18

Comprehensive history
Examine the area o tissue that it drains
Examine other lymph nodes and body systems if systemic disease/malignancy is suspected

Question 19

What are the two groups of lymph nodes?

Answer 19

Regional

Terminal

Question 20

What are regional lymph nodes?

Answer 20

Lymph nodes that drain specific areas

Superficial

Question 21

What are terminal lymph nodes?

Answer 21

Lymph nodes that receive drainage from a number of regional nodes

Deep

Question 22

In what regions of the body may lymph nodes be palpable?

Answer 22

Neck, armpit, diaphragm, spleen, abdominal, pelvic, groin

Question 23

What term describes enlarged lymph nodes?

Answer 23

Lymphadenopathy

Question 24

What is the most common cause of swelling in the neck?

Answer 24

Enlarged cervical lymph nodes

Question 25

What separates regional and terminal lymph nodes?

Answer 25

Investing layer of deep cervical fascia of neck

Question 26

Name the 7 superficial lymph nodes of head and neck

Answer 26

``` Sub mental Sub mandibular Pre auricular Post auricular (mastoid) Occipital Superficial EJV Posterior EJV Anterior EJV ```

Question 27

What is Waldeyer's ring?

Answer 27

Annular collection of lymphatic tissue (nodules) surrounding the entrance to the aerodigestive tracts Consists of the tonsils

Question 28

Which tonsils does Waldeyer's ring consist of?

Answer 28

Pharyngeal Tubal Palatine Lingual

Question 29

Which of the tonsils are also called the adenoids?

Answer 29

Pharyngeal

Question 30

Where can lymphatics from tonsils draining the upper pharynx drain into?

Answer 30

Retropharyngeal lymph nodes

Question 31

Describe the position of the deep cervical lymph nodes

Answer 31

Deep to SCM | Closely related to IJV and carotid sheath

Question 32

Name the 3 deep cervical lymph nodes

Answer 32

Jugulo-digastric Jugulo-omohyoid Supraclavicular

Question 33

What do the supraclavicular lymph nodes do?

Answer 33

Oversee transport of lymph from thoracic cavity and abdomen

Question 34

Which node is also called Virchow's node?

Answer 34

Left supraclavicular

Question 35

Where do the left and right supraclavicular lymph nodes drain from?

Answer 35

Left - Abdomen and thorax | Right - Mid section chest, oesophagus and lungs

Question 36

Which lymph node will be enlarged if someone has an ulcer on their lip?

Answer 36

Submental

Question 37

Which lymph node will be enlarged in conjunctivitis?

Answer 37

Pre auricular

Question 38

Are regional or terminal cervical lymph nodes more likely to be enlarged in cancer?

Answer 38

Deep

Question 39

What are the three main roles of the lymphatic system?

Answer 39

Remove excess fluid from interstitial space Return small proteins and fluid that has leaked from capillaries Immune defence and surveillance