Anatomy/Physiology Flashcards
The lymph fluid absorbed by the initial lymph vessel system reaches the lymph collectors via
pre-collectors
The anatomical structure of the larger lymph collectors consists of (3).
an inner wall, a layer of smooth musculature in the middle layer, and an outer layer.
Lymph collectors have valves, which allow the flow of lymph in one direction only - the section between a distal and a proximal pair of valves is called
Lymph Angion
Lymph collectors transport the lymph towards groups of lymph nodes, also known as
Regional Lymph Nodes.
From the lymph nodes, the lymphatic fluid is then transported by _____________ and then back to _________.
- Lymphatic Trunks
- The venous part of the blood circulatory system.
The main purpose of the lymph capillaries is
lymph formation - absorption of lymphatic loads into the lymphatic system
Describe Lymphedema (4)
- Abnormal accumulation of protein and water in the interstitial space
- Lymphedema is a protein-rich swelling
- Lymphedema is a disease process
- Mechanical insufficiency of the lymphatic system
Purpose of the Lymphatic System
Absorb substances that can not be drained and reabsorbed by the blood system
Define Edema and causes of. (4)
Accumulation of water in the tissues caused by renal failure, heart conditions, venous insufficiency, pregnancy
Breast Cancer most often develops in the….
upper lateral quadrant of the mammary gland.
Order of incidence of Lymphedema (3)
1) Parasitic 140-250 Million Worldwide
2) Secondary 2-3 Million (US)
3) Primary 1-2 Million (US)
Lymphatic Loads Consist of (4)
- Water
- Protien
- Cells/Cell fragments
- Fat (long-chain fatty acids)
Describe the path of blood from the Left Ventricle
Left Ventricle - Aorta - Arteries - Arterioles - Pre-Capilary Arterioles
Describe the path of blood from Capilaries
Post-Capulary Venules - Venules - Veins - Vena Cava - Right Atrium - Right Ventricle - Lungs- Left Atrium - Left Ventricle
Lymphatic Load - Water leaves ____ end of the capillaries and is 80-90% reabsorbed at the ____ end of the capillaries
arteriole - venous
The percentage of water that becomes Lymphatic Load is also known as ____ ____.
Net Filtrate
What is Cytopempsis Theory
Blood capillaries are not permeable to protein - this requires active transport in/out of a cell in a vesicle without being used by the cell.
Lymphatic Load - Protein are what type of molecules
Macromolecules (too large to enter venules) and hydrophilic (attracting water)
Lymphatic Load - The body uses protein for (3)
- Provide cell nutrition ( transport water and water-insoluble substances - fat, vitamin K/D, hormones)
- aid in immune defense (albumin/globulin)
- aid in blood coagulation (fibrinogen)
Short Chain Fatty Acids are reabsorbed by ______ in the _______ and returned to the ______.
venous blood capillaries - intestines - liver
Long Chain Fatty Acids are resynthesized by the body into
Chylomikrons
Lymphatic Load - Chylomikrons are a lymphatic load only absorbed in the _______ by lymph vessels called ______.
digestive system - chylous vessels
Chylomikrons travel from ______ to _________ to_______to_______to________to_________
Small intestines →Gastrointestinal Trunk →Cisterna Chyli →Thoracic Duct → Venous Angle → bloodstream.
Lymph fluid is normally colored ________ but when from the intestinal system ______ makes it _______.
clear/transparent - chylomikrons - milky/white/cloudy
Lymphatic Load - Cell fragments consist of ______
all cells that become free in the interstitial space (hematoma, RBC, WCB, cancer, bacteria, tattoo ink
Superficial and Deep lymphatic systems are separated by the ____
body’s fascia
Purpose of the Superficial Lymphatic System
- drain lymphatic load of the skin (most often causes of lymphedema)
- composed of: lymph capillaries, precollectors, and lymph collectors
Purpose of Deep Lymphatic System
drain lymphatic load of everything but the skin ( muscle, tendons, joints, organs).
Not usually cause of lymphedema as fascia hold back the swelling.
Initial Lymph Capillaries location and purpose.
- located just below the dermis (1mm) and forms initial lymph vessel plexus
- to pick up the lymphatic load
Initial lymph vessels appear as _____ and __to__ are attached to each _______ capillary.
finger-like projections - 1to3 projections - lymph capillary
Initial Lymph Vessels are made up of a __________ and attached to surrounding interstitial tissue via _______.
- a single layer of epithelial cells
- anchoring filaments
Initial Lymph Vessels have inlet valves that open when______
interstitial pressure is greater than that within the lymph capillaries.
Internal pressure on Initial Lymph Vessels is from _____
increased water content
External pressure on Initial Lymph Vessels occurs from ______ and _______.
- manual pressure
- atmospheric pressure
Initial Lymph Capillary Characteristics (4)
1) no valves
2) Slightly larger than blood capillaries
3) Covers the entire body forming a Plexus
4) Each capillary is responsible for a 3-4cm area.
5) Concentrated on the palms/soles
Pre-Collectors Purpose and Characteristic (1)
- connect superficial capillaries with superficial collectors
- hybrid vessel
Pre-Collectors - Perferating are found in (3)
Parasternal
Paravertebral
Intercostal
What structure has the following Characteristics.
- well-developed muscular walls
- promote the unidirectional flow
- located in the superficial fatty tissue
- suprafascial
Collectors
Explain Lymph Angiomotoricity
Once lymphatic fluid enters a lymph angion, the smooth muscles are stretched. This stretch causes the smooth musculature in the wall of the angion to contract, thus injecting the lymph fluid into the lymph angion located further proximally.
Which part of the nervous system innervates the smooth muscles?
Sympathetic portion of the Autonomic nervous system.
Describe LYMPHANGIOMOTORICITY
- Lymph collectors react to an increase in lymph formation with an increase in contraction frequency
- Contraction of Angions 10-12 x per min up to 60x per min (safety factor)
An oval-shaped organ of the immune system, is distributed widely throughout the body and linked by lymph vessels. Name this thing and 3 facts.
Lymph Node
- 600-700 in a human body
- do not regenerate
- fatty or fibrotic with age
The “chambers” in the lymph nodes are filled with (3)
Macrophages to detect foreign material
B,T and other Immune Cells
Lymphocytes
What is the purpose of the lymph nodes? (3)
They act as filters or traps for foreign particles
Produce antigen-stimulated lymphocytes
Thicken lymph fluid
Regional Lymph Nodes Locations (3)
Cervical, Inguinal and Axilliary
Cervical Lymph Nodes drain what areas?
head and neck
Inguinal Lymph Nodes drain what areas?
Abdominal, lumbar and gluteal areas, exterior genitalia and the lower extremities
Axillary Lymph Nodes drain what areas?
Upper extremities and the skin of the anterior and posterior thorax.
Inguinal lymph nodes are located in the medial femoral triangle, which is outlined by (3)
Inguinal ligament (proximal border)
Sartorius muscle (lateral border)
Gracilis muscle (medial border).
Describe the path of Lymph from the inguinal lymph nodes to the left venous angle (blood flow).
Inguinal lymph nodes - pelvic lymph nodes - lumbar lymph nodes - lumbar trunks - cisterna chyli - thoracic duct - left venous angle.
Where are Axillary Lymph Nodes located and how many?
- Between the pectoralis and latissimus dorsi muscles on the thorax
- 10-24 per side
Describe the path of lymph from the axillary lymph nodes to the left venous angle (blood flow).
Converge to form the subclavian trunk which transports the lymph fluid to the venous angles.
Where does the cephalic bundle drain into?
Axillary and supraclavicular lymph nodes
Name 4 Watersheds
Upper horizontal watershed
Sagittal or median watershed
Lower horizontal, or transverse watershed
Gluteal watershed
What has Linear areas that separate territories and contain relatively few lymph collectors.
Watershed
Describe specific locations of the Watersheds (4)
Upper Horizontal: sternal notch - clavicle - acromion - spine of scapula - between C7 - T2
Lower Horizontal: umbilicus-caudal limitation of ribs - T12
Sagittal: midline dividing body left and right - vertex to the perineum (ant. and post.)
Gluteal: top of vertical gluteal fold, dividing gluteus in half
Lymph collectors drain lymph fluid from specific areas of the body, creating _________ ________ that drain to specific regional lymph nodes.
Lymphatic Territories
Lyphmatic Territories are separated by?
Watersheds and collectors will not usually cross them.
What territories originate at the watersheds and run directly to regional lymph nodes?
Trunk territories ( 4 quadrants)
On extremities, territories are called ______ and run _____ to the watersheds.
- Bundles
- Parallel
Upper Quadrants (trunk territories) drain into the ______ lymph nodes.
Axillary
Lower Quadrants (trunk territories) drain into the ______ lymph nodes.
Inguinal
Lymph above the upper horizontal watershed drains into _____.
Cervical Lymph Nodes
Superficial Collectors that allow fluid to cross the watershed boundaries.
What is anastomosis?
When adjacent collectors directly align with each other at the watershed this is called _______.
Inter-territorial Anastomosis
Connects the axillary lymph nodes of both sides on
the anterior thorax.
AAA : Anterior Axillo-Axillary Anastomosis
- located b/w axillary node crossing sagittal watershed
Connects the inguinal lymph nodes of both sides.
Anterior Inter-Inguinal Anastomosis
- located on the mons pub
Connects the inguinal and axillary lymph nodes on the same side.
Al or IA - Axillo-Inguinal or Inguinal-Axillary
Anastomosis
- located on the front of the body
Connects the axillary lymph nodes of both
sides on the posterior thorax.
PAA : Posterior Axillo- Axillary Anastomosis
- located just below T3
Connects the inguinal lymph nodes of both sides on the posterior aspect of the body.
PII: Posterior Inter- Inguinal Anastomosis
-located on the sacrum
What lymph nodes are responsible for drainage of the internal organs, ovaries, testicles, uterus, and prostate?
Pelvic Lymph Nodes (deep lymphatic system)
Describe the flow of Lymph with the Pelvic Lymph Nodes.
Inguinal Node - beneath the inguinal ligament - pelvic lymph nodes - lumbar lymph nodes
Where are lumbar lymph nodes located?
Adjacent to the vertebral column.
Located behind the left clavicle and is made up by the connection of the left subclavian and internal jugular veins.
Left venous angle (left terminus area)
Located behind the right clavicle and is made up by the connection of the right subclavian and internal jugular veins.
Right Venous Angle (right terminus area)
What returns lymph fluid from the left side of the face, head and neck area into the left venous angle. (trunk)
left jugular trunk
Returns lymph fluid from the skin area above the upper horizontal watershed and the supraclavicular lymph nodes to the left venous angle. (trunk)
left supraclavicular trunk
Returns lymph fluid from the left upper extremity (axillary lymph nodes) to the left venous angle. (trunk)
left subclavian trunk
The flow of lymph from lumbar lymph nodes.
Gastrointestinal trunk - Cisterna Chyli (T11-L2) - Thoracic trunk (largest, perforates diaphragm, 10-18’ long) - Left venous angle
Returns lymph fluid from the right side of the face, head and neck area into the right venous angle. (Trunk)
right jugular trunk
Returns lymph fluid from the skin area above the upper horizontal watershed and the supraclavicular lymph nodes to the right venous angle.
right supraclavicular trunk
Returns lymph fluid from the right upper extremity to the right venous angle. (Trunk)
right subclavian trunk
Amount of lymph that drains into the Left and Right Venous Angles (24hr)
Left - 2 to 4 litres
Right - 300mls
Skin areas that drain into the left venous angle. (5)
- Lower extremities - Both lower quadrants
- External genitalia
-Left upper quadrant (anterior and posterior) - Left upper extremity
- Left side of head/face/shoulder
Skin areas that drain into the right venous angle. (3)
- Right upper quadrant (anterior and posterior)
- Right arm
- Right head/face/shoulder
What is the location of the deep cervical lymph nodes?
Lateral Cervical Triangle
Anterior: Sternocleidomastoid
Posterior: Upper Trapezius
Inferior: Clavicle
What 3 chains make up the deep cervical lymph nodes and where do they drain?
Jugual Chain (into Supraclavicular trunk then venous angle)
Accessory Chain (into Supraclavicular chain)
Supraclavicular Chain (into Supraclavicular trunk then venous angle
What term is used to describe the location of several lymph node groups on the head/neck border?
Peri-Cervical Lymphatic Circle
The peri-cervical lymphatic circle consists of the following lymph node groups: (5)
- Occipital Lymph Nodes
- Retro-Auricular Lymph Nodes
- Pre-Auricular, or Parotid Lymph Nodes
- Submandibular Lymph Nodes
- Submental Lymph Nodes
Occipital Lymph Nodes are located where and drain what area?
- Between the splenius capitis and skull
- Drain posterior scalp, muscles and ligaments, skin of upper neck and 1-3 facets
Retro-Auricular Lymph Nodes are located where and drain what area?
- On the mastoid process
- Drains parietal scalp and skin of posterior ear
Pre-Auricular, or Parotid Lymph Nodes are located where and drain what area?
- Embedded in parotid glands
- Drains forehead, upper lid, lateral part of lower lid and - skin of anterior ear
Submandibular Lymph Nodes are located where?
- Embedded in salivary glands; posterior to the mandible
- Tend to be large with chronic ear/nose/sinus infections
What areas do the submental lymph nodes drain?
The middle of the lower lip and chin.
Name the hand bundles (4)
Radial
Ulnar
Mesothenar
Desending
Where do hand bundles converge?
Dorsum of the hand before continuing to the posterior forearm.
Name the forearm bundles (3) and where they converge.
Radial, Ulnar and Medial
Converge at the antecubital fossa
What territory is located between the biceps and triceps?
Medial Upper Arm Territory
What collectors are part of the medial upper arm territory and where do they drain?
Bottleneck collectors - drain into the axillary lymph nodes
Where does the Lateral Upper Arm Territory drain to?
Axillary and supraclavicular lymph nodes.
Very important for de-congesting the arm
What Upper Arm bundle is rare and why some do not develop lymphedema?
Long Upper Arm Type
Ventral Medial Bundle drains what areas of the lower extremity. (4)
- Plantar surface of the feet (metatarsals heads to distal toes)
- Medial malleolus 1/2
- Medial sole of foot
- Dorsum of foot
What bundle bottlenecks behind the femoral condyle (medial aspect knee)and then increases in collectors to drain into the inguinal lymph nodes?
Ventral Medial Bundle
Dorso-Lateral bundle (lower extremity) drains what areas to what node and is located where?
- Lateral malleolus 1⁄2
- Lateral/planter sole of foot
- Heel area with a narrow strip following achilles tendon, along the calf to the popliteal fossa
Drains lymph to politeal nodes
Located in the posterior knee.
What lymph nodes drain 1/4 (25%) of the mammary glands, are not removed in breast cancer and deep?
Parasternal Lymph Nodes
In what area of the arm can radiation or surgery cause paresthesia or paralysis?
Brachial Plexus
Where are intercostal collectors located?
- 1 in each intercostal space
- below the fascia
What lymph nodes drain the anterior intercostal spaces?
Para-Sternal Lymph nodes
What lymph nodes drain the posterior intercostal spaces?
Para-Vertebral Lymph nodes
Paravertebral, Parasternal and Intercostal areas contain what type of collectors?
Perforating Pre-Collectors
What parts of the human genital anatomy drain into the inguinal lymph nodes?
External Genital Anatomy
Male - skin of penis and scrotum
Female - external labia
What parts of the human genital anatomy drain into the pelvic lymph nodes?
Internal genital organs
How many grams of protein are in the blood at any given time?
300-450gm
What percentage of the total circulating blood proteins leave the capillaries and move into the interstitial space in 24 hours?
50%
How much lymph fluid is normally returned to the venous system in 24hrs?
2-4 litres
