EW LYMPH WHY DO I EVEN CARE

Question 1

What are the stupid goddamn lymphatic ducks that we have to know?

Answer 1

1. Thoracic Duck
2. Right Lymphatic Duck

Question 2

What does the Thoracic Duck drain?

Answer 2

Ok, you don’t even have to remember any information for this. All you have to know is that the thoracic duck drains EVERYTHING that the right lympathic duck doesn’t drain.

Question 3

So then what does the stupid ass right lymphatic duck drain?

Answer 3

The right lymphatic duck = weak sauce. It drains the right arm, the right side of your stupid fucking face, and your right thorax.

Question 4

Where do these damn ducks drain into?

Answer 4

The right lymphatic duck drains into the right subclavian vein. Now every source I saw on the interwebs says that the thoracic duck drains into the left subclavian vein, but Dr. Carey says left brachiocephalic. So let’s go with that.

Question 5

Is there anything particularly stupid I have to know about the thoracic duck? Like a particular dilation or something of that nature?

Answer 5

Very astute. Of course, you are correct. The thoracic duck has a dilation at the beginning of it called the cisterna chyli. We’ll go over the nodes that drain directly into the cisterna chyli.

Question 6

Ok. Let’s talk about nodes. What nodes do we care about in this unit in terms of the breast?

Answer 6

We care about several boob nodes. I came up with a boob-related mnemonic: “Interested individuals, please always ask”

Interested - Inguinal (inferior breast)

Individuals - Infraclavicular (superior breast)

Please - Parasternal (medial breast bilaterally)

Always - Axillary (main guy on the job)

Ask - Apical axillary (superior breast and other axillary nodes)

Note: the parasternal nodes are the only ones that show up in Dr. Carey’s drawing.

Question 7

Woah woah. That was a lot of info, asshole. Let’s slow it down. Inguinal nodes, what do those drain (in terms of the lady chest balls)?

Answer 7

Well what do you think? Inguinal nodes are way the hell down in your goddamn…inguine, or whatever, so they are draining the inferior breast.

Question 8

What do the infraclavicular stupid-ass nodes drain?

Answer 8

Just…think… Where would the “beneath the clavicle” nodes exist in relation to the breast? Did you just say above it? Good job! You’re right! The infraclavicular nodes drain the superior breast.

Question 9

What part of the all-organic milk bags do the parasternal nodes drain? Think about the name of the nodes….

Answer 9

Did you say medial breast? Awesome! Did you say that they drain the medial breast bilaterally? Even better! Give yourself a pat on the back. No seriously. Do it. You think I’m not watching but I am. I’m always watching. Pat. That. Goddamn. Back.

Question 10

What part of your sweater meat gets drained by the axillary nodes?

Answer 10

All it says in the B-pages is “predominant drainage of the breast….”

So just imagine this guy named Axel who is definitely a boob man and he is all over those zeppelins like a (insert hilarious Southern saying here).

Question 11

Ok, final chesticle node: what do the apical axillary nodes drain?

Answer 11

Apical = top. These guys also drain the superior breast (can you remember the other node that does that?). They also drain the axillary nodes.

Question 12

Ok. I’m going to give you the mnemonic again. Try to name all the associated nodes.

“Interested individuals, please always ask.”

Answer 12

Inguinal, infraclavicular, parasternal, axillary, apical axillary

(inferior, superior, medial, predominate, superior + axillary)

Question 13

THORACIC NODES HELL YEAH LETS DO IT LETS NAME THEM I DON’T GIVE A FUCK!

Answer 13

Ok, chill the fuck out bro. We can split thoracic nodes into two categories:

1. Parietal Nodes
2. Visceral Nodes

Each of these categories have 4 nodes associated with them. Let’s continue, shall we?

Question 14

What are the parietal thoracic nodes?

Answer 14

1. Parasternal (Overlap alert! Apparently parasternal has love for a little more than just the Grand Tetons.)
2. Intercostal
3. Diaphragmatic
4. Posterior mediastinal

Here’s a mnemonic: “Parasternal, Intercostal, Diaphragmatic, Posterior mediastinal”

I know, I know: “fuck you, Chad!” I’m an asshole. What’s your excuse?

Question 15

What does the parasternal parietal thoracic nodes drain (other than booooooooooooobs)?

Answer 15

These naughty nodes (only 10 miles from where you live, PM them now!) drain the upper abdominal wall, the anterior pleura, and part of the liver.

All those things (including medial gazongas) seem to be pretty much in the same area so that makes sense to me.

Question 16

What do the stupid fucking dumb shitty ass asshole intercostal thoracic nodes drain?

Answer 16

Intercostals take care of the lateral and posterior thoracic wall.

From an ancient text: “Sir Intercostal was one of King Arthur’s bravest knights. Legend tells of a time, during the great battle of Lymph, when Sir Intercostal single-handedly defended the lateral and posterior walls of the kingdom’s stronghold, Thoracic Castle, in the county of Parietal.”

Medieval times were weird…

Question 17

Why do I care about the diaphragmatic nodes? Do they even lift?

Answer 17

They do lift. They lift lymph out of the diaphragm. And also out of the pleura. And also the liver.

They should be called diaphrapleurver nodes.

Question 18

And then the final set of parietal thoracic nodes: the stupid posterior mediastinal nodes, what do they drain?

Answer 18

Oh posterior mediastinal! How would my pleura and esophagus rid themselves of infections without you? You are truly a hero of the ages!

Question 19

GEAR SWITCHING. Name what is being covered in this picture.

Answer 19

Red, intercostal nodes.

Blue, parasternal nodes.

Green, diaphragmatic nodes.

Orange, cisterna chyli.

Yellow, thoracic duck. (Hmm… that doesn’t really look like a duck to me…)

Question 20

Guys we don’t have actual ducks in us they are really just ducts. I know, I’m disappointed too.

Answer 20

And this duck is super pissed…

Question 21

Ok we just worked through parietal thoracic nodes. Now let’s do visceral thoracic nodes. Name ‘em, if you dare.

Answer 21

1. Pulmonary
2. Bronchopulmonary
3. Tracheobronchial
4. Paratracheal

(Based on these names, it sounds like we’ve got some nodes moving closer and closer to the midline like a bunch of creeps.)

Question 22

What do the pulmonary nodes drain?

Answer 22

The uterus. What do you fucking think? The goddamn lungs. Jeez.

Question 23

What do the bronchopulmonary nodes drain?

Answer 23

The pulmonary nodes and the bronchi (a single member of Denver’s football team)

Question 24

What do the tracheobronchial nodes drain?

Answer 24

The bronchopulmonary nodes, the posterior mediastinal nodes (remember them from earlier? remember what they drain?), the trachea, and the heart.

Question 25

Final dude in the list: paratracheal nodes. What do they drain?

Answer 25

The tracheobronchial nodes.

Question 26

So the visceral thoracic nodes are just like… a lymphatic human centipede, except tracheobronchial really likes it so is excepting shit from places other than the chain it’s in?

Answer 26

Sure…

Question 27

Alright, Ok. Done with Thoracic Nodes! Wubbalubbadubdub! (google it)

Final fucking category: Abdominal and Pelvic nodes.

Answer 27

Here’s a mnemonic for these: “Please, let’s rest”

Please - Preaortic

Let’s - Lateral aortic

Rest - Retroaortic

Question 28

What do the preaortic nodes drain?

Answer 28

These motherfuckers drain the abdominal viscera supplied by the celiac, superior mesenteric, and inferior mesenteric arteries. The visceral nodes are named after the organ they drain.

Question 29

Quick! This guy is drained by what node?

Answer 29

preaortic node

Question 30

What do the retroaortic nodes drain?

Answer 30

the posterior abdominal wall. That’s it. That’s all. They’ve got one fucking job.

Question 31

Are the lateral aortic nodes the only nodes that are lateral aortic or are there goddamn subcategories or something stupid like that?

Answer 31

Oh you better believe there are subcategories for this fucker.

The lateral aortic nodes also consist of the following:

1. Common iliac nodes
2. External iliac nodes
3. Internal iliac nodes

I know, it sucks. Bear, with me!

Question 32

Ok, so what do the lateral aortic nodes drain?

Answer 32

kidneys! suprarenal glands! ureter! (all the kidney things)

posterior abdominal wall! (apparently retroaortic needs help)

testes, ovaries, uterine tubes, superior uterus! (baby-making things)

iliac nodes! (the ones I mentioned as subcategories for this guy)

Question 33

What does common iliac drain?

Answer 33

Common iliac just accepts donations from internal and external iliac nodes. And then it hands these donations to lateral aortic. Someone must have poor job satisfaction.

Common iliac: But when am I going to get my own assignment, boss?

Lateral aortic: Goddamn it C man! I’ve already told you. You are a go-betweener. That’s your job. That’s what you do. Stop dreaming!

Question 34

What does external iliac drain?

Answer 34

Other than my energy and will to live? The inguinal nodes (ooo, a little second-hand boob action there, external iliac?), the abdominal wall, the perinum and the lower pelvic viscera.

Question 35

Final lymph bullshit: What does internal iliac drain?

Answer 35

Internal iliac takes care of the pelvic viscera, the perineum and the gluteal region.

Except skin of the gluteal region goes to inguinal nodes. (and from there external iliac, and then common iliac, and then lateral aortic, and then cisterna chyli, and then thoracic duct, and then the left brachiocephalic vein. *mic drop*)

Question 36

Which stupid ass nodes drain directly into cisterna chyli?

Answer 36

The abdominal nodes!! “Please, let’s rest”

Remember?

Preaortic, lateral aortic, retroaortic.

Question 37

Which fucking nodes drain the super important but also stupid liver?

Answer 37

diaphragmatic and parasternal

DP on liver duty!

(…shame on you)

Question 38

Which nodes drain the sexiest wall of them all, the abdominal wall?

Answer 38

parasternal, lateral aortic, retroaortic, external iliac. But mostly retroaortic.

I have no mnemonic for this.

Question 39

Which nodes drain the handwarmers?

Answer 39

“Interested individuals, please always ask”

inguinal, infraclavicular, parasternal, axillary, apical axillary

Question 40

Which nodes drain the viscera supplied by the celiac, superior mesenteric, and inferior mesenteric arteries?

Answer 40

Just the preaortic nodes.

(Not to be confused with the prehistoric nodes, which drain the cenozoic, superior mesozoic and inferior mesozoic epochs)

(Is that even a helpful mnemonic? I don’t know what I’m doing anymore.)

Question 41

NODES THAT DRAIN THE THORACIC WALL, GO!

Answer 41

Sir Intercostal is on wall duty, ladies and gents.