Lecture 7 -Lymphatic System

Question 1

What does the lymphatic system comprise of?

Answer 1

Lymph vessels, lymphatic organs and diffuse lymphatic tissue

Question 2

What are the three general functions and features of lymph vessels

Answer 2

1. Collection of tissue fluid and return to systemic circulation
2. Transport of lymphocytes and other cells
3. Uptake and transport of long chain fatty acids absorbed in intestine

Question 3

What is the composition of tissue fluid/plasma (3)

Answer 3

Water, proteins, lipids extruded from blood capillaries into connective tissue matrix

Question 4

How is 20% of tissue fluid returned to main systemic circulation

Answer 4

Lymph vessels

Question 5

What happens to the other 80% of tissue fluid not returned

Answer 5

Removed via blood capillaries and perspiration

Question 6

What is lymphoedema

Answer 6

Compromised fluid or protein return

Question 7

Where is the majority of lymph returned to the venous system

Answer 7

1. Junction of subclavian and internal jugular veins (usual)

2. Additional: IVC, renal and suprarenal, azygous and iliac veins but also lymph nodes

Question 8

Where are lymphocytes produced

Answer 8

Lymph nodes along the course of larger lymph vessels and by other lymphatic organs and tissue such as spleen and gut associated lymphatic tissue (GALT)

Question 9

How long do FAs havae to be to be absorbed by intestinal epithelial cells and transported into extracellular space + lymph vessels of intestinal villi

Answer 9

more than 12 carbon atoms

Question 10

Where is lymph transported to from lymph vessels of intestinal villi /lacteals

Answer 10

Thoracic duct and ultimately blood stream

Question 11

Where do smaller fatty acids less than 12 carbons go

Answer 11

Taken into blood stream and then portal vein and liver

Question 12

What are lymph capillaries?

Answer 12

Blindly ending tubes in connective tissue which are initially a plexus which anastamose to form larger vessels

Question 13

Which lymph vessel is the larger and what is its diameter

Answer 13

Throacic duct

2-5mm in diameter

Question 14

Lymph vessels have thick walls

Answer 14

False

Question 15

What are characteristics of lymph fluid return

Answer 15

Gravity
Pressure from adjacent organs
Viscera
Valves

Question 16

Larger lymph vessels have their own blood supply of small vessels forming a plexus true or false

Answer 16

True

Question 17

Lymph vessels do not repair after damage

Answer 17

False, repair is rapid especially in smaller vessels

Question 18

Lymph vessels do not follow large blood vessels true or false

Answer 18

False, often follow large blood vessels as a plexus on adventitia

Question 19

Lymph vessels are difficult to recognise in classical divisions, how are they usually sutdied

Answer 19

Dyes, coloured latex or radioopaque material (lipidol) in conjunction with x-rays

Question 20

Lymph vessels are not found in: (3)

Answer 20

CNS
Bone marrow
Avascular tissue - cornea, epidermis, cartilage

Question 21

Lymph vessels are often associated with?

Answer 21

Lymph nodes

Question 22

What is a general length of lymph organs/nodes

Answer 22

1-25mm

Question 23

What do lymph nodes contain

Answer 23

Proliferative structures - lymph nodules

Question 24

What do lymph nodules produce

Answer 24

Lymphocytes, other cells of the immune system which are involved in immunosurveillance of lymph or added back to lymph (lymphocytes)

Question 25

How many lymph nodes are there around

Answer 25

300-400

Question 26

Where are most of the lymph nodes

Answer 26

Neck, thorax, abdomen, pelvis and groin | Relatively few in limbs

Question 27

How are lymph nodes named

Answer 27

Whether they are superficial/deep | Associated structures

Question 28

Lymph nodes are always situated along most lymph vessels true or false

Answer 28

True

Question 29

How do lymph vessels associate with nodes

Answer 29

Vessels divide into a number of afferent branches which penetrate the capsule of the node

Question 30

What does lymph do in the node

Answer 30

Percolates sinuses and collects lymphocytes produced by the node and leaves via one or several efferent vessels

Question 31

What else do lymph nodes produce that arent lymphocytes

Answer 31

Macrophages and plasma cells which are involved in immunosurveillance of lymph

Question 32

What are lymph nodes not associated with

Answer 32

Lymph capillaries and the smallest lymph vessels or the thoracic duct or right lymphatic duct (if present)

Question 33

The thoracic duct has lymph nodes true or false

Answer 33

False

Question 34

What are the first group of nodes into which lymph from a particular organ drains

Answer 34

Sentinal lymph node

Question 35

What are other lymphatic organs

Answer 35

Spleen, tonsils, thymus

Question 36

Where is the thoracic duct located

Answer 36

Thorax between azygos vein and aorta

Question 37

What are the 5 main tributaries of the thoracic duct

Answer 37

2 lumbar trunks 1 gastrointestinal trunk (variable) 2 descending intercostal/thoracic trunks

Question 38

Where is the origin of the thoracic duct

Answer 38

L2 and often described as being marked by a dilation called the cisterna chyli

Question 39

The cisterna chylis is present in all individuals

Answer 39

False only 20%

Question 40

Where does the thoracic duct pass through the diaphragm

Answer 40

The aortic hiatus

Question 41

Where does the thoracic duct pass in the thorax

Answer 41

Through posterior mediastinum from right to left. It eventually passes posterior to the left IVC, brachiocephalic vein and internal jugular to enter the left jugulosubclavian junction

Question 42

Where does the thoracic duct receive lymph from in the thorax

Answer 42

Mediastinal trunks from upper liver, diaphragm, heart and oesophagus 5-6 upper intercostal trunks on either side

Question 43

Where does the thoracic duct receive lymph from in the thoracic trunk

Answer 43

``` Left subclavian trunk (upper limb) Left jugular (head and neck) Left bronchomediastinal (upper left thorax and heart) ```

Question 44

What does the right subclavian, jugular and mediastinul trunks sometimes converge to form

Answer 44

Right lymphatic duct (approx 1cm)

Question 45

Where does the right lymphatic duct drain into if it exists

Answer 45

Right jugulosubclavian junction

Question 46

If the right lymphatic duct doesnt exist where do the right trunks drain into

Answer 46

The adjacent great veins separately i.e. subclavian, internal jugular and IVC

Question 47

What are the three sets of nodes of lymph drainage

Answer 47

Axillary, deep cervical and inguinal group

Question 48

Older women have less fatty breasts true or false

Answer 48

False

Question 49

What is the resting breast gland like

Answer 49

``` Mainly fibrous (white, radio opaque) and adipose (yellow, radiolucent) Some ducts but few alveoli (secretory part of gland) ```

Question 50

What occurs to breast tissue during pregnancy

Answer 50

Ducts and alveoli proliferate considerably and secrete during pregnancy and lactation Fibrous and fatty tissue decreases

Question 51

What occurs to the breast post lactation

Answer 51

Glandular tissue involutes and is replaced with fibrous tissue and fat

Question 52

Lymph drainage is implicated in spread of malignancies true or false

Answer 52

True

Question 53

Where does 75% of breast lymph drain into

Answer 53

Axillary group of nodes which also receives almost all lymph from upper limbs

Question 54

Where does most of the remaining breast lymph drain into

Answer 54

Infraclavicular and parasternal nodes Some intercostal nodes Also abdominal nodes and across midline

Question 55

Where will breast lymph go if normal lymph channels are blocked

Answer 55

Inferior deep cervical nodes | Contralateral breast

Question 56

The superficial and deep plexii of the breast lymph interconnect true or false

Answer 56

True

Question 57

What are the two groups of inguinal nodes

Answer 57

Superficial and deep

Question 58

Where are the superficial proximal group of inguinal nodes located along

Answer 58

Inguinal ligament

Question 59

What do the superficial proximal group of inguinal nodes receive vessels from

Answer 59

External genitalia, anal region, skin below level of umbilicus also some from the uterus

Question 60

Which ligament do lymph vessels from the uterus travel with

Answer 60

Round ligament

Question 61

Where are the distal group of superficial inguinal nodes

Answer 61

Termination of great saphenous vein

Question 62

What do the distal group of superficial inguinal nodes receive vessels from

Answer 62

Lower limbs

Question 63

Where are the deep nodes located

Answer 63

1-3 deep and medial to femoral vein

Question 64

Where do efferent vessels from superficial and deep inguinal nodes drain into

Answer 64

External and common iliac nodes and aortic nodes

Question 65

What do efferents from aortic nodes form

Answer 65

Lumbar trunks

Question 66

Nodes in the lower limb are sparse but where are some found

Answer 66

In popliteal fossa behind the knee

Question 67

What do lymph vessels which form the intestinal lymph trunk drain

Answer 67

Most of the abdominal organs especially the alimentary system

Question 68

What do the intestinal lymph trunk follow

Answer 68

Major anterior branches of the abdominal aorta (3 non-paired branches)

Question 69

What are nodes that the lymph vessels of the intestinal lymph trunk collected called

Answer 69

Preaortic nodes which can be further classified according to location or artery they are accompanying e.g. superior mesenteric nodes

Question 70

What are lumbar lymph trunks formed from

Answer 70

Vessels that follow iliac vessels and sides of the aorta

Question 71

What do lumbar lymph trunk vessels drain

Answer 71

Urogenital organs, posterior body wall and lower limbs

Question 72

What are the associated nodes of the lumbar lymph trunks called

Answer 72

Lateral aortic or lumbar nodes

Question 73

What occurs as a result of anastamoses between lumbar and intestinal lymph trunks

Answer 73

Lymph from pelvic organs may end up draining into intestinal lymph trunks. e.g. lymph from testis is known to pass through both preaortic and lumbar n odes.

Question 74

Where do lower thoracic vessels drain into

Answer 74

Descending thoracic lymph trunks that contribute to the formation of the cisterna chyli or origin of l=thoracic duct.

Question 75

Where do the upper thorax vessels drain into

Answer 75

Bronchomediastinal lymph trunks and from ther einto the jugulosubclavian junction. Others drain into the thoracic duct in the thorax

Question 76

What is the lymph drainage of the lungs like

Answer 76

Deep plexus of lymph vessels and fairly separate group of superficial subpleural vessels.

Question 77

Where are lymh nodes likely to be seen in the lung

Answer 77

At the hilus and along bronchi especially at the branching of the bronchi

Question 78

Where do both superifical and deep pleural lymph vessels ultimately drain into

Answer 78

Bronchomediastinal lymph trunks

Question 79

What is the highest part of the thoracic duct as it arches behind the internal jugular

Answer 79

C7

Question 80

Where does the thoracic duct enter the jugulo-subclavian junction

Answer 80

Posterior to the clavicle