Lymph Drainage of the Limbs Flashcards
What are the components of the lymphatic system ?
Lymph vessels, lymph nodes as well as tonsils, thymus, spleen and intestinal wall
What is the main function of the lymphatic system ?
Collecting interstitial fluid from capillary beds and delivering it back to the venous system.
What substances can also be carried in lymph vessels, in addition to interstitial fluid ?
Cell debris, hormones, and pathogens
What is the function of lymph nodes ?
Filter and phagocytose particulate matter with the help of macrophages and lymphocytes.
Summarise the path of interstitial fluid inside the lymphatic system.
- Interstitial fluid from capillary bed absorbed by lymph capillaries
- Call debris, hormones and pathogens also absorbed by lymph capillaries
- Lymph (containing all of the above) carried through lymph vessel
- Lymph passes through lymph node where it it filtered
- Lymph returned to veinous system
What kind of CT makes up lymph capillaries ? Are they thick or thin-walled ?
Thin-walled endothelium
What are the superficial, palpable lymph node collections of the body ? What do superficial lymph nodes (all together, in general) drain ?
- Cervical lymph nodes
- Axillary lymph nodes
- Inguinal lymph nodes
Drain body wall and limbs
What do the deep nodes of the body drain ?
Drain the viscera (abdomen, thorax)
Which of superficial or deep nods follow veinous drainage, and which of the two is around/accompanies the arteries ?
Superficial nodes follow venous drainage
Deep nodes are around, or accompany the arteries
Which structures do the channels which drain the lymph of the hand and forearm accompany ?
Basilic and cephalic veins
Where do the lymph vessels accompanying the basilic vein drain ?
Drain to superficial and deep cubital lymph nodes around the elbow leading to the axillary nodes (lateral group)
Where do the lymph vessels accompanying the cephalic vein drain ?
The lymph vessels accompanying the cephalic vein continue with the vein leading to the axillary nodes (apical group) near where the cephalic enters the axillary vein. Some may drain into deep brachial nodes or deltopectoral (with infraclavicular) nodes enroute.
Where do the deep channels of the lymphatic system of the arm drain ?
Deep channels of the lymphatic system accompany the arteries and drain via the deep lymph nodes accompanying arteries in the forearm to the axillary nodes.
Name the axillary lymph node groups.
- Anterior (pectoral) group
- Posterior (subscapular) group
- Lateral (humeral) group
- Central group
- Apical group
What do the axillary lymph node groups drain ?
- upper limb
- adjacent shoulder and neck regions
- breast (75%)
- posterior and anterior thoracic wall
- anterior abdominal wall (above the umbilicus)
- skin of the back (above the iliac crests)
True or False: There is free communication between the axillary nodes and the cervical nodes.
True
Describe the location within the axilla of the lateral (humeral) group, and state what it drains.
Location: at lateral wall of axilla, medial and posterior to axillary vein.
Drainage: Receive lymph from majority of upper
limb (expect from cephalic vessels).
Describe the location within the axilla of the anterior (pectoral) group, and state what it drains.
Location: at medial wall of axilla near inferior border of pec minor.
Drainage: Receive lymph from the anterior thoracic wall and breast.
Describe the location within the axilla of the posterior (subscapular) group, and state what it drains.
Location: at posterior axillary fold.
Drainage: Receive lymph from posterior thoracic
wall and scapula.
Describe the location within the axilla of the central group, and state what it drains.
Location: Deep to pec minor within axilla.
Drainage: Receive lymph from anterior, posterior, lateral groups.
Describe the location within the axilla of the apical group, and state what it drains.
Location: apex of axilla.
Drainage: Receive lymph from central nodes and lymph from vessels along cephalic vein.
What is the proportion of breast/mammary glands lymph drains into pectoral group of the axillary nodes ?
75%
What nodes are often palpated in breast exams ? Why ?
Pectoral group of axillary nodes.
Because breast cancer is most likely to metastasise to these nodes.
Which structure can be damaged in a biopsy of the breast ?
Long thoracic nerve
Where do the apical group (of axillary node) drain ?
To SUPRACLAVICULAR NODES, leading on to SUBCLAVIAN LYMPH TRUNK (SLT)
Where does the SLT drain into the venous system ?
- At junction between internal jugular and subclavian veins (right side)
- Into thoracic duct (left side)
What is the largest between right drainage area or left drainage area ?
Left drainage area
What are the main lymphatic vessels of the lower limbs which drain lymph of the foot and leg ? What does each one specifically drain ?
Medial superficial vessels: drain the medial side of the dorsum of the foot and sole of foot and leg
Lateral superficial vessels: drain the lateral side of the foot, and posterolateral leg
Identify the structures which are accompanied by the medial superficial vessels and lateral superficial vessels respectively.
Medial superfical vessels: accompany the great saphenous vein
Lateral superficial vessels: accompany the small saphenous vein
Describe the path of the lymph following the medial and lateral superficial vessels respectively.
Medial superfical vessels –> superficial inguinal nodes –> deep inguinal nodes –> external iliac nodes
Lateral superficial vessels –> popliteal lymph nodes –> deep inguinal nodes (a few will go to superfical inguinal nodes first then to deep inguinal nodes) –> external iliac nodes
What is the function of the deep channels of the leg, wrt lymphatic drainage ?
Accompany deep veins and enter the popliteal lymph nodes
Accompany femoral vein to the deep inguinal nodes.
Where are the superficial inguinal nodes found ? What do they drain ?
-LOCATION: Form a T Along inguinal ligament and great saphenous vein and its tributaries Outside femoral triangle Superifical to fascia lata
-DRAIN:
Anterior abdominal wall (under umbilicus)
Skin of back (below line of iliac crests)
Perineum
Gluteal region
Superficial Lower limb
Where are the deep inguinal nodes found ? What do they drain ?
-LOCATION:
In the femoral triangle, medial to femoral vein
-DRAIN:
Lower limb (accompanying the femoral vessels, including from popliteal nodes)
Superficial inguinal nodes (some can proceed directly to external iliac nodes)
External genitalia
Where is the femoral canal found ?
What does the femoral canal contain ?
- Short and conical space between the medial wall of the femoral sheath and the femoral vein
- Contains deep inguinal lymph nodes
What is the femoral ring ? What are its boundaries ?
Femoral ring is the base of the femoral canal
BOUNDARIES:
• Ant: the med part of the inguinal ligament
• Med: lacunar ligament
• Lat: septum between the femoral canal and vein
• Post: Pectineus muscle and fascia (superior ramus of the pubis)
Describe the path of the lymph, from the superficial and deep inguinal nodes to the veinous system.
-deep inguinal nodes and superficial inguinal nodes (the latter will drain into deep inguinal nodes)
-external iliac nodes
-common iliac nodes
-lateral lumbar lymph nodes
-cisterna chyli
-thoracic duct
-Pirogov’s venous angle
-venous system
