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MBChB II Anatomical Pathology > Lymphatic System > Flashcards

Lymphatic System Flashcards

1
Q

Skin of the thoracic wall

A

– Superficial lymphatic vessels (superficial
to deep fascia): ant. & post. wall
• → Ant. & post. axillary lymph nodes

– Superior to umbilicus & iliac crest
• → Axillary nodes

– Inferior to umbilicus
• → Inguinal lymph nodes

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2
Q

Thoracic wall intercostal spaces

A

Anteriorly – parasternal nodes

Posteriorly – posterior intercostal nodes

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3
Q

Thoracic wall periphery of diaphragm

A

Diaphragmatic nodes

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4
Q

Parietal pleura

A

Parasternal, posterior intercostal &

diaphragmatic

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5
Q

Posterior intercostal terminal drainage

A

– Thoracic duct & right lymphatic duct
(direct)
– Deep cervical nodes

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6
Q

Diaphragmatic terminal drainage

A

Parasternal, post. & sup. mediastinal

nodes

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7
Q

Superior mediastinal

A

AKA brachicephalic

Afferent: thymus, thyroid & pericardium

Efferent: + tracheobronchial = right & left bronchomediastinal trunks

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8
Q

Posterior mediastinal

A

Afferent: oesophagus, post. pericardium & diaphragm

Efferent: thoracic duct (some – tracheobronchial)

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9
Q

Tracheobronchial

A

Afferent: lungs, bronchi, trachea & heart

Efferent: right & left bronchomediastinal trunks

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10
Q

Tracheobronchial nodes (5 groups)

A 
– Paratracheal
– Superior tracheobronchial
– Inferior tracheobronchial
– Bronchopulmonary
– Pulmonary (intra)
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11
Q

Lung tissue

Visceral pleura

A

Superficial lymphatic plexus to bronchopulmonary to superior and inferior tracheobronchial

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12
Q

Deep to root of lung

A

Deep lymphatic plexus to pulmonary to bronchopulmonary to superior and inferior tracheobronchial

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13
Q

Inferior tracheobronchial

A

R and L bronchomediastinal trunks

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14
Q

Superior tracheobronchial

A

R lymphatic duct and thoracic duct

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15
Q

Anterior pericardium

A

Superior mediastinal to tracheobronchial to R and L bronchomediastinal trunks

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16
Q

Posterior pericardium

A

Posterior mediastinal to thoracic duct

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17
Q

Myocardium & subendocardial connective tissue

A

Subepicardial lymphatic plexus to coronary groove to coronary trunks

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18
Q

L coronary trunk

A

Ascend between pulmonary trunk and L atrium

Drains LV, LA, small portion RV

Inferior tracheobronchial

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19
Q

R coronary trunk

A

Ascending anterior to asc aorta

Drains RV, RA

Superior mediastinal

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20
Q

Oesophagus

A

Paraoesophageal

Upper 1/3: Deep cervical

Middle 1/3: Inferior tracheobronchial & posterior
mediastinal lymph nodes to R and L bronchomediastinal

Lower 1/3: Superior gastric

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21
Q

Diaphragm thoracic surface

A

Anterior and posterior diaphragmatic nodes to superior phrenic lymph nodes, parasternal lymph nodes, posterior mediastinal lymph nodes

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22
Q

Diaphragm abdominal surface

A

Anterior diaphragmatic to anterior diaphragmatic lymph nodes, inferior phrenic lymph nodes, superior lumbar lymph nodes

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23
Q

Axilla (6 groups)

A 
– Pectoral/anterior group
– Subscapular/posterior group
– Lateral group
– Central group
– Apical/infraclavicular group
– Deltopectoral group
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24
Q

Pectoral

A

AKA anterior

• 3 – 5 nodes
– Med. wall of axilla
– Around: lat. thoracic vein & inf. border of
pectoralis minor
• Afferent:
– Ant. thoracic wall (most of breast)
– Upper, anterior abdominal wall
• Efferent:
– Central nodes
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25
Q

Subscapular

A

AKA posterior

• 6 – 7 nodes
– Post. axillary fold
– Subscapular blood vessels
• Afferent:
– Post. aspect of thoracic wall (back)
– Scapular region (shoulder)
– Neck
• Efferent:
– Central nodes
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26
Q

Central

A 
• 3 – 4 large nodes
– Deep to pectoralis minor (near axilla
base)
– 2
nd part of axillary artery
• Afferent:
– Pectoral (ant), subscapular (post) &
humeral (lat)
• Efferent:
– Apical/Infraclavicular lymph nodes
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27
Q

Apical

A 
• Located:
– Med. side of axillary vein
– 1st part of axillary artery
• Afferent:
– Pectoral, subscapular, humeral & central
– Lymphatics: proximal cephalic vein
• Efferent:
– Unite → Subclavian lymphatic trunk
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28
Q

Lateral

A 
• 4 – 6 nodes
– Lat. wall of axilla
– Med. & post. to axillary vein
• Afferent:
– Medial aspect of the arm
– Most of lymphatics from upper limb
• Efferent:
– Central nodes
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29
Q

Mammary tissue

A 
• Subareolar plexus
– Pectoral nodes
• Medial border
– Parasternal nodes
• Inferomedial quadrant
– Subperitoneal and
pelvis
• 75% via axillary tail
– Pectoral nodes
• Lateral border
– Parasternal nodes
– Posterior intercostal
nodes
• Deep breast tissue
– Apical nodes
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30
Q

Hand drainage

A

NB!

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31
Q

Occipital

A

1 – 3 nodes ; back of head; apex of post. triangle
Afferents: occipital region of scalp
Efferents: sup. deep cervical nodes

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32
Q

Posterior auricular/mastoid

A

2 nodes; post. to ear on mastoid process
Afferents: post. surface of auricle, post. part
of scalp & post. wall of external acoustic meatus
Efferents: sup. deep cervical nodes

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33
Q

Preauricular

A

1 – 3 nodes; ant. to trachus of ear
Afferents: lat. surface of auricula & skin of
adjacent temporal region
Efferents: sup. deep cervical glands

34
Q

Parotid

A

2 groups: inside the gland & ant. to gland
Afferents: root of nose, eyelids, frontotemporal
region, ant. wall external acoustic meatus, conjunctiva
Efferents: sup. deep cervical nodes

35
Q

Buccal

A

1/more nodes; on buccinator @ ant. border of
masseter (relation: facial vein)
Afferents: cheek & lower eyelid
Efferents: submandibular nodes

36
Q

Submandibular

A

3 – 6 nodes; below deep fascia & on submandibular
salivary gland
Afferents: middle of forehead, nose & paranasal sinuses,
cheek, palate, gingiva, upper lip & ant. 2/3 of tongue
Efferents: sup. deep cervical nodes

37
Q

Submental

A

Between ant. bellies of digastric in submental
triangle
Afferents: apex of tongue, floor of mouth,
gingiva (lower incisors), chin, middle section of lower
lip
Efferents: submandibular nodes

38
Q

Superficial cervical

A

Along: ant, jugular vein & external jugular vein
Afferents: infrahyoid region, larynx, trachea, thyroid,
cervical part of oesophagus, lower part of ear and
parotid region
Efferents: submandibular nodes

39
Q

Pretracheal

A

Front of trachea
Afferents: lower larynx, thyroid gland, upper trachea
Efferents: lowest of sup. deep cervical nodes &
inf. deep cervical nodes

40
Q

Paratracheal

A

Few; alongside recurrent laryngeal nerves on
lat,. aspects of trachea & oesophagus
Afferents: thyroid gland, cervical portion trachea
Efferents: lowest of sup. deep cervical nodes & inf.
deep cervical nodes

41
Q

Prelaryngeal

A

On the middle cricothyroid ligament
Afferents: lower larynx, thyroid gland, upper trachea
Efferents: sup. deep cervical nodes

42
Q

Infrahyoid

A

Located: between levels of hyoid bone and thyroid
cartilage
Afferents: thyroid gland, larynx
Efferents: sup. deep cervical nodes

43
Q

Retropharyngeal

A

1 – 3 nodes; in buccopharyngeal fascia
Afferents: nasal cavities, nasal part of pharynx, auditory
tubes
Efferents: sup. deep cervical nodes

44
Q

Face

A

Submental
Afferents: Medial part of lower lip
and chin
Efferents: Submandibular nodes

Submandibular
Afferents: Medial corner of the orbit,
most of the external nose, medial part
of the cheek, upper lip, lateral part
of the lower lip
Efferents: superior deep cervical nodes

Preauricular and parotid
Afferents: Lateral part of face, eyelids,
part of the external nose, lateral part of
the cheek
Efferents: superior deep cervical nodes

45
Q

Scalp

A

Occipital
Afferents: Occipital area
Efferents: Superior deep cervical nodes

Postauricular/mastoid
Afferents: Post. To vertex of head
Efferents: Superior deep cervical node

Preauricular/parotid
Afferents: Ant. to vertex of head
Efferents: Superior deep cervical nodes

Submandibular
Afferents: Part of the forehead
Efferents: superior deep cervical nodes

46
Q

Eyelids and conjuctiva

A

Parotid
Afferents: Eyelids (lateral ¾)
Efferents: Superior deep cervical nodes

Submandibular
Afferents: Medial corner of eye (medial ¼)
Efferents: Superior deep cervical nodes

47
Q

Nose

A

Parotid
Afferents: Root of the nose
Efferents: Superior deep cervical nodes

Submandibular
Afferents: Surface of nose, ant. nasal cavities:
Efferents: Superior deep cervical nodes

Retropharyngeal
Afferents: Air sinuses, adenoids
Efferents: Superior deep cervical nodes

48
Q

Lips

A

Submandibular
Afferents: Upper lip, lateral parts of lower lip
Efferents: Superior deep cervical nodes

Submental
Afferents: Medial part of lower lip
Efferents: Submandibular nodes

49
Q

Teeth

A

Submandibular
Afferents: post. gums & teeth (lower)
Efferents: superior deep cervical nodes

Submental
Afferents: ant. gums & teeth (lower)
Efferents: submandibular nodes

Jugulodigastric
Afferents: ant. & post. gums & teeth (upper)
Efferents: inferior deep cervical nodes

50
Q

Tongue

A

Jugulodigastric
Afferents: Posterior third of tongue
Efferents: Inferior deep cervical nodes

Juguloomohyoid
Afferents: Medial part of anterior 2/3 of tongue
Efferents: Jugular trunks

Submandibular
Afferents: Lateral parts of anterior 2/3 of tongue
Efferents: Superior deep cervical nodes

Submental
Afferents: Apex and frenulum
Efferents: jugulo-omohyoid node

51
Q

Paratracheal

A

Afferents: Superior to vocal folds
Efferents: Inferior deep cervical nodes

52
Q

Thyroid

A

Prelaryngeal nodes
Afferents: Sup. lymphatic vessels from thyroid
Efferents: Superior deep cervical nodes

Inferior deep cervical nodes
Afferents: Ant. lymphatic vessels from thyroid
Efferents: Inferior deep cervical nodes

Pretracheal and Paratracheal nodes
Afferents: Lateral lymphatic vessels from thyroid
Efferents: right & left jugular trunks

Brachiocephalic nodes or thoracic duct
Afferents: Some lymphatic vessels

53
Q

Larynx

A

Superior deep cervical nodes
Afferents: Superior to vocal folds
Efferents: Inferior deep cervical nodes

Pretracheal OR paratracheal nodes
Afferents: Inferior to vocal folds
Efferents: Inferior deep cervical nodes

54
Q

Tonsils and adenoids

A

Jugulo-digastric nodes
Afferents: Tonsils
Efferents: right & left jugular trunks

Retropharyngeal nodes
Afferents: Adenoids
Efferents: inferior deep cervical nodes

55
Q

Deep lymphatic drainage of abdominal wall

A

Accompany deep veins of abdominal wall

Lumbar lymph nodes
Abdominal aorta

External iliac lymph nodes
External iliac artery

Common iliac lymph nodes
Common iliac artery

56
Q

Preaortic LN

A

Celiac nodes
Afferent: organs (foregut), superior & inferior mesenteric nodes
Efferents: cisterna chyli

Superior mesenteric nodes
Afferents: organs (midgut), inferior mesenteric nodes
Efferents: celiac nodes

Inferior mesenteric nodes
Afferents: organs (hindgut)
Efferents: superior mesenteric nodes

57
Q

Para aortic

A

Afferents: body wall, kidneys, suprarenal

glands, testes or ovaries

58
Q

Oesophagus

A

Left gastric lymph nodes
Afferents: abdominal part of oesophagus
Efferents: celiac lymph nodes

59
Q

Stomach

A

Gastric lymph nodes
Afferents: sup. 2/3 of stomach
Efferents: celiac lymph nodes

Gastro-omental lymph nodes
Afferents: ant. & post. surface of stomach
Efferents: celiac lymph nodes

Pancreaticosplenic lymph nodes
Afferents: fundus, superior part of body of stomach
Efferents: celiac lymph nodes

Pyloric lymph nodes
Afferents: right 2/3 of inferior 1/3 stomach
Efferents: celiac lymph nodes

Pancreaticoduodenal lymph nodes
Afferents: left 1/3 of greater curvature
Efferents: pyloric OR celiac lymph nodes

60
Q

Duodenum

A

Pacreaticosplenic lymph nodes
Afferents: anterior surface of duodenum
Efferents: celiac lymph nodes

Pyloric lymph nodes
Afferents: anterior surface of duodenum
Efferents: superior mesenteric lymph nodes

Superior mesenteric lymph nodes
Afferents: posterior surface of duodenum
Efferents: celiac lymph nodes

61
Q

Jejenum and ileum

A

Juxta-intestinal lymph nodes
Located close to intestinal wall
Afferents: jejunum & ileum
Efferents: mesenteric lymph nodes

Mesenteric lymph nodes
Scattered along the arterial arcades
Afferents: Jejunum & ileum
Efferents: superior central nodes

Superior central lymph nodes
Located along proximal part of SMA
Afferents: anterior surface of duodenum
Efferents: superior mesenteric lymph nodes

62
Q

Caecum and appendix

A

Ileocolic lymph nodes
Located along ileocolic artery
Afferents: cecum & appendix
Efferents: superior mesenteric nodes

Mesoappendix lymph nodes

63
Q

Ascending colon & prox. 2/3 of transverse colon

A

NB!!!

64
Q

Distal 1/3 of transverse colon & descending colon & sigmoid colon

A

NB!!!

65
Q

Pancreas

A

Pancreaticosplenic lymph nodes
Along splenic artery
Afferents: most of body of pancreas and tail
Efferents: superior mesenteric nodes

Pyloric lymph nodes
Along gastroduocenal artery
Afferents: some of body of pancreas and
the head
Efferents: superior mesenteric nodes
66
Q

Liver and gallbladder

A 
Hepatic nodes
Superficial lymphatics: ant. aspects of diaphragmatic
& visceral surfaces
Deep lymphatics: portal triad vessels
Gallbladder (via cystic nodes)
Efferents: celiac nodes

Phrenic nodes
Superficial lymphatics: post. aspects of diaphragmatic
& visceral surfaces (drain to bare area of liver)
Efferents: posterior mediastinal lymph nodes

67
Q

Spleen

A

Splenic hilar nodes to pancreaticosplenic nodes

68
Q

Kidneys, suprarenal glands and ureters

A

Lymphatic plexuses in kidney = 3
Substance of kidney
Under fibrous capsule of kidney
Perirenal fat

Lumbar nodes
Afferents: 4/5 lymphatic trunks leave renal hilum, lymph
from suprarenal glands, superior part of ureters
Efferents: Lumbar trunks → cisterna chyli

Common iliac nodes
Afferents: middle part of ureters
Efferents: lumbar nodes

Common iliac, external iliac or internal iliac nodes
Afferents: inferior part of ureters
Efferents: lumbar nodes

69
Q

Pelvis

A 
External iliac lymph nodes
Location: above pelvic brim, along
external iliac vessels
Afferents: inguinal lymph nodes, pelvic
viscera (sup. parts of middle to ant.
pelvic organs)
Efferents: common iliac nodes

Internal iliac lymph nodes
Location: clustered: ant. & post. divisions
of internal iliac arteries & origins of
gluteal arteries
Afferents: inf. pelvic viscera, deep perineum,
gluteal region
Efferents: common iliac nodes

Sacral iliac lymph nodes
Location: concavity of sacrum, adjacent to
median sacral vessels
Afferents: posteroinferior pelvic viscera
Efferents: internal or common iliac nodes

Common iliac lymph nodes
Location: superior to pelvis
Afferents: external, internal & sacral nodes,
neck of bladder, inferior vagina
Efferents: lumbar nodes
70
Q

Bladder

A

External iliac nodes
Afferents: superolateral aspects of bladder
Efferents: common iliac nodes

Internal iliac nodes
Afferents: fundus and neck of bladder
Efferents: common iliac nodes

Common iliac nodes
Afferents: neck of bladder (some)
Efferents: lumbar nodes

71
Q

Rectum

A

Pararectal nodes
Directly on muscle layer of rectum
Afferents: superior ½ of rectum
Efferents: inf. mesenteric nodes

Sacral nodes
Afferents: inferior ½ of rectum
Efferents: internal iliac nodes (some vessels
may drain directly into internal iliac nodes

72
Q

Anal canal

A

Internal iliac nodes
Afferents: superior to pectinate line
Efferents: common iliac nodes → lumbar

Superficial inguinal nodes
Afferents: inferior to pectinate line
Efferents: external iliac nodes OR deep inguinal
nodes → lumbar

73
Q

Male intrapelvic organs

A

Internal iliac nodes
Afferents: majority of prostate, proximal urethra, inferior
part of seminal glands,
Efferents: common iliac nodes → lumbar

Sacral nodes
Afferents: some of prostate
Efferents: internal iliac nodes

External iliac nodes
Afferents: proximal urethra(some), ductus deferens,
ejaculatory ducts, superior part of seminal glands
Efferents: common iliac nodes → lumbar

Deep inguinal nodes
Afferents: distal urethra
Efferents: external iliac nodes

74
Q

Female intrapelvis nodes

A

Internal iliac nodes
Afferents: cervix of uterus, superior & middle parts of vagina,
proximal urethra
Efferents: common iliac nodes → lumbar

Sacral nodes
Afferents: cervix of uterus, inferior part of vagina (or CIN)
Efferents: internal iliac nodes

External iliac nodes
Afferents: body & cervix of uterus, superior part of vagina
Efferents: common iliac nodes → lumbar

Superficial inguinal nodes
Afferents: external orifice of vagina, fundus (uterus)
Efferents: external iliac nodes or deep inguinal nodes

Deep inguinal nodes
Afferents: distal urethra
Efferents: external iliac nodes

Lumbar nodes
Afferents: ovaries & uterine tubes,
fundus of uterus
Efferents: cisterna chyli

75
Q

Male external genitalia organs

A

Internal iliac nodes
Afferents: cavernous bodies of penis
Efferents: common iliac nodes

Superficial inguinal nodes
Afferents: skin of penis, scrotum
Efferents: external iliac nodes OR deep inguinal

External iliac nodes
Afferents: glans of penis
Efferents: external iliac nodes

Lumbar nodes
Afferents: testis & epididymis
Efferents: cisterna chyli

Deep inguinal nodes
Afferents: glans of penis,
Efferents: external iliac nodes

76
Q

Female external genitalia organs

A

Superficial inguinal nodes
Afferents: vulva
Efferents: external iliac nodes OR deep inguinal

Deep inguinal nodes
Afferents: glans clitoris & labia
Efferents: external iliac nodes

77
Q

Inguinal nodes

A

– Superficial group of nodes
• Subdivided in 2
• Horizontal chain (superior) – inferior inguinal
ligament
• Vertical (inferior) chain – along great saphenous
vein
– Deep group of nodes

78
Q

Popliteal nodes

A

• 5 – 6 nodes; surrounding popliteal vessels
in popliteal fossa
• Superficial (in subcutaneous tissue) and
deep nodes (surround vessels)
• Afferents:
– Superficial vessels (small saphenous vein)
– Deep areas of leg and foot
• Efferents:
– Deep inguinal nodes → external iliac nodes

79
Q

Deep inguinal nodes

A 
• Vary in number between 1 – 3
• Lie medial to femoral vein
• Nodes located as follows:
– Great saphenous vein join femoral vein
– In femoral sheath
– Lateral part of femoral ring
• Afferents:
– Deep lymphatics associated with femoral
vessels
– Glans penis or clitoris (perineum)
– Connection: superficial inguinal nodes
80
Q

Superficial inguinal nodes

A 
• ± 10 nodes; in superficial fascia
• Afferents:
– Gluteal region
– Lower abdominal wall
– Perineum & external genitalia
– Superficial regions of lower limbs
• Efferents:
– External iliac nodes (interconnect – deep
inguinal nodes)
• Common iliac nodes → lumbar nodes → lumbar
trunks → cisterna chyli
81
Q

Foot

A 
• Subcutaneous plexuses
– Superficial & deep lymphatic vessels
• Superficial lymphatic vessels
– Medial superficial lymphatic vessels
– Lateral superficial lymphatic vessels
• Deep lymphatic vessels

MBChB II Anatomical Pathology (2 decks)

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