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lymphatics Flashcards

1
Q

what are the functions of the lymphatic system?

A
  • Drains excess interstitial fluid (up to 3L per day) back into venous circulation.
  • Involved in transporting dietary lipids from GI tract to blood (as well as hormones0
  • Involved in immune responses that protect against invasion
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2
Q

what is the main disadvantage of the lymphatic system?

A

plays a role in the spread of malignancy

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3
Q

describe the oncotic and hydrostatic pressure at the arterial and venous end of the capillary bed

A

o Arterial end: high hydrostatic pressure and low oncotic pressure. Fluid moves out of the capillary into the interstitum to form ISF.
o Venous end: low hydrostatic pressure and high oncotic pressure

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4
Q

how much fluid is taken in and out of the capillary bed each day? what is the excess?

A

excess 3L/day
o 17 litres taken in per day
o 20 litres removed per day

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5
Q

describe the structure of lymphatic capillaries

A
  • Lymphatic capillaries are one-way tubes
  • Made of an endothelial tube. Either have a discontinuous basement membrane or no basement membrane at all – v permeable
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6
Q

describe the composition of lymph

A

same as interstitial fluid

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7
Q

what do lymphatic capillaries join together to form?

A

join together to form lymphatic collecting ducts

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8
Q

what’s the difference between lymphatic capillaries and ducts?

A

ducts have valves

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9
Q

what’s the difference between veins and lymphatic ducts?

A

• Ducts have valves – more than veins bc they’re at a lower pressure than veins and there’s no heart pumping lymph around.

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10
Q

why do ducts need valves?

A

needed to stop backflow of lymph into the capillary beds

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11
Q

put the lymphatic vessels in order of biggest to smallest

A

• Lymphatic duct  lymphatic trunk  lymph nodes  lymph collecting vessels  lymphatic capillaries

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12
Q

what is elephantitis and what causes it?

A

• Roundworm infection of lymph nodes blocking the lymphatic drainage so interstitial fluid builds up in the tissues.

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13
Q

what are lymph nodes?

A

small masses of lymphoid tissue located along the length of the lymphatic vessels through which lymph is filtered

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14
Q

what surrounds each lymph node?

A

fibrous capsule

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15
Q

what divides lymph nodes into different segments?

A

trabeculae

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16
Q

what are the 2 different sections of a lymph node?

A

outer cortex and inner medulla

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17
Q

what cells are found in the cortex of lymph nodes?

A

lymphocytes

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18
Q

describe the passage of lymph into, through and out of a lymph node

A

o Afferent vessel  cortex  medulla  efferent vessel

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19
Q

why do lymph nodes swell?

A

During infection, you get more lymphocytes to the nodes so there’s swelling of the lymph nodes

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20
Q

where does the thoracic duct run?

A

in the posterior mediastinum

between the descending aorta and azygous vein

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21
Q

what is the cisterna chyli?

A

the beginning of the thoracic duct in the abdomen

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22
Q

what is the left venous angle?

A

where the internal jugular vein joins the subclavian vein and they form an angle

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23
Q

what parts of the body drain into the left venous angle?

A

3/4 - all abdomen, both legs, left side of thorax, left upper limb, left side of the head and neck drain into the left venous angle

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24
Q

what parts of the body drain into the right venous angle?

A

Remaining ¼ drains via the right lymphatic trunk

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25
Q

what is a chylothorax?

A

Any sort of laceration or disruption to the thoracic duct, it leaks lymph into the thoracic cavity

26
Q

what are the superficial lymph nodes?

A

cervical, axillary and inguinal

27
Q

where are the superficial cervical lymph nodes found?

A

gathered around the external jugular vein

found on the superficial surface of the SCM

28
Q

describe the passage of vessels from the superficial lymph nodes to the deep lymph nodes?

A

afferent vessels into the superficial lymph nodes

efferent vessels into the deep lymph nodes

29
Q

where are the deep cervical lymph nodes found?

A

vertical chain along the IJV

30
Q

where is the internal jugular vein?

A

• Underneath the SCM is the IJV in the carotid sheath with the common carotid artery and the vagus nerve

31
Q

what is the right jugular trunk?

A

efferent vessels from the deep cervical lymph nodes

32
Q

when are lymph nodes most readily palpable?

A

when fighting infection

33
Q

how do infected lymph nodes feel?

A

Firm, tender, enlarged and warm.

34
Q

how do lymph nodes with malignancies feel?

A

Firm, non-tender, matted (i.e. stuck to each other), fixed (i.e. not freely mobile but rather stuck down to underlying tissue), and increase in size over time.

35
Q

what are the primary sites of metastatic neck disease?

A

mucosal areas of the upper digestive tract.

36
Q

what type of cancer is metastatic neck disease?

A

squamous cell carcinoma

37
Q

what does radical neck dissection involve?

A

removal of SCM, IJV and the spinal accessory nerve and the cervical lymph nodes.

38
Q

what are the most common procedures for radical neck dissection?

A

2 procedures in common use today are the modified radical (leave 1+ structure) and the selective neck dissections (leave 1+ LN group).

39
Q

what drains into the axillary lymph nodes?

A
  • Important bc 75% of lymph from the breasts drain to these

* Other 25% drain to the parasternal lymph nodes

40
Q

what are the axillary lymph nodes and what drains into them?

A
  • Humeral – close to axillary pulse. Most lymph from the upper limb comes here
  • Pectoral – lymph from anterior chest wall (aka breast)
  • Subscapular – posterior chest wall.
41
Q

describe the route of the lymph once it drains out of the axillary lymph nodes

A

All of these drain towards central  apical which are just below the clavicle  supraclavicular nodes  right venous angle (on the left side they’ll drain towards the left venous angle)

42
Q

what is a radical mastectomy

A

removal of all breast tissue, along with the nipple, axillary lymph nodes and a portion of pectoralis major. This is rarely performed today.

43
Q

what is a modified radical mastectomy?

A

removal of breast, nipple and most axillary lymph nodes.

44
Q

what is the sentinel lymph node?

A

the first lymph node a tumour reaches

45
Q

how is sentinel lymph node identification carried out?

A
  • Known tumour is injected with radioactive substance or dye
  • Allowed to drain and see where the dye goes
  • Remove these nodes and the tumour. Less extensive than removing all the nodes
46
Q

where are the inguinal lymph nodes found?

A

in the femoral triangle

47
Q

what drains into the inguinal lymph nodes

A

• Drain all the lymph from the lower limb and external genitalia

48
Q

what are the 2 groups of the inguinal lymph nodes

A

o Horizontal – (run superficial to inguinal ligament). Superficial lymphatics from anterior abdominal wall, the perineum, and the external genitalia (excl. testes)
o Vertical – lie along termination great saphenous vein

49
Q

where do the testes and ovaries develop?

A

Both testes and ovaries start development in the posterior abdominal wall and then descend

50
Q

where do the testicular and ovarian artery come from and why?

A

as they descend they take their blood supply with them – testicular and ovarian artery come from the abdominal aorta at L2

51
Q

where does lymph from the testes drain?

A

Travels back up with the testicular vein to the para-aortic or the lumbar lymph node - lymph nodes around the aorta

52
Q

where does lymph from the scrotum go?

A

goes to the superficial inguinal nodes

53
Q

where does lymph from the internal and external iliac nodes drain?

A

drains into the common iliac nodes and then the lumbar nodes.

54
Q

where does lymph from the GI tract drain?

A

• Lymph from the GI tract drains into the pre-aortic lymph nodes (celiac, superior mesenteric and inferior mesenteric nodes)

55
Q

where does lymph from intestinal and right and left lumbar trunks drain?

A

into cisterna chyli

56
Q

what is the largest lymphoid organ?

A

spleen

57
Q

where is the spleen located?

A

located in the left hypochondrium, deep to the 9th-11th ribs

58
Q

what happens in the spleen?

A

o lymphocyte proliferation

o RBC filtration, destruction and storage.

59
Q

where is the thymus gland found?

A

superior mediastinum

60
Q

what happens to the thymus gland after puberty?

A

• After puberty the thymus gland undergoes progressive atrophy and is replaced by fat.

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