1. Lymphatic system
Dr Sanjay Singhal
Ms general surgery
Professor and head of Unit II
Department of General Surgery
2. Lymph
•What is lymph ?
Tissue fluid (interstitial fluid) that enters
the lymphatic vessel
3. Essentially a drainage
system accessory to
venous system
larger particles that escape into
tissue fluid can only be removed
via lymphatic system
Lymphatic system
4. Functions
Network that filters antigens from the interstitial fluid
Primary site of immune response from tissue antigens
Lymphatic drainage in all organs of the body except brain, eyes,
marrow and cartilage
Flaccid thin walled channels progressive caliber
600 lymph nodes in body
Slow flow, low pressure system returns interstitial fluid to the blood
system
7. Lymphatic Capillaries
Features of structure:
• Blind end
• Single layer of overlapping
endothelial cells
• More permeable than that of blood
capillary
• Absent from avascular structures,
brain, spinal cord splenic pulp and
bone marrow
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8. Lymphatic Vessels
Three layered wall but
thinner than vein
More numerous valves than
in vein
Interposed by lymph nodes
at intervals
Arranged in superficial and
deep sets
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9. Lymph Trunks
Right and left jugular trunks
Right and left subclavian trunks
Right and left bronchomediastinal trunks
Right and left lumbar trunks
Intestinal trunk
11. Lymphatic Cells
• Also called lymphoid cells
• Located in both the lymphatic system and the cardiovascular
system.
• Work together to elicit an immune response.
• Types of lymphatic cells are:
Macrophages
Epithelial cells
Dendritic cells
Lymphocytes
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13. Lymph nodes
• Capsular shell
• Fibroblasts and reticulin
fibers
• Macrophages
• Dendritic cells
• T cells
• B cells
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15. LOCAL
EXAMINATION
• INSPECTION-
• 1. Swelling-
• Shape
• Size
• Surface
• Edge
• Number- single or multiple
• Generalised LN seen in Hodgkin’s lymphoma, Tuberculosis,
lymphosarcoma, lymphatic leukaemia, brucellosis , sarcoidosis etc.
• Position- gives an idea about the group of LN involved as well as help in
diagnosing the disease.
• Eg- Hodgkin’s disease and TB affect the cervical group of LN in the
beginning.
• Filariasis and lymphogranuloma inguinale affect the inguinal group of
LNs.
• Secondary stage of Syphilis involves the epitrochlear and occipital groups.
16. 2.Skin over the swelling-
Inflammed in case of Acute lymphadenitis (
Redness, odema, brawny induration )
In case of chronic lymphadenitis, skin doesn’t show such
angriness.
Skin over Tuberculous lymphadenitis and cold abscess
remains “cold “ till they reach the point of bursting when the
skin becomes red and glossy
3. Pressure effects- Careful inspection must be made of the
whole body to detect any pressure effect due to enlargement
of LNs.
Eg- odema of upper and lower limb may occur due to
enlargement of axillary and inguinal LN respectively.
Nerves may be involved.
Dyspnoea and dysphagia due to pressure on the trachea and
oesophagus
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18. PALPATION
1.Local rise in temperature
2. Tenderness over the swelling
3.Number
4.Situation
5.Surface
6. Margin
7. Consistency-
Can be Soft / firm/ hard .
Should be palpated with palmar aspects of the 3 fingers,while rolling the fingers against
the swelling slight pressure is maintained to know the actual consistency of swelling.
Eg- Hodgkin’s disease- LNs may be Soft ( fluctuating) or elastic and rubbery in consistency
Syphilis – firm, discrete and shotty
POINTS TO REMEMBER- “NORMAL LYMPH NODES WITHOUT ENLARGEMENT ARE NOT
PALPABLE”
Matted LNs seen in case of Tuberculosis, acute lymphadenitis and metastatic carcinoma(
Matting of LNs suggests periadenitis.
19. 8. Fixity to surrounding
structures- LN should be
palpated to know if they are
fixed to the skin, the deep
muscles ,the vessels ,the nerves
etc.
9. Drainage area – should be
examined properly
20. GENERAL EXAMINATION
1.Lymph nodes in other parts of the body should always
examined.
2. Always examine – a) Spleen
b) Liver
c) Mesentric and iliac LNs
3.Examine the lungs for TB and Secondary metastasis
4. Syphilitic Stigmas
5. Parotid and Lacrimal glands
21. Lymphangitis
• Inflammation of the lymph vessels
• Commonest cause bacteria called streptococcus
pyogenes(most common).
• Lymph vessels appear as red streaks through
the skin
24. Lymphedema
• Occurs due to accumulation
of lymphatic fluid in the
interstitial tissue
• Sometimes can be
appreciated after wearing
tight clothing or jewellary on
affected limb
25. Lymphadenopathy
• Means a disease of the
lymph nodes
• Lymph nodes become
swollen/ enlarged and
may be painful to touch