lymphatic system of body and clinical

1. THE LYMPHATIC SYSTEM
Dr. Pallavi Jain

2. CONTENT
➤ Introduction
➤ Micro anatomy and physiology of
lymphatics
➤ Components
➤ Drainage of lymphatics
➤ Lymphoid organ
➤ Regional lymphatic distribution in the
body
➤ Clinical importance

3. INTRODUCTION
➤ PART OF CIRCULATORY SYSTEM AND FORMS THE IMMUNE SYSTEM OF
BODY
➤ LATIN,LYMPHA MEANING “WATER” directionally toward heart
➤ WIDELY DISTRIBUTED IN BODY EXCEPT FROM CNS ,EYEBALL, INTERNAL
EAR,CARTILAGE AND BONE

4. LYMPH
➤ DERIVED FROM TISSUE FLUID
➤ CONTAINS MORE WHITE BLOOD CELLS THAN PLASMA
➤ ENTERS NODES THROUGH AFFERENT LYMPHATIC VESSELS
➤ FLOWS THROUGH NODE IN ONE DIRECTION

5. FUNCTION
Returns some plasma proteins that leak into extracellular spaces as well
as cellular debris that cannot return through the wall of blood
capillaries
Essential for immunological defences.

6. MICROANATOMY AND PHYSIOLOGY
➤ LYMPHATIC COLLECTORS DRAIN
INTO LYMPH NODES WHICH ARE
ARRANGED IN REGIONAL GROUPS.
➤ THEY FINALLY DRAIN INTO VENOUS
CIRCULATION
➤ EXCEPTION-
➤ THYROID GLAND
➤ ESOPHAGUS
➤ CORONARY AND TRIANGULAR
LIGAMENT OF LIVER

7. COMPONENT
➤ LYMPHATIC PLEXUSES:network of lymphatic capillaries.
➤ LYMPHATIC VESSELS:thin walled vessels with abundant valves.beaded appearance
➤ LYMPHOID TISSUE:
Sites that produce lymphocytes,
aggregated in walls of digestive tract,
Spleen, thymus and lymph nodes

8. DRAINAGE OF LYMPHATIC SYSTEM
SUPERFICIAL LYMPHATIC VESSELS
DEEP LYMPHATIC VESSELS
LYMPH NODES
LYMPH TRUNKS
LYMPH DUCTS
FLOW RATE :1-3 mL/min

9. ➤ MICROSCOPIC CLOSED ENDED VESSELS
➤ LOCATED NEXT TO BLOOD CAPILLARIES
➤ PERMEABLE TO PLASMA PROTEINS
➤ MERGE TO FORM LYMPH VESSELS
LYMPHATIC CAPILLARIES

10. ➤ ACTS AS ONE-WAY VALVES FOR INTERSTITIAL FLUID TO FLOW
➤ ATTACHED TO SURROUNDING TISSUE BY ANCHORING FILAMENTS
➤ LYMPH IS KEPT MOVING BY-
➤ Constriction of vessels
➤ Skeletal muscle pump
➤ Respiratory pump
➤ AT INTERVALS ALONG VESSELS LYMPH FLOWS INTO LN
➤ LYMPHATIC VESSELS UNITE TO FORM LYMPH TRUNKS
LYMPHATIC VESSELS

11. ➤ Formed by lymphatic vessels uniting
➤ Large tubes
➤ Empty their lymph into lymphatic ducts
LYMPH TRUNKS
LYMPHATIC DUCTS
➤ Two conducting ducts
➤ The thoracic duct(left lymphatic duct)
➤ The right lymphatic duct

12. THORACIC DUCT (LEFT LYMPHATIC DUCT)
➤ 15-18 inches(38-45cm) in length
➤ Begins as dilation called cisterns
chyli
➤ Main collecting duct of lymphatic
system
➤ Receives lymph from lower body
and upper left quadrant
➤ Empties into the left subclavian
vein

13. RIGHT LYMPHATIC DUCT
➤ About 0.5 inches (1.5 cm ) in
length
➤ Receives lymph from upper
right quadrant
➤ Empties into the right
subclavian vein

14. CISTERNA CHYLI
➤ Large lymph vessel
➤ Formed by the union of lymph vessels from lower limb
➤ Located anterior to the second lumbar vertebra
➤ Continues superiorly as thoracic duct

15. LYMPHOID
TISSUES

16. LYMPHOID ORGANS
➤ Primary /Central Lymphoid organs
➤ Bone marrow
➤ Thymus
➤ Secondary/Peripheral lymphoid organs
➤ Lymph nodes
➤ Spleen
➤ MALT(mucosal associated lymphoid tissue)

17. BONE MARROW
➤ Site of B cell development and maturation
➤ T cell originate in marrow but mature in thymus
Thymus
➤ Bilobed organ on the top of heart
➤ Reaches maximum size during puberty
➤ 70g in infants , 3g in adults
➤ 95-99% T cell die in thymus
➤ Consist of cortex and medulla
➤ T cells maturation takes place in thymus

18. LYMPH NODES
➤ Oval or bean shaped
➤ Masses of lymphatic tissue
➤ Aid in defence and white blood cell
formation
➤ Located along length of lymphatic
vessels
➤ Scattered throughout the body
usually in clusters
➤ Covered by capsule

19. ➤ Contain capsular extension called trabecular (form partitions within node)
➤ Internal to capsule are reticular
fi
bres and
fi
broblast
➤ Form framework of a lymph node
➤ Two main regions of a lymph node:
➤ Cortex- outer rim of follicle T cells, macrophages, and follicular dendritic cells
➤ Medulla- inner region contain macrophages and plasma cells

23. LYMPHATIC DRAINAGE OF LOWER LIMB
➤ SUPERFICIAL INGUINAL LN
➤ Parallel to and below inguinal ligament
➤ Vertically along the great saphenous vein
➤ Drainage area-
➤ Lower limb except posterolateral part of calf
➤ Lower abdominal wall below umbilicus
➤ External genitalia (excluding testes)
➤ Cornu of uterus and round ligament
➤ Perineum, lower anal canal ,vagina

24. ➤ DEEP INGUINAL LN
➤ 3 out of 4 LN lie medial to femoral vein and one in
femoral canal
➤ Drainage area
➤ Femoral vessels from popliteal fossa
➤ Glans penis (or clitoris)
➤ E
ff
erent lymphatics from super
fi
cial inguinal LN
E
ff
erent from deep inguinal LN enter external iliac LN
through femoral canal

30. Upper deep cervical examination Lower deep cervical examination

35. CLINICAL IMPORTANCE
➤ Obstruction- Lymphoedema.
➤ Conduit for spread of
malignant diseases and
infection
➤ May be site of primary tumor

36. LYMPHANGIOGRAM

37. SENTINEL LYMPH NODE
➤ First lymph node draining the anatomical region
➤ Techniques
➤ Preoperative
lymphoscintigraphy(technetium-99)
➤ Intaoperative gamma probe
➤ Blue dye agent(isosulfan blue)

38. ➤ LN are most common site for tumour metastasis.
➤ Poor prognosis and need for systemic therapies
➤ Positive lymph nodes-ability of tumour to metastasis to distant organ
➤ Role of lymph node positivity in tumour outcome is controversial.
LYMPHATIC SYSTEM IN CANCER PROGRESSION

39. THANK YOU