The lymphatic system acts as a drainage system that filters antigens and returns interstitial fluid to the bloodstream. It is composed of lymph, lymphatic vessels, lymphatic organs, and lymphatic cells. Lymphatic capillaries are permeable and collect tissue fluid known as lymph before draining it into lymphatic vessels and lymph nodes, which filter antigens and initiate immune responses. Physical examination of lymph nodes involves inspection for features like size, number, and tenderness, as well as palpation to determine consistency, mobility, and related drainage areas. Common diseases of the lymphatic system include lymphadenopathy, lymphangitis, filariasis, lymphedema, and lymph

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

5. Components of lymphatics
 Lymph
 Lymphatic Vessels
 Lymphatic Organs
 Lymphatic cells

6. Secondary lymphoid tissue

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

10. Lymphatic Ducts
Thoracic duct
Right lymphatic duct

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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12. Lymphatic Organs
Primary organs
 Red bone marrow
 Thymus gland
Secondary organs
 Lymph nodes
 Lymph nodules
 Spleen

13. Lymph nodes
• Capsular shell
• Fibroblasts and reticulin
fibers
• Macrophages
• Dendritic cells
• T cells
• B cells

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

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

23. Filariasis

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

26. Lymphomas
• Cancers originating either
from the lymphocytes in the
lymph nodes or the
lymphatic tissue in organs