The document provides an overview of the lymphatic system. It describes how the lymphatic system was first discovered over 2000 years ago and defines key components including lymph, lymphatic vessels, lymph nodes, and lymphoid organs such as the spleen, thymus, and bone marrow. The document then discusses several conditions related to the lymphatic system including lymphangitis, lymphoedema, filariasis, elephantiasis, and lipodema. It provides details on the causes, symptoms, and management of these conditions.

1. DR ZULKIFLU MUSA
ARGUNGU

2. INTRODUCTION
 The lymphatic system was first described by
Erasistratus in Alexandria more than 2000 years
ago.
 William Hunter, in the late eighteenth century, was
the first to describe the function of the lymphatic
system.
 Starling’s pioneering work on the hydrostatic and
haemodynamic forces controlling the movement of
fluid across the capillary provided further insights
into the function of the lymphatics.
 However, there is much about the lymphatic system that is
not understood and debate continues over the precise
aetiology of the most common abnormality of the system,
namely lymphoedema.

3. WHAT IS LYMPHATIC SYSTEM?
• The lymphatic system is part of the
circulatory system and an important part of
the immune system, comprising a network of
lymphatic vessels that carry a clear fluid
called lymph (from Latin, lympha meaning
"water”) directionally towards the heart.

4. Lymph
Lymph vessels
Lymph node
Lymph organ eg.
Spleen, Thymus
Diffuse lymphoid
tissue eg. Tonsil
It consist of...........

5.  Meaning:-After blood travels through capillary beds
and is moved to the venous system, some of its fluid is
left behind in the tissues it called lymph.
 Lymph is a clear, colorless liquid with a
composition similar to blood plasma.
 It is nothing but the clear, watery blood plasma leaked out
through the capillary walls to flow around the cells.
 It contains oxygen, proteins, glucose and white blood
cells.
Lymph:-

6. The cardiovascular system pumps blood through its system but
it cannot return all the fluid from the body cells.
The lymph system picks up 60% of the fluid dropped off at the
cellular level,
at this point we are talking about interstial fluid, the IF
picks up plasma and becomes tissue fluid
The tissue fluid is then picked up by lymph capillaries,
The tissue fluid is called lymph
Lymph is an alkaline (pH > 7.0)
The origin on lymph :-

7. ⦁ Lymph acts as a "middle man" which transports
oxygen, food materials, hormones, etc., to the body
cells
⦁ Body cells are kept moist by the lymph
⦁ Transports fats from digestive system
⦁ It destroys the invading microorganisms and foreign
particles in the lymph nodes

8. Lymphatic Vessels

9. LYMPH VESSELS
• These originate as blind end tubes in the interstitial
spaces.
• Structurely,they are same as blood capillaries.
• Their walls are more permeable to all interstitial fluid
including proteins and cell debris.
• The capillaries joint to form larger lypmph vessels.
• Lymph vessels have numerous cup shaped valves that
prevent back flow of movements of lymph in vessels.
• Lymph vessels join together to form two larger ducts
(i) The Thoracic duct
(ii) The right Lymphatic duct

10. LYMPH VESSELS

11. (i) THE THORACIC DUCT
• What is duct?
A duct is a circumscribed channel leading from
an organ.
Length-40cm
Ascends through the diaphragm and passes
upwards in the thoracic cavity.
it drains Lymph from
Both legs
The pelvicabdominal cavities
Left half of the The Thorax
Head & Neck
The Left upper Limbs.

12. (ii) THE RIGHT LYMPHATIC DUCT
• It lies in the root of the neck and open into
right subclavian vein.
• It drains lymph from
Right half of the thorax neck
Right upper limb

13. Lymph node

14. ⦁ Small bean-shaped structures
⦁ Usually less than 2.5 cm (1 inch) in length.
⦁ Three superficial regions where lymph nodes
tend to cluster
1. Inguinal nodes in the groin
2. Axillary nodes in the armpit
3. Cervical nodes in the neck

15. ⦁ Filter the lymph before it is returned to the
blood.
⦁ Preventing foreign particles from entering the
bloodstream
⦁ They also produce lymphocytes

16. Lymphoid Organs
 Several other
organs contribute
to lymphatic
function
Spleen
Thymus
Tonsils
Bone Marrow

17. The Spleen
 Also known as blood
bank organ, largest
organ of the LS
 Function
• Phagocytosis of
Bacteria
• Break down of RBC.
• Production of
Antibodies

18. SPLEEN
• The Spleen is formed partly by lymphatic system.
• Location-left hypochondriac region
• Length-12 cm
• Width-7 cm
• Thick-2.5 cm
• Shape-oval
• Relations-
Posteriorly & Superiorly- Diaphragm
Inferiorly-Left colic flexure of large intestine
Anteriorly-Fundus of the stomach

19. STRUCTURE OF SPLEEN
• Enclosed in peritoneum.
• Covered by a capsule.
• The spleen has no afferent lymphatic vessels, so it
does not filter lymph.
• Spleen consists red and white tissue.
• Blood supply
• Splenic artery
• Splenic vein
• Lymphatic vessels
• Nerves

20. Thymus
 The thymus gland is the body
organ that took scientists the
longest time to understand.
 Organ's mystery that has baffled
scientists for centuries.
 Some experts say the ancient
Greeks, who discovered the
organ, named it thymus because
its shape looks like the leaves of
thyme, a cooking herb

21.  Others say the name came from the Greek word for
the soul because the organ is near the heart.
 The famous Greek philosopher-surgeon, Galen, was
the first to notice that the thymus gland changes
with age. Galen wrote that it's large in newborn
animals and becomes smaller when they're adults.
 Thymus gland reaches its maximum size when
you're a teenager. Then, it starts to shrink slowly. By
the time you turn 75 years old, your thymus gland
turns to fat.

22. THYMUS GLAND
• Weight-15 gms
Relations-
Anteriorly-Sternum.
Posteriorly –Aortic arch.
Superiorly- Root of neck.
Inferiorly-Heart.
Laterally-Lungs.
Lobes- two
Each lobule has aggregation of lymphocytes.
The cortex is composed of aggregation of lymphocytes.
Medulla contains less lymphocytes.
The Thymus gland develops mature T lymphocytes.

24. BLOOD SUPPLY TO THE THYMUS GLAND
• Inferior thyroid artery.
• Internal thoracic artery.
• Nerves derived from vagus nerve.
Functions
• Activation of T-lymphocytes
• Production of antibodies.
• Production of Thymosin hormone.
[Thymosins are small proteins present in many
animal tissues. they are named thymosins because
they were originally isolated from the thymus]

25. Tonsils
 Small masses of
lymphoid tissue
around the pharynx
 Trap and remove
bacteria and other
foreign materials
 Tonsillitis is caused
by congestion with
bacteria

26. BONE MARROW
• The Red Bone Marrow is a key element of
the lymphatic system, being one of the primary
lymphoid organs that generate lymphocytes
from immature hematopoietic progenitor cells.
• The bone marrow and Thymus constitute the
primary lymphoid tissues involved in the
production and early selection of lymphocytes.
• Furthermore, bone marrow performs a valve-like
function to prevent the backflow of lymphatic fluid
in the lymphatic system.

28. Acute Lymphangitis
• Lymphangitis is an inflammation of the lymphatic system, which is a major
component of your immune system.
Causes
• Acute lymphangitis is an infection, often caused by Streptococcus pyogenes or
Staphylococcus aureus, which spreads to the draining lymphatics and lymph
nodes (lymphadenitis) where an abscess may form.
S/S
• The normal signs of infection (rubor, calor, dolor{redness, heat, pain}) are
present and a red line is seen in the skin along the line of the inflamed
lymphatic (Figure 58.1).
MGT
• The part should be rested to reduce lymphatic drainage and elevated to reduce
swelling, and the patient should be treated with intravenous antibiotics.
Complication
• Bacteraemia
• Septicaemia
• Skin infection

30. LYMPHOEDEMA
Definition
• Lymphoedema may be defined as abnormal limb
swelling caused by the accumulation of increased
amounts of high protein ISF(interstitial fluid)
secondary to defective lymphatic drainage in the
presence of (near) normal net capillary filtration.
• It most commonly affects the arms or legs, but can
also occur in the chest wall, abdomen, neck and
genitals.

31. The severity of unilateral limb lymphoedema
can be classified as:
• mild: <20 per cent excess limb volume;
• moderate: 20–40 per cent excess limb volume;
• severe: >40 per cent excess limb volume.

33. Classification
1 Primary lymphoedema, in which the cause is
unknown (or at least uncertain and unproven); it is
thought to be caused by ‘congenital lymphatic
dysplasia’.
2 Secondary or acquired lymphoedema, in which there
is a clear underlying cause, e.g. removal of axillary
lymphatics in radical mastectomy.
• Primary lymphoedema is usually further subdivided
on the basis of the presence of family history, age of
onset and lymphangiographic findings (Tables 58.1
and 58.2).

41. SECONDARY LYMPHOEDEMA
• This is the most common form of lymphoedema.
• There are several well-recognised causes including
infection, inflammation, neoplasia and trauma (Table
58.6).

44. MANAGEMENT LYMPHOEDEMA

45. Filariasis
• Filariasis is an infectious tropical disease caused by any one
of several thread-like parasitic round worms.
 This is the most common cause of lymphoedema worldwide,
affecting up to 100 million individuals.
 It is particularly prevalent in Africa, India and South America
where 5–10 per cent of the population may be affected.

46. Causes
Wuchereria bancrofti, which
is responsible for 90% of the
cases.
Brugia malayi, which causes
most of the remainder of
the cases.
Brugia timori, which also
causes the disease.

47. • Symptoms result primarily from inflammatory reactions
to the adult worms.
• Some people may also develop hypersensitivity reactions
to the small larval parasites (microfilariae).
• The disease is associated with poor sanitation.
• The parasite enters lymphatics from the blood and lodges
in lymph nodes, where it causes fibrosis and obstruction,
due partly to direct physical damage and partly to the
immune response of the host.

49. Endemic elephantiasis (podoconiosis)
• Elephantiasis is also known as lymphatic filariasis.
It’s caused by parasitic worms, and can spread from
person to person through mosquitoes.
Elephantiasis causes swelling of the scrotum, legs,
or breasts.
• Elephantiasis is considered a neglected tropical
disease (NTD). It’s more common in tropical and
subtropical areas of the world, including Africa and
Southeast Asia. It’s estimated that 120
million people have elephantiasis.

51. Causes Elephantiasis
Elephantiasis is caused by parasitic worms that are spread by mosquitoes. There
are three types of worms involved:
• Wuchereria bancrofti
• Brugia malayi
• Brugia timori
The worms affect the lymphatic system in the body. The lymphatic system is
responsible for removing waste and toxins. If It becomes blocked, then it
doesn’t properly remove waste. This leads to a backup of lymphatic fluid,
which causes swelling.
The most common symptom of elephantiasis is swelling of body parts.
The swelling tends to happen in the:
•Legs
•Genitals
•Breasts
•Arms

52. Treatment for Elephantiasis includes:
 Antiparasitic drugs, such as diethylcarbamazine (dec), mectizan,
and albendazole (albenza)
 Using good hygiene to clean the affected areas
 Elevating the affected areas
 Caring for wounds in the affected areas
 Exercising based on a doctor’s directions
 Surgery in extreme cases, which may include reconstructive surgery for
the affected areas or surgery to remove affected lymphatic tissue
 Treatment may also include emotional and psychological support.

53. LIPOEDEMA
• This presents almost exclusively in women and
comprises bilateral, usually symmetrical, enlargement of
the legs and, sometimes, the lower half of the body
because of the abnormal deposition of fat.
• Lipoedema affects women, due to oestrogen receptors in
the white adipose tissue, oestrogen is considered to be a
major factor.
• Similar changes to lipoedema can occur in men with
hormone disorders such as testosterone
deficiency in association with cirrhosis of the liver
and renal failure, testicular cancer, and hypogonadism.

54. Stages
A three-stage system was developed in Germany to classify
lipoedema. The system describes only the morphology of
the skin, and not the signs and symptoms.
Stage I: Smooth skin surface, homogeneous subcutis.
Stage II: Uneven skin surface, palpable subcutaneous
nodules.
Stage III: Mutilating lobules of fat, skin folds, grossly
nodular tissue structure

57. MANAGEMENT OF LIPOEDEMA
• Psychosocial support,
• Healthy eating
• Weight management
• Physical activity
• Improving mobility
• Skin care and protection
• Compression therapy
• Management of symptoms such as pain.

58. Multilayer Lymphoedema Bandaging (MLLB)

59. THANK YOU