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MBChB II Anatomical Pathology > Lymphatic System > Flashcards

Lymphatic System Flashcards

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1
Q

Skin of the thoracic wall

A

– Superficial lymphatic vessels (superficial
to deep fascia): ant. & post. wall
• → Ant. & post. axillary lymph nodes

– Superior to umbilicus & iliac crest
• → Axillary nodes

– Inferior to umbilicus
• → Inguinal lymph nodes

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2
Q

Thoracic wall intercostal spaces

A

Anteriorly – parasternal nodes

Posteriorly – posterior intercostal nodes

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3
Q

Thoracic wall periphery of diaphragm

A

Diaphragmatic nodes

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4
Q

Parietal pleura

A

Parasternal, posterior intercostal &

diaphragmatic

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5
Q

Posterior intercostal terminal drainage

A

– Thoracic duct & right lymphatic duct
(direct)
– Deep cervical nodes

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6
Q

Diaphragmatic terminal drainage

A

Parasternal, post. & sup. mediastinal

nodes

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7
Q

Superior mediastinal

A

AKA brachicephalic

Afferent: thymus, thyroid & pericardium

Efferent: + tracheobronchial = right & left bronchomediastinal trunks

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8
Q

Posterior mediastinal

A

Afferent: oesophagus, post. pericardium & diaphragm

Efferent: thoracic duct (some – tracheobronchial)

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9
Q

Tracheobronchial

A

Afferent: lungs, bronchi, trachea & heart

Efferent: right & left bronchomediastinal trunks

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10
Q

Tracheobronchial nodes (5 groups)

A 
– Paratracheal
– Superior tracheobronchial
– Inferior tracheobronchial
– Bronchopulmonary
– Pulmonary (intra)
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11
Q

Lung tissue

Visceral pleura

A

Superficial lymphatic plexus to bronchopulmonary to superior and inferior tracheobronchial

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12
Q

Deep to root of lung

A

Deep lymphatic plexus to pulmonary to bronchopulmonary to superior and inferior tracheobronchial

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13
Q

Inferior tracheobronchial

A

R and L bronchomediastinal trunks

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14
Q

Superior tracheobronchial

A

R lymphatic duct and thoracic duct

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15
Q

Anterior pericardium

A

Superior mediastinal to tracheobronchial to R and L bronchomediastinal trunks

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16
Q

Posterior pericardium

A

Posterior mediastinal to thoracic duct

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17
Q

Myocardium & subendocardial connective tissue

A

Subepicardial lymphatic plexus to coronary groove to coronary trunks

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18
Q

L coronary trunk

A

Ascend between pulmonary trunk and L atrium

Drains LV, LA, small portion RV

Inferior tracheobronchial

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19
Q

R coronary trunk

A

Ascending anterior to asc aorta

Drains RV, RA

Superior mediastinal

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20
Q

Oesophagus

A

Paraoesophageal

Upper 1/3: Deep cervical

Middle 1/3: Inferior tracheobronchial & posterior
mediastinal lymph nodes to R and L bronchomediastinal

Lower 1/3: Superior gastric

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21
Q

Diaphragm thoracic surface

A

Anterior and posterior diaphragmatic nodes to superior phrenic lymph nodes, parasternal lymph nodes, posterior mediastinal lymph nodes

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22
Q

Diaphragm abdominal surface

A

Anterior diaphragmatic to anterior diaphragmatic lymph nodes, inferior phrenic lymph nodes, superior lumbar lymph nodes

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23
Q

Axilla (6 groups)

A 
– Pectoral/anterior group
– Subscapular/posterior group
– Lateral group
– Central group
– Apical/infraclavicular group
– Deltopectoral group
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24
Q

Pectoral

A

AKA anterior

• 3 – 5 nodes
– Med. wall of axilla
– Around: lat. thoracic vein & inf. border of
pectoralis minor
• Afferent:
– Ant. thoracic wall (most of breast)
– Upper, anterior abdominal wall
• Efferent:
– Central nodes
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25
Subscapular
AKA posterior ``` • 6 – 7 nodes – Post. axillary fold – Subscapular blood vessels • Afferent: – Post. aspect of thoracic wall (back) – Scapular region (shoulder) – Neck • Efferent: – Central nodes ```
26
Central
``` • 3 – 4 large nodes – Deep to pectoralis minor (near axilla base) – 2 nd part of axillary artery • Afferent: – Pectoral (ant), subscapular (post) & humeral (lat) • Efferent: – Apical/Infraclavicular lymph nodes ```
27
Apical
``` • Located: – Med. side of axillary vein – 1st part of axillary artery • Afferent: – Pectoral, subscapular, humeral & central – Lymphatics: proximal cephalic vein • Efferent: – Unite → Subclavian lymphatic trunk ```
28
Lateral
``` • 4 – 6 nodes – Lat. wall of axilla – Med. & post. to axillary vein • Afferent: – Medial aspect of the arm – Most of lymphatics from upper limb • Efferent: – Central nodes ```
29
Mammary tissue
``` • Subareolar plexus – Pectoral nodes • Medial border – Parasternal nodes • Inferomedial quadrant – Subperitoneal and pelvis • 75% via axillary tail – Pectoral nodes • Lateral border – Parasternal nodes – Posterior intercostal nodes • Deep breast tissue – Apical nodes ```
30
Hand drainage
NB!
31
Occipital
1 – 3 nodes ; back of head; apex of post. triangle Afferents: occipital region of scalp Efferents: sup. deep cervical nodes
32
Posterior auricular/mastoid
2 nodes; post. to ear on mastoid process Afferents: post. surface of auricle, post. part of scalp & post. wall of external acoustic meatus Efferents: sup. deep cervical nodes
33
Preauricular
1 – 3 nodes; ant. to trachus of ear Afferents: lat. surface of auricula & skin of adjacent temporal region Efferents: sup. deep cervical glands
34
Parotid
2 groups: inside the gland & ant. to gland Afferents: root of nose, eyelids, frontotemporal region, ant. wall external acoustic meatus, conjunctiva Efferents: sup. deep cervical nodes
35
Buccal
1/more nodes; on buccinator @ ant. border of masseter (relation: facial vein) Afferents: cheek & lower eyelid Efferents: submandibular nodes
36
Submandibular
3 – 6 nodes; below deep fascia & on submandibular salivary gland Afferents: middle of forehead, nose & paranasal sinuses, cheek, palate, gingiva, upper lip & ant. 2/3 of tongue Efferents: sup. deep cervical nodes
37
Submental
Between ant. bellies of digastric in submental triangle Afferents: apex of tongue, floor of mouth, gingiva (lower incisors), chin, middle section of lower lip Efferents: submandibular nodes
38
Superficial cervical
Along: ant, jugular vein & external jugular vein Afferents: infrahyoid region, larynx, trachea, thyroid, cervical part of oesophagus, lower part of ear and parotid region Efferents: submandibular nodes
39
Pretracheal
Front of trachea Afferents: lower larynx, thyroid gland, upper trachea Efferents: lowest of sup. deep cervical nodes & inf. deep cervical nodes
40
Paratracheal
Few; alongside recurrent laryngeal nerves on lat,. aspects of trachea & oesophagus Afferents: thyroid gland, cervical portion trachea Efferents: lowest of sup. deep cervical nodes & inf. deep cervical nodes
41
Prelaryngeal
On the middle cricothyroid ligament Afferents: lower larynx, thyroid gland, upper trachea Efferents: sup. deep cervical nodes
42
Infrahyoid
Located: between levels of hyoid bone and thyroid cartilage Afferents: thyroid gland, larynx Efferents: sup. deep cervical nodes
43
Retropharyngeal
1 – 3 nodes; in buccopharyngeal fascia Afferents: nasal cavities, nasal part of pharynx, auditory tubes Efferents: sup. deep cervical nodes
44
Face
Submental Afferents: Medial part of lower lip and chin Efferents: Submandibular nodes ``` Submandibular Afferents: Medial corner of the orbit, most of the external nose, medial part of the cheek, upper lip, lateral part of the lower lip Efferents: superior deep cervical nodes ``` Preauricular and parotid Afferents: Lateral part of face, eyelids, part of the external nose, lateral part of the cheek Efferents: superior deep cervical nodes
45
Scalp
Occipital Afferents: Occipital area Efferents: Superior deep cervical nodes Postauricular/mastoid Afferents: Post. To vertex of head Efferents: Superior deep cervical node Preauricular/parotid Afferents: Ant. to vertex of head Efferents: Superior deep cervical nodes Submandibular Afferents: Part of the forehead Efferents: superior deep cervical nodes
46
Eyelids and conjuctiva
Parotid Afferents: Eyelids (lateral ¾) Efferents: Superior deep cervical nodes Submandibular Afferents: Medial corner of eye (medial ¼) Efferents: Superior deep cervical nodes
47
Nose
Parotid Afferents: Root of the nose Efferents: Superior deep cervical nodes Submandibular Afferents: Surface of nose, ant. nasal cavities: Efferents: Superior deep cervical nodes Retropharyngeal Afferents: Air sinuses, adenoids Efferents: Superior deep cervical nodes
48
Lips
Submandibular Afferents: Upper lip, lateral parts of lower lip Efferents: Superior deep cervical nodes Submental Afferents: Medial part of lower lip Efferents: Submandibular nodes
49
Teeth
Submandibular Afferents: post. gums & teeth (lower) Efferents: superior deep cervical nodes Submental Afferents: ant. gums & teeth (lower) Efferents: submandibular nodes Jugulodigastric Afferents: ant. & post. gums & teeth (upper) Efferents: inferior deep cervical nodes
50
Tongue
Jugulodigastric Afferents: Posterior third of tongue Efferents: Inferior deep cervical nodes Juguloomohyoid Afferents: Medial part of anterior 2/3 of tongue Efferents: Jugular trunks Submandibular Afferents: Lateral parts of anterior 2/3 of tongue Efferents: Superior deep cervical nodes Submental Afferents: Apex and frenulum Efferents: jugulo-omohyoid node
51
Paratracheal
Afferents: Superior to vocal folds Efferents: Inferior deep cervical nodes
52
Thyroid
Prelaryngeal nodes Afferents: Sup. lymphatic vessels from thyroid Efferents: Superior deep cervical nodes Inferior deep cervical nodes Afferents: Ant. lymphatic vessels from thyroid Efferents: Inferior deep cervical nodes Pretracheal and Paratracheal nodes Afferents: Lateral lymphatic vessels from thyroid Efferents: right & left jugular trunks Brachiocephalic nodes or thoracic duct Afferents: Some lymphatic vessels
53
Larynx
Superior deep cervical nodes Afferents: Superior to vocal folds Efferents: Inferior deep cervical nodes Pretracheal OR paratracheal nodes Afferents: Inferior to vocal folds Efferents: Inferior deep cervical nodes
54
Tonsils and adenoids
Jugulo-digastric nodes Afferents: Tonsils Efferents: right & left jugular trunks Retropharyngeal nodes Afferents: Adenoids Efferents: inferior deep cervical nodes
55
Deep lymphatic drainage of abdominal wall
Accompany deep veins of abdominal wall Lumbar lymph nodes Abdominal aorta External iliac lymph nodes External iliac artery Common iliac lymph nodes Common iliac artery
56
Preaortic LN
Celiac nodes Afferent: organs (foregut), superior & inferior mesenteric nodes Efferents: cisterna chyli Superior mesenteric nodes Afferents: organs (midgut), inferior mesenteric nodes Efferents: celiac nodes Inferior mesenteric nodes Afferents: organs (hindgut) Efferents: superior mesenteric nodes
57
Para aortic
Afferents: body wall, kidneys, suprarenal | glands, testes or ovaries
58
Oesophagus
Left gastric lymph nodes Afferents: abdominal part of oesophagus Efferents: celiac lymph nodes
59
Stomach
Gastric lymph nodes Afferents: sup. 2/3 of stomach Efferents: celiac lymph nodes Gastro-omental lymph nodes Afferents: ant. & post. surface of stomach Efferents: celiac lymph nodes Pancreaticosplenic lymph nodes Afferents: fundus, superior part of body of stomach Efferents: celiac lymph nodes Pyloric lymph nodes Afferents: right 2/3 of inferior 1/3 stomach Efferents: celiac lymph nodes Pancreaticoduodenal lymph nodes Afferents: left 1/3 of greater curvature Efferents: pyloric OR celiac lymph nodes
60
Duodenum
Pacreaticosplenic lymph nodes Afferents: anterior surface of duodenum Efferents: celiac lymph nodes Pyloric lymph nodes Afferents: anterior surface of duodenum Efferents: superior mesenteric lymph nodes Superior mesenteric lymph nodes Afferents: posterior surface of duodenum Efferents: celiac lymph nodes
61
Jejenum and ileum
Juxta-intestinal lymph nodes Located close to intestinal wall Afferents: jejunum & ileum Efferents: mesenteric lymph nodes Mesenteric lymph nodes Scattered along the arterial arcades Afferents: Jejunum & ileum Efferents: superior central nodes Superior central lymph nodes Located along proximal part of SMA Afferents: anterior surface of duodenum Efferents: superior mesenteric lymph nodes
62
Caecum and appendix
Ileocolic lymph nodes Located along ileocolic artery Afferents: cecum & appendix Efferents: superior mesenteric nodes Mesoappendix lymph nodes
63
Ascending colon & prox. 2/3 of transverse colon
NB!!!
64
Distal 1/3 of transverse colon & descending colon & sigmoid colon
NB!!!
65
Pancreas
Pancreaticosplenic lymph nodes Along splenic artery Afferents: most of body of pancreas and tail Efferents: superior mesenteric nodes ``` Pyloric lymph nodes Along gastroduocenal artery Afferents: some of body of pancreas and the head Efferents: superior mesenteric nodes ```
66
Liver and gallbladder
``` Hepatic nodes Superficial lymphatics: ant. aspects of diaphragmatic & visceral surfaces Deep lymphatics: portal triad vessels Gallbladder (via cystic nodes) Efferents: celiac nodes ``` Phrenic nodes Superficial lymphatics: post. aspects of diaphragmatic & visceral surfaces (drain to bare area of liver) Efferents: posterior mediastinal lymph nodes
67
Spleen
Splenic hilar nodes to pancreaticosplenic nodes
68
Kidneys, suprarenal glands and ureters
Lymphatic plexuses in kidney = 3 Substance of kidney Under fibrous capsule of kidney Perirenal fat Lumbar nodes Afferents: 4/5 lymphatic trunks leave renal hilum, lymph from suprarenal glands, superior part of ureters Efferents: Lumbar trunks → cisterna chyli Common iliac nodes Afferents: middle part of ureters Efferents: lumbar nodes Common iliac, external iliac or internal iliac nodes Afferents: inferior part of ureters Efferents: lumbar nodes
69
Pelvis
``` External iliac lymph nodes Location: above pelvic brim, along external iliac vessels Afferents: inguinal lymph nodes, pelvic viscera (sup. parts of middle to ant. pelvic organs) Efferents: common iliac nodes ``` Internal iliac lymph nodes Location: clustered: ant. & post. divisions of internal iliac arteries & origins of gluteal arteries Afferents: inf. pelvic viscera, deep perineum, gluteal region Efferents: common iliac nodes Sacral iliac lymph nodes Location: concavity of sacrum, adjacent to median sacral vessels Afferents: posteroinferior pelvic viscera Efferents: internal or common iliac nodes ``` Common iliac lymph nodes Location: superior to pelvis Afferents: external, internal & sacral nodes, neck of bladder, inferior vagina Efferents: lumbar nodes ```
70
Bladder
External iliac nodes Afferents: superolateral aspects of bladder Efferents: common iliac nodes Internal iliac nodes Afferents: fundus and neck of bladder Efferents: common iliac nodes Common iliac nodes Afferents: neck of bladder (some) Efferents: lumbar nodes
71
Rectum
Pararectal nodes Directly on muscle layer of rectum Afferents: superior ½ of rectum Efferents: inf. mesenteric nodes Sacral nodes Afferents: inferior ½ of rectum Efferents: internal iliac nodes (some vessels may drain directly into internal iliac nodes
72
Anal canal
Internal iliac nodes Afferents: superior to pectinate line Efferents: common iliac nodes → lumbar Superficial inguinal nodes Afferents: inferior to pectinate line Efferents: external iliac nodes OR deep inguinal nodes → lumbar
73
Male intrapelvic organs
Internal iliac nodes Afferents: majority of prostate, proximal urethra, inferior part of seminal glands, Efferents: common iliac nodes → lumbar Sacral nodes Afferents: some of prostate Efferents: internal iliac nodes External iliac nodes Afferents: proximal urethra(some), ductus deferens, ejaculatory ducts, superior part of seminal glands Efferents: common iliac nodes → lumbar Deep inguinal nodes Afferents: distal urethra Efferents: external iliac nodes
74
Female intrapelvis nodes
Internal iliac nodes Afferents: cervix of uterus, superior & middle parts of vagina, proximal urethra Efferents: common iliac nodes → lumbar Sacral nodes Afferents: cervix of uterus, inferior part of vagina (or CIN) Efferents: internal iliac nodes External iliac nodes Afferents: body & cervix of uterus, superior part of vagina Efferents: common iliac nodes → lumbar Superficial inguinal nodes Afferents: external orifice of vagina, fundus (uterus) Efferents: external iliac nodes or deep inguinal nodes Deep inguinal nodes Afferents: distal urethra Efferents: external iliac nodes Lumbar nodes Afferents: ovaries & uterine tubes, fundus of uterus Efferents: cisterna chyli
75
Male external genitalia organs
Internal iliac nodes Afferents: cavernous bodies of penis Efferents: common iliac nodes Superficial inguinal nodes Afferents: skin of penis, scrotum Efferents: external iliac nodes OR deep inguinal External iliac nodes Afferents: glans of penis Efferents: external iliac nodes Lumbar nodes Afferents: testis & epididymis Efferents: cisterna chyli Deep inguinal nodes Afferents: glans of penis, Efferents: external iliac nodes
76
Female external genitalia organs
Superficial inguinal nodes Afferents: vulva Efferents: external iliac nodes OR deep inguinal Deep inguinal nodes Afferents: glans clitoris & labia Efferents: external iliac nodes
77
Inguinal nodes
– Superficial group of nodes • Subdivided in 2 • Horizontal chain (superior) – inferior inguinal ligament • Vertical (inferior) chain – along great saphenous vein – Deep group of nodes
78
Popliteal nodes
• 5 – 6 nodes; surrounding popliteal vessels in popliteal fossa • Superficial (in subcutaneous tissue) and deep nodes (surround vessels) • Afferents: – Superficial vessels (small saphenous vein) – Deep areas of leg and foot • Efferents: – Deep inguinal nodes → external iliac nodes
79
Deep inguinal nodes
``` • Vary in number between 1 – 3 • Lie medial to femoral vein • Nodes located as follows: – Great saphenous vein join femoral vein – In femoral sheath – Lateral part of femoral ring • Afferents: – Deep lymphatics associated with femoral vessels – Glans penis or clitoris (perineum) – Connection: superficial inguinal nodes ```
80
Superficial inguinal nodes
``` • ± 10 nodes; in superficial fascia • Afferents: – Gluteal region – Lower abdominal wall – Perineum & external genitalia – Superficial regions of lower limbs • Efferents: – External iliac nodes (interconnect – deep inguinal nodes) • Common iliac nodes → lumbar nodes → lumbar trunks → cisterna chyli ```
81
Foot
``` • Subcutaneous plexuses – Superficial & deep lymphatic vessels • Superficial lymphatic vessels – Medial superficial lymphatic vessels – Lateral superficial lymphatic vessels • Deep lymphatic vessels ```

MBChB II Anatomical Pathology (2 decks)

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