Lymphatic System Flashcards Preview

BLOCK 4A > Lymphatic System > Flashcards

Flashcards in Lymphatic System Deck (81):
1

Skin of the thoracic wall

– 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

2

Thoracic wall intercostal spaces

Anteriorly – parasternal nodes
Posteriorly – posterior intercostal nodes

3

Thoracic wall periphery of diaphragm

Diaphragmatic nodes

4

Parietal pleura

Parasternal, posterior intercostal &
diaphragmatic

5

Posterior intercostal terminal drainage

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

6

Diaphragmatic terminal drainage

Parasternal, post. & sup. mediastinal
nodes

7

Superior mediastinal

AKA brachicephalic

Afferent: thymus, thyroid & pericardium

Efferent: + tracheobronchial = right & left bronchomediastinal trunks

8

Posterior mediastinal

Afferent: oesophagus, post. pericardium & diaphragm

Efferent: thoracic duct (some – tracheobronchial)

9

Tracheobronchial

Afferent: lungs, bronchi, trachea & heart

Efferent: right & left bronchomediastinal trunks

10

Tracheobronchial nodes (5 groups)

– Paratracheal
– Superior tracheobronchial
– Inferior tracheobronchial
– Bronchopulmonary
– Pulmonary (intra)

11

Lung tissue
Visceral pleura

Superficial lymphatic plexus to bronchopulmonary to superior and inferior tracheobronchial

12

Deep to root of lung

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

13

Inferior tracheobronchial

R and L bronchomediastinal trunks

14

Superior tracheobronchial

R lymphatic duct and thoracic duct

15

Anterior pericardium

Superior mediastinal to tracheobronchial to R and L bronchomediastinal trunks

16

Posterior pericardium

Posterior mediastinal to thoracic duct

17

Myocardium & subendocardial connective tissue

Subepicardial lymphatic plexus to coronary groove to coronary trunks

18

L coronary trunk

Ascend between pulmonary trunk and L atrium

Drains LV, LA, small portion RV

Inferior tracheobronchial

19

R coronary trunk

Ascending anterior to asc aorta

Drains RV, RA

Superior mediastinal

20

Oesophagus

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

21

Diaphragm thoracic surface

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

22

Diaphragm abdominal surface

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

23

Axilla (6 groups)

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

24

Pectoral

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

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