Lymph quiz

At the peak of inspiration, when the pressure in the chest is at its lowest, lymph is

"sucked" along the right lymphatic duct and thoracic duct.

Swelling of the feet in anyone who has sat immobile for hours attests to the importance of muscular activity to overcome __________.

*edema*

On the venous side of the capillary bed

hydrostatic blood pressure has dropped sufficiently while osmotic pressure is rising, until the time comes when osmotic pressure exceeds blood pressure and fluid now passes from tissue spaces to the capillaries.

Lymphangitis

inflammation of a lymphatic vessel

Many digested fats, however, are too large to enter the blood capillaries and are instead absorbed into specialized lymphatic capillaries called

intestinal lacteals

Ultimately, the thoracic duct empties all its lymph into the:

junctions of the left internal jugular vein and left subclavian vein (left venous angle)

the left subclavian trunk brings lymph from:

left upper limb and left breast

Lumbar trunk drains lymph from:

lower limbs, pelvic viscera, and posterior abdominal wall

Once the interstitial fluid enters a lymphatic vessel, it is referred to as

lymph

The largest lymphatic vessels are called:

lymphatic trunks

lymphangioma

a benign tumor of the lymph vessels

lymph nodes are:

oval, encapsulated structures located along the length of lymphatic vessels; as lymph passes through them, it is filtered of foreign and toxic substances to prevent their entry into the blood system

All these particulate matter find their way to lymphatic vessels (a.k.a. lymphatics) which deliver their contents to lymph nodes located along their course. At the lymph nodes the foreign substances are:

phagocytosed and lymph is filtered; also, lymphocytes are added to the lymph.

the left bronchomediastinal trunk brings lymph from the:

thoracic viscerae (left side)

the right bronchomediastinal trunk brings lymph from:

thoracic viscerae (right side)

Edema

- Abnormal accumulation of fluid in interstitial spaces of tissues - may be caused by an obstruction in the lymphatic capillaries (called lymphoedema) - maybe be caused by a rise in blood pressure, in which case interstitial fluid is formed faster that it is passed into lymphatics) - most common cause of lymphedema are tumors and surgical removal of lymph nodes - macroscopically, edema can appear as an increase in volume that yields easily to localize pressure, creating a depression which slowly disappears called pitting edema

Lymph capillaries are located throughout the body except at:

- CNS (excess fluid drains into the cerebrospinal fluid) - eyeball - internal ear - avascular tissue (cornea, articular cartilage, skin epidermis, epithelium, bone marrow teeth)

Lymph flow and metastasis:

- Cancerous cells can slowly travel unchecked in the lymphatic system if they are not stopped by any of the lymph nodes along the lymphatic vessels. - If the cancer metastasizes past all the nodes, the cancer cells can enter the blood system by way of the lymphatic ducts (i.e., thoracic duct and right lymphatic duct). - The spread of cancer by way of the blood vessels is quicker than by way of the lymph vessels, so the cancer can quickly metastasize to the rest of the body.

lymphadenopathy

- When a group of lymph nodes are enlarged, tender, and inflamed due to an infection. - In this case, phagocytosis of bacteria is incomplete, therefore, inflammation and enlargement of the node is stimulated. - The lymph nodes can feel tender to the pt. when palpated due to the pressure on the nerves of the area from the node enlargement. - Palpable nodes when inflamed: cervical, axillary and inguinal

Chyle is:

- a fat-rich creamy lymph that drains from the intestinal lacteals. - is not clearless - chyle finally enters the cisterna chyli - from the cisterna chill this fat-rich creamy lymph is transported in lymphatic vessels until the lymph is added to the blood

lymphomas

- are malignant tumor (cancer) of lymphoid tissue and are classified as either Hodgkin or non-Hodgkin lymphomas

Non-Hodgkin lymphomas

- are more common. - They may be associated with immunodeficiency states and certain viral infections, including HIV. - They may occur in any lymphoid tissue or in bone marrow - In general, their prognosis is poor.

Lymphs capillaries:

- arise as blind-ended tubes - are slightly larger and more permeable than blood capillaries - their endothelial cells making up the capillary wall overlap each other, forming pores - pores permit fluid to flow easily into the lymph capillary but prevent the flow of fluid out of the lymph capillary (much like a one-way valve would operate) - are more numerous in mucous membranes

Central node group of axillary nodes:

- efferent lymphatic vessels pass to the apical nodes

Osmotic pressure of the blood plasma

- forces liquid back into the capillaries - is due mainly to plasma proteins (these plasma proteins are macromolecules that cannot pass through the capillary walls) - pulls fluid INTO capillaries

Hydrostatic pressure of the blood

- forces liquid through the capillary walls into the tissue spaces - is a consequence of the pumping action of the heart- - pushes fluid OUT of capillaries

Lymphatic vessels:

- have thinner walls and more valves than veins - contain *lymph* *nodes* at various intervals - the numerous valves give them a beaded appearance

Not only does interstitial fluid pass into the lumen of lymph capillaries but also solid material enters them, such as:

- high-molecular weight plasma protein - bacteria and cell debris from damaged tissue - fats - foreign substances - cells (both normal and tumor cells)

Deep lymphatic vessels are located in:

- in deep fascia

Superficial lymphatic vessels are located in:

- in the superficial fascia

Thoracic duct:

- is the main collecting vessel of the lymphatic system and receives lymph from the left side of the head, neck and thorax, the left upper extremity, and the entire body below the ribs - begins as a dilated sac (cistern chili) in front of the body of the first 2 lumbar vertebrae

Hodgkin lymphoma

- less common than non-Hodgkin lymphomas - It presents with painless enlargement of lymph nodes throughout the body. - The superficial lymph nodes in the neck are often the first to be noticed. - It is often curable, especially if caught early. - The cause is unknown.

within the lymph nodes...

- macrophages digest foreign and toxic substances by phagocytosis - T-cells may destroy them by releasing certain substances - B-cells may produce antibodies that destroy the foreign and toxic substances

Infraclavicular lymph nodes

- receive afferent lymph vessels from the upper limb and axilla - located in the deltopectoral triangle

Supraclavicular lymph nodes:

- receive lymph vessels from apical and infraclavicular group of lymph nodes

The lateral (humeral) lymph node group:

- receives almost all of the lymph from the upper limb, therefore, an infection in the upper limb can cause these nodes to enlarge and become tender and inflamed - efferent lymphatic vessels pass to the central nodes

Apical group of axillary nodes:

- receives lymph from all other groups of axillary nodes - efferent lymphatic vessels unite to form the subclavian lymphatic trunk, although some lymph may also drain into the clavicular group of nodes

Subscapular (posterior) group of axillary nodes:

- receives lymph from posterior thoracic wall and scapular region - efferent lymphatic vessels pass to the central nodes

pectoral (anterior) group of axillary nodes:

- receives lymph mainly from anterior thoracic wall and most of the breast (approx. 75% of the lymphatic drainage from the bests) - efferent lymphatic vessels pass to the central nodes

Where are the tracheobronchial (superior and inferior) lymph nodes located?

- superior and inferior to the bifurcation to the trachea, respectively - The superior tracheobronchial lymph nodes receive lymph from the inferior tracheobronchial lymph nodes. - The inferior tracheobronchial lymph nodes are also known as carinal nodes. - If the inferior tracheobronchial lymph nodes are enlarged because cancer cells have metastasized from a bronchogenic carcinoma, for example, the carina is distorted, widened posteriorly, and immobile.

Axillary lymph nodes are removed during mastectomy to examine:

- the extent of metastasis (lymph nodes are sometimes removed because cancer cells may have already spread to them)

In healthy patients, lymph nodes are:

- usually small, soft and free or mobile - normally, lymph nodes cannot be palpated in a healthy patient

Where are the pulmonary lymph nodes located?

Along the secondary bronchi, within the substance of the lungs

lymphadenitis

acute infection of lymph nodes - usually caused by microbes transported in lymph from other areas of infection - nodes become inflamed, enlarged, and congested with blood. - acute lymphadenitis indicates the normal proliferation of defense cells within the lymph nodes

The abdominal and pelvic nodes are mainly situated close to:

the blood vessels supplying the organs and also close to the aorta, and internal and external iliac arteries.

Ultimately, the right lymphatic duct empties all of its lymph into:

the junction of the right internal jugular vein and right subclavian vein(right venous angle)

Since lymph is not pumped through the system by the heart, lymph flow tends to be comparatively sluggish and its flow is aided, in part, by:

the massaging action of neighboring muscles of the upper and lower limbs.

Lymphatic pump

the muscle layer in the walls of the large lymph vessels has an intrinsic ability to contract rhythmically

The prognosis of breast cancer has been correlated with:

the number of involved axillary lymph nodes

As you can see, all the lymph from the lung leaves the hilum, passes through the tracheobronchial lymph nodes to be filtered, and then into the bronchomediastinal lymph trunks to enter either

the right lymphatic duct (on the right side) or the thoracic duct (on the left side)

Very, very, very important information: When they are involved with cancer,the lymph nodes can become:

bony hard and fixed to surrounding tissues. The cancerous nodes are usually not tender. In comparison, nodes involved with acute infection (acute lymphadenitis) are mobile and tender.

Fats absorbed by intestinal lacteals gives the lymph a milky appearance. This lymph is now called:

chyle

Lymph from the pelvic and abdominal cavities passes through many lymph nodes before entering the:

cisterna chyli

Efferent lymph vessels from the axillary nodes drain mainly into the subclavian lymphatic trunk, but some also drain into the

clavicular lymph nodes

The superficial lymphatic vessels eventually drain into the:

deep lymphatic vessels

Right lymphatic duct:

drains lymph from upper right side of the body

One should know that all lymph:

filters through at least one lymph node before it reaches the heart. Usually, several nodes are involved.

five groups of axillary lymph nodes

1. Apical- associated with first part of axillary artery 2. Central- deep to the pectorals minor in association with the second part of axillary artery 3. Anterior (pectoral)- can be palpated inside the anterior axillary fold 4. Posterior (sub scapular)- can be palpated inside the posterior axillary fold 5. Lateral (humeral)- posterior to axillary vein

The lymphatic trunks emptying into the cisternal chyli are:

1. Intestinal trunk 2. Lumbar trunk

The 2 sets of lymphatic vessels:

1. Superficial lymphatic vessels 2. Deep lymphatic vessels

Axillary lymph nodes drain lymph from the:

1. lateral quadrants of the breast 2. thoracoabdominal walls above the level of the umbilicus 3. upper limbs

In the neck, the thoracic duct also receives lymph from the following trunks:

1. left jugular trunk 2. left subclavian trunk 3. left bronchomediastinal trunk

flow of lymph is aided during inspiration because:

1. pressure increases within the abdominal cavity 2. pressure decreases within the thoracic cavity

Trunks emptying into the right lymphatic duct are:

1. right jugular trunk 2. right subclavian trunk 3. right bronchomediastinal trunk

Lymph is:

Clear and watery; similar in composition to blood plasma although it contains much less proteins.

Intestinal trunk drains lymph from:

GI tract, pancreas, spleen and liver

Where are the bronchopulmonary (hilar) lymph nodes located?

In the hilum of the lung

Superficial lymphatic plexus (aka subpleural lymphatic plexus)

Location: beneath visceral pleura Drains lymph from lung parenchyma and visceral pleura Drains lymph into the following lymph pathway (in order): Bronchopulmonary (hilar) lymph nodes ----- superior and inferior tracheobronchial lymph nodes ----- bronchomediastinal lymph trunks ---- lymphatic duct on the right side and thoracic duct on the left side

Deep lymphatic plexus

Location: submucosa of bronchi and stroma of lungs Drains lymph from lung stroma and root of lung Drains lymph into the following lymph pathway (in order): Pulmonary lymph nodes ----- bronchopulmonary (hilar) lymph nodes ----- superior and inferior tracheobronchial lymph nodes ----- bronchomediastinal lymph trunks ----- lymphatic duct on the right side and thoracic duct on the left side.

Why should a clinician known the position of lymph nodes?

The lymph nodes become swollen during infections and inflammations. Since specific nodes receive specific areas of the body, the clinician should be able to deduce the general location of the infection by knowledge of lymphatic drainage.

The Left Jugular trunk brings lymph from:

head and neck structures (left side)

the right jugular trunk brings lymph from:

head and neck structures (right side)

On the arterial side of the capillary bed,

hydrostatic blood pressure exceeds osmotic pressure and fluid leaves the capillaries to enter the tissue spaces

Approximately only 90% of the interstitial fluid is returned to the blood capillaries; the remaining 10% that remains in the interstitial space then enters:

lymph capillaries

Lymph capillaries unite to form larger and larger vessels called:

lymphatic vessels

the right subclavian trunk brings lymph from:

right upper limb and right breast

lymph nodes are scattered throughout the body, usually in groups; typically, these groups are arranged in two sets:

superficial and deep