1. Lymphatic System SHANDONG UNIVERSITY Liu Zhiyu。

2. The Lymphatic System Lymphatic ducts Lymphatic trunks V A Lymphatic
Lymph nodes
Cap
Lymphatic
Lymphatic-Capillary

3. A assistant system to the vein

4. Composition Lymphatic vessels Lymphatic organs Lymphatic capillary
Lymph vessels
Lymphatic trunks (9)
Lymphatic ducts(2)
thoracic duct
right lymphatic duck
Lymphatic organs
Lymph nodes
spleen
thymus
tonsil
Lymphatic tissues

5. Lymphatic vessels Lymphatic capillary 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

6. Lymphatic vessels Lymphatic vessel Features of structure
Three layered wall similar to, but thinner than vein,
More numerous valves than in vein
Interposed by lymph node at interval along the course
Arranged in superficial and deep sets

7. Lymphatic vessels Lymphatic trunks right and left jugular trunks
right and left subclavian trunks
right and left bronchomediastinal trunks
right and left lumbar trunks
intestinal trunk

8. Lymphatic vessels Lymphatic ducts Right lymphatic duct
Formed by union of right jugular, subclavian, and bronchomediastinal trunks
Ends by entering the right venous angle
Receives lymph from right half of head, neck, thorax and right upper limb

9. Lymphatic vessels Thoracic duct
Begins in front of L1 as a dilated sac, the cisterna chyli, which formed by joining of left and right lumbar trunks and intestinal trunk
Enter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column, between thoracic aorta and azygos vein

10. Lymphatic vessels Thoracic duct
Travels upward, veering to the left at the level of T5
At the roof of the neck, it turns laterally and arches forwards and descends to enter the left venous angle
Just before termination, it
receives the left jugular,
subclavian and ronchomediastinal
trunks

11. Lymphatic vessels Thoracic duct
Just before termination, it receives the left jugular, subclavian and bronchomediastinal trunks
Drains lymph from lower limbs, pelvic cavity, abdominal cavity, left side of thorax, and left side of the head, neck and left upper limb

12. Lymph node Features Bean-shaped bodies
With afferent lymph vessels (entering at the periphery) and efferent lymph vessels(emerging at the hilus)
Arranged in groups, along the blood vessels or the flexural side of the joint
Divided into superficial and deep groups

13. Lymph drainage of breast
Regional Lymph Node is the lymph node where the lymph of the organ or part of the body drainge to firstly
Sentinel Lymph Node(in clinic)

14. Lymph drainage of the body

15. Ⅰ.Lymph drainage of the head
Lymph nodes of head
Located at junction of head and neck
Consist of occipital, mastoid, parotid, submandibular, submental lymph nodes
Drain into deep cervical lymph nodes
Submandibular lymph node lies near the submandibular gland, receive lymphatic vessels from the face, nose and mouth

16. Lymph drainage of neck Anterior cervical lymph nodes
Superficial anterior cervical lymph nodes
Deep anterior cervical lymph nodes
Lateral cervical lymph node
Superficial lateral cervical lymph nodes－lie along the external jugular vein
Deep lateral cervical lymph nodes

17. Lymph drainage of neck Deep lateral cervical lymph nodes
extend along the internal jugular vein from the base of skull to the root of neck
divide into
Superior deep lateral cervical lymph nodes
Inferior deep lateral cervical lymph nodes

18. Lymph drainage of neck → right lymphatic duct
Deep lateral cervical lymph nodes
receive lymphatic vessels from head, neck, tongue, larynx, cervical parts of esophagus and trachea, thyroid gland, upper parts of the thoracic wall and breast
efferent vessels form the jugular trunk →thoracic duct(left)
→ right lymphatic duct
(right)

19. Lymph drainage of neck
Superior deep lateral cervical lymph nodes Jugulodigastric lymph node : lies at the junction of posterior belly of digastric and internal jugular vein
Inferior deep lateral cervical lymph nodes Juguloomohyoid lymph node : lies at the junction of the intermediate tendon of omohyoid and internal jugular vein
Supraclavicular lymph nodes : lie along the subclavian artery

20. The lymphatic drainage of upper limb
Lymphatic vessels
Superficial lymphatic vessels
Deep lymphatic vessels
lymph nodes
Cubital lymph nodeAxillary lymph node

21. Axillary lymph nodes The axillary lymph nodes mey be divided into
lateral ln.
pectoral ln.
subscapular ln.
central ln.
apical ln.
lateral ln.
pectoral ln.
subscapular ln.
central ln.
apical ln.
subclavian trunk

22. The lymphatic drainage of thorax
The lymphatic drainage of thoracic wall
To axillary lymph nodes
To parasternal lymph nodes(along internal thoracic vessels)
To intercostals lymph nodes from deeper structures

23. The lymphatic drainage of thorax
Paratracheal lymph nodes
lymph nodes of the thoracic contents
lymph nodes of trachea, bronchi and lungs
Pulmonary lymph nodes ie in the angles of bifurcation of branching lobar bronchi
Bronchopulmonary hilar lymph nodes lie in the hilus of the lung
Tracheobronchial lymph nodes situated above or below the bifurcation of trachea
Paratracheal lymph nodes along each side of the trachea

24. The lymphatic drainage of thorax
Anterior mediastinal lymph node lies anterior to the large blood vessels of thoracic cavity and pericardium; the efferents unite with those of paratracheal lymph nodes, to form the right and left bronchomediastinal trunks. The left bronchomediastinal trunk terminates in thoracic duct, and right in the right lymphtic duct
Posterior mediastinal lymph nodes lie along the esophagus and thoracic aorta

25. The lymphatic drainage of abdomen
Lymphatic drainage of abdominal wall
To axillary lymph node from region above umbilicus
To superficial inguinal lymph node from region below umbilicus
To lumbar lymph node from post wall of abdomen
axillary lymph node
superficial inguinal lymph node

26. The lymphatic drainage of abdomen
Lymphatic drainage of abdominal viscera
Lumbar lymph nodes
Lie on posterior abdominal wall, along the abdominal aorta and inferior vena cava
Receive lymph from kidneys, suprarenal glands, testes, ovarirs, fundus of uterus, ovary, and common iliac nodes
Their efferent vessel form the right and left lumbar trunks

27. The lymphatic drainage of abdomen
Celiac lymph nodes －situated around the celiac trunk
Superior mesenteric lymph node situated around superior mesenteric a.
Inferior mesenteric lymph node situated around inferior mesenteric a.
Intestinal trunk formed by efferent vessel of celiac, superior and inferior mesenteric lymph nodes

28. The lymphatic drainage of pelvis
Internal iliac lymph node Surround internal iliac vessels
Receive lymph from pelvic viscera, perineum, buttock and back of thigh
External iliac lymph nodes Lie along external iliac artery
Receive lymph from lower limb and some parts of pelvic viscera

29. The lymphatic drainage of pelvis
Sacral lymph node
locate along middle sacral a. and lateral sacral a.
Receive lymph from posterior pelvic wall ,rectum,prostate or uterus
Common iliac lymph node
Lie along common iliac artery
Receive afferents from all the above nodes
Efferents pass to lumbar lymph node

30. lymph drainage of lower limb
lymphatic vessels
Superficial lymphatic
Deep lymphatic
Lymph nodes
Superficial lymph node
Deep lymph node

31. lymph drainage of lower limb
Superficial lymph node
　may be divided into two groups
Upper group: below the inguinal lig.
Lower group: around the terminal part of great saphenous v.
Receive lymph from lower part of abdominal wall,perineum and lower limb with the exception of region drained by popliteal ln.

32. lymph drainage of lower limb
deep lymph node 　
Locate around the proximal end of femoral v.
Receive lymph from deep lymphatic vessels of lower limb and the efferentlymphatic vessels of superficial inguinal ln. Their efferent lymphatic vessels empty into external iliac ln.

33. lymph drainage of lower limb
Popliteal ln.
Embedded in the fatty connective tissue of popliteal fossa
Receive superficial lymphatic vessels from posterolateral part of calf, and from deep lymphatic vessels accompanying anterior and posterior tibial a.
Efferents pass to the deep inguinal ln.

34. Spleen Location Features Function Left epigastric region
between 9th-11th rib
in line of 10th rib
Features
Diaphragmatic surface
Visceral surface - Splenic Hilum
Anterior extremity
Posterior extremity
Superior border- Splenic Notch
Inferior border
Function

35. Thymus Featrues Consists of two elongated lobes
Is large organ in the fetus
Occupies the thoracic cavity behind the sternum
Secrete lymphopoietin

36. Clinic information