anatomy 403: lymphatics 1

lymphatic system

• lymph, lymph vessels, lymphatic organs, and red bone marrow

• reticular connective tissue + lymphocytes

• functions:

  • fluid _____ (drains excess interstitial fluid)

  • fat _____ (transports lipids, lipid-soluble vitamins A,D,E,K)

  • immune responses

balance, absorption

lymphatic system

• what makes up the lymphatic system?

lymph, lymph vessels, lymphatic organs, and red bone marrow

immunity

• ____ immunity

  • non-specific

  • fever, inflammation

    • fever, pain, swelling, redness

• ____ immunity

  • specific

  • T-cell, B-cell, memory cells 

innate, acquired

lymphocytes and acquired immunity

• ____ immunity: work via antibodies

  • B-cells → plasma ells → memory B cells

humoral

lymphocytes and acquired immunity

• _____ immunity

  • work via cells

  • T-cells

    • T-helper cells (CD4+)

    • T cytotoxic cells (CD8+) → T memory cells

    • T regulatory cells

cellular

lymphocytes and acquired immunity

• humoral immunity works via ______

  • B-cells → plasma cells → memory B cells

antibodies

lymphocytes and acquired immunity

• cellular immunity works via _____

  • T-helper cells (CD4+)

  • T-cytotoxic cells (CD8+)

  • T-memory cells

  • T regulatory cells 

cells

lymph circulation

• returns excess interstitial fluid to venous return

• lymphatic _____:

  • drain interstitial fluid

  • very permeable 

  • unidirectional flow

  • lacteals and chyle (small intestine)

• lymphatic _____:

  • lymph nodes

  • skin: follow veins

  • viscera: follow arteries

• vessels and nodes → trunks → ducts

capillaries, vessels

edema

• ______ > reabsorption

  • at the level of capillary

• many different etiologies

  • localized or systemic

• lymphedema

filtration

HIV/AIDS

• HIV

  • retrovirus

  • transmission via bodily fluids

  • attacks ____ (helper T) cells 

    • these are key to acquired immunity 

CD4+

HIV/AIDS

• AIDS

  • lower Th count (<200 cells/mL)

  • opportunist _____ 

infections

lymphatic organs and tissues

• ____ lymphatic organs: stem cell mitosis and immunocompetence

  • red bone marrow

  • thymus

• ____ lymphatic organs and tissues: immune response sites

  • lymph nodes and nodules

  • spleen

primary, secondary

lymphatic organs and tissues

• what organs make up the primary lymphatic organs?

red bone marrow and thymus

lymphatic organs and tissues

• what organs/tissues make up the secondary lymphatics?

lymph nodes/nodules, spleen

red bone marrow

• hemopoietic connective tissue; _____ tissue

• myeloid stem cells

  • erythrocutes

  • thrombocytes

  • granular leukocytes

  • monocytes & macrophages

• lymphoid stem cells

  • B cells

  • T cells

• abundant in _____ (axial skeleton) and the ends of long bones (appendicular skeleton)

myeloid, flat bones

thymus

• mediastinum

• bilobed, capsulated

  • trabeculae: lobules

• ____

  • thymocyte selection and maturation

    • positive and negative selection

  • 2% survive

• ____

  • T cell release

• maximum size at puberty

  • involution

    • slowly diminishes and becomes adipose 

cortex, medulla

thymus

• what part of the thymus does thymocyte selection and maturation?

cortex

thymus

• what part of the thymus does T cell release?

medulla

what structure is this?

thymus

lymph nodes

• bean-shaped, and typically clustered

• capsule and compartments

  • outer cortex sinuses

    • lymphatic nodules (___ B cells)

  • inner cortex sinuses

    • T cells and dendritic cells

  • medullary sinuses

    • B cells, plasma cells, and macrophages

• afferent vessels → sinuses → efferent vessels (hilus) 

germinal

lymph nodes

• what are the sinuses of the lymph nodes?

outer cortex sinus, inner cortex sinus, and medullary sinus

lymph nodes

• what does the outer cortex sinus make?

lymphatic nodules (germinal B cells)

lymph nodes

• what does the inner cortex sinus make?

T cells and dendritic cells

lymph nodes

• what does the medullary sinus make?

B cells, plasma cells, macrophages

lymphatic nodules

• _______

• mucosa-associated lymphoid tissue (MALT)

  • lamina propria of mucous membranes

    • lymphocytes and antigen-presenting cells abundant

  • aggregated lymphoid follicles (Peyer’s patches of GALT)

  • diffuse or organized

    • waldeyer’s ring (of tonsils)

acapsular

spleen: secondary organ

• left hypochondriac 

  • largest single mass of lymphoid tissue

• ___ pulp

  • lymphocyte action

• ___ pulp

  • RBC removal

  • platelet sequestration

  • hemopoiesis

white, red

tonsilitis

• inflammation of the tonsils

  • _____ tonsils

• typically viral, but can also be group A streptococcus infection

• time, antibiotics

• tonsillectomy

palatine

signs of infection

• _____: disease of lymph nodes

  • very common and non-specific

  • abnormal size or consistenct

  • generalized or localized

lymphadenopathy

signs of infection

• _____: enlarged, painful, inflamed

  • most common form of lymphadenopathy

• malignancies

  • enlarged, often painless

  • lymphomas

  • metases

lymphadenitis

signs of infection

• ____: inflammation of lymph vessels

lymphangitis 

metastasis

• spread of a disease

  • _____: spread of disease along surface barrier/membranes

transcoelomic

metastasis

• spread of a disease

  • _____: spread of disease through blood (usually venous)

    • sarcomas (mesenchyme) and renal carcinomas

hematogenous

metastasis

• spread of a disease

  • _____: spread of disease via lymphatics

    • carcinomas (epithelial)

    • “firmed, fixed, and enlarged”

lymphogenous

what is metastasis?

spread of disease

what are the three types of metastasis?

transcoelomic, hematogenous, and lymphogenous

lymphatic ducts

• _____

  • jugular

  • subclavian

  • bronchomediastinal

• _____

  • vicinity of venous angles

  • right lymphatic duct

  • thoracic duct

    • receives left jugular, subclavian, and bronchomediastinal trunks

    • cisterna chyli → thoracic duct

trunks, ducts

lymphatic ducts

• what are the trunks?

jugular, subclavian, and bronchomediastinal

lymphatic ducts

• what are the ducts?

right lymphatic and thoracic ducts

lymphatic ducts

• what duct receives the jugular, subclavian, and bronchomediastinal trunks?

thoracic duct

thorax: pulmonary

• pulmonary nodes → bronchopulmonary nodes → inferior tracheobronchial nodes → superior tracheobrochial nodes → bronchomediastinal trunk → duct

  • which part does it bifurcate?

inferior tracheobronchial nodes

thorax: breast and axilla

• subareolar plexus → 75% to ______

• subareolar plexus —> 25% to ______

axillary: pectoral nodes, parasternal nodes and contralateral breast

upper limbs

• deep lymphatics are _____

• superficial lymphatics are ______

arteries, veins

abdominopelvic cavity

• everything in the abdominopelvic cavity drains into the ______

cisterna chyli

abdominal wall

• lymphatics above transumbilical plane go to _____

• lymphatics below transumbilical plane go to _____

axillary nodes, superficial inguinal nodes

lower limb

• travels along ____

veins