BY AZUBUIKE A. EKWUOFU DEPARTMENT OF CLINICAL PHARMACY AND PHARMACY OUTLINE: GENERAL CONSIDERATIONS FUNCTIONS OF THE LYMPHATIC SYSTEM COMPONENTS OF THE LYMPHATIC SYSTEM ~ LYMPH ¥ LYMPH CHANNELS ~ LYMPHNOD! ¥ LYMPH ORGANS) + FORMATION OF THE MAIN LYMPH TIC TRUNKS AND pucts. \ | /ERAL CONSIDERATIONS ports lymph fipm interstitial space in o organs (wards the i The lymphatic system trans; base of the neck. Its pathway begins after resorption from initial lymphatics and lympb transport collectors and trunks) finally reaching the donftuchee as lymphatic and thoracic ducts, respectively at the of the internal jugular and subclavian vein} to progressively larger vessels (lymphatic right and left venous angles. ‘ im therapeutical issues may exist duc 19 the elpse ‘lationship of blood and lymphatic 7T there are Even though important physiopathological the ‘some marked differences between the 0 lymphatic System cannot be considered asa real circulatory system! While blood bi closed circle pumped by the heart, both ig systemic and pulmonary © ulation, lymph 7 is unidirectional from peripheral tissues to ood and is considered to be an open ere E \ ! anatomical, embryological, and functional systems. In that sense, srt i |the wate xvi ubiquitous and exists in all tissues) except the placenta, 5! cial layer of skin, bon ste. For along time, the existence of ymphaties in the cen of discussion among anatomist. Hawever, NOW Liquor is ithas clear ih with a iymphatic pathways: “The functions of the kymphatte system are: 1. Fluid batonce. The Iymphatc vessels transport bac fim thg blood vascular system About 30 liters oe into the ret spaces each day, iterstitil spaces back into the blood copillaries remained in the interstitial spaces, ebentually death. rf chiled lymph. edema would snaining fluid enters the Ly also found, where blood vessels are marrow, cartilages, umbilical cord, was system has been subject jral nervor aph and sidered as the neuroaxis ly to the blood fluids that have escaped (@ of fluid pass from the blood lvereas only 27 L pass from the ff the extra 3 L of interstitial fluid d result, causing tissue damage iphatic capillaries, where the fluid is Fiamarts arohored 19 onsen Lymph_sLarge cite ducts * P veins Lowest pressurext absorption. The lymphatic system absorbs fats and other substances ‘roms the act. Lacteals are special lymphatic vessels located jn the lining of the small intestine, Pats enter the lacteals ahd pass through the lymphatic vessels tothe venow: 4 House of the body's defenses. Thy lymphoid tissues and organs house phagocytic Sell: and lymphocytes, which play esserfial roles in body defense ang resistance to disease, Components of the lymphatic system The fluid originated from capillary filtratipn flows preferentially through the tissue channels, the After absorption of the interstitial fluid by the ‘microcirculatory highway” of the intersftium nitial lymphatics, lymph is transported| through progressively larger and stryctirally more plex vessels until its final destination into the blood system. Alf along the| way, compact ted lymphocytes, the lymph nodes, filter the lymph and are responsible ystem- the infmune response ts of the follolving: \ o ‘The lying lymph is a watery fluid that circulated throughout the lymphatic system, the tail way blood in the arteries and veins of the cirqulatory system. It is essentially recycled blood plasma it a watery fluid that leak out of blood in the circulatory system. It consists of majnly of plastt ter, inorganic & orghni¢ substances, globulins | (antibodies), jete, When vated with the blood, iymph has lesser number of calcium, blood proteins, pHosghioroys|and smnount of glucose concentration. Red blood corpuscl (erytlrocytes) and Hately are+ The lymphatic channels| nt order pf Lymphatie hee tan be clagsified in @ er capillaries, precollectors, collectors and trunks. The lymphatic capillaries The strusture GF lymph capillaries whose prime fun es is some essentt macromolecules, differ from blood capilla glove fingers, have incomplete basal membrane and are capillary Vessels, Their ecco cells have a small nun blood vessels (ebbett for sinusoidal capillaries and injured cells forming the walls of the capillaries loosely overlap valves that act as one-way swinging doors. The flaps, surroundiig strubtures, open when the fluid pressure is hi fluid to enter the lymphatic ¢apillary, Anchoring filame presented by lymph capillaries; these structures are ext originatejon| the outer surface of the intercellular conta _ Valve open — Overla| endothel fi Direction capillary ping ial cell of lymph flow Valve closed Fluid entering lymphatic size and complexity In tion ts absorption of fluid and ial features; their format revembl larger than the correspondent blood lber of open junctions, not found In essels). The edges of the ne another, forming flapelike mini dothielial nchored by fine collagen fibers to in the interstitial space, allowing ts are a unique anatomical feature Insions of the endothelial cells and t area between two adjacent cells, tion of lymph flow rei | capillary shdwing the valves and the di. 1 larger meshvlike netwdes of tb that are Toeated ins, even though theif 1 also a valve at d bead-like sh es, formed by folds of endo m, $m@pth muscle an ymphatic confluence at the jugulosubelavia Jing blood reflux t9 the major lymphatic duets. The areas between the val snion of lymphatic vessels, There are eleven lympha sar, brpnchomediastinal, subclavign, jugular apd descending * srilestnal trunk, are pired. They are nanedltr the regionLymphatic vessels ve ; | Fig 3. Major iyctphitic trunks | ‘The lymphatic ducts The lymphatic ducts empty “ lymph into the veins, Thefe are two lymphatic ducts: the right | Tymphatie duct aba the thoraci¢ duct. The right lymphatic dict is formed by the confluence of the | Fight jugular trun, right subclavian trunk and right bronchoqmediastinal trunk; generally this duct t jugulosubelavian confluence originated) from the descending intercqstal trunks, the right‘and left |wmbar according to its topography, can bp divided into superficial, deep and rains skin and subcutaneoys tissue whereas the deep lymphatic for the} subfascial tissue drainage) The visceral system can also bePORMATION OF THE MAIN Lynd Lumbar trunks fod infra umbilical portion of the abdom Efferent lymph vessels from celiac gastrointestinal trunk, The right and left bronchomediastinal t from the deep layer of the superior and af of the diaphragm, lungs, heart and visce The subclavian trunks are formed by umbilical area of the abdominal wall and Lymph from head, face, inner structure the jugular trunks The descending intercostal trunks colle} region, corresponding to the last five inte The thoracic duct is originated from the trunks and the gastrointestinal trunk. Cis where those trunks meet and is located Hptween the azygous vein ang aorta. Just after its origin, the thoracic duet runs cranially through| median sagital plane and around DS lev the thoracic esophagus. At the base of t! near its terminal portion receives the Ie trunks. Therefore, according to the lymphatic dr all but the upper right quadrant are draine are formed by the union) Hower limbs, urogenital system, anator HATIC TRUNKS AND of lymphatic vessels which Heain the eal structures irrigated by the inferior inal wail pnd superior mesenterie Iymph nodes iginate the 4 inks are responsible for the transport of lymph coming pterior areas of the abdomen|and thorax, terior portion | aspect of the right lobe of fhe liver. | lymphatic collectors draining the upper limbs, supra anterior thoracic wall | of the neck and posterior pil reploaicin toad t the lymph originated at the deep posterior thoracic | )4 idescending intercostal trunks, the right a left liimbar 4 ferna chyli is an ampular dilatation frequently observed ‘costal spaces. the sonic hiatus of the diaphragm, to thalright of the | turns to the left side, crossing the posterlor aspect of ie neck, reaches the left jugulosubclavian junction and t jugular, left subclavian and left bronchomediastinal { and ided into four quadrant (nage the body can be divi by the thoracic duct, a‘Entrance of thoracic into left subclavian Cisterne chy! —— Right lumbar — } . trunk \ e caiman Trachea Ribs Thoreele duct Hemiazygos vein Left tumbar trunk Inferior vena cava Intestinal trunk Figure 4}Lymphatic trunks andl ducts } | + Lymph Nodes | glomerate of lymphoid tisshe surrounded by @ capsule of dense » 7 Lymph odes consist in an * connestive tissHe nd some |smooth muscle fibers and] trabeculae, extensions of the inner aspect of the capsule that limit lymph fol the Iymgh node, lymph flows through its sub caps n the network formed. \ | oe its inner framework ig formed by icles. After reaching sular spact and is filtered i tehe trabecular and mi constant areas of the body as chains found in reasondbly © number of nodes; the total numbet of lymph godes in hiumans is estimated to be arg aan soeskall ° 10 700. The shape of the lymph node is sually Bemees ean-shape or round and can |coasidersbly it sine ad 1 1 size gnd may reacll a nosma diameter of up to one inch. They r Th nk-grey in colour, and structurally, haye a shall depression called hilus and an opposite cot x surface, Eff iph vessels and nodal arteries and veins a found in the hilus whereas hffe rent lymph esselsreaclt the lymph nde ih many points along its convex surface Afferent Ifmph vessels ar generally smaller and more numefous than the efferent v Is. Afferent lymphtic vessels (arrive) bring lymph int the lymph node, while ef nit lymphatic vessels (exit ye the lymph node thro gh the hilus h vessels, lymph node \ gtoups or chains can be classified actording to their ficial, when they are enfbedded into the subcutaneobs tissue or deep, situated under the muscular fascia or i joracic cavities. je abdominal or There are about five regional lymph nodes named according to {heir locations, in various segments of the body. These include: ct ical(neck), axillary (armpit), inguinal(groin), yertebral | | ‘ column, and mesenteric(intestinal), 4Germinal center in Ni, follicle Capsule Subcapsular sinus . — Medullary sinus Sue Aegional fymph nodes: Entrance of Tigh lymphatia) dugt Into right || subclavian veln Intermat jugular vein Entrange ot Thoracic duct ‘Aorta || Cistama chy Lymphatic collecting vessels Figure 6. Regional lymph nodes READ UP THE LYMPHOID ORGANS (THYMUS, SPLEEN, TONSILS)