Download Lymphatics Notes

The Lymphatic System
I. Physiology

Blind lymphatic capillaries remove excess fluid from tissues

Lymph moves centrally through lymph vessels and collecting ducts

It is filtered by lymph nodes interposed along the way

Lymph eventually dumps back into venous system at the root of the
neck

“Radical” associated with the removal of an organ implies removal
of lymph nodes of area – e.g. modified radical mastectomy
 This type of surgery can lead to edema of area normally
drained by the nodes. In the case of a radical mastectomy,
this is the arm.
 Results in “lymphedema” or swelling of the arm
 Inflammation (or infection) of that area is also more common
because the lymph nodes are not available to fight the
infection
II. Anatomy
A. Head and neck
1. Pre-auricular – front of ear
2. Posterior auricular – superficial to mastoid process
3. Occipital – base of skull posteriorly
4. Tonsillar – angle of mandible may be palpable
5. Submaxillary or submandibular – halfway between angle and tip
of mandible
6. Submental – midline behind tip of mandible
7. Superficial cervical – superficial to sternomastoid
8. Posterior cervical chain – anterior edge of trapezius
9. Anterior deep cervical chain – deep to sternomastoid; often not
possible to palpate
10. Supraclavicular – deep in angle formed by clavicle and
sternomastoid; may be palpable
B. Arm
1. Epitrochlear – medial and proximal to elbow
2. Axillary
3. Infraclavicular
C. Leg and groin
1. Vertical group in groin drains leg
2. Horizontal group in groin drains lower abdomen and genitalia
D. Deep nodes

Many non-palpable nodes are found in body cavities:
abdomen, pelvis, mediastinum, etc.
III. Characteristics
A. Normal nodes are small, non-tender and non-palpable or barely
palpable
B. Nodes may be enlarged without pathology

movable

may feel like peanuts or peas
C. Tenderness suggests inflammation
D. Look for source of infection in area being drained by node (e.g. if
tonsillar nodes are tender and palpable, look for tonsillitis)
E. Nodes suggestive of malignancy – primary such as lymphatic cancer
or secondary such as metastasis – are enlarged, hardened, more likely
to be fixed (immovable) and irregular in shape