Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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