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LYMPHATIC DRAINAGE OF ABDOMEN Learning Objectives • • • • • • • • By the end of this lecture, the students should be able to understand: The types of lymph nodes draining the abdomen The lymphatics draining the abdominal wall The lymphatics draining the abdominal viscera The terminal group of lymph nodes around abdominal aorta The lymphatic trunks The cisterna chyli The thoracic duct Lymphatic drainage of abdominal wall To axillary lymph nodes from region above umbilicus • • To superficial inguinal lymph nodes from region below umbilicus To lumbar lymph nodes from post wall of abdomen Lymph nodes of the Abdomen • The lymph nodes of the abdomen may be divided from their location into: • Parietal lymph nodes: lying behind the peritoneum and in close association with the larger blood vessels. • Visceral lymph nodes: which are found in relation to the visceral arteries. Parietal Lymph Nodes • External Iliac nodes – Lie along the external iliac vessels • Common Iliac nodes – grouped behind and on the sides of the common iliac artery • Epigastric nodes – placed alongside the lower portion of the inferior epigastric vessels • Iliac Circumflex nodes – situated along the course of the deep iliac circumflex vessels • Hypogastric nodes – Surround the hypogastric vessels Sacral nodes • – • Placed in the concavity of the sacrum, in relation to the middle and lateral sacral arteries Lumbar nodes – Lateral Aortic nodes – – Preaortic nodes Retroaortic nodes Visceral Lymph Nodes • • • • Form the preaortic group of nodes surrounding the abdominal aorta Celiac nodes: situated around the celiac trunk – – – Gastric nodes Hepatic nodes Pancreaticolienal nodes Superior mesentric nodes: situated around superior mesenteric artery – – – Mesenteric nodes Ileocolic nodes Mesocolic nodes Inferior mesentric nodes: situated around inferior mesenteric artery Terminal Lymph Nodes of the Abdomen • • Entire lymph from the abdomen ultimately drains into the terminal group of lymph nodes in relation to the abdominal aorta These terminal nodes are arranged in three groups: • • • Lateral Aortic Nodes: on either side of aorta are the Right and Left lateral Aortic nodes Retro aortic nodes: lying behind the aorta are the Retroaortic nodes Preaortic nodes: lying in front of the aorta are the Preaortic nodes, grouped as celiac, superior mesenteric and inferior mesenteric nodes Celiac Nodes • • Celiac Nodes lie in relation to the celiac trunk Drain: – – – – – – Stomach Most of the duodenum Liver Extra hepatic biliary apparatus Pancreas Spleen Superior Mesenteric Nodes Lie in relation to superior mesenteric vessels • Drain: – – – – – – – Part of duodenum Jejunum Ileum Cecum Appendix Ascending colon Transverse colon Inferior Mesenteric Nodes • • • • • Lie in relation to inferior mesenteric nodes Drain: Descending colon Sigmoid colon Upper part of rectum PREAORTIC NODES • All the efferent lymphatics from the preaortic nodes (celiac, superior mesenteric, inferior mesenteric group of nodes) forms the intestinal trunk The intestinal trunk drains into the cisterna chyli Lateral Aortic Nodes • • Receive all the lymph draining the common aortic artery Also drain: – – – – – – • • The posterior abdominal wall The Kidney The upper parts of ureters The gonads The uterine tubes The parts of uterus Effernt lymphatics from these nodes forms the corresponding lumber trunk Lumber trunk ends by joining the cisterna chyli Intestinal Lymphatic Trunks • Located at left side of the abdominal aorta or between the abdominal aorta and the inferior vena cava near the level of the superior mesenteric artery Receive lymph from efferent lymphatic vessels from the celiac nodes and superior mesenteric nodes • Drain into left lumbar trunk or the cisterna chyli/thoracic duct • Carries lymph that is rich in fat from small and large intestines Cisterna Chyli • Cisterna chyli is an enlargement of the lower end of the thoracic duct • Drain all of the body below the respiratory diaphragm; all of the abdominal and pelvic viscera • Located between the abdominal aorta and the inferior vena cava anterior to the body of the L1 or L2 vertebra • Receive lymph from right and & left lumbar trunks; possibly the intestinal trunk • Drain into the thoracic duct 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 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 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 ------------------------------------------------xxxxxxxxxxxxxxxx----------------------------------------------------------