Download 6.LYMPHATIC OF THE ABDOMINAL VISCERA

BY
PROF. SAEED MAKAREM
Lower end of the esophagus
The efferent lymph vessels of the abdominal esophagus
follow the arteries into the left gastric nodes.
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The stomach
The stomach lymph vessels follow the arteries into the left and
right gastric nodes, the left and right gastroepiploic nodes, and
the short gastric nodes.
All lymph from the stomach eventually passes to the celiac nodes
located around the root of the celiac artery.
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The duodenum
The duodenal lymph vessels follow the arteries and drain:
Upward via pancreaticoduodenal nodes to the gastroduodenal
nodes and then to the celiac nodes.
Downward via pancreaticoduodenal nodes to the superior
mesenteric nodes around the origin of the superior mesenteric
artery.
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The jejunum and the
ileum
The lymph vessels of
the jejunum and ileum
pass through many
intermediate
mesenteric nodes and
finally reach the
superior mesenteric
nodes, which are
situated around the
origin of the superior
mesenteric artery.
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The cecum
The lymph
vessels of the
cecum pass
through several
mesenteric
nodes and finally
reach the
superior
mesenteric
nodes.
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The appendix
Lymph vessels of the appendix drain into one
or two nodes lying in the mesoappendix and
then eventually into the superior mesenteric
nodes.
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The ascending
colon
Lymph vessels of
the ascending colon
drain into lymph
nodes lying along
the course of the
colic blood vessels
and ultimately
reach the superior
mesenteric nodes.
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Transverse Colon
The proximal two thirds drain into the middle colic nodes and
then into the superior mesenteric nodes;
The distal third drains into the colic nodes and then into the
inferior mesenteric nodes.
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Descending Colon
The lymph from the descending colon is drained to the colic lymph
nodes and the inferior mesenteric nodes around the origin of the
inferior mesenteric artery.
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• Liver
• The liver produces a
large amount of
lymph—about one
third to one half of
all body lymph.
• The lymph vessels
leave the liver and
enter several lymph
nodes in the porta
hepatis.
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The efferent vessels pass to the celiac nodes.
A few vessels pass from the bare area of the liver through the
diaphragm to the posterior mediastinal lymph nodes.
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Gall Bladder
The lymph drains into a cystic lymph node situated near the neck
of the gallbladder.
From here, the lymph vessels pass to the hepatic nodes along the
course of the hepatic artery and then to the celiac nodes.
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The pancreatic lymph nodes are situated along the
arteries that supply the gland.
The efferent vessels ultimately drain into the celiac and
superior mesenteric lymph nodes.
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Spleen
The lymph vessels of the spleen emerge from the hilum and pass
through a few lymph nodes along the course of the splenic artery
and then drain into the celiac nodes.
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Kidney
The lymph of the
kidneys go to the
lateral aortic lymph
nodes around the
origin of the renal
artery.
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Ureter
The lymph of the
ureters drains to
the lateral aortic
nodes and the
iliac nodes.
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Suprarenal gland
The lymph from the
suprarenal glands
drains into the
lateral aortic nodes.
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The lymph nodes are closely related to the aorta and form a
preaortic and a right and left lateral aortic (Para-aortic or
lumbar) chain.
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The preaortic lymph
nodes lie around the
origins of the celiac,
superior & inferior
mesenteric arteries.
They are referred to
as the celiac,
superior, and inferior
mesenteric lymph
nodes, respectively.
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These nodes drain the
lymph from the
gastrointestinal tract,
extending from the
lower one third of the
esophagus to halfway
down the anal canal,
and from the spleen,
pancreas, gallbladder,
and greater part of
the liver.
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The efferent
lymph vessels
from the
preaortic
nodes form the
large
intestinal
lymph trunk.
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The lateral aortic (para-aortic or lumbar) lymph nodes drain
lymph from the kidneys and suprarenals; from the testes in the
male and from the ovaries, uterine tubes, and fundus of the uterus
in the female; from the deep lymph vessels of the abdominal
walls; and from the common iliac nodes.
The efferent lymph vessels form the right and left lumbar trunks.
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The thoracic
duct begins in
the abdomen as
an elongated
lymph sac, the
cisterna chyli.
 The cisterna
chyli lies just
below the
diaphragm in
front of the
first two lumbar
vertebrae and
on the right
side of the
aorta.
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The cisterna chyli receives the intestinal trunk, the right
and left lumbar trunks, and some small lymph vessels that
descend from the lower part of the thorax.
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Five cm. long (2 inches)
 Formed behind the neck
of the pancreas.
 Formed by the union of
the splenic and superior
mesenteric veins, behind
the neck of the pancreas.
 Drains blood from the
gastrointestinal tract.
 (From the lower1/3rd of
esophagus to halfway
down the anal canal).
 It also drains, the spleen,
the pancreas, and the gall
bladder.
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 It
ascends behind the
1st part of the duodenum
 Then
it lies in the free
margin of the lesser
omentum, behind the
hepatic artery and the
bile duct.
 In the liver it breaks up
into liver sinusoids,
from which blood
passes to the inferior
vena cava through the
two hepatic veins.
12345-
Splenic.
Superior
mesenteric.
Left gastric.
Right gastric.
Cystic.
Ascends in the root of the
mesentery.
 In the right side of the superior
mesenteric artery.
 It passes in front of 3rd part of
the duodenum.
 Tributaries:
 1- Jejunal & Ilial veins.
 2-Iliocolic.
 3-Right colic.
 4-Middle colic.
 5- Inferior
pancreaticoduodenal
 6- Right gastroepiploic
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 Runs
in the spleniorenal
ligament.
 Runs below the splenic
artery, behind the body
of the pancreas.
 Tributaries:
 1- Short gastric.
 2- Left gastroepiploic.
 3- Inferior mesenteric.
 4- Pancreatic veins.
 Ascends
n the posterior
abdominal wall, in the
left side of the inferior
mesenteric artery.
 It joins the splenic vein
behind the body of the
pancreas.
 Tributaries:
 1- Superior rectal vein.
 2- Sigmoid veins.
 3- Left colic vein.
 Normally,
portal blood passes
to the liver, then it drained
into the IVC.
 Other smaller communications
are exist between the portal
and systemic systems.
 These communications become
important when the normal
route faces a resistant, e.g.
portal hypertension or liver
cirrhosis.
 1-
In the submucosa of the
lower 1/3rd of esophagus
between esophageal
branches of left gastric
vein (portal) and
esophageal branches of
azygos vein ( systemic).
 These veins become
dilated, tortuous and
engorged with blood
forming esophageal
varices.
2-
Halfway down the
anal canal, between the
superior rectal vein
(portal) and middle &
inferior rectal veins
(systemic).
These veins become
dilated tortuous, and
engorged with blood
forming piles
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3- Paraumbilical veins: which
connects the left branch of
portal vein with he superficial
veins of the anterior abdominal
wall.
These veins appear engorged
with blood radiating from he
umbilicus and called caput
Medusae.
4- The veins of the ascending & descending
colon, duodenum, pancreas and bare area of
liver (which are retroperitoneal) and drained by
portal vein may anastomosis with vines on the
posterior abdominal wall (e.g. Lumbar veins,
systemic).