Introduction to Anatomy & Physiology

THE LYMPHATIC SYSTEM

DR. MILIMO
BSc.HB, MBChB, MPH, MSc.EB*,DTM,
AdvCert.Psy.
 Objectives
By the end of this section, you will be able to:
• Identify the components, anatomy and physiology of the lymphatic system
• The immune system is the complex collection of cells and organs that
destroys or neutralizes pathogens that would otherwise cause disease or
death.
• The lymphatic system, for most people, is associated with the immune
system to such a degree that the two systems are virtually
indistinguishable.
• The lymphatic system is the system of vessels, cells, and organs that
carries excess fluids to the bloodstream and filters pathogens from the
blood.
• The swelling of lymph nodes during an infection and the transport of
lymphocytes via the lymphatic vessels are but two examples of the many
connections between these critical organ systems.
 Lymphatic system
• lymphatic system performs 3 important
tasks
• intimately associated to the
cardiovascular system and helps
maintain the fluid balance between the
blood vessels and the tissues.
• plays a large role in immunity.
• absorbs digested fats from the small
intestine.
Lymphatic vessels

• System of thin walled channels that collect

excess interstitial fluids (lymph) from
tissue spaces returned to vascular system
• consists of; a fluid called lymph, lymphatic
vessels, organs that contain lymphatic
tissue and the red bone marrow.
Lymph

• a clear watery fluid, similar in

composition to plasma with
exception to amount of plasma
proteins
• it is identical in composition to
interstitial fluid.
Lymph
• Carries large particles i.e. bacteria, cell debris from
damaged tissue which are destroyed by
lymphnodes.
• Contains lymphocytes which circulate in the
lymphatic system to protect the body against
invasion by infections.
• From small intestines in the lacteals, fats are
absorbed into the lymphatic system and give lymph
a milky appearance (chyle).
Lymphatic vessels

• Originate as closed-ended vessels in the

interstitial spaces
• Consists of a single layer of very thin
endothelial cells on an incomplete basal
lamina
• Back flow is prevented by folds of
endothelial cells
Lymphatic vessel
Lymphatic capillaries
Lymphatic vessels
• Lymphatic capillaries converge to form large
vessels.
• Interposed along the path of lymphatic are lymph
nodes
• Lymphatics are found in almost all organs except
CNS and bone marrow
• Structure of larger lymphatic vessels are similar
with veins except the walls are thinner, no
distinct separation of the 3 tunics,
• Contain numerous internal valves than vein
Lymphatic system
• Lymphatic circulation is aided by external
forces:
• contraction of surrounding skeletal
muscles
• valves keep lymph flow unidirectional,
• contraction of smooth muscle in the
wall help propel lymph towards the heart
Lymphatic system

• Lymphatic vessels ultimately converge

as 2 large trunks:
• Thoracic trunk
• Right lymphatic duct
The thoracic duct
• Conveys greater part of the lymph and chyle into
the blood.
• Common trunk of all the lymphatic vessels of the
body, except those on the right side of the
head, neck, and thorax, and right upper
extremity, the right lung, right side of the
heart, and the convex surface of the liver.
• Varies in length from 38 to 45 cm (adult).
• Extends from 2nd lumbar vertebra to the root
of the neck.
Thoracic duct
• Begins in the abdomen by a dilatation, cisterna
chyli,
• Situated in front of the body of the 2nd lumbar
vertebra, to the right side of and behind the
aorta, by the side of the right crus of the
diaphragm.
• Enters the thorax through the aortic hiatus of the
diaphragm,
• Ascends through the posterior mediastinal cavity
between the aorta and azygos vein.
Thoracic duct
Relations
• Posteriorly: vertebral column, right intercostal
arteries, hemiazygos veins
• Anteriorly: diaphragm, esophagus, and
pericardium,
• Opposite the 5th Thoracic vert, inclines toward
the left side,
• ascends behind the aortic arch and the thoracic
part of the left subclavian artery.
• it ends by opening into the angle of junction of
the left subclavian vein with the left internal
jugular vein.
Thoracic duct
• Cisterna chyli;
• receives 2 lumbar lymphatic trunks, right and left,
• intestinal lymphatic trunk.
• lumbar trunks are formed by the union of the efferent
vessels from the lateral aortic lymph glands.
• Receive lymph from the lower limbs, walls and viscera
of the pelvis, kidneys, suprarenal glands, deep
lymphatics of the greater part of the abdominal wall.
• Intestinal trunk receives lymph from the stomach and
intestine, pancreas, spleen, and lower and front part
of the liver.
Thoracic duct
Tributaries of the thoracic duct
• on either side, descending trunk from the posterior
intercostal lymph glands of the lower 6 or 7 intercostal
spaces.
• joined, on either side, by a trunk which drains the upper
lumbar lymph glands and pierces the crus of the diaphragm.
• receives the efferents from the posterior mediastinal
lymph glands and from the posterior intercostal
lymph glands of the upper six left spaces.
• In the neck it is joined by the left jugular and left
subclavian trunks
The right lymphatic duct
• about 1.25 cm. in length,
• Courses along the medial border of the
Scalenus anterior muscle at the root of
the neck
• Ends in the right subclavian vein, at its
angle of junction with the right internal
jugular vein.
• Orifice is guarded by 2 semilunar valves,
which prevent the passage of venous blood
into the duct
Right lymphatic duct
Tributaries of right lymphatic duct;
• Right side of the head and neck through the right
jugular trunk;
• Right upper extremity through the right
subclavian trunk;
• Right side of the thorax, right lung, right side of the
heart, and part of the convex surface of the liver,
through the right bronchomediastinal trunk.
The Organization of Immune Function
• The lymphoid component of the immune system consists of a network of
lymphoid organs, tissues and cells and the product of these cells.
Lymphoid organs can be classified into:
• A. Central or primary lymphoid organs, which include:
• I. Thymus
• II. Bursa equivalent (fetal liver and bone marrow)
• B. Peripheral lymphoid organs which include:
• I. Lymph nodes
• II. Spleen
• III. Mucosa associated lymphoid tissue (MALT)
• IV. Tonsils
• V. Appendix
 THYMUS
• The thymus gland is a bilobed organ found in the
space between the sternum and the aorta of the
heart.
• Connective tissue holds the lobes closely together
but also separates them and forms a capsule.
• Anteriorly:
Sternum and upper
four costal cartilage
• Posteriorly:
Aortic arch and its
branches
• Laterally: Lungs
• Superiorly:
Structures in the
root of the neck
• Inferiorly: Heart
DISTINGUISHING CHARACTERISTIC FEATURES OF THE THYMUS
• Central lymphoid organ—essential for development of other lymphoid
organs.
• Dual origin (lymphocytes from mesoderm and epithelial reticular cells
from the endoderm).
• Supporting stroma is formed by ‘cytoplasmic reticulum’ derived from
epithelial reticular cells.
• Formed only by T lymphocytes/thymocytes (no B lymphocytes).
• Divided into lobules of lymphoid tissue by interlobular septum (no
lymphatic nodules).
• Has Hassall’s corpuscles.
• Produces many thymic hormones.
• Fully developed at birth.
• Involutes after puberty.
 Role of thymus in the immune system
• The main function of the thymus is development of cell-mediated
immunity.
• The thymus confers immunological competence on the
lymphocytes during their stay in the organ. In the thymus, T
lymphocytes are educated so that they become capable of mounting cell-
mediated immune response against appropriate antigen.
• The immunologically competent lymphocytes migrate from the
thymus into peripheral lymphoid organs as mature and these are
selectively seeded into the paracortical areas of the peripheral lymph
nodes and into the white pulp of the spleen around the central arterioles.
These regions are known as thymus-dependent areas.
 SPLEEN
• Spleen is the largest lymphoid organ present in the upper
left part of abdominal cavity behind the stomach and is
completely covered by peritoneum.
• Normally it is a blood-forming organ in foetal life and blood-
destroying organ in postnatal life.
• It is attached to the lateral border of the stomach via the
gastrosplenic ligament.
• On average it is 2.5cm thick, 7.5cm broad, 12.5cm long
• Under normal conditions, the average weight of the spleen is
about 150g
• The spleen is a fragile organ without a strong capsule, and is
dark red due to its extensive vascularization.
 Spleen Relations
• Superiory and posteriorly: diaphragm
• Inferiorly: left colic flexure of large
intestines
• Anteriorly: fundus of the stomach
• Medially: pancreas and the left kidney
• Laterally: separated from 9th, 10th, 11th ribs
and intercostal muscle by the diaphragm
 Structural characteristics
• Capsule of the connective tissue surrounds the
spleen. From the capsule, the connective tissue
trabeculae extend into the pulp of the organ and
serve as a supportive network.
• Grossly on cut section, the spleen consists of
homogeneous, soft, dark red mass called red
pulp.
• In the red pulp are seen scattered white
nodules called white pulp (malpighian bodies).
• Microscopically, the structural characteristics are:
• Red pulp consists of the thin walled blood sinuses with
splenic cords between them. The splenic cords consist of
collection of lymphocytes and macrophages arranged in
cords in the fine network of reticular cells and fibres. This
finer network forms a filtering bed that filters out red
cells, white cells and platelets passing through the red
pulp.
• White pulp consists of lymphocytes surrounding an
eccentrically placed central artery. These periarteriolar
lymphocytes are mainly T lymphocytes. In addition, the
white pulp also contains the lymphoid follicles
composed principally of B lymphocytes.
 Functions of the spleen
• 1. Role in immune response: The spleen is an active site for production
of T and B lymphocytes and antibodies.
• 2. Role in removal of old RBCs, WBCs and platelets: Tissue
macrophages present in the spleen like other components of the MPS play
an important role in the removal of old RBCs, WBCs and platelets.
• 3. Role in haematopoiesis: During fourth and fifth month of fetal life
erythropoiesis occurs in the spleen.
• 4. Role in iron metabolism: Spleen macrophages have a special ability
to recycle the iron, liberated from the phagocytosed RBCs, for
synthesis of fresh haemoglobin in the bone marrow.
• 5. Role as a reservoir: Spleen serves as a reservoir for the mobilization
of RBCs in some animals like cat and dog. About 30% of the total
circulating platelets in humans may be present in the spleen adhering to
the reticular cells in the red pulp or endothelial cells of the sinusoids.
• 6. Role in regulating portal blood flow: The vasculature of spleen
also plays a role in regulating the portal blood flow.
 Lymph nodes
• The lymph nodes are small bean-shaped or oval structures which form
part of the lymphatic network distributed throughout the body.
Structural characteristics of lymph node
• Capsule of connective tissue covers each lymph node.
From the capsule, trabeculae penetrate into the lymph
node.
• Afferent lymphatics enter into each lymph node at its
convex surface and drain into the peripheral subcapsular
sinus.
• Efferent lymphatics leave the lymph node at the
concavity (hilum) as a single large lymph vessel.
• Microscopically, the lymph node consists of two parts—
peripheral cortex and central medulla.
• Cortex of the lymph node consists of several rounded
aggregates of lymphocytes called lymphoid follicles,
representing B-cell area of the node.
• Paracortex is deeper part of cortex, i.e. the zone between
the peripheral cortex and the inner medulla and represents
the T-cell area (the bursa-independent area).
• Medulla is predominantly composed of cords of plasma
cells and some lymphocytes (medullary cords). The
medullary cords contain B lymphocytes and along with
the lymphoid follicles constitute the bursa-dependent
areas of the lymph node.
The Lymph Glands of the Head
lymph glands of the head
are arranged in the
following groups:
• Occipital.
• Facial.
• Posterior Auricular.
• Deep Facial.
• Anterior Auricular.
• Lingual.
• Parotid.
• Retropharyngeal.
Lymphatics of the upper extremity
• divided into 2 sets, superficial and deep.
• Superficial lymph glands are few and of
small size.
• supratrochlear glands
• deltoideopectoral glands
• The deep lymph glands; mainly grouped in the
axilla.
• Axillary Glands are large in size, vary from 20 t0 30
in number, arranged in the following groups:
• lateral group; 4 to 6 glands
• anterior or pectoral group
• posterior or subscapular group; 6 to 7 glands
• central or intermediate group; 3 to 4 large
glands,
• medial or subclavicular group; 6 to 12
glands,
The Lymphatics of the Lower Extremity
• anterior tibial gland, popliteal and
inguinal glands.
• anterior tibial gland; lies on the
interosseous membrane in relation to the
upper part of the anterior tibial vessels
• popliteal glands; small in size 4 to 6 in
number, are imbedded in the fat contained in
the popliteal fossa.
The Lymphatics of the Lower Extremity

• Inguinal glands: divided into 2

groups by a horizontal line at the
level of the termination of the
great saphenous vein:
• superficial inguinal glands,
• deep set.
The Lymph Glands of the Abdomen and Pelvis;

• divided, from their situations, into

• parietal, lying behind the
peritoneum and in close
association with the larger blood
vessels;
• visceral, which are found in
relation to the visceral arteries.
 Functions of lymph nodes
• 1. To mount immune response in the
body: The bulk of antigens are processed and
antibody production occurs in the lymphoid
follicles.
• 2. The lymph nodes constitute a series of
inline filters: Lymph must pass through at
least one lymph node before mixing with the
blood stream. Over 99% of the lymph passes
through the lymph sinuses and only 1%
penetrates the lymphoid follicles.
 Tonsils
• Are large irregular masses of lymphoid tissue in the mucosa of the posterior
oral cavity and nasopharynx
• Named by their location; palatine, lingual, and pharyngeal tonsils
• Lymphoid tissue in tonsils is closely associated with surface epithelium
 Mucosa-associated lymphoid tissue (MALT)
• MALT consists of an aggregate of lymphoid follicles directly
associated with the mucous membrane epithelia.
• MALT makes up dome-shaped structures found underlying
the mucosa of the gastrointestinal tract, breast tissue, lungs,
and eyes.
• Peyer’s patches, a type of MALT in the small intestine,
are especially important for immune responses against
ingested substances.
• Peyer’s patches contain specialized endothelial cells called
M (or microfold) cells that sample material from the
intestinal lumen and transport it to nearby follicles so that
adaptive immune responses to potential pathogens can be
mounted.
Bronchus-associated lymphoid tissue (BALT)
• Bronchus-associated lymphoid tissue
(BALT) consists of lymphoid follicular structures
with an overlying epithelial layer found along the
bifurcations of the bronchi, and between
bronchi and arteries.
• They also have the typically less-organized
structure of other lymphoid nodules. These tissues,
in addition to the tonsils, are effective against
inhaled pathogens.
 QUIZ
1. Which of the following regarding white pulp of the spleen is
false?
a. It predominantly contains lymphocytes.
b. It is contained within a reticular meshwork
c. It is distinguished by the presence of the central artery.
d. It is encapsulated.

2. Which of the following concerning the medulla of the thymus is

true:
a. It is the site of B lymphocyte education.
b. It contains epithelioreticular cells.
c. It is characterized by a central artery.
d. It is supported by a reticular framework.