Anatomy day program

• Event day
On Saturday the 20th of August 2022 from 10:00 AM – 1:00 PM.
• Meeting point: at 9:50 AM in front of the Adelaide Medical School,
Helen Mayo North, Frome Road.

North terrace
• 10:00 – 10:45 Presentation about the anatomy of the
Lymphatic system
• 10:45 – 11:00 Responding to questions
• 11:00 – 12:30 Studying the wet lab specimens (10
stations) using the supplied work book activities that
cover lymphatic tissues and related organs.
• 12:30 – 12:45 feel the most commonly palpable lymph
nodes in living
• 12:45 – 1:00 Responding to questions and sharing
experiences.
 The topic presentation

Lymphatics
Anatomy
Lymph
The clear water as it is a clear watery fluid which may be
faintly yellow or slightly opalescent. It is collected by the
lymphatic capillaries from the interstitial fluid contained in the
extracellular extravascular space of various organs and tissues.
It has the same constituents as present in the plasma, i.e.,
electrolytes, protein, and many lymphocytes (Moore 1992).
Interstitial Fluid (ISF)
The tissues and cells of the body need oxygen, water, and
nutrition for their metabolic needs and survival, and they
reach them through the arterial side of the capillary network
to the interstitial space and the waste deoxygenated blod will
be pushed by pressure deference into the venous side of the
capillary network.
A part of water and large particles which cannot
enter the blood capillaries are removed by
lymphatics (initial lymphatics) which have large
pores.
The lymphatic system main functions:

• Return of interstitial fluid into the lymphatics

• Help to expand the lungs at the time of birth
and maintain this for the rest of the life
• Transport of protein-rich interstitial or tissue
fluid into the blood circulation.
• Transport of th e large particles in ISF such as
bacteria, parasites, and even malignant cells
enter the initial lymphatics.
• In the small intestine, the absorbed Fat
(resynthesized triglycerides, lipoproteins, cholesterol, long-
chain fatty acids, and fat-soluble vitamins (A. E, D, and K) )
The chylomicrons are large particles, hence are
carried in the intestinal lymphatics as chyle by the
intestinal lymph trunks to cisterna chyli bypassing
the liver.
Lymphatics Anatomy
The lympahtics are present all over the body and
accompany the veins except in cortical bone, central
nervous system, and eyeball although the latter two
systems possess cerebrospinal fluid and aqueous humor,
respectively. Other structures where the lymphatics are not
found include epidermis, cornea, cartilage, tendon, and
muscle (Pipinos and Baxter 2012).
The dermis is very rich in lymphatics that it is not possible
to dermis without puncturing a dermal puncture the
lymphatic (McMaster 1937).
The lymphatic system consists of
lymphatic channels and lymph
nodes and other related organs.
 Other Lymphoid tissues and organs

Tonsils Thymus
Liver Spleen

Mucosa
associated
lymphatic
tissue
The liver is a major lymph-
producing organ. Between one
quarter and one half of the lymph
comes from the liver.
Lymph nodes
There are about 800 lymph nodes in the body of which about 300
lymph nodes are present in the neck.
The lymph nodes are flattened, ovoid structures that
vary in size from a pinhead to 2.5 cm or more in
diameter. They are situated in the course of lymph
T and B
vessels so that the lymph passes through them on its lymphocytes
way to drain into the venous circulation.

. It receives afferent lymph vessels that have

unidirectional valves which open towards the lymph
nodes and send an efferent lymphatic which of may
become afferent lymphatic of a proximal lymph node
or drain to a lymph trunk. Thus, the lymph from any The functions of lymph nodes are production of
tissue or organ traverses one or more lymph nodes lymphocytes and antibodies, filteration of tissue
before it eventually drains into venous blood stream. fluid of particulate material including bacteria,
and reduction of volume of tissue fluid by half.
The lymphatic system consists of
lymphatic channels and lymph
nodes.
Lymphatic Capillaries
They develop in the interstitial fluid space. The initial
lymphatics are much larger (50 μm) than capillaries
and are blind-ended.
They permit the entry of larger molecules (even cells
and microbes) as the basement membrane is
fenestrated, tenuous, or even absent and the
endothelium has intracellular and intercellular pores.
They are attached to interstitial matrix by filaments
(4–6 nm) tethering the interstitial matrix to the
endothelial cells.
Terminal (Collecting)
Lymphatics
Many initial lymphatics drain into
terminal lymphatics which have
bicuspid valves and endothelial cells
having actin, a contractile protein.
Larger terminal lymphatics are
surrounded by smooth muscle
fibers and have valves that divide the
lymphatics into segments
(lymphangions) which contract
sequentially to propel lymph into the
lymph trunks.
Lymph Trunks
Many terminal lymphatics join to form lymph trunks
which are of two types – superficial trunks along with
major superficial veins, and deep trunks
accompanying the main neurovascular bundles. The
deep lymphatics transport only about 10% of
lymph of the extremities. There are only a few
communications among the superficial and deep
lymphatics with direction of flow from
superficial to deep lymphatics (Handley 1908;
Manokaran 2005).

The lymph trunks drain into the lymph ducts,

which in turn return lymph to the blood by
emptying into the respective subclavian veins.
There are two lymph ducts in the body: the
right lymph duct and the thoracic duct.
Thoracic Duct
It is the main lymphatic channel that
drains most of the lymph of the
body, i.e., the lymph of lower half of
body and left half of body above
diaphragm. It is of about 45 cm in
length and starts from the upper end
of cisterna chyli, and opens in the
junction of left internal jugular vein
with left subclavian vein at the level Half of head and neck
of seventh cervical vertebra. Jugular trunk,
Right Lymphatic Duct
It is present in the root of the neck (upper limb)
on the right side and is about 1 cm in
length. It receives lymph from right Subclavian trunk
half of head and neck, right upper
extremity and from right half of (half of thorax)
thorax and its contents. It runs along Bronchomediastinal
the medial border of scalenus
anterior in the root of neck and trunk.
opens into the junction of right
subclavian with right internal jujular Abdomen and lower
vein where there is a bicuspid valve Limb Cisterna Chyli
which prevents reflux of blood into
the duct.
Put in order the chain sequence of the lymphatic circulation

Systemic
vein
Lymph node

Lymphatic trunk

Lymphatic
capillary
Lymph vessel

Lymphatic duct
Transport of lymph
1. The main driving force in the extremities is the
compression of local lymphatics by the contraction of
adjacent skeletal muscles pushing the lymph upwards
similar to the mechanism of venous return (Cuschieri and
Giles 1995).
2. Contraction and relaxation of lymphangions in a
sequence from below up without reflux because of
competent valves in the lymphatics
3. The negative intra-thoracic pressure together with a
positive intra-abdominal pressure pulls/pushes the
lymph from abdomen (lower half of body) to thorax. This
movement synchronizes with the movements of
diaphragm.
4. Negative pressure in neck veins – The venous pressure
in the neck veins is always negative. Hence the lymph is
sucked into neck veins during diastole of right atrium.
5. Arterial pulsation – The pulsation of arteries in the
vicinity of lymphatic trunks may help in the movements of
lymph
Lymphatics of Head and Neck
There are about 300 lymph nodes are present in the neck. Hence, the neck is the part of the body that has maximum number of
lymph nodes (out of 800). The lymphatic vessels of the head and neck can be divided into two major groups; superficial vessels
and deep vessels. The superficial vessels drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the
junction of the neck and head. Deep vessels, the deep lymphatic vessels of the head and neck arise from the deep cervical lymph
nodes. They converge to form the left and right jugular lymphatic trunks ( form the thoracic duct (on the left side) and the right
lymphatic duct on the right side.
Superficial Lymph Nodes.
+ Transverse group: They are arranged in a ring shape; extending from
underneath the chin, to the posterior aspect of the head. They ultimately
drain into the deep lymph nodes. + Occipital nodes + Retroauricular
(mastoid) nodes + Parotid nodes + Facial: This group comprises
the maxillary/infraorbital, buccinator and supramandibular lymph
nodes. + Submandibular nodes. + Submental nodes.
+ Longitudinal group (Superficial Cervical): can be divided into the
superficial anterior cervical nodes and the posterior lateral superficial
cervical lymph nodes. The anterior nodes lie close to the anterior jugular
vein and collect lymph from the superficial surfaces of the anterior neck.
The posterior lateral nodes lie close to the external jugular vein and collect
lymph from superficial surfaces of the neck.
Anterior midline nodes; 1. Suprahyoid 2. Infrahyoid 3. Suprasternal nodes
Lateral cervical nodes along the external jugular vein.
Deep Lymph Nodes
They are situated deep to fascia of neck (fascia colli)
and are arranged anterior or posterior to
sternocleidomastoid muscle.
A. Anterior deep cervical group
Upper set; 1. Jugulodigastric nodes
Lower set 1. infrahyoid 2. Prelaryngeal, Pretracheal
3. Retropharyngeal nodes 4. Retrotracheal nodes
5. Paratracheal nodes
B. Posterior deep cervical group
Upper set:1. Jugular nodes (along IJV) 2. Deep
occipital nodes
Lower set:1. Juguloomohyoid nodes 2. Supraclavicular
nodes 3. Subclavian nodes
All the lymphatics of head and neck region drain into
deep cervical lymph nodes along the carotid sheath
either directly or indirectly after draining into the nodes in
the vicinity.
The efferents of deep cervical nodes form a jugular
trunk of either side.
Lymphatics of Thorax
There are two types of lymph node groups in the thorax.
Parietal groups - Parasternal (along internal thoracic vessels) - Posterior intercostal
(along posterior intercostal vessels)
Visceral groups - Pulmonary (within lungs) - Bronchopulmonary (at hilum) -
Inferior tracheobronchial (below carina) - Superior tracheobronchial (above carina -
Paratracheal (alongside trachea) - Mediastinal (scattered in mediastinum).
Superficial Lymph Vessels
The clavicles demarcate the superior division between zones of lymphatic
drainage: above the clavicles, lymph flows ultimately to inferior jugular
lymph nodes; below them, parietal lymph (that from the body wall and
upper limbs) flows to the axillary lymph nodes.

(The lymph vessels of the skin of the anterior thoracic wall and above the
umbilicus drain to the anterior axillary nodes (pectoral). The lymph vessels
of the skin of the posterior thoracic wall and back above iliac crest drain to
the posterior axillary nodes.
(Pectoral) group of nodes, which can be palpated just beneath the lower
border of the pectoralis major muscle).
Below the level of the Umblicus anteriorly or iliac crests posteriorly , it
drains downward to the superficial inguinal nodes.
Lymphatics of Upper Extremity Including Breast
All the lymphatics of the upper extremity drain into a terminal group of lymph
nodes in the axilla. They are of two types – superficial and deep (below the deep
fascia)
Axillary Lymph Nodes
They vary from 20 to 30 in number, are of a relatively large size, and are divided
into five groups depending upon their anatomical location.
1. Anterior or pectoral group – They are situated along the lower border of
pectoralis minor in relation to lateral thoracic vessels. They drain the skin and
muscles of anterior and lateral walls of the body above the level of umbilicus, and
the central and lateral parts of breast.
2. Posterior or subscapular group – They are placed on the lower border of
posterior axillary fold (Latissimus dorsi and teres major muscles) in relation to
subscapular vessels. They drain the skin and muscles of lower part of back of neck
and back of trunk up to iliac crest.
3. Lateral group (humeral) – They drain most of the upper extremity. (anterior
axillary fold made by pectoralis major)
4. Central group – They are embedded in the axillary fat. This group receives
afferent from all the three groups described above. Its efferents drain into the
apical group.
5. Apical group – It situated partly posterior to upper part of pectoralis minor
and extends upwards into the apex of axilla. It receives the afferents from upper
and peripheral part of breast and all other axillary lymph nodes. The efferents of
this group join to form the subclavian trunk.
Other Lymph Nodes
1. Supratrochlear lymph nodes – They are one to two in number, and are situated on medial side of upper arm above medial
epicondyle along the basilic vein. They drain the medial border of forearm and hand. Their efferents pass along the basilic vein to
join the deep lymph vessels of axilla.
2. Infraclavicular lymph nodes – They are one to two in number situated along cephalic vein in the deltopectoral groove below
the clavicle. They drain the upper part of chest wall including the breast. Their efferents penetrate the clavipectoral fascia and
drain into apical lymph nodes. Some efferents may pass anterior to clavicle to drain into lower deep cervical
(supra-clavicular) nodes.
Lymphatics of Abdomen and Pelvis
There are about 200 lymph nodes are present in the abdomen and pelvis. They are of
three types – preaortic, para-aortic, and retro-aortic.
1. Preaortic lymph nodes – They are situated directly anterior to abdominal aorta and drain the
subdiaphragmatic part of alimentary canal, hepatobiliary tract including pancreas and spleen. Their
efferents form the intestinal trunks which enter the cisterna chyli.
2. Para-aortic lymph nodes – The para-aortic or lateral lymph nodes lie on each side of aorta
up to its bifurcation in front of medial margin of psoas major. They drain these organs – kidneys,
suprarenals, testes, ovaries, abdominal ureters, fallopian tubes, and upper part of uterus and most
of the pelvic viscera and deep pelvic parietes.. The lymphatics from these structures form a
lumbar trunk on each side.
3. Retroaortic lymph nodes – They are placed
behind the aorta and are closely related to para-aortic
lymph nodes. They drain the deeper layer of
abdominal wall especially the posterior wall and drain
to the lumbar trunk on each side
Cisterna Chyli
It is a 5–7-cm-long saccular dilatation duct
situated in front of first and second lumbar
vertebral body immediately to the right of back
of abdominal aorta. It is joined by right and left
lumbar trunks and intestinal lymphatic trunks
draining lower limbs, pelvis and abdomen.
Lymphatics of Inferior Extremity.
The lower limb is drained by extensive subcutaneous network of lymphatics into the
inguinal and popliteal nodes.
Inguinal Lymph Nodes. They are situated at the root of thigh below the inguinal
ligament. They are classified as 1. Superficial inguinal and 2. Deep inguinal lymph
nodes. Superficial inguinal lymph nodes are present in the subcutaneous tissue
of the root of thigh superficial to fascia lata (deep fascia). They are arranged in
two sets – upper (transverse) and lower (vertical).
Deep inguinal lymph nodes They are usually one to three in number and
situated deep to fascia lata of thigh.
Popliteal Lymph Nodes
They are embedded in the popliteal pad of fat and are six to seven in number. They
drain along the popliteal vessels to deep inguinal nodes but a few lymphatics may
go along the long saphenous vein and drain into superficial inguinal lymph nodes.

The inguinal lymph nodes drain the lower extremity, external genitalia
in male (except testis), and external genitalia in female below hymen,
lower quadrant of abdomen below the level of umbilicus, gluteal
region, perineum, and anus. The popliteal lymph nodes drain the
lateral aspect of leg and foot, especially the heel.
Activities
to be done
in the wet
lab
 Examine the following specimens and comment on
1 2 3 4 5
Identify the Lymph
related structure

Guess the function

Is it within normal
anatomical
features

Can you feel it in

normal living
person
 1 2 3 4 5
Identify the Lymph
related structure

Guess the function

Is it within normal
anatomical
features

Can you feel it in

normal living
person
Lymph nodes
are they
palpable or
not?