2. ¾ of the body is being emptied by the thoracic duct (the largest vessel of the body)
Left side is emptied by the thoracic duct, the right side is emptied by the right lymphatic duct.

3. Thoracic duct lymph drainage will go into the venous system.
Thoracic duct travels in the posterior mediastinum. Crosses covers to the left hand sides, and continues up to pass thru the thoracic outlet, it will then enter into the junction where the internal jugular vein and subclavian from the left brachiocephalic vein. This is where all the lymph of the thoracic duct will empty.

4. Cysterni Chyli great lymphatic lake, which will first collect all of the lymph from the abdomen, pelvic cavity, perineum and the lower limbs.
Thoracic duct is located close to the abdominal aorta, this is because it will use the aortic hiatus to gain entry into the thorax. It hugs the aorta.
#23 is one of the abdominal para-aortic lymph nodes. The arota is surrounded by lymphatics.

5. Cisterna chyli is the great lymphatic lake
Cisterna chyli is the great lymphatic lake. The R and L lumbar trucks have lymph nodes that are called paraaortic nodes (on either side of the aorta). They empty out, and the lymph from the lunbar trunk (posterior abdominal wall, pelvic cavity, and periuneum) will empty out from the perinum into the cisterna chyli
Cisternal chyli (located at L1 and L2)
Lmyph from the GI tracts will be emptied by the intestinal trunks, which will go to the cisternal chyli. Will then go thru to the throacic duct which will enter aortic haitus at the level of T-12. In front of T5 thoracic duct will cross over to the left hand side, and will enter into the subclavian vein.

6. Superficial lymphatics are found in the superficial fascia of the body, located immediately deep to the skin. Lymph nodes are clustered in certain areas. Lymphatics of the superficial fascia will accompany veins.
Lymphatics of the thoracic, abdominal, or pelvic cavity will accompany arteries

8. Follow the diagram:
If you know the arterial supply of the abdomen you can then map the distribution of the lymphatics in this area. Nodes will be located close to the arteries leading up to the aorta. Median sacral supplies the caudal region of the body wall (it is an unpaired vessel) it does NOT supply the GI tract.
On either side you have pair branches that go to the paired organs.

9. Cross Section of abdominal aorta.
Unpaired branches come out anteriorally and lymphatics will go go to the thoracic duct.
Lymph nodes are located at the junction of each of the vessels with the aorta. These are pre-aortic lymph nodes. Pre aortic nodes will service the GI tract, because they are located with reference to the arteries that supply the GI tract. The renal aa’s and gonadal aa’s come off the side of the aorta and they are serviced by the para-aortic nodes.
Paired Vessels: go to the paired glands. They come off the side of the aorta and are serviced by the para-aortic nodes.
Single vessels go to the abominal wall, located on the dorsal apsect of the aorta and will be serviced by the retro aortic nodes.

10. Spleen is the largest lymphatic organ, located with reference to the foregut. Located to the left of the greater curvature of the stomach.
-supply of the spleen will be shared with the foregut, via the celiac system.
-rib 10 divdes the spleen into two halves. Spleen is in the upper part of the abdomen.
Spleen is an intraperiotneal organ. It is anchored by many ligaments of the peritoneum. Linogatric ligament is how all infections come in spleen.
Spleen is the largest lymph node of the body. Often refereed to as the “cemetery” of the body. Cells come here to die, or be recycled.
-Tail of the pancreas touches the spleen. posterior to the pancreas is the splenic vein and aa, that will go and supply the spleen. Splenic vein will join the superior mesenteric vein to form the portal vein.
Lymph will eventually drain into the celiac nodes.

11. Shows the spleen dissected from the back
Shows the spleen dissected from the back. You can see the splenic aa and vein.

12. Stomach has been retracted to see the splenic aa and vein.

15. Type of malaria, trophozites are multiplying inside the RBC’s
Type of malaria, trophozites are multiplying inside the RBC’s. This can cause splenomegaly.

16. Infection of the spleen.

17. Protozoan infection of the spleen.
You can see an enlargement of the spleen drawn on the body. Spleen has spread beyond the border of the thorax

18. Important slide.

19. Unpaired are the celiac, sup mesenteric, and inf mesenteric

21. FOLLOW THE DIAGRAM:
Each organ will have its own cluster of nodes.
Celiac nodes cluster around the celiac trunk and all the lymph of the foregut will eventually end up here.
Gastric nodes- service the stomach
Hepatic nodes –service the liver
Splenic nodes- service the spleen
Once again, follow the arterial supply to track the lymphatic drainage.

22. Abominal infection will accompany with ascites accumulation of fluid in the periotneal cavity.
Virchow’s node trossier’s sings, one of the signs of stomach cancer. This node will enlarge in stomach cancer.

23. The lymph nodes that surround the sup mesenteric aa, will be the end point of all the lymph that comes from the mid gut. Each of the organs has their own individual nodes.
Track dem arteries and follow the lymph drainage fools.

26. All of the final drainage of the hind gut will be into the inferior mesenteric nodes. Then goes to the intestinal trunk to the cysterna chyli to the thoracic duct.
Lower rectum is supplied by mid and inf rectal aa’s. The upper lymph nodes of the rectum will go into the sup mesenteric nodes. Drainage from the lower rectum and anal canal drain into the para aortic nodes (This is a border area between the portal circulation and systemic circulation.)

27. Upper ½ of the rectum supplied by the superior mesenteric aa, will drain into the inf mesenteric nodes, but the lower ½ supplied by the middle rectal aa will go to the lumbar nodes
Below the pectinate line lymph from here will go into the superficial inguinal nodes. Tumor in the middle part of the lower quadrant will effect the middle rectal aa (branch of internal iliac) this will go to the lunbar nodes which are para-aortic

28. Tumor in the upper quadrant will go along with the superior mesenteric aa. If you haven’t arrested the metastasis, cancer will begin to travel with the venous drainage. It will travel with the superior rectal vein, and cancer cells will end up going into the portal vein and into the liver.
Middle rectal vein will conduct the tumor cells to the Internal iliac vein, goes to the common iliac veins, to the IVC, this will go to the R. Ventricle, and the tumor will end up in the lungs.

29. Summary slide of the lymphatic drainage.

30. Eventually the celiac, sup mesenteric, and inf mesenteric nodes will empty into the intestinal trunks. There is some variation in the number of intestinal trunks that are formed in the body.
Intestinal trunk I Celiac trunk will form its own intestinal trunk, and there will be one serving the mid and hind guts. (Two total intestinal trunks)
Intestinal trunk II one intestinal trunk with branches to the nodes
Intestinal Trunk III three separate intestinal trunks.

31. Paired vessels will be accompanied by the Para-aortic nodes, they are named according to the arteries. All the lymph from the paired nodes will gather into the lumbar trunk.
Para-aortic nodes are also known as the lunbar nodes

32. Shows how lymph travels coming from the lunbar trunks

33. Hodgkins disease You have enormous swelling of the paraaortic nodes on either side of the abdominal aorta.

35. Follow the diagram

36. Ovarian nodes, go from the ovary along the ovarian aa,, they empty via the lunbar trunk into the cysterna chyli.

38. Carcinoma of the intra-abodimnal organs
Carcinoma of the intra-abodimnal organs. Cancer travels thru the lumbar nodes, and you will have ascites associated with cancer.

40. Lymph from pelvic cavity will be organized around the internal iliac aa’s, except for the posterior wall of the pelvic cavity which will be serviced by the medial sacral nodes.
Lymph from the lower limbs will drain via the external iliac nodes.

41. Remember if you know the arterial supply you can track the nodes
Review of the internal iliac aa branches in the male and the female.
Know dat arterial supply and track dem nodes shawty.

42. Lymph from perineum goes to the superficial or deep inguinal nodes, because they are located so close to these areas.

43. Inguinal nodes are in the femoral triangle, they are located in reference to the femoral vein. These are nodes of the superficial fascia. Lymph from the superficial inguinal nodes will go up to the paraaortic nodes.

44. Glans penis and the spongy urethra in the male will go directly to the deep inguinal nodes.

45. Urinary bladder will track mainly along the internal iliac nodes to lunbar trunk nodes. Some parts will go directly to the external iliac nodes

46. Travels to the internal iliac nodes and the median sacral nodes
Travels to the internal iliac nodes and the median sacral nodes. They will track with the paraaortics and then to the lunbar trunk.

47. Vagina recives branches from the internal iliac nodes, but since it is is located closed to the external iliac nodes, so some of the vagina will be supplied via the external aa as well.
Fallopian tube and uterus mostly along the internal iliac nodes
Below the hymen lymph wil track to the sup. Inguinal nodes.

49. Femoral triangle

51. Here you can see all of the nodes popping out. There is Ascites

52. Scrotum also goes into the superficial ingunal nodes.

54. Obstruction of the lmyph vessels caused by the falaria worm
Obstruction of the lmyph vessels caused by the falaria worm. When the lymph vessels get clogged, lymph will gather and give rise to elephatitis.

56. You can see scrotal elephantitis, then elephantits of the lower limb
Worm will obstruct the lymphatic channels.

57. PEACE OUT Dr. AZIZ
HOLLA!!!!