Chapter 13

Emphatic Over the Lymphatic System

Personally, I don’t get too excited about the lymphatic system. Yes, I know a good portion of
the immune system resides there and immunity is very interesting, but I don’t find the
lymphatic system as sexy as, say, the cardiovascular system. But that’s just my opinion. Many
an A&P instructor will delightfully cover the minute details of the anatomy of a lymph node.

Don’t get me wrong, the lymphatic system is important and vital to our health. Also, allied
health practitioners will be assessing it by poking on lymph nodes and looking for swelling
associated with lymph fluid (lymphedema). So let’s get going and get emphatic about learning
about lymphatics.

Big Picture: Lymphatic System

The lymph picks up fluid that has moved out of the circulatory system and carries it back into
circulation while cleaning it up along the way.

Why do we have this system?

As I mentioned before a good portion of the immune system resides in the lymphatic system. A
host of white blood cells stands ready to defend against nasty pathogens. We will cover
immunity in another chapter so let’s look at some of the other functions.

Circulatory system capillaries are leaky. It should be this way because substances should leak
out of capillaries and into cells and tissues. Actually the function of capillaries is to bring good
stuff like oxygen and nutrients to tissues so they can survive. The capillaries work much like a
filter and we will see that filters work because of changes in fluid pressure. Well, when we
calculate the pressures involved in pushing fluid through the capillaries we find that there is a
net loss of fluid from the capillaries into the interstitium. This means that as blood flows
through the capillaries some fluid is lost. Something’s gotta pick up that fluid or we would swell
up. That something is the lymphatic system.

Another important function is related to the digestive system. When you eat a Big Mac the
carbs, fats and proteins get broken down by enzymes in the stomach and intestines. The broken
down substances are then absorbed. Carbs and proteins move directly into the blood via
digestive system capillaries. Fat however is packaged up in special packages called chylomicrons
and gets dumped into, you guessed it, the lymphatic system. The lymphatic system then
transports the chylomicrons to the blood.
How does it work?
Let’s look at how the lymphatic system picks up interstitial fluid. Well ,it actually has its own set
of capillaries called, you guessed it again, lymphatic capillaries. These babies intertwine with
circulatory system capillaries and pick up that extra fluid. They are designed to allow fluid to
flow one way, into them and off to the rest of the lymphatic system.

Part of that special design of lymphatic capillaries is that the layer of epithelial tissue forms a
series of one way valves to only allow fluid in. The fluid flows from the capillaries to a series of
vessels. The vessels have three layers of tissue and contain one way valves that only allow fluid
to flow toward the circulatory system. The pressure to push the fluid through the vessels comes
from contracting muscles. This acts like a pump to push fluid through the system. So if you want
to move lymph fluid then you need to move some muscles.

Another way that lymph fluid moves is a bit trickier. As you inhale the pressure in the thoracic
cavity becomes lower (actually it becomes a negative pressure). The lower pressure creates a
suction that pulls lymph fluid into the thorax.

Lymph Nodes
If you’ve visited your doctor for the flu you would have probably been poked for swollen lymph
nodes. Doc usually pokes around your neck and under your jaw for these. So you probably
figured out that you have lymph nodes in your neck. You also have them in other locations.

These locations besides the neck (cervical) include:

Axilla (armpit)
Infraclavicular (under the clavicle)
Epitrochlear (elbow)
Inguinal (groin)
Popliteal (knee)
Pectoral (chest)

Lymph nodes are oval structures (Fig. 13.1). They have a cortex (outer layer) and medulla (inner
layer). Vessels carry fluid into the node (afferent vessels) and out (efferent vessels). There is a
“dented” area called the hilus where the efferent vessel exits and blood vessels enter. There is
also good ole reticular connective tissue forming a web-like structure throughout the inside of
the node.
Fig. 13.1. Lymph Node.

Lymph nodes contain white blood cells that help to “clean up” the fluid that flows through the
node. These white blood cells include macrophages and lymphocytes. The macrophages “eat
up” pathogens and the lymphocytes also attack pathogens by secreting chemicals that destroy
them (more about this in the immunity chapter).

The lymphatic vessels eventually form larger structures known as lymphatic trunks. The
lymphatic trunks drain specific portions of the body. The subclavian trunks drain the upper
extremities. The jugular trunks drain the head and neck. The bronchomediastinal trunks drain
the thoracic area. The intestinal trunks drain the abdomen. The lumbar trunks drain the lower
extremities and pelvic area.

The lymphatic trunks connect with larger structures called lymphatic ducts which connect with
the venous system at the subclavian veins. There are two ducts including the thoracic duct and
right lymphatic duct. The jugular, subclavian and bronchomediastinal trunks connect to either
the right internal jugular, right subclavian, or right brachiocephalic trunk. In some people the
three trunks merge to form the right lymphatic duct.

The remaining trunks connect with the thoracic duct. The drainage of lymph fluid is therefore
asymmetrical with respect to the arrangement of the right lymphatic and thoracic duct. In other
words the right lymphatic duct drains the right side of the head, neck and trunk while the
thoracic duct drains the left side of the head, neck and trunk as well as both lower extremities.

In some cases the intestinal and lumbar trunks merge to form a sac like structure called the
cisterna chili.

Lymphatic System Organs

There are two organs associated with the lymphatic system. These are the spleen and thymus.
The organs contain lymphatic tissue consisting primarily of the white blood cells we mentioned
earlier. As far as the lymphocytes are concerned there are two general types. These are the T
and B lymphocytes. Both are produced in the bone marrow and carried to the lymphatic
system. Activation of the immune system causes these cells to divide and attach pathogens.

Lymphatic tissue also contains reticular cells that produce reticular fibers. White blood cells
connect with these fibers so that fluid moving through the tissue is exposed to the cells. The
white blood cells can then destroy bacteria and debris.

Lymphatic tissue resides throughout the lymphatic system. When it is not located in a lymph
node or organ such as in the mucous membranes of the digestive, urinary, respiratory and
reproductive systems it has a fancy name known as Mucosa Associated Lymphoid Tissue
(MALT). The tonsils are another example of MALT.

The spleen is located in the left upper quadrant of the abdominal area generally close to the
diaphragm and is about as large as an adult fist (Fig. 13.2). It consists of an outer connective
tissue capsule. The inner portion has a trabeculated structure containing areas of red and white
pulp. The spleen also contains venous sinuses.

White pulp consists of lymphatic tissue associated with arteries within lymphatic organs. Red
pulp contains both white and red blood cells and is associated with veins.

The splenic artery and vein enter and exit the spleen at the hilum. Blood flows into the spleen
and through the trabeculated network. The cells in the spleen work to destroy pathogens.
Lymphocytes in the spleen can react to pathogens and trigger the immune system. The spleen
also acts as a blood reservoir.
Fig. 13.2. Spleen.
The thymus is a gland located just deep to the sternum in the superior portion of the
mediastinum (Fig. 13.3). Early in life the thymus is larger and decreases in size with age
although it continues to produce white blood cells.

The thymus has two lobes each surrounded by a connective tissue capsule. It contains an outer
cortex and inner medulla. The internal region of the thymus is trabeculated and filled with
lymphocytes. The thymus produces large numbers of T-lymphocytes that can travel to the
blood.
Fig. 13.3. Thymus.
Image Credits

Chapter 14
14.1 From: [Link]