LYMPHATIC OF THE ABDOMINAL VISCERA BY PROF SAEED

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. 2

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. 3

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. 4

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. 5

The cecum The lymph vessels of the cecum pass through several mesenteric nodes and finally reach the superior mesenteric nodes. 6

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. 7

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. 8

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. 9

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. 10

• 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. 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. 11

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. 12

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. 13

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. 14

Kidney The lymph of the kidneys go to the lateral aortic lymph nodes around the origin of the renal artery. 15

Ureter The lymph of the ureters drains to the lateral aortic nodes and the iliac nodes. 16

Suprarenal gland The lymph from the suprarenal glands drains into the lateral aortic nodes. 17

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. 18

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. 19

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. 20

The efferent lymph vessels from the preaortic nodes form the large intestinal lymph trunk. 21

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. 22

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. 23

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. 24

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 lower 1/3 rd of esophagus to halfway down the anal canal). It also drains, the spleen, the pancreas, and the gall bladder.

It ascends behind the 1 st 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 - Splenic. 2 - Superior mesenteric. 3 - Left gastric. 4 - Right gastric. 5 - Cystic.

SUPERIOR MESENTERIC VEIN Ascends in the root of the mesentery. In the right side of the superior mesenteric artery. It passes in front of 3 rd part of the duodenum. Tributaries: 1 - Jejunal & Ilial veins. 2 -Iliocolic. 3 -Right colic. 4 -Middle colic. 5 - Inferior pancreaticoduodenal 6 - Right gastroepiploic

SPLENIC VEIN 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 1/3 rd 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

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).