Transcript ch20_wcr

Lymphatic System
Slides by Barbara Heard and W. Rose.
figures from Marieb & Hoehn 9th ed.
Portions copyright Pearson Education
Functions
Lymphatic System
Solves a plumbing problem: leaky pipes
Returns fluids that leaked from blood
vessels (capillaries) back to blood
Solves a security problem
Monitors for presence of foreign material
and initiates defensive countermeasures
when necessary
Lymphatic
System Components
Functions
1.Lymphatic vessels (lymphatics)
2.Lymphoid organs and tissues
Monitor lymph and initiate immune
response if pathogens or abnormal
cells are detected; provide a home for
immune cells
3.Lymph – fluid in vessels
Lymphatic Vessels (lymphatics)
• Return interstitial fluid and leaked plasma
proteins back to blood
• Approximately 3L / day
• Once interstitial fluid enters lymphatics, it is
called lymph
Dept. of K.A.A.P.
Lymphatic Vessels
One-way system; lymph flows toward heart
Lymph vessels (lymphatics) include:
• Lymphatic capillaries
• Collecting lymphatic vessels
• Lymphatic trunks and ducts
Marieb & Hoehn 9th ed. Fig 20.01a
Dept. of K.A.A.P.
Lymphatic Capillaries
• Similar to blood capillaries, except
– Very permeable (take up proteins, cell debris,
pathogens, and cancer cells)
• Endothelial cells overlap loosely to form one-way
minivalves
• Anchored by collagen filaments, preventing
collapse of capillaries; increased ECF volume
opens minivalves
– Pathogens travel throughout body via
lymphatics
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Lymphatic Capillaries
• Absent from bones, teeth, bone marrow,
and CNS
• Lacteals: specialized lymph capillaries
present in intestinal mucosa
– Absorb digested fat and deliver fatty lymph
(chyle) to the blood
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Figure 20.1b Distribution and special features of lymphatic capillaries.
Filaments anchored
to connective tissue
Endothelial cell
Flaplike minivalve
Fibroblast in loose
connective tissue
Lymphatic capillaries are blind-ended tubes in which
adjacent endothelial cells overlap each other,
forming flaplike minivalves.
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Lymphatic Collecting Vessels
• Similar to veins, except
– Have thinner walls, with more internal valves
– Anastomose more frequently
• Collecting vessels in skin travel with
superficial veins
• Deep vessels travel with arteries
• Nutrients supplied from branching vasa
vasorum
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Lymphatic Trunks
• Formed by union of largest collecting
ducts
– Paired lumbar
– Paired bronchomediastinal
– Paired subclavian
– Paired jugular trunks
– Single intestinal trunk
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Lymphatic Ducts
• Lymph delivered into one of two large
ducts
– Right lymphatic duct drains right upper arm
and right side of head and thorax
– Thoracic duct arises as cisterna chyli;
drains rest of body
• Each empties lymph into venous
circulation at junction of internal jugular
and subclavian veins on its own side of
body
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Regional
lymph
nodes:
Internal
jugular vein
Entrance of
right lymphatic
duct into vein
Cervical
nodes
Entrance of
thoracic duct
into vein
Thoracic
duct
Axillary
nodes
Cisterna
chyli
Aorta
Collecting
lymphatic
vessels
Inguinal
nodes
Drained by the right lymphatic duct
Drained by the thoracic duct
Lymphatic vessels and ducts
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Right jugular trunk
Right lymphatic
duct
Right subclavian
trunk
Right subclavian
vein
Right bronchomediastinal trunk
Brachiocephalic
veins
Superior
vena cava
Azygos vein
Internal
jugular veins
Esophagus
Trachea
Left jugular
trunk
Left subclavian
trunk
Left subclavian
vein
Entrance of
thoracic duct
into vein
Left bronchomediastinal
trunk
Ribs
Thoracic duct
Cisterna chyli
Right lumbar
trunk
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Hemiazygos
vein
Left lumbar
trunk
Inferior vena cava
Intestinal trunk
Lymphatic Vessels
Anterior view of thoracic and abdominal wall.
Lymph Transport
• Lymph propelled by
– Milking action of skeletal muscle
– Pressure changes in thorax during breathing
– Valves to prevent backflow
– Pulsations of nearby arteries
– Contractions of smooth muscle in walls of
lymphatics
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Lymphoid Organs and Tissues
Structural basis of immune system
House phagocytic cells and lymphocytes
Structures
•
•
•
•
Lymph nodes
Spleen
Thymus
“MALT”: mucosa-associated lymphoid tissue
Tonsils, Peyer’s patches, appendix
Dept. of K.A.A.P.
Lymphoid Cells
• Lymphocytes main warriors of immune
system
– Arise in red bone marrow
• Mature into one of two main varieties
– T cells (T lymphocytes)
– B cells (B lymphocytes)
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Lymphocytes
• T cells and B cells protect against
antigens
– Anything body perceives as foreign
• Bacteria and bacterial toxins, viruses,
mismatched RBCs, cancer cells
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Lymphocytes
• T cells
– Manage immune response
– Attack and destroy infected cells
• B cells
– Produce plasma cells, which secrete
antibodies
• Antibodies mark antigens for destruction by
phagocytosis or other means
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Other Lymphoid Cells
• Macrophages phagocytize foreign
substances; help activate T cells
• Dendritic cells capture antigens and
deliver them to lymph nodes; activate
T cells
• Reticular cells produce reticular fiber
stroma that supports other cells in
lymphoid organs
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Figure 20.3 Reticular connective tissue in a human lymph node.
Macrophage
Reticular cells on
reticular fibers
Lymphocytes
Medullary sinus
Reticular fiber
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Lymphoid Tissue
Home and proliferation site for lymphocytes
Surveillance vantage point for lymphocytes
and macrophages
Largely reticular connective tissue
Two main types
• Diffuse lymphoid tissue
• Lymphoid follicles
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Diffuse Lymphoid Tissue
• Lymphoid cells and reticular fibers in
almost all body organs
• Larger collections are found in lamina
propria of mucous membranes: MALT
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Lymphoid Follicles
(Nodules) Solid, spherical bodies of tightly
packed lymphoid cells and reticular fibers
–Germinal centers of proliferating B cells
–May form part of larger lymphoid
organs
–Isolated aggregations of Peyer's
patches and in appendix
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Lymphoid
Organs
Tonsils (in pharyngeal
region)
Thymus (in thorax; most
active during youth)
Spleen (curves around
left side of stomach)
Peyer’s patches
(aggregated lymphoid
nodules in small
intestine)
Appendix
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Lymph Nodes
• Principal lymphoid organs of body
• Embedded in connective tissue, in clusters
along lymphatic vessels
• Near body surface in inguinal, axillary, and
cervical regions of body
© 2013 Pearson Education, Inc.
Regional
lymph
nodes:
Internal
jugular vein
Entrance of
right lymphatic
duct into vein
Cervical
nodes
Entrance of
thoracic duct
into vein
Thoracic
duct
Axillary
nodes
Cisterna
chyli
Aorta
Collecting
lymphatic
vessels
Drained by the right lymphatic duct
Drained by the thoracic duct
Inguinal
nodes
Lymph node distribution
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Lymph Nodes
• Functions
1. Filter lymph—macrophages destroy
microorganisms and debris
2. Immune system activation—lymphocytes
activated and mount attack against antigens
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Structure of a Lymph Node
• Vary in shape and size but most bean
shaped
• External fibrous capsule
• Trabeculae extend inward and divide
node into compartments
• Two histologically distinct regions
– Cortex
– Medulla
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Structure of a Lymph Node
• Cortex contains follicles with germinal
centers, heavy with dividing B cells
• Dendritic cells nearly encapsulate follicles
• Deep cortex houses T cells in transit
• T cells circulate continuously among
blood, lymph nodes, and lymph
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Figure 20.4a Lymph node.
Afferent
lymphatic
vessels
Cortex
• Lymphoid follicle
• Germinal center
• Subcapsular sinus
Efferent
lymphatic
vessels
Hilum
Medulla
• Medullary
cord
• Medullary
sinus
Trabeculae
Capsule
Longitudinal view of the internal structure of a lymph
node and associated lymphatics
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Structure of a Lymph Node
• Medullary cords extend inward from cortex
and contain B cells, T cells, and plasma
cells
• Lymph sinuses contain macrophages
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Figure 20.4b Lymph node.
Follicles
Trabecula
Subcapsular
sinus
Capsule
Medullary
cords
Medullary
sinuses
Photomicrograph of part of a lymph
node (72x)
© 2013 Pearson Education, Inc.
Circulation in the Lymph Nodes
• Lymph
– Enters convex side via afferent lymphatic
vessels; travels through large subcapsular
sinus and smaller sinuses to medullary
sinuses; exits concave side at hilum via
efferent vessels
• Fewer efferent vessels so flow somewhat
stagnate; allows lymphocytes and
macrophages time to function
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Figure 20.4 Lymph node.
Cortex
Afferent
lymphatic
vessels
• Lymphoid follicle
• Germinal center
• Subcapsular sinus
Efferent
lymphatic
vessels
Follicles
Trabecula
Subcapsular
sinus
Hilum
Medulla
• Medullary
cord
• Medullary
sinus
Capsule
Medullary
cords
Trabeculae
Capsule
Longitudinal view of the internal structure of a lymph
node and associated lymphatics
© 2013 Pearson Education, Inc.
Medullary
sinuses
Photomicrograph of part of a lymph
node (72x)
Sentinel node biopsy is a
technique which helps
determine if a cancer has
spread (metastasized), or is
contained locally. When a
cancer has been detected,
often the next step is to
find the lymph node closest
to the tumor site and
retrieve it for analysis. The
concept of the "sentinel"
node, or the first node to
drain the area of the
cancer, allows a more
accurate staging of the
cancer, and leaves
unaffected nodes behind to
continue the important job
of draining fluids. NYT
©2009.
The procedure involves the injection of a dye (sometimes mildly
radioactive) to pinpoint the lymph node which is closest to the
cancer site. Sentinel node biopsy is used to stage many kinds of
cancer, including lung and skin (melanoma). NYT ©2009.
KAAP
Spleen
• Largest lymphoid organ
• Served by splenic artery and vein, which
enter and exit at the hilum
• Functions
– Site of lymphocyte proliferation and immune
surveillance and response
– Cleanses blood of aged cells and platelets,
macrophages remove debris
© 2013 Pearson Education, Inc.
Figure 20.6c The spleen.
Diaphragm
Spleen
Adrenal
gland
Left
kidney
Splenic
artery
Pancreas
Photograph of the spleen in its normal position in
the abdominal cavity, anterior view.
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Spleen: Additional Functions
• Stores breakdown products of RBCs (e.g.,
iron) for later reuse
• Stores blood platelets and monocytes
• May be site of fetal erythrocyte production
(normally ceases before birth)
• Encased by fibrous capsule; has
trabeculae
• Contains lymphocytes, macrophages, and
huge numbers of erythrocytes
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Structure of the Spleen
• Two distinct areas
– White pulp around central arteries
• Mostly lymphocytes on reticular fibers; involved in
immune functions
– Red pulp in venous sinuses and splenic
cords
• Rich in RBCs and macrophages for disposal of
worn-out RBCs and bloodborne pathogens
• Composed of splenic cords and sinusoids
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Figure 20.6a–b The spleen.
Capsule
Trabecula
Splenic cords
Splenic
sinusoids
Arterioles
and
capillaries
Splenic
artery
Splenic
vein
Hilum
Red pulp
White pulp
Central artery
Diagram of the spleen,
anterior view
Splenic artery
Splenic vein
Diagram of spleen histology
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Thymus
• Important functions early in life
• Found in inferior neck; extends into
mediastinum; partially overlies heart
• Increases in size and most active during
childhood
• Stops growing during adolescence, then
gradually atrophies
– Still produces immunocompetent cells, though
slowly
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Thymus
• Thymic lobules contain outer cortex and
inner medulla
• Most thymic cells are lymphocytes
– Cortex contains rapidly dividing lymphocytes
and scattered macrophages
• Medulla contains fewer lymphocytes and
thymic corpuscles involved in regulatory
T cell development (prevent autoimmunity)
© 2013 Pearson Education, Inc.
Figure 20.7 The thymus.
Capsule
Cortex
Medulla
Thymic
corpuscles
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Thymus
• Differs from other lymphoid organs in
important ways
– Has no follicles because it lacks B cells
– Does not directly fight antigens
• Functions strictly in T lymphocyte maturation
– Keeps isolated via blood thymus barrier
• Stroma of epithelial cells (not reticular
fibers)
– Provide environment in which T lymphocytes
become immunocompetent
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Mucosa-associated Lymphoid Tissue
(MALT)
• Lymphoid tissues in mucous membranes
throughout body
• Protects from pathogens trying to enter
body
• Largest collections of MALT in tonsils,
Peyer's patches, appendix
• Also in mucosa of respiratory and
genitourinary organs; rest of digestive tract
© 2013 Pearson Education, Inc.
Tonsils
• Simplest lymphoid organs
• Form ring of lymphatic tissue around pharynx
–
–
–
–
Palatine tonsils—at posterior end of oral cavity
Lingual tonsil—grouped at base of tongue
Pharyngeal tonsil—in posterior wall of nasopharynx
Tubal tonsils—surrounding openings of auditory
tubes into pharynx
• Gather and remove pathogens in food or air
© 2013 Pearson Education, Inc.
Tonsils
• Contain follicles with germinal centers
• Are not fully encapsulated
• Overlying epithelium invaginates forming
tonsillar crypts
– Trap and destroy bacteria and particulate
matter
– Allow immune cells to build memory for
pathogens
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Figure 20.8 Histology of the palatine tonsil.
Pharyngeal tonsil
Palatine tonsil
Lingual tonsil
© 2013 Pearson Education, Inc.
Germinal centers
in lymphoid follicles
Tonsillar
crypt
Aggregates of Lymphoid Follicles
• Peyer's patches and appendix
– Clusters of lymphoid follicles
– In wall of distal portion of small intestine
– Similar structures are also found in the
appendix
– Destroy bacteria, preventing them from
breaching intestinal wall
– Generate "memory" lymphocytes
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Figure 20.9 Peyer’s patch (aggregated lymphoid nodules).
Follicles of a
Peyer’s patch
(aggregated
lymphoid nodules)
Smooth muscle in
the intestinal wall
© 2013 Pearson Education, Inc.
Spleen images
Splenic cyst: http://www.nejm.org.proxy.nss.udel.edu/doi/full/10.1056/NEJM200311273492222
Pelvic spleen: http://www.nejm.org.proxy.nss.udel.edu/doi/full/10.1056/NEJMicm0802024
Impaled rower: http://www.nejm.org.proxy.nss.udel.edu/doi/full/10.1056/NEJMcpc079004
College or Department name here
Figure 1. Computed
Tomography of the Abdomen.
Coronal (Panel A) and axial (Panel B)
images show splenomegaly (30 cm in
greatest length, Panel A) and
scattered, slightly enlarged lymph
nodes in the para-aortic and splenic
hilar regions (arrows, Panel B).
Abramson, Chatterji, Rahemtullah. “Case 39-2008
— A 51-Year-Old Woman with Splenomegaly and
Anemia”. N Engl J Med 2008; 359:2707-2718
Dx: Splenic marginal-zone lymphoma (a
lymphoma of B cells)
Tx: Splenectomy, followed 15 mos later by
chemotherapy when cancer symptoms returned.
Dept. of K.A.A.P.
Abramson, Chatterji, Rahemtullah. “Case 39-2008 — A 51-Year-Old Woman with
Splenomegaly and Anemia”. N Engl J Med 2008; 359:2707-2718
College or Department name here