LYMPHATIC DRAINAGE OF ABDOMEN

Learning Objectives

By the end of this lecture, the students should be able to understand:

The types of lymph nodes draining the abdomen
The lymphatics draining the abdominal wall
The lymphatics draining the abdominal viscera
The terminal group of lymph nodes around abdominal aorta
The lymphatic trunks
The cisterna chyli
The thoracic duct

Lymphatic drainage of abdominal wall

To axillary lymph nodes from region above umbilicus

To superficial inguinal lymph nodes from region below umbilicus

To lumbar lymph nodes from post wall of abdomen

Lymph nodes of the Abdomen

The lymph nodes of the abdomen may be divided from their location into:

Parietal lymph nodes: lying behind the peritoneum and in close

association with the larger blood vessels.

Visceral lymph nodes: which are found in relation to the visceral arteries.

Parietal Lymph Nodes

External Iliac nodes
Lie along the external iliac vessels
Common Iliac nodes
grouped behind and on the sides of the common iliac artery
Epigastric nodes
placed alongside the lower portion of the inferior epigastric
vessels
 Iliac Circumflex nodes
situated along the course of the deep iliac circumflex vessels
Hypogastric nodes
Surround the hypogastric vessels
Sacral nodes
Placed in the concavity of the sacrum, in relation to the middle and lateral sacral
arteries
Lumbar nodes
Lateral Aortic nodes
Preaortic nodes
Retroaortic nodes

Visceral Lymph Nodes

Form the preaortic group of nodes surrounding the abdominal

aorta
Celiac nodes: situated around the celiac trunk
Gastric nodes
Hepatic nodes
Pancreaticolienal nodes
Superior mesentric nodes: situated around superior
mesenteric artery
Mesenteric nodes
Ileocolic nodes
Mesocolic nodes
Inferior mesentric nodes: situated around inferior mesenteric
artery

Terminal Lymph Nodes of the Abdomen

Entire lymph from the abdomen ultimately drains into

the terminal group of lymph nodes in relation to the
abdominal aorta
These terminal nodes are arranged in three groups:
 Lateral Aortic Nodes: on either side of aorta are the Right and Left lateral Aortic nodes
Retro aortic nodes: lying behind the aorta are the Retroaortic nodes
Preaortic nodes: lying in front of the aorta are the Preaortic nodes, grouped as celiac,
superior mesenteric and inferior mesenteric nodes
Celiac Nodes
Celiac Nodes lie in relation to the celiac trunk
Drain:

Stomach

Most of the duodenum

Liver

Extra hepatic biliary apparatus

Pancreas

Spleen

Superior Mesenteric Nodes

Lie in relation to superior mesenteric vessels

Drain:
Part of duodenum
Jejunum
Ileum
Cecum
Appendix
Ascending colon
Transverse colon

Inferior Mesenteric Nodes

Lie in relation to inferior mesenteric nodes
Drain:
Descending colon
Sigmoid colon
Upper part of rectum
 PREAORTIC NODES
All the efferent lymphatics from the preaortic nodes (celiac, superior mesenteric,
inferior mesenteric group of nodes) forms the intestinal trunk
The intestinal trunk drains into the cisterna chyli

Lateral Aortic Nodes

Receive all the lymph draining the common aortic artery
Also drain:

The posterior abdominal wall

The Kidney

The upper parts of ureters

The gonads

The uterine tubes

The parts of uterus

Effernt lymphatics from these nodes forms the corresponding
lumber trunk
Lumber trunk ends by joining the cisterna chyli
Intestinal Lymphatic Trunks
Located at left side of the abdominal aorta or between the abdominal
aorta and the inferior vena cava near the level of the superior mesenteric artery
Receive lymph from efferent lymphatic vessels from the celiac nodes and superior
mesenteric nodes

Drain into left lumbar trunk or the cisterna chyli/thoracic duct

Carries lymph that is rich in fat from small and large intestines

Cisterna Chyli

Cisterna chyli is an enlargement of the lower end of the

thoracic duct

Drain all of the body below the respiratory diaphragm; all of the abdominal and pelvic
viscera

Located between the abdominal aorta and the inferior vena cava anterior to the body of the
 L1 or L2 vertebra

Receive lymph from right and & left lumbar trunks; possibly the
intestinal trunk

Drain into the thoracic duct

Thoracic duct

Begins in front of L1 as a dilated sac, the cisterna chyli, which formed

by joining of left and right lumbar trunks and intestinal trunk
Enter thoracic cavity by passing through the aortic hiatus of the
diaphragm and ascends along on the front of the vertebral column,
between thoracic aorta and azygos vein
Travels upward, veering to the left at the level of T5
At the roof of the neck, it turns laterally and arches forwards and descends
to enter the left venous angle
Just before termination, it receives the left jugular, subclavian and
bronchomediastinal trunks
Drains lymph from lower limbs, pelvic cavity, abdominal
cavity, left side of thorax, and left side of the head, neck
and left upper limb

------------------------------------------------xxxxxxxxxxxxxxxx----------------------------------------------------------