The lymphatic system of the human body and health

The lymphatic system

1. The Lymphatic System

2. Learning objectives By the end of this section, we all will be able to: Define lymphatic system and its related terms. Discuss the structures and location of components of this system. Describe the function of various components of this system. 2

3. The Lymphatic System The lymphatic system ( lim -FAT- ik ) consists of a fluid called lymph, vessels called lymphatic vessels that transport the lymph, a number of structures and organs containing lymphatic tissue, and red bone marrow, where stem cells develop into the various types of blood cells, including lymphocytes. 3

4. The Lymphatic System contd.. It assists in circulating body fluids and helps defend the body against disease-causing agents. As we will see shortly, most components of blood plasma filter through blood capillary walls to form interstitial fluid. After interstitial fluid passes into lymphatic vessels, it is called lymph (LIMF clear fluid). 4

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6. The lymphatic system consists of: • lymph • lymph vessels • lymph nodes • lymph organs, e.g. spleen and thymus • diffuse lymphoid tissue, e.g . tonsils • bone marrow. 6

7. Lymph The body cells are bathed in interstitial (tissue) fluid, which leaks constantly out of the bloodstream through the permeable walls of blood capillaries. It is therefore very similar in composition to blood plasma. Some tissue fluid returns to the capillaries at their venous end and the remainder diffuses through the more permeable walls of the lymph capillaries, forming lymph. 7

8. Lymph contd.. 8

9. Lymph contd.. Lymph transports the plasma proteins that seep out of the capillary beds back to the bloodstream. It also carries away larger particles, e.g. bacteria and cell debris from damaged tissues, which can then be filtered out and destroyed by the lymph nodes. 9

10. Lymph contd.. Lymph contains lymphocytes, which circulate in the lymphatic system allowing them to patrol the different regions of the body. In the lacteals of the small intestine, fats absorbed into the lymphatics give the lymph (now called chyle ), a milky appearance. 10

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12. Difference between Interstitial fluid and Lymph The major difference between interstitial fluid and lymph is location . Interstitial fluid is found between cells, and lymph is located within lymphatic vessels and lymphatic tissue. Lymph passes through vessels of increasing size and a varying number of lymph nodes before returning to the blood. 12

13. Lymph Capillaries These originate as blind-end tubes in the interstitial spaces. They have the same structure as blood capillaries, i.e. a single layer of endothelial cells, but their walls are more permeable to all interstitial fluid constituents, including proteins and cell debris. The tiny capillaries join up to form larger lymph vessels. 13

14. Lymph Capillaries 14

15. Lymph Capillaries contd.. Nearly all tissues have a network of lymphatic vessels, important exceptions being the central nervous system, the cornea of the eye, the bones and the most superficial layers of the skin. 15

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17. Larger lymph vessels Lymph vessels are often found running alongside the arteries and veins serving the area. Their walls are about the same thickness as those of small veins and have the same layers of tissue, i.e. a fibrous covering, a middle layer of smooth muscle and elastic tissue and an inner lining of endothelium. 17

18. Larger lymph vessels contd.. Like veins, lymph vessels have numerous cup-shaped valves to ensure that lymph flows in a one-way system towards the thorax. There is no ‘pump’, like the heart, involved in the onward movement of lymph, but the muscle layer in the walls of the large lymph vessels has an intrinsic ability to contract rhythmically (the lymphatic pump). 18

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20. Larger lymph vessels contd.. In addition, lymph vessels are compressed by activity in adjacent structures, such as contraction of muscles and the regular pulsation of large arteries. This ‘milking’ action on the lymph vessel wall helps to push lymph along. 20

21. Larger lymph vessels contd.. Lymph vessels become larger as they join together, eventually forming two large ducts, the thoracic duct and right lymphatic duct, which empty lymph into the subclavian veins. Area drained by thoracic duct Area drained by right lymphatic duct 21

22. Large Lymphatic Vessels 22

23. Thoracic duct This duct begins at the cisterna chyli , which is a dilated lymph channel situated in front of the bodies of the first two lumbar vertebrae. The duct is about 40 cm long and opens into the left subclavian vein in the root of the neck. 23

24. Thoracic duct contd.. It drains lymph from both legs, the pelvic and abdominal cavities, the left half of the thorax, head and neck and the left arm. 24

25. Right lymphatic duct This is a dilated lymph vessel about 1 cm long. It lies in the root of the neck and opens into the right subclavian vein. It drains lymph from the right half of the thorax, head and neck and the right arm. 25

26. Functions of the lymphatic system Tissue drainage Every day, around 21 litres of fluid from plasma, carrying dissolved substances and some plasma protein, escape from the arterial end of the capillaries and into the tissues. Most of this fluid is returned directly to the bloodstream via the capillary at its venous end, but the excess, about 3–4 litres of fluid, is drained away by the lymphatic vessels. 26

27. b Venule Tissue cell Interstitial fluid Blood Blood capillary Lymphatic capillary Arteriole Lymph Anchoring filament Endothelium of lymphatic capillary Interstitial fluid Tissue cell 27

28. Functions of the lymphatic system contd.. Without this, the tissues would rapidly become waterlogged, and the cardiovascular system would begin to fail as the blood volume falls. Absorption in the small intestine: Fat and fat-soluble materials, e.g. the fat-soluble vitamins, are absorbed into the central lacteals (lymphatic vessels) of the villi . 28

29. Functions of the lymphatic system contd.. Immunity: The lymphatic organs are concerned with the production and maturation of lymphocytes, the white blood cells responsible for immunity. Bone marrow is therefore considered to be lymphatic tissue, since lymphocytes are produced there. 29

30. Direction of flow of lymph The sequence of fluid flow is blood capillaries (blood) interstitial spaces (interstitial fluid) lymphatic capillaries (lymph) lymphatic vessels (lymph) lymphatic ducts (lymph) junction of the internal jugular and subclavian veins (blood). 30

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32. Flow of Lymph The same two “pumps” that aid the return of venous blood to the heart maintain the flow of lymph. 1. Skeletal muscle pump. The “milking action” of skeletal muscle contractions compresses lymphatic vessels (as well as veins) and forces lymph toward the junction of the internal jugular and subclavian veins. 32

33. Flow of lymph contd.. 2. Respiratory pump. Lymph flow is also maintained by pressure changes that occur during inhalation (breathing in). Lymph flows from the abdominal region, where the pressure is higher, toward the thoracic region, where it is lower. When the pressures reverse during exhalation (breathing out), the valves prevent backflow of lymph. 33

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35. Lymphatic organs and tissues Lymphatic tissue is a specialized form of reticular connective tissue that contains large numbers of lymphocytes. The primary lymphatic organs are the red bone marrow (in flat bones and the epiphyses of long bones of adults) and the thymus. Pluripotent stem cells in red bone marrow give rise to mature, immunocompetent B cells and to pre-T cells. 35

36. Lymphatic organs and tissues contd.. The secondary lymphatic organs and tissues are the sites where most immune responses occur. They include lymph nodes, the spleen, and lymphatic nodules (follicles). The thymus, lymph nodes, and spleen are considered organs because each is surrounded by a connective tissue capsule; lymphatic nodules, in contrast, are not considered organs because they lack a capsule. 36

37. Thymus gland The thymus gland lies in the upper part of the mediastinum behind the sternum and extends upwards into the root of the neck. It weighs about 10 to 15 g at birth and grows until puberty, when it begins to atrophy. Its maximum weight, at puberty, is between 30 and 40 g and by middle age it has returned to approximately its weight at birth. 37

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39. Organs associated with the thymus Anteriorly – sternum and upper four costal cartilages Posteriorly – aortic arch and its branches, brachiocephalic veins, trachea Laterally – lungs Superiorly – structures in the root of the neck Inferiorly – heart 39

40. Structure of Thymus gland The thymus consists of two lobes joined by areolar tissue. The lobes are enclosed by a fibrous capsule which dips into their substance, dividing them into lobules that consist of an irregular branching framework of epithelial cells and lymphocytes. 40

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42. Structure of Thymus gland contd.. Each thymic lobule consists of a deeply staining outer cortex and a lighter-staining central medulla. The cortex is composed of large numbers of T cells and scattered dendritic cells, epithelial cells, and macrophages. 42

43. Structure of Thymus gland contd.. Immature T cells (pre-T cells) migrate from red bone marrow to the cortex of the thymus, where they proliferate and begin to mature. Dendritic cells ( dendr - a tree), which are derived from monocytes , and so named because they have long, branched projections that resemble the dendrites of a neuron, assist the maturation process. 43

44. Structure of Thymus gland contd.. The medulla consists of widely scattered, more mature T cells, epithelial cells, dendritic cells, and macrophages. T cells that leave the thymus via the blood migrate to lymph nodes, the spleen, and other lymphatic tissues where they colonize parts of these organs and tissues. 44

45. Function of Thymus gland Lymphocytes originate from stem cells in red bone marrow. Those that enter the thymus develop into activated T-lymphocytes. Thymic processing produces mature T-lymphocytes that can distinguish ‘self ’ tissue from foreign tissue, and also provides each T-lymphocyte with the ability to react to only one specific antigen from the millions it will encounter. 45

46. Function of Thymus gland contd.. T-lymphocytes then leave the thymus and enter the blood. Some enter lymphoid tissues and others circulate in the bloodstream. T-lymphocyte production, although most prolific in youth, probably continues throughout life from a resident population of thymic stem cells. 46

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48. Function of Thymus gland contd.. The maturation of the thymus and other lymphoid tissue is stimulated by thymosin , a hormone secreted by the epithelial cells that form the framework of the thymus gland. Shrinking of the gland begins in adolescence and, with increasing age, the effectiveness of the T-lymphocyte response to antigens declines. 48

49. Lymph nodes Lymph nodes are oval or bean-shaped organs that lie, often in groups, along the length of lymph vessels. The lymph drains through a number of nodes, usually 8–10, before returning to the venous circulation. These nodes vary considerably in size: some are as small as a pin head and the largest are about the size of an almond. 49

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51. Structure of Lymph Nodes Lymph nodes have an outer capsule of fibrous tissue that dips down into the node substance forming partitions, or trabeculae . The main substance of the node consists of reticular and lymphatic tissue containing many lymphocytes and macrophages. 51

52. Structure of Lymph Nodes contd.. Reticular cells produce the network of fibres that provide internal structure within the lymph node. The lymphatic tissue contains immune and defence cells, including lymphocytes and macrophages. Each node has a concave surface called the hilum where an artery enters and a vein and the efferent lymph vessel leave. 52

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54. Functions of lymph nodes Filtering and phagocytosis Lymph is filtered by the reticular and lymphatic tissue as it passes through lymph nodes. Particulate matter may include bacteria, dead and live phagocytes containing ingested microbes, cells from malignant tumours, worn-out and damaged tissue cells and inhaled particles. Organic material is destroyed in lymph nodes by macrophages and antibodies. 54

55. Functions of lymph nodes contd.. Organic material is destroyed in lymph nodes by macrophages and antibodies. In some cases where phagocytosis of bacteria is incomplete they may stimulate inflammation and enlargement of the node ( lymphadenopathy ). 55

56. Functions of lymph nodes contd.. Proliferation of lymphocytes Activated T- and B-lymphocytes multiply in lymph nodes. Antibodies produced by sensitised B-lymphocytes enter lymph and blood draining the node. 56

57. Spleen The spleen contains reticular and lymphatic tissue and is the largest lymph organ. The spleen lies in the left hypochondriac region of the abdominal cavity between the fundus of the stomach and the diaphragm. Like lymph nodes, the spleen has a hilum . Through it pass the splenic artery, splenic vein, and efferent lymphatic vessels. 57

58. Spleen contd.. It is purplish in colour and varies in size in different individuals, but is usually about 12 cm long, 7 cm wide and 2.5 cm thick. It weighs about 200 g. 58

59. Organs associated with the spleen Superiorly and posteriorly diaphragm Inferiorly left colic flexure of the large intestine Anteriorly fundus of the stomach Medially pancreas and the left kidney Laterally separated from the 9th, 10th and 11th ribs and the intercostal muscles by the diaphragm 59

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61. Structure of Spleen The spleen is slightly oval in shape with the hilum on the lower medial border. The anterior surface is covered with peritoneum. It is enclosed in a fibroelastic capsule that dips into the organ, forming trabeculae . The cellular material, consisting of lymphocytes and macrophages, is called splenic pulp, and lies between the trabeculae . 61

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63. Structure of Spleen contd.. White pulp is lymphatic tissue, consisting mostly of lymphocytes and macrophages arranged around branches of the splenic artery called central arteries. The red pulp consists of blood-filled venous sinuses and cords of splenic tissue called splenic ( Billroth’s ) cords. 63

64. Structure of Spleen contd.. Splenic cords consist of red blood cells, macrophages, lymphocytes, plasma cells, and granulocytes. Veins are closely associated with the red pulp. 64

65. Structure of Spleen contd.. The structures entering and leaving the spleen at the hilum are: • splenic artery, a branch of the coeliac artery • splenic vein, a branch of the portal vein • lymph vessels (efferent only) • nerves. 65

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67. Structure of Spleen contd.. Blood passing through the spleen flows in sinusoids , which have distinct pores between the endothelial cells, allowing it to come into close association with splenic pulp. This is essential for the spleen’s function in removing ageing or damaged cells from the bloodstream. 67

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69. Sinusoids in Spleen 69

70. Functions of Spleen Phagocytosis Old and abnormal erythrocytes are mainly destroyed in the spleen, and the breakdown products, bilirubin and iron, are transported to the liver via the splenic and portal veins. Other cellular material, e.g. leukocytes, platelets and bacteria, is phagocytosed in the spleen. 70

71. Functions of Spleen contd.. Storage of blood The spleen contains up to 350 mL of blood, and in response to sympathetic stimulation can rapidly return most of this volume to the circulation, e.g. in haemorrhage. 71

72. Functions of Spleen contd.. Immune response The spleen contains T- and B-lymphocytes, which are activated by the presence of antigens, e.g. in infection. Lymphocyte proliferation during serious infection can cause enlargement of the spleen ( splenomegaly ). 72

73. Functions of Spleen contd.. Erythropoiesis The spleen and liver are important sites of fetal blood cell production, and the spleen can also fulfil this function in adults in times of great need. 73

74. Mucosa-associated lymphoid tissue (MALT) Throughout the body, at strategically placed locations, are collections of lymphoid tissue which, unlike the spleen and thymus, are not enclosed within a capsule. They contain B- and T-lymphocytes, which have migrated from bone marrow and the thymus, and are important in the early detection of invaders. 74

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76. Lymphatic nodules (follicles) are egg-shaped masses of lymphatic tissue that are not surrounded by a capsule. However, as they have no afferent lymphatic vessels, they do not filter lymph, and are therefore not exposed to diseases spread by lymph. 76

77. MALT is found throughout the gastrointestinal tract, in the respiratory tract and in the genitourinary tract, all systems of the body exposed to the external environment. The main groups of MALT are the tonsils and aggregated lymphoid follicles ( Peyer’s patches). 77

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80. Tonsils. Tonsils  are collection of lymphoid tissue facing into the aerodigestive tract. Usually there are five tonsils, which form a ring at the junction of the oral cavity and oropharynx and at the junction of the nasal cavity and nasopharynx . 80

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82. The tonsils are strategically positioned to participate in immune responses against inhaled or ingested foreign substances. The single pharyngeal tonsil ( fa -RIN-je¯ -al) or adenoid is embedded in the posterior wall of the nasopharynx . 82

83. The two palatine tonsils (PAL-a- tı¯n ) lie at the posterior region of the oral cavity, one on either side; these are the tonsils commonly removed in a tonsillectomy. 83

84. Function of Tonsills These  immuno-competent  tissues are the immune system’s first line of defense against ingested or inhaled foreign pathogens. Tonsils have on their surface specialized antigen capture cells called M cells that allow for the uptake of antigens produced by pathogens. 84

85. These M cells then alert the underlying B cells and T cells in the tonsil that a pathogen is present and an immune response is stimulated.  B cells are activated and proliferate in areas called germinal centres in the tonsil. Recent studies have provided evidence that the tonsils produce T lymphocytes, also known as T-cells, in a manner similar to, but different from, the way the thymus does. 85

86. Aggregated lymphoid follicles ( Peyer’s patches). These large collections of lymphoid tissue are found in the small intestine, and intercept swallowed antigens. They are aggregations of gut associated lymphoid tissue that are usually found in the lowest portion of the small intestine, the ileum, in humans; as such, they differentiate the ileum from the duodenum and jejunum. The duodenum can be identified by Brunner's glands. 86

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88. Functions of Peyer’s patches Because the lumen of the gastrointestinal tract is exposed to the external environment, much of it is populated with potentially pathogenic microorganisms. Pathogenic microorganisms and other antigens entering the intestinal tract encounter macrophages,  dendritic cells, B-lymphocytes, and T-lymphocytes found in Peyer's patches and other mucosa-associated lymphoid tissue (MALT). 88

89. Functions of Peyer’s patches contd.. Peyer's patches thus act for the gastrointestinal system much as the tonsils act for the respiratory system, trapping foreign particles, surveilling them, and destroying them. 89

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