14. Kardio 1 - 14. Sistem Limfatikus

HUMAN ANATOMY
LYMPHATIC SYSTEM
Nurul Hidayati
Anatomy and Histology
Faculty of Medicine Universitas
Brawijaya
Target pembelajaran
• Memahami struktur dari organ limphatic dan
lokasinya dalam tubuh manusia
• Memahami sistem organ limphatic
• Memahami hubungan sistem organ limfatik dan
sistem cardiovaskular
• Memahami aplikasi fungsi sistem limphatic dalam
sistem organ limphatic secara terstruktur
• Memperkirakan korelasi klinis struktur organ
limfatik
1. Function
1)
2)
Basic Concept
Fluid balance : maintain fluid balance in internal system
Immunity
2. Structural System
1)
2)
3)
Structure and Organ Composition (in correlation with basic
function)
Systematic connection : Specialized component of the
circulatory system  Lymphatic vessels (capillary, vessel, trunk,
duct), lymph nodes, isolated nodules of lymphatic tissue; Tonsil
(and adenoid), Thymus, Spleen
Part in a whole human body system : lymphatic system and
other human body system particularly cardiovascular system
3. Clinical apperance
1)
2)
Lymphatic disorder
Immunity Disorder
Cycle of Life:
Lymphatic System
A. Experience dramatic changes throughout life
B. Intrauterine : organs with lymphocytes appear
before birth
After birth : grow until puberty
C. Post-puberty
1. Thymus : organ atrophy (shrink in size, degenerate)
through late adulthood and become fatty or fibrous.
2. Spleen : it develops early and remains intact
3. Others develops with normal pattern
Lymphoid
Organs
1. Primary lymphoid
organs : thymus and
bone marrow
2. Secondary lymphoid
organs : spleen, lymph
nodes, aggregate
nodules
3. Tertiary lymphoid
organs : chronic
inflammatory lymphoid
tissue
Basic structure of Lymph Tissue
3 types
• Diffuse lymphatic tissue
–No capsule present
–Found in connective tissue of almost all organs
• Lymphatic nodules
–No capsule present
–Oval-shaped masses
–Found singly or in clusters
• Lymphatic organs
–Capsule present
–Lymph nodes, spleen, thymus gland
• Lymphatic tissue
– Diffuse lymphaticus tissue
• Limphatic organ
– Nodus limfatikus (Lymp nodes)
– Tonsil : Tonsila palatina, tonsila lingualis, adenoid
– Timus
Structure and
– Limpa (Spleen)
• Limphatic vessel
organ Composition
– Pembuluh kapiler limfe (Lymp capillaries)
– Lymp afferent and efferent vessels  nodus limfatikus
– Trunkus limfatikus (Lymph Trunks)
– Duktus limfatikus (Lymph Ducts)
Nodulus limfatikus
• Small, localized collection of lymphoid tissue, usually located in the
loose connective tissue beneath wet epithelial (covering or lining)
membranes, as in the digestive system, respiratory system
and urinary bladder. Lymph nodules form in regions of frequent
exposure to microorganisms or foreign materials and contribute to
the defense against them.
• Lymph nodules frequently contain germinal center (sites for localized
production of lymphocytes). In the small intestine, collections of
lymph nodules are called Peyer’s patches. The tonsils are also local
regions where the nodules have merged together.
• This nodule differs from a lymph node in that it is much smaller and
does not have a well-defined connective-tissue capsule as a boundary
Nodus limfatikus (lymp nodes) Lymphatic
Organs
• Connected to lymph vessels
• Lymph nodes are oval-shaped structures
enclosed by a fibrous capsule
• Consist of cortex and medulla
– Cortex = outer portion
• Germinal centers produce lymphocytes
– Medulla = inner portion
• Medullary cords
• Nodes are similar to biological filter & fagositosis
• Once lymph enters a node, it moves slowly
through sinuses to drain in to efferent exit vessel
Nodus limfatikus (lymp nodes) Lymphatic
Functions of lymph nodes :
Organs
1. Defense functions : filtration & phagocytosis—
reticuloendothelial cells remove microorganisms
and other injurious particles from lymph and
phagocytose them; if overwhelmed, the lymph
nodes can become infected or damaged.
2. Hematopoiesis : process of blood cell formation,
lymphatic tissue is the site for the final stages of
maturation of some lymphocytes & monocytes.
• Location of lymph nodes
o Cervical : nodus limfatikus cervicalis
 head and neck
o Axillary : nodus limfatikus axillaris 
hand, arm and breast
o Inguinal : nodus limfatikus inguinalis –
lower extremities and external genital
organs
o Tracheobronchial lymph nodes nodes
o Aortic lymph nodes
o Iliac lymp nodes etc
Lymph nodes are located throughout
the body but the largest groupings are found in
the neck, armpits, and groin areas. Swollen
lymph nodes may be a sign that the body is
dealing with an infection, injury, or cancer
• Lymph nodes of the head
– Occipital lymph nodes
– Mastoid lymph nodes
– Parotid lymph nodes
• Lymph nodes of the neck
– Cervical lymp nodes
• Submental lymp nodes
• Submandibular lymph nodes
– Deep cervical lymp nodes
• Deep anterior cervical lymph nodes
• Deep lateral cervical lymph nodes
– Inferior deep cervical lymph nodes
• Jugulo-omohyoid lymph nodes
• Jugulodigastric lymph nodes
– Supracavicular lymph nodes
• Virchow’s nodes
Lymp Nodes
Lymph nodes of the thorax
• Lymph nodes of the lungs: The lymph is drained from the lung tissue
to the hilar lymph nodes, which are located around the of each lung.
The lymph flows subsequently to the mediastinal lymph nodes.
• Mediastinal lymph nodes: They consist of several lymph node groups,
especially along the trachea, along the esophagus and between the
lung and the diaphragma. In the mediastinal lymph nodes arises
lymphatic ducts, which drains the lymph to the left subclavian
vein (to the venous angle in the confluence of the subclavian and
deep jugular veins).
Lymph nodes of the abdomen
The mediastinal lymph nodes along the esophagus are in tight connection
with the abdominal lymph nodes along the esophagus and the stomach.
Through the mediastinum, the main lymphatic drainage from the abdominal
organs goes via the thoracic duct (ductus thoracicus), which drains majority
of the lymph from the abdomen to the above mentioned left venous angle.
• Lymph nodes of the arm
Extremity areas
These drain the whole of the arm, and are divided into superficial and deep.
The superficial nodes are supplied by lymphatics that are present throughout
the arm, but are particularly rich on the palm and flexor aspects of the digits.
– Superficial lymph nodes of the arm:
• Supratrochlear nodes: Situated above the medial epicondyle of the
humerus, medial to the basilic vein
• Deltoideo-pectoral nodes: Situated between the pectoralis major and
deltoid muscle inferior to the clavicle
– Deep lymph nodes of the arm:
These comprise the axillary nodes can be s
• Lateral nodes
• Anterior or pectoral nodes
• Posterior or subscapular nodes
• Central or intermediate nodes
• Medial or subclavicular nodes
• Lymph Nodes of the Lower limbs
– Superficial Inguinal Lymph Nodes
– Deep Inguinal Lymph Nodes
– Popliteal Lymp Nodes
Possible palpable
lymphadenopathy
Tonsil
• Multiple groups of large lymphatic nodules
– Tonsila Palatina (posterior-lateral
walls of the oropharynx)
– Tonsila pharyngealis (posterior
wall of nasopharynx)
– Tonsila lingualis (base of tongue)
• Multipel location  mucous membrane
of the oral and pharyngeal cavities
• Function- Protect against bacteria that
may invade tissues around the openings
the nasal & oral cavities
Lymphatic Organs
• Primary central organ
of lymphatic system
• Single, unpaired
organ located in the
mediastinum,
extending upward to
the lower edge of the
thyroid & inferiorly as
far as the 4th costal
cartilage
• Thymus is pinkish
gray in children and
wish advancing age,
becomes yellowish as
lymphatic tissue is
replaced by fat.
Tymus
Pryamid-shaped lobes are
subdivided into small lobules
Each lobule is composed of a
dense cellular cortex & an
inner, less dense, medulla
Medullary tissue can be
identified by presence of
Thymic corpuscle.
Functions :
1. Plays vital role in immunity mechanis
2. Source of lymphocytes before birth
3. Shortly after birth, the thymus secretes Thymosin, which enables
lymphocytes to develop into T-Cells
• A. Location :
In the left hypochondrium
(either one of two regions of
the abdomen), directly below
the diaphragm, above the left
kidney & descending colon, &
behind the fundus (the base of
an organ) of the stomach
• The largest lymphatic organ
• Structure is similar to a node
• Capsule present
• But no afferent vessels or
sinuses
Limpa
B. Structure of the Spleen
o Ovoid in shape
o Surrounded by fibrous capsule with inward extensions that divide
the organ into compartments.
o White pulp-dense masses of developing lymphocytes. White pulp
is similar to lymphatic nodules
o Red pulp-near outer regions, made up of a network of fine
reticular fibers submerged in blood that comes from nearby
arterioles. Red pulp contains all the components of circulating
blood
C. Functions of the Spleen
1. Defense-macrophages lining the sinusoids of the spleen remove
microorganisms from the blood & phagocytose them
2. Hematopoiesis-monocytes & lymphocytes complete their
development in the spleen.
3. Red blood cell and platelet destruction-macrophages remove
worn-out RBC’s and imperfect platelets and destroy them by
phagocytosis; also salvage iron and globin from destroyed RBC’s
Pembuluh kapiler Limfe
• Konsep cairan limfe 
fluid similar to blood
plasma
– no erythrocytes or
platelets
– less proteins
– more leukocytes
• filters out of blood
vessels
• lymph capillaries collect
interstitial fluid
Lymphatic
Vessels
Lymphatic
Vessels
• The lymphatic vessels link the
lymph nodes through :
– Afferent vessels
– Efferent vessels
• Function :
– Pick up excess tissue fluid
 lymph  return it to
the blood stream
• One way system flows only
to the heart
• Features :
– Thin wall
– Valved
– pumpless
Trunkus limfatikus
• Confluence of many efferent lymph vessels
• Comprise of :
– Truncus limfatikus jugularis (jugular lymph trunks)
– Truncus subclavia (subclavian lymph trunks)
– Truncus bronkomediastinalis (bronchomediastinal
lymph trunks)
– Truncus lumbalis (lumbar lymph trunks)
– Truncus intestinalis (intestinal lymph trunk—unpaired)
Ductus
Limfatikus
• Function to return to
vein vessels
• From lymph trunk
• Comprise of
– Ductus limfatikus dextra
(Right lymphatic duct)
– Ductus thoracicus
(thoracic duct)
– return fluid to blood
• Ductus limfatikus dextra
– about 1.5 cm in length
– lymph from right half of
head, neck, thorax and
right upper limb
– right venous angle
Ductus
thoracicus
about 38-45 cm in length
> front of L1 as cisterna chyli –
emulsified fats and free fatty
acids absorbed by lacteals
> aortic hiatus of the diaphragm
> ascends along on the front of
the vertebral column, between
thoracic aorta and azygos vein
> left venous angle
• must be
returned to
blood stream
to maintain
blood volume
and pressure
• antibodies,
lymphocytes,
and
monocytes
• obstruction
leads to
edema
Lymph circulation
Lymph
Metastasis
• Cancer metastasis
• See the regional
section
• Each area has its
own circulation of
lymph
Systematic
connection of ..
Sistem Limfatik
A. Lymphatic system drains
away excess water
from large areas
B. Lymph is conducted
through lymphatic
vessels to nodes,
where contaminants
are removed.
C. Lymphatic system
benefits the whole
body by maintaining
fluid balance and
freedom from disease
Interrelationship with human body system
Derivation and Distribution of
Lymphocytes
TERIMA KASIH
Additional Sources, despite the main sources of Anatomy & Histology Text Book
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http://www.innerbody.com/image/lympov.html
http://en.wikipedia.org/wiki/Lymphatic_system
https://www.boundless.com/physiology/the-lymphatic-system/
http://www.cea1.com/anatomy-sistems/lymph-capillaries