1st year BS Nursing, Batch 2023

Large Group Interactive Session (LGIS)

The Lymphatic System

Usman Date:-25th August 2023

Sr # Content Slide #
1 Motto, Vision 4
2 Professor Umar Model of Integrated Lecture 5
3 Bloom’s Taxonomy (Domains of learning) 6
4 Diagrammatic Representation of Blooms Taxonomy 7
5 Learning Objectives 8
6 Horizontal Integration 8, 16, 19
7 Core Concept 9 – 63
8 Vertical Integration 64-66
9 Biomedical Ethics (lesson of the day) 67-68
10 Brainstorming (SEQ/MCQs relevant with lecture) 43-47
11 Suggested Research Article 69
12 Promoting IT and research culture(Digital Library) 71
13 References of this lecture 72
Motto Vision; The Dream/Tomorrow

To impart evidence based

research oriented medical
education
To provide best possible
Truth patient care
To inculcate the values of
Wisdom
mutual respect and ethical
practice of medicine
Professor Umar Model of Integrated Lecture

20%
HORIZONTAL
60%
INTEGRATION
CORE SUBJECT Physiology
biochemistry

7% 8%
VERTICAL VERTICAL
INTEGRATION INTEGRATION
Clinical Pathology
integration pharmacology

5%
VERTICAL
INTEGRATION
Research,
professionalism
Ethics
Digital library
5
BLOOM'S TAXONOMY : DOMAINS OF LEARNING

Sr. # Domain of learning Abbreviation Levels of the Meaning

domain

1 cognition C C1 Recall / Remembering

2 C2 Understanding
3 C3 Applying / Problem solving
4 Psychomotor P P1 Imitation / copying
5 P2 Manipulation / Follows instructions
6 P3 Precision / Can perform accurately
7 Attitude A A1 Receiving / Learning
8 A2 Respond / Starts responding to the learned
attitude
9 A3 Valuing / starts behaving according to the
learned attitude
 LEARNING OBJECTIVES

Sr. # Learning Objective Domain of

Learning
1 To illustrate composition of lymph C3

2 To describe the functions of lymph and its components C2

3 To understand the concept of lymph formation C1

4 To identify and describe the Bone Marrow microenvironment. C2

And Hematopoietic stem/Progenitor cells.
5 To apply the knowledge of the regulation of lymph flow C3
to practical scenarios
Horizontal integration
(With Anatomy/Histology)
Horizontal integration
(With Anatomy/Histology)

9
The Lymphatic System
Core concept
 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.

12
 Core
Concept

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

13
 Core
Concept

14
 Core
Concept

The lymphatic system consists of:

• lymph
• lymph vessels
• lymph nodes
• lymph organs, e.g. spleen and thym
• diffuse lymphoid tissue, e.g. tonsils us
• bone marrow.

15
 Core
Concept
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.

16
 Core
Concept

Lymph contd..

17
 Core
Concept

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.

18
 Core
Concept

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.

19
20
 Core
Concept

• The major difference between interstitial

fluid and lymph is
• 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.

21
 Core
Concept
Lym

• 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.

22
 Core
Concept

Lymph Capillaries

23
 Core
Concept

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.

24
Core Concept

• 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.

25
 Core
Concept

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).

26
 Core
Concept

27
 Core
Concept

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.

28
 Core
Concept

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 vei ns.
Area drained by
right lymphatic
duct
Area drained by
thoracic duct

29
Core Concept and Horizontal
Integration with Anatomy

Large Lymphatic Vessels

30
 Core
Concept

Thorac
• 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.

31
 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.

32
 Core
Concept

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.

33
 Core
Concept

Ti
• 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.
34
 b
Venule Arteriole Lymph

Blood
capillar Tissue
y cell

Lymphatic
Anchori g
capillary
filament
Interstiti
al fluid

Tissue cell

Endothelium Interstitial fluid

of
27
lymphatic
 Core
Concept

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.

• Fat and fat-soluble materials, e.g. the fat-

soluble vitamins, are absorbed into the
central lacteals (lymphatic vessels) of the
villi. 36
 Core
Concept

Functions of the lymphatic system

• 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.

37
 Core
Concept

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) junctionand subclavian
of the internal veins
jugular
(blood).

38
 Core Concept and
Horizontal Integration
with Anatomy

https://training.seer.cancer.gov/anatomy/ 39
lymphatic/components/
 Lympha
• .
• 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.

40
 Core
Concept

Lymphatic organs and tissues contd

The secondary lymphatic organs and
Tissues are the site where the immune response
occur.
They include lymph node,the spleen and
lymphatic nodules.
 Core
Concept

Th
• 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.

42
 Core
Concept

43
 Core
Concept

Organs associated with the thymus

–

Posteriorly – aortic arch and its branches,

brachiocephalic veins, trachea

Laterally – lungs

Superiorly – structures in the root of the neck

Inferiorly – heart

44
 Core
Concept
Stru

• 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.

45
 Core
Concept

46
 Core
Concept

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.

47
 Core
Concept

48
 Core
Concept

Splee
• 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.

49
 Core
Concept

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.

50
 Core
Concept

51
 Core
Concept

52
 Core
Concept

Func
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.

53
 Core
Concept

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.

54
 Core
Concept

Functions of Spleen contd..

• 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.

55
 Core
Concept

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.

56
 Core
Concept

Mucosa-associated lymph 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.
 Core
Concept

58
 Core
Concept

Tonsils.

Collectionof 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.

59
 Core
Concept

60
 Core
Concept

• The tonsils are strategically positioned to

participate in immune responses against
inhaled or ingested foreign substances.
• The single pharyngeal tonsil or adenoid is
embedded in the posterior wall of the
nasopharynx.

61
 Core
Concept

• The two

62
 Core
Concept

63
64
 Vertical Integration
with
Hematology/Oncology

Clinical Disorders Associated with Lymphatic

System Physiology
 Vertical Integration
with Hematology/
Infectious Diseases

Clinical Disorders Associated with Lymphatic

System Physiology
 Vertical Integration https://api.semanticscholar.org/CorpusID:9311455?
with Hematology/ utm_source=wikipedia
Infectious Diseases

Clinical Disorders Associated with Lymphatic

System Physiology
 Understanding
Biomedical Ethics

 The core pillars/principles of medical ethical

include:
 Understanding
Biomedical Ethics Beneficence
The principle of beneficence is the obligation
of physician to act for the benefit of the
patient and supports a number of moral rules
to protect and defend the right of others,
prevent harm, remove conditions that will
cause harm, help persons with disabilities,
and rescue persons in danger.
Promoting IT &
Research
Culture

Suggested research article

https://doi.org/10.3390/jcdd9110402
 Promoting IT &
Research Culture

How To Access Digital Library

Steps to Access HEC Digital Library
1.Go to the website of HEC National Digital Library.
2.On Home Page, click on the INSTITUTES.
3.A page will appear showing the universities from Public
and Private Sector and other Institutes which have access to
HEC National Digital Library HNDL.
4.Select your desired Institute.
5. A page will appear showing the resources of the
institution
6. Journals and Researches will appear
7. You can find a Journal by clicking on JOURNALS AND
DATABASE and enter a keyword to search for your desired
journal.
 References
Sr.# Types of Names/links of reference material
reference
material
1 Text book Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Philadelphia, PA:
Saunders; 2020

2 Text book Boron WF, Boulpaep EL. Medical Physiology: A Cellular and Molecular Approach.
3rd ed. Philadelphia, PA: Elsevier; 2017.

3 Text book Sherwood L. Human Physiology: From Cells to Systems. 10th ed. Boston, MA:
Cengage Learning; 2020.

4 Text book Widmaier EP, Raff H, Strang KT. Vander's Human Physiology: The Mechanisms of
Body Function. 16th ed. New York, NY: McGraw-Hill Education; 2021.

5 Text book Costanzo LS. Physiology. 7th ed. Philadelphia, PA: Saunders; 2021.

6 Research https://doi.org/10.1016/S0140-6736(09)61925-5
papers
https://doi.org/10.3390/jcdd9110402

7 YouTube https://www.youtube.com/watch?v=_0UTZR7PVzc&ab_channel=AndreyK
Video
Thank You