 section 49 of Gray's Anatomy Part 3. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer please visit LibriVox.org. Recording by Jennifer Stearns. Anatomy of the Human Body Part 3 by Henry Gray. Lymphatics of the abdomen and pelvis Part 2. The lymphatic vessels of the abdomen and pelvic viscera. The lymphatic vessels of the abdominal and pelvic visceral. Consist of 1. Those of the sub-diaphragmic portion of the digestive tube and its associated glands. Liver and pancreas. 2. Those of the spleen and super-renal glands. 3. Those of the urinary organs. 4. Those of the reproductive organs. 1. The lymphatic vessels of the sub-diaphragmatic portion of the digestive tube are situated partly in the mucous membrane and partly in the seromuscular coats, but as a former system drains into the bladder that you may be considered as one. Lymphatic vessels of the stomach are continuous at the cardiac orifice with those of the esophagus and at the pylorus with those of the duodenum. They mainly follow the blood vessels and may be arranged to four sets. Those of the first set accompany the branches of the left gastric artery receiving tributaries from a large area on either surface of the stomach and terminate the superior gastric glands. Those of the second set drain the fundus and body of the stomach on the left of a line drawn vertically from the esophagus. They accompany more or less closely the short gastric and left gastroepilotic arteries and end in the pancreatic collenal glands. The vessels of the third set drain the right portion of the greater curvature as far as the pyloric portion and end in the inferior gastric glands the efferents of which pass the sub pyloric group. Those of the fourth set drain the pyloric portion and pass to the hepatic and sub pyloric glands and to the superior gastric glands. Lymphatic vessels of the duodenum consist of an anterior and posterior set which open into a series of small pancreatical duodenal glands on the anterior and posterior aspects of the groove behind the head of the pancreas and the duodenum. The efferents of these glands run in two directions upward to the hepatic glands and down to the pre aortic glands around the origin of superior mesoteric artery. Lymphatic vessels of the duodenum and ileum are termed lactales from the milk white fluid they contain during intestinal digestion. They run between the layers of the mesoteric and enter the mesoteric glands the efferents of which end in the pre aortic glands. The lymphatic vessels of the vermaform process and cecum are numerous since in the wall of this process there is a large amount of adenoid tissue from the body and tail of the vermaform process eight to 15 vessels ascend between the layers of the mesoteric one or two being interrupted in the gland which lies between the layers of this peritoneal fold. They unite to form three or four vessels which end partly in the lower and partly in the upper glands of the ileocolic chain. The vessels from the root of the vermaform process and from the cecum consist of an anterior and posterior group. The anterior vessels pass in front of the cecum and end in the anterior ileocolic glands and in the upper and lower glands of the ileocolic chain. The posterior vessels ascend over the back of the cecum and terminate in the posterior ileocolic glands and in the lower glands of the ileocolic chain. Lymphatic vessels of the colon the lymphatic vessels of the ascending and transverse parts of the colon finally end in the mesoteric glands after transversing the right colic and mesocolic glands. Those of the descending and iliac sigmoid parts of the colon are interrupted by the small glands on the branches of the left colic and sigmoid arteries and ultimately end in the pre aortic glands around the origin of the inferior mesoteric artery. Lymphatic vessels of the anus, anal canal and rectum. The lymphatics from the anus pass forward and end with those of the integument of the perineum and scrotum in the superficial inguinal glands. Those from the anal cavity accompany the middle and inferior hemorrhidal arteries and end in the hypogastric glands. While the vessels from the rectum traverse the para rectal glands and pass through those in the sigmoid mesocolon, the efferents of the latter terminate in the pre aortic glands around the origin of the inferior mesoteric artery. The lymphatic vessels of the liver are divisible into two sets superficial and deep. The former arise in the sub peritoneal areiolotissue over the entire surface of the organ and may be grouped into a those on the convex surface, b those on the inferior surface, a on the convex surface. The vessels from the back part of this surface reach their terminal glands by three different routes. The vessels of the middle set, five or six in number, pass through the vena cava formin in the diaphragm and end in one or two glands which are situated around the terminal part of the inferior vena cava. A few vessels on the left side pass backward toward the esophageal hiatus and terminate in the pericardial group of superior gastric glands. The vessels from the right side, one or two in number, run on the abdominal surface of the diaphragm and after crossing its right cruise end in the pre aortic glands which surround the origin of the celiac artery. From the portions of the right and left lobes adjacent to the phasiform ligament, the lymphatic vessels converge to form two trunks, one of which accompanies the inferior vena cava through the diaphragm and ends in the glands around the terminal part of this vessel. The other runs downward and forward and turning around the anterior sharp margin of the liver accompanies the upper part of the ligamentum terrace and ends in the upper hepatic glands. From the anterior surface, a few additional vessels turn around the anterior sharp margin to reach the upper hepatic glands. B. On the inferior surface, the vessels from this surface mostly converge to the portahepatus and accompany the deep lymphatics emerging from the porta to the hepatic glands. One or two from the posterior parts of the right and caudal lobes accompany the inferior vena cava through the diaphragm and end in the glands around the terminal part of this vein. The deep lymphatics converge to ascending and descending trunks. The ascending trunks accompany the hepatic veins and pass through the diaphragm to end in the glands around the terminal part of the inferior vena cava. The descending trunks emerge from the portahepatus and end in the hepatic glands. Lymphatic vessels of the gallbladder pass through the hepatic glands in the portahepatus. Those are the common bile ducts to the hepatic glands alongside the duct and to the upper pancreotidotodododonal glands. The lymphatic vessels of the pancreas follow the course of its blood vessels. Most of them enter the pancreotrolinal glands but some end in the pancreotodododonal glands and others in the pre-aortic glands in the origin of the superior mesoteric artery. 2. Lymphatic vessels of the spleen and super-renal glands. Lymphatic vessels of the spleen, both superficial and deep, pass through the pancreotrolinal glands. The lymphatic vessels of the super-renal glands usually accompany the super-renal veins and end in the lateral aortic glands. Occasionally, some of them pierce the crura of the diaphragm and end in the glands of the posterior mediastenum. 3. The lymphatic vessels of the urinary organs. The lymphatic vessels of the kidney form three plexuses. One in the substance of the kidney, a second beneath its fibrous capsule, and a third in the perinephric fat. The second and third communicate freely with each other. The vessels from the plexus in the kidney substance converge to form four or five trunks which issue at the hillum. Here they are joined by vessels from the plexus under the capsule and following the course of the renal vein and in the lateral aortic glands. The perinephric plexus is drained directly into the upper lateral aortic glands. The lymphatic vessels of the ureter run in different directions. Those from its upper portion end partly in the efferent vessels of the kidney and partly in the lateral aortic glands. Those in the portion immediately above the brim of the lesser pelvis are drained into the common iliac glands while the vessels from the interpelvic portion of the tube either join the efferents from the bladder or end in the hypogastric glands. The lymphatic vessels of the bladder originate in two plexuses, an intra and extra muscular. It being generally admitted the mucous membrane is a default of lymphatics. Footnote. Some authorities maintain that a plexus of lymphatic vessels does exist in the mucous membrane of the bladder. Consult Medicine, Operateur, Devois, Younere, Parget, Everon, Paris, 1909 and footnotes. The efferent vessels are arranged in two groups, one from the anterior and one another from the posterior surface of the bladder. The vessels from the anterior surface pass to the external iliac glands, but in the course menu glands are situated. These menu glands are arranged in two groups, an anterior vesicle in front of the bladder and a lateral vesicle in relation to the lateral umbilical ligament. The vessels from the posterior surface pass to the hypogastric external and common iliac glands, those draining the upper part of the surface traverse the lateral vesicle glands. Lymphatic vessels of the prostate terminate chiefly in the hypogastric and sacral glands, but one trunk from the posterior surface ends in the external iliac glands and another from the anterior surface joins the vessels which drain the membranous part of the urethra. Lymphatic vessels of the urethra. The lymphatics of the cavernous portion of the urethra accompany those of the glands penis and terminate with them in the deep subbingonal and external iliac glands. Those are the membranous and prosthetic portions and those of the whole urethra and the female pass to the hypogastric glands. Four, the lymphatic vessels of the reproductive organs. The lymphatic vessels of the testes consist of two sets, superficial and deep, the form or commencing on the surface of the tunica vaginalis, the bladder and the epididymis and body of the testes. They form from four to eight collecting trunks which ascend with the spermatic veins in the spermatic cord and along the front of the psoas major to the level with the spermatic vessels cross the urethra and end in the lateral and pre-aortic groups of lumbar glands. The lymphatic vessels of the ductus deferens pass to the external iliac glands, those of the vesicule, seminalis, partly to the hypogastric and partly to the external glands. The lymphatic vessels of the ovary are similar to those of the testes and descend with the ovarian artery to the lateral and pre-aortic glands. The lymphatic vessels of the uterine tube pass partly with those of the ovary and partly with those of the uterus. The lymphatic vessels of the uterus consist of two sets, superficial and deep, the form or being placed beneath the peritoneum, the bladder and the septum of the organ. The lymphatics of the cervix uteri run in three directions, transversely to the external iliac glands, postural laterally to the hypogastric glands and posteriorly to the common iliac glands. The majority of the vessels of the body and fundus of the uterus pass lateral would in the broad ligaments and are continued up with ovarian vessels to the lateral and pre-aortic glands. A few, however, run to the external iliac glands and one or two to the superficial inguinal glands. In the unimpregnated uterus, the lymphatic vessels are very small, but during gestation they are greatly enlarged. The lymphatic vessels of the vagina are carried in three directions, those of the upper part of the vagina to the external iliac glands, those of the middle part to the hypogastric glands and those of the lower part to the common iliac glands. On the chorus of the vessels for the middle and lower parts, small glands are situated. Some lymphatic vessels for the lower part of the vagina show in those of the vulva and pass in the superficial inguinal glands. The lymphatics of the vagina, anastomose, for those of the cervical suitori, vulva and rectum, but not for those of the bladder, and to section 49. According by Jennifer Stearns, Concord, New Hampshire. The lymphatic vessels of the thorax. The lymph glands of the thorax may be divided into parietal and visceral, the former being situated in the thoracic wall, the latter in relation to the viscera. The parietal lymph glands include the sternal, intercostal, and diaphragmatic glands. One, the sternal glands, lymphoglanduli, sternallis, internal mammary glands, are placed at the anterior ends of the intercostal spaces by the side of the internal mammary artery. They derive afferents from the mammar, from the deeper structures of the anterior abdominal wall above the level of the umbilicus, from the upper surface of the liver through a small group of glands which lie behind the xiphoid process, and from the deeper parts of the anterior portion of the thoracic wall. Their afferents usually unite to form a single trunk on either side. This may open directly into the junction of the internal jugular and subclavian veins, or that of the right side may join the right subclavian trunk, and that of the left, the thoracic duct. Two, the intercostal glands, lymphoglanduli intercostalis, occupy the posterior parts of the intercostal spaces in relation to the intercostal vessels. They receive the deep lymphatics from the postural lateral aspect of the chest. Some of these vessels are interrupted by small lateral intercostal glands. The efferents of the glands in the lower four or five spaces unite to form a trunk, which descends and opens either into the cisterna chile or into the commencement of the thoracic duct. The efferents of the glands in the upper spaces of the left side end in the thoracic duct, those of the corresponding right spaces in the right lymphatic duct. Three, the diaphragmatic glands lie on the thoracic aspect of the diaphragm and consist of three sets, anterior, middle, and posterior. The anterior set comprises A, two or three small glands behind the base of the xiphoid process which receive efferents from the convex surface of the liver, and B, one or two glands on either side near the junction of the seventh rib with its cartilage, which receive lymphatic vessels from the front part of the diaphragm. The efferent vessels of the anterior set pass to the sternal glands. The middle set consists of two or three glands on either side close to where the phrenic nerves enter the diaphragm. On the right side, some of the glands of this group lie within the fibrous sac of the pericardium on the front of the termination of the inferior vena cava. The efferents of this set are derived from the middle part of the diaphragm, those on the right side also receiving efferents from the convex surface of the liver. Their efferents pass to the posterior medistinal glands. The posterior set consists of a few glands situated on the back of the crura of the diaphragm and connected on the one hand with the lumbar glands and on the other with the posterior medistinal glands. The superficial lymphatic vessels of the thoracic wall ramify beneath the skin and converge to the axillary glands. Those over the trapezius and latissimus dorsi run forward and unite to form about 10 or 12 trunks which end in the subscapular group. Those over the pectoral region, including the vessels from the skin covering the peripheral part of the mammar, run backward and those over the serratus anterior upward to the pectoral group. Others near the lateral margin of the sternum pass inward between the rib cartilages and end in the sternal glands, while the vessels of opposite sides anastomose across the front of the sternum. A few vessels from the upper part of the pectoral region ascend over the clavicle to the superclavicular group of cervical glands. The lymphatic vessels of the mammar originate in aplexus in the interlibrular spaces and on the walls of the galactophorus ducts. Those from the central part of the gland pass to an intricate plexus situated beneath the areola, aplexus which receives also the lymphatics from the skin over the central part of the gland and those from the areola and nipple. Its efferents are collected into two trunks which pass to the pectoral group of axillary glands. The vessels which drain the medial part of the mammar pierce the thoracic wall and end in the sternal glands, while a vessel has occasionally been seen to emerge from the upper part of the mammar and piercing the pectoralis major terminate in the subclavicular glands. The deep lymphatic vessels of the thoracic wall consist of one the lymphatics of the muscles which lie on the ribs most of these end in the axillary glands but some from the pectoralis major pass to the sternal glands. Two the intercostal vessels which drain the intercostales and parietal pleura. Those draining the intercostales external run backward and after receiving the vessels which accompany the posterior branches of the intercostal arteries end in the intercostal glands. Those of the intercostales interni and parietal pleura consist of a single trunk in each space. These trunks run forward in the subplural tissue and the upper six open separately into the sternal glands or into the vessels which unite them. Those of the lower spaces unite to form a single trunk which terminates in the lowest of the sternal glands. Three the lymphatic vessels of the diaphragm which form two plexuses one on its thoracic and another on its abdominal surface. These plexuses anastomose freely with each other and are best marked on the parts covered respectively by the pluri and peritoneum. That on the thoracic surface communicates with the lymphatics of the costal and medistinal parts of the pleura and its efferents consist of three groups a anterior passing to the gland which lies near the junction of the seventh rib with its cartilage b middle to the glands on the esophagus and to those around the termination of the inferior vena cava and c posterior to the glands which surround the aorta at the point where this vessel leaves the thoracic cavity. The plexus on the abdominal surface is composed of fine vessels and anastomoses with the lymphatics of the liver and at the periphery of the diaphragm with those of the subperitoneal tissue. The efferents from the right half of this plexus terminate partly in a group of glands on the trunk of the corresponding inferior phrenic artery while others end in the right lateral aortic glands. Those from the left half of the plexus pass to the pre and lateral aortic glands and to the glands on the terminal portion of the esophagus. The visceral lymph glands consist of three groups that is anterior medistinal, posterior medistinal and tracheobronchial. The anterior medistinal glands, lymphoglangeli medistinalis anterioris, are placed in the anterior part of the superior medistinal cavity in front of the aortic arch and in relation to the inominate veins and the large arterial trunks which arise from the aortic arch. They receive efferents from the thymus and pericardium and from the sternal glands. Their efferents unite with those of the tracheobronchial glands to form the right and left bronchomediastinal trunks. The posterior medistinal glands, lymphoglangeli medistinalis posterioris, lie behind the pericardium in relation to the esophagus and descending thoracic aorta. Their efferents are derived from the esophagus, the posterior part of the pericardium, the diaphragm, and the convex surface of the liver. Their efferents mostly end in the thoracic duct, but some join the tracheobronchial glands. The tracheobronchial glands form four main groups, a. tracheal on either side of the trachea, b. bronchial in the angles between the lower part of the trachea and bronchi, and in the angle between the two bronchi, c. bronchopulmonary in the hilus of each lung, and d. pulmonary in the lung substance on the larger branches of the bronchi. The efferents of the tracheobronchial glands drain the lungs in bronchi, the thoracic part of the trachea and the heart. Some of the efferents of the posterior medistinal glands also end in this group. Their efferent vessels ascend upon the trachea and unite with efferents of the internal mammary and anterior medistinal glands to form the right and left bronchomedistinal trunks. The right bronchomedistinal trunk may join the right lymphatic duct and the left the thoracic duct, but more frequently they open independently of these ducts into the junction of the internal jugular and subclavian veins of their own side. In all town dwellers there are continually being swept into these glands from the bronchi and alveoli, large quantities of the dust and black carbonaceous pigment that are so freely inhaled in cities. At first the glands are moderately enlarged, firm, inky black, and gritty on section. Later they enlarge still further, often becoming fibrous from the irritation set up by the minute foreign bodies with which they are crammed and may break down into a soft slimy mass or may calcify. The lymphatic vessels of the thoracic viscera comprise those of the heart and pericardium, lungs and pleura, thymus and esophagus. The lymphatic vessels of the heart consist of two plexuses, A, deep, immediately under the endocardium, and B, superficial, adjacent to the visceral pericardium. The deep plexus opens into the superficial, the efferents of which form right and left collecting trunks. The left trunks, two or three in number, ascend in the anterior longitudinal socus, receiving in their course vessels from both ventricles. On reaching the coronary socus they are joined by a large trunk from the diaphragmatic surface of the heart and then unite to form a single vessel which ascends between the pulmonary artery and the left atrium and ends in one of the tracheobronchial glands. The right trunk receives its efferents from the right atrium and from the right border and diaphragmatic surface of the right ventricle. It ascends in the posterior longitudinal socus and then runs forward in the coronary socus and passes up behind the pulmonary artery to end in one of the tracheobronchial glands. The lymphatic vessels of the lungs originate in two plexuses, a superficial and a deep. The superficial plexus is placed beneath the pulmonary pleura. The deep accompanies the branches of the pulmonary vessels and the ramifications of the bronchi. In the case of the larger bronchi the deep plexus consists of two networks, one submucous between the mucous membrane and another peri bronchial outside the walls of the bronchi. In the smaller bronchi there is but a single plexus which extends as far as the bronchioles but fails to reach the alveoli in the walls of which there are no traces of lymphatic vessels. The superficial efferents turn around the borders of the lungs and the margins of their fissures and converge to end in some glands situated at the hilus. The deep efferents are conducted to the hilus along the pulmonary vessels in bronchi and end in the tracheobronchial glands. Little or no anastomosis occurs between the superficial and deep lymphatics of the lungs except in the region of the hilus. The lymphatic vessels of the pleura consist of two sets, one in the visceral and another in the parietal part of the membrane. Those of the visceral pleura drain into the superficial efferents of the lung while the lymphatics of the parietal pleura have three modes of ending. These are A. Those of the costal portion join the lymphatics of the intercostales internei and so reach the sternal glands. B. Those of the diaphragmatic part are drained by the efferents of the diaphragm while C. Those of the medistinal portion terminate in the posterior medistinal glands. The lymphatic vessels of the thymus end in the anterior medistinal, tracheobronchial, and sternal glands. The lymphatic vessels of the esophagus form a plexus around that tube and the collecting vessels from the plexus drain into the posterior medistinal glands. End of section 50. End of Anatomy of the Human Body part 3 by Henry Gray.