Lymphatic vessels and nodes of the abdominal cavity

In the abdominal cavity, visceral (internal) and parietal (parietal) lymph nodes are also isolated.

Visceral lymph nodes (nodi lymphatici viscerales) are located near the unpaired visceral branches of the abdominal aorta and their branching (near the celiac trunk, the hepatic, splenic and gastric arteries, the superior and inferior mesenteric arteries and their branches). Ciliary lymph nodes (nodi lymphatici coeliaci, total 1-5) are located near the celiac trunk on the lymphatic drainage pathway from many visceral lymph nodes of the abdominal cavity. Lymphatic vessels from the nodes of the stomach, pancreas and spleen, from the renal and hepatic lymph nodes are suitable for celiac lymph nodes. The lymphatic vessels that carry lymph nodes go to the lumbar lymph nodes, and also flow into the initial section of the thoracic duct.

Gastric lymph nodes (nodi limphatici gastrici) are located near the small and large curvature of the stomach, along the course of its arteries, and seem to surround the stomach. The left gastric lymph nodes (7-38) are located near the left gastric artery and its branches. These nodes are adjacent to the small curvature of the stomach and its walls (front and back). They lymphatic vessels, forming in the thickness of that part of the anterior and posterior walls of the stomach, which form a small curvature. The lymph nodes, located near the cardial part (cardia) of the stomach and in the form of a chain embracing the entrance from all sides, are called the lymphatic ring of the cardia (annulus lymphaticus cardiae, only 1-11), or "cardiac lymph nodes" (nodi lymphatici cardiaci - BNA ). Lymphatic vessels of the cardial part of the stomach and its bottom are directed to these nodes, as well as from the ventral part of the esophagus.

Right gastric lymph nodes (1-3) are unstable, located along the course of the same artery over the gatekeeper.

The pilor lymph nodes (nodi lymphatici pilorici, only 1-16) are located above the doormen, behind and below it (on the head of the pancreas), next to the upper gastroduodenal artery. In the pyloric nodes lymphatic vessels flow not only from the pylorus, but also from the head of the pancreas.

Along the great curvature of the stomach are the right and left gastro-omental nodes. They lie in the form of chains near the same arteries and veins and take the lymph vessels, which receives lymph from the walls of the stomach, adjacent to the large curvature, as well as from the large omentum.

Right gastro-omental lymph nodes (nodi lymphatici gastroomentalis dextri, total 1-49) are located in the gastro-osseous ligament, in the right half of the large curvature of the stomach, and adhere to the right gastro-omental artery and vein. Left gastro-omental lymph nodes (nodi lymphatici gastroomentalis sinistri, total 1 - 17) lie in the left half of the large curvature of the stomach, along the course of the same artery and vein, between the leaves of the gastro-colonic ligament. At the top edge of the pancreas (near the splenic artery and vein), on the posterior and anterior surfaces of it, pancreatic lymph nodes (nodi lymphatici pancreatici, only 2-8) are located, which take the lymph vessels from the pancreas. Splenic lymph nodes [nodi lymphatici lienales (splenici), total 3-6] are located in the spleen gates, near the branching of the splenic artery and the formation of the splenic vein, in the thickness of the gastro-splenic ligament. Lymphatic vessels from the bottom of the stomach, the left gastro-omental lymph nodes and the capsule of the spleen are sent to these nodes.

Between the head of the pancreas and the wall of the duodenum at the point of entry into it of the common bile duct, and also near the branch of the upper and lower pancreatic-duodenal arteries, there are pancreatic-duodenum lymph nodes (nodi lymphatici pancreaticoduodenales), regional for the head of the pancreas and for the duodenum . One of the nodes of this group, usually of large size, is located behind the upper part of the duodenum and takes part in the formation of the anterior wall of the gland opening. Therefore, he received the corresponding name - the node of the gland opening (nodus foraminalis). Increasing the size of this assembly can narrow the entrance to the stuffing box.

Hepatic lymph nodes (nodi lymphatici hepatici, only 1-10) are in the thickness of the hepatic-duodenal ligament along the common hepatic artery and portal vein. They are also near the cervix of the gallbladder - these are the gall-bladder lymph nodes (nodi lymphatici cystici). They are only 1-2, they take the lymph vessels from the liver and gall bladder. In rare cases (about 2%), the lymphatic vessels of the liver flow directly into the thoracic duct. The lymphatic vessels carrying the hepatic and biliary lymph nodes are directed to the celiac and lumbar lymph nodes.

The most numerous group of visceral lymph nodes of the abdominal cavity is mesenteric lymph nodes (nodi lymphatici mesenterici). They number from 66 to 404, they are located in the mesentery of the small intestine near the superior mesenteric artery and vein, their branches and tributaries in the form of three subgroups. The first subgroup (peripheral) is located between the mesenteric margin of the small intestine and the vascular arches - arcades. These are the cecal mesenteric nodes. The nodes of the second subgroup (middle) are adjacent to the trunks, branches and tributaries of the superior mesenteric artery and vein, and the nodes of the third - central subgroup are located near the superior mesenteric vessels from the lower edge of the pancreas to the point of the right colonic artery. Lymph nodes of the central subgroup at the beginning of the superior mesenteric artery rather closely adjacent to each other and in some cases form a conglomerate.

From the skinny and ileum, lymphatic vessels are sent mainly to the peripheral subgroup of the mesenteric lymph nodes. Some lymphatic vessels pass these nodes and follow the nodes of the middle and even central subgroup. The vascular lymph nodes of the mesenteric lymph nodes (central subgroup) flow into the lumbar lymph nodes, and in some cases (about 25%) directly into the thoracic duct, forming intestinal trunks (trunci intestinales). Lymphatic vessels of the terminal part of the ileum do not flow into the mesenteric, but into the ilio-lymph nodes.

The regional lymph nodes of the colon are the nodes adjacent to the articular arteries and veins - branches and tributaries of the upper and lower mesenteric arteries and veins. Lymphatic vessels that carry lymph from the cecum and vermiform appendage flow into numerous (3-15) relatively small cecal sites (nodi lymphatici caecales). Among these nodes, pre-leukemia and intestinal lymph nodes (nodi lymphatici precaecales and retrocaecales) are located, respectively, near the anterior and posterior cecal walls. Single lymphatic vessels of this organ, as well as the appendix, flow into the ilio-lymph nodes (nodi fymphitici ileocolici, only 1-7), to which the lymphatic vessels of the terminal ileum are also directed. Lymphatic vessels of the ascending colon enter the right lymph nodes (nodi lymphatici colici dextri, total 7-55), located near the right articular artery and vein, their branches and tributaries. From the descending colon and sigmoid colon, lymphatic vessels are directed to the left lymph nodes (nodi lymphatici colici sinistri, only 8-65) and to the sigmoid lymph nodes (nodi lymphatici sigmoidei, only 5-50) that are located near the same arteries and veins, their branches and tributaries. Sigmoid lymph nodes are also suitable for lymphatic vessels from the upper part of the rectum. The lymphatic vessels of the sigmoid and left-sided lymph nodes follow the lower mesenteric nodes (nodi lymphatici mesenterici inferiores), and the vascular vessels of the latter enter the abdominal aorta and lower genital lumen, the lumbar lymph nodes (parental nodes of the abdominal cavity).

On the lymphatic vessels from the colon to its regional lymph nodes (the rim) lie not very large near-intestinal nodes (nodi lymphatici paracolici). They are located directly near the medial (lower - for the transverse colonic) wall of the gut or near it.

The lymphatic vessels of the iliac-colon, mesenteric, intestinal, right and left lymph nodes are delivered to the parietal lumbar lymph nodes, as well as to the central subgroup of the superior mesenteric lymph nodes located at the origin of the superior mesenteric artery and near the vein of the same name.

Parietal lymph nodes (nodi lymphatici parietales) of the abdominal cavity are located on the anterior abdominal wall (lower epigastric) and on the posterior abdominal wall (lumbar). The lower epigastric lymph nodes (nodi lymphatici epigastrici inferiores, only 3-4) paired, lie in the thickness of the anterior abdominal wall along the course of the blood vessels of the same name. These nodes collect lymph from adjacent parts of the straight, transverse and oblique abdominal muscles, the peritoneum lining the anterior abdominal wall, and from the subperitoneal tissue. The vascular lymph nodes of these nodes are sent down the lower hypogastric blood vessels downward, to the external iliac, and up along the upper epigastric vessels, and then along the internal thoracic blood vessels to the peri-chest lymph nodes.

Numerous lumbar lymph nodes (nodi lymphatici lumbales, total 11-41) are located throughout the posterior abdominal wall (retroperitoneal) near the aorta and posterior vena cava. In connection with the position of these nodes in relation to large vessels they are divided into left, right and intermediate lumbar lymph nodes. Left lumbar lymph nodes (left lateroortic) are attached as a chain to the ventral part of the aorta on the left, front and back. In the group of these nodes, in turn, the following are distinguished: lateral aortic (nodi lymphatici aortici laterales, 1-17 in total), preorortal (nodi lymphatici preaortici, only 1-14) and postorthal (nodi lymphatici postaortici, 1-15 in total).

The right lumbar lymph nodes are located near the anterior, posterior and right surfaces of the inferior vena cava, all the way from the place of its formation from the common iliac veins to the diaphragm. These lymph nodes are subdivided into the ancestral (nodi lymphatici precavales, only 1-7), postavalnye (nodi lymphatici postcavales, only 1-12) and lateral caval (nodi lymphatici cavales laterales, total 1-4). In the furrow between the abdominal part of the aorta and the inferior vena cava there is a chain of intermediate lumbar (interorthocaval) lymph nodes (nodi lymphatici lumbales intermedin only 1-9).

The listed lumbar lymph nodes together with the lymphatic vessels connecting them form a dense lymphatic plexus near the abdominal part of the aorta and in the inferior vena cava. Through the lumbar lymph nodes passes the lymph from the lower extremities, the walls and organs of the pelvis. In these nodes also lymph nodes that carry lymphatic vessels, located near the internal organs of the abdominal cavity (gastric, mesenteric, colonic, etc.) also flow.

The lymphatic vasculitis of the lumbar lymph nodes forms the right and left lumbar trunks, which give rise to the thoracic duct, or flow into the initial part of the duct itself.

On the posterior abdominal wall, near the inferior diaphragm artery, the paired, non-constant lower diaphragmatic lymph nodes are distinguished (nodi lymphatici phrenici inferiores, only 1-3). They are also parietal parietal lymph nodes of the abdominal cavity. Into these nodes lymphatic vessels of the diaphragm, the back of the right and left lobes of the liver, flow into. The vascular lymphatic vessels of the lower diaphragmatic nodes are directed to the celiac, post-pituitary and intermediate lumbar lymph nodes.

[1], [2], [3], [4], [5]