Lymphatic system – Better Health Channel

The lymphatic system is a network of delicate tubes throughout the body. It drains fluid (called lymph) that has leaked from the blood vessels into the tissues and empties it back into the bloodstream via the lymph nodes.

The main roles of the lymphatic system include:

• managing the fluid levels in the body
• reacting to bacteria
• dealing with cancer cells
• dealing with cell products that otherwise would result in disease or disorders
• absorbing some of the fats in our diet from the intestine.

The lymph nodes and other lymphatic structures like the spleen and thymus hold special white blood cells called lymphocytes. These can rapidly multiply and release antibodies in response to bacteria, viruses, and a range of other stimuli from dead or dying cells and abnormally behaving cells such as cancer cells.

The lymphatic system and fluid balance

The blood in our blood vessels is under constant pressure. We need that to push nutrients (food the cells need), fluids and some cells into the body’s tissues to supply those tissues with food, oxygen and defence.

All of the fluids and its contents that leak out into the tissues (as well as waste products formed in the tissues, and bacteria that enter them through our skin) are removed from them by the lymphatic system.

When the lymphatic system does not drain fluids from the tissues properly, the tissues swell, appearing puffy and uncomfortable. If the swelling only lasts for a short period it is called oedema. If it lasts longer (more than about three months) it is called lymphoedema.

Lymphatic vessels

The lymphatic vessels are found everywhere in our body. Generally, more active areas have more of them.

The smaller lymphatic vessels, which take up the fluids, are called lymph capillaries. The larger lymphatic vessels have muscles in their walls which helps them gently and slowly pulsate. These larger lymphatic vessels also have valves that stop the lymph flowing back the wrong way.

Lymph vessels take the lymph back to the lymph nodes (there are about 700 of these in total), which are found in our arm pit and groin as well as many other areas of the body such as the mouth, throat and intestines.

The fluid that arrives in the lymph nodes is checked and filtered. Most of it continues on to where the lymphatic system from most of our body (the left arm, tummy, chest, and legs) empties out at the left shoulder area. Lymph from the right arm and face and part of the right chest empties into the blood at the right shoulder area.

Spleen

The spleen is located in the abdominal (tummy) area on the left side, just under the diaphragm. It is the largest of our lymphatic organs.

The spleen does many things as it filters and monitors our blood. It contains a range of cells, including macrophages – the body’s garbage trucks. It also produces and stores many cells, including a range of white blood cells, all of which are important for our body’s defence.

As well as removing microbes, the spleen also destroys old or damaged red blood cells. It can also help in increasing blood volume quickly if a person loses a lot of blood.

Thymus

The thymus is inside the ribcage, just behind the breastbone. It filters and monitors our blood content. It produces cells called T-lymphocytes which circulate around the body. These cells are important for cell mediated response to an immune challenge, such as may occur when we have an infection.

Other lymphoid tissue

Much of our digestive and respiratory system is lined with lymphatic tissue. It’s needed there because those systems are exposed to the external environment. This lymphatic tissue plays a very important role in the defence of our body.
The most important sites of this lymphoid tissue are in the throat (called the tonsils), in the intestine area (called Peyer’s patches) and in the appendix.

Lymph nodes

Lymph nodes are filters. They are found at various points around the body, including the throat, armpits, chest, abdomen and groin. Generally they are in chains or groups All are imbedded in fatty tissue and lie close to veins and arteries.

Lymph nodes have a wide range of functions but are generally associated with body defence. Bacteria (or their products) picked up from the tissues by cells called macrophages, or those that flow into the lymph, are forced to percolate through the lymph nodes. There, white blood cells called lymphocytes can attack and kill the bacteria. Viruses and cancer cells are also trapped and destroyed in the lymph nodes.

More lymphocytes are produced when you have an infection. That is why your lymph nodes tend to swell when you have an infection.

Common problems involving the lymphatic system

Common problems involving the lymphatic system can be separated into those related to:

• infection
• disease
• destruction or damage to the lymphatic system or its nodes.

Those related to infection include:

• glandular fever – symptoms include tender lymph nodes
• tonsillitis – infection of the tonsils in the throat
• Crohn’s disease – inflammatory bowel disorder.

Those related to disease include:

• Hodgkin’s disease – a type of cancer of the lymphatic system.

Those related to malformation or destruction or damage to the lymphatic system or its nodes include:

• primary lymphoedema – when the lymphatic system has not formed properly. May present as a limb or part body swelling at birth, or may develop at puberty or later in life
• secondary lymphoedema – When the lymphatic system is damaged by surgery or radiotherapy associated with the treatment of cancer, when the soft tissues are damaged by trauma, or when the lymphatic system has some other cause of structural or functional impairment.

Where to get help

• Your GP

Swollen Lymph Nodes Information

Overview

What are lymph nodes?

Lymph nodes are small, bean-shaped glands throughout the body. They are part of the lymph system, which carries fluid (lymph fluid), nutrients, and waste material between the body tissues and the bloodstream.

The lymph system is an important part of the immune system, the body’s defense system against disease. The lymph nodes filter lymph fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white blood cells called lymphocytes.

Lymph nodes may be found singly or in groups. And they may be as small as the head of a pin or as large as an olive. Groups of lymph nodes can be felt in the neck, groin, and underarms. Lymph nodes generally are not tender or painful. Most lymph nodes in the body cannot be felt.

What causes swollen lymph nodes?

Lymph nodes often swell in one location when a problem such as an injury, infection, or tumor develops in or near the lymph node. Which lymph nodes are swollen can help identify the problem.

• The glands on either side of the neck, under the jaw, or behind the ears commonly swell when you have a cold or sore throat. Glands can also swell following an injury, such as a cut or bite, near the gland or when a tumor or infection occurs in the mouth, head, or neck.
• Glands in the armpit (axillary lymph nodes) may swell from an injury or infection to the arm or hand. A rare cause of axillary swelling may be breast cancer or lymphoma.
• The lymph nodes in the groin (femoral or inguinal lymph nodes) may swell from an injury or infection in the foot, leg, groin, or genitals. In rare cases, testicular cancer, lymphoma, or melanoma may cause a lump in this area.
• Glands above the collarbone (supraclavicular lymph nodes) may swell from an infection or tumor in the areas of the lungs, breasts, neck, or abdomen.

Common sites for swollen lymph nodes include the neck, groin, and underarms.

When lymph nodes swell in two or more areas of the body, it is called generalized lymphadenopathy. This may be caused by:

• A viral illness, such as measles, rubella, chickenpox (varicella), or mumps.
• Mononucleosis (Epstein-Barr virus), which results in fever, sore throat, and fatigue, or cytomegalovirus (CMV), a viral infection that causes symptoms similar to those of mononucleosis.
• A bacterial illness, such as strep throat (caused by the streptococcus bacterium) or Lyme disease (a bacterial infection spread by certain types of ticks).
• Side effects of phenytoin (Dilantin), a medicine used to prevent seizures.
• Side effects of measles-mumps-rubella (MMR) vaccination.
• Cancer, such as leukemia, Hodgkin disease, and non-Hodgkin lymphoma.
• Acquired immunodeficiency syndrome (AIDS), which develops after a person contracts HIV (human immunodeficiency virus). This virus attacks the immune system, making it difficult for the body to fight off infection and some disease.
• Syphilis, a sexually transmitted infection.

How are swollen lymph nodes treated?

Treatment for swollen glands focuses on treating the cause. For example, a bacterial infection may be treated with antibiotics, while a viral infection often goes away on its own. If cancer is suspected, a biopsy may be done to confirm the diagnosis.

Any swollen lymph nodes that don’t go away or return to normal size within about a month should be checked by your doctor.

How long will lymph nodes remain swollen?

Lymph nodes may remain swollen or firm long after an initial infection is gone. This is especially true in children, whose glands may decrease in size while remaining firm and visible for many weeks.

Credits

where they are located, what functions they perform, in what diseases they increase

Inflammation and enlargement of the lymph nodes usually cause discomfort and pain. As a rule, this indicates that an inflammatory process is going on in the body.

What are lymph nodes

Lymph nodes are the most important organs that perform a barrier-filtration function ¹ . Their main function is the biological filter of lymph – a colorless liquid that washes all the tissues and cells of the body. It consists of plasma and formed elements. Interestingly, lymph plasma has an almost similar chemical structure to blood plasma, but contains fewer proteins ² .

Useful information about lymph nodes

Where are the lymph nodes

Lymph nodes are found almost everywhere. They are arranged in such a way as to become an obstacle in the way of various “garbage”: toxins, viruses, bacteria, parasites, fungi, cancer cells.

Most lymph nodes are located deep under the skin and even near internal organs where they cannot be felt. But some lymph nodes – under the jaw, in the armpits, in the groin – can be palpated even in a healthy, non-inflamed state.

Photo: Shutterstock

Functions of the lymph nodes

As mentioned earlier, the main function of the lymph nodes is barrier-protective function. In these organs of the lymphatic system, protective cells of the body are formed, such as lymphocytes, antibodies, phagocytes. Lymph nodes protect against the penetration of infections, and also prevent the reproduction of malignant tumor cells and play a role in the immune response to substances foreign to the body.

Lymph nodes also perform the following functions:

• hematopoietic – after the lymph nodes, lymph enriched with lymphocytes enters the blood;
• drainage – promote the outflow of excess fluid;
• depositing (reserve) – a lymph node is a temporary storage of lymphocytes and lymph. The latter lingers in the lymph node in order to ensure the unloading of the bloodstream in “emergency” situations, for example, during venous congestion;
• metabolic – lymph nodes are involved in the metabolism of fats, proteins, carbohydrates and other substances.

Causes of swollen lymph nodes

Lymph nodes have their own diseases, and most often their inflammation is a reaction to some other disease or condition. Completely different reasons can lead to an increase in lymph nodes (lymphadenopathy). Consider the most common of them.

Local infections

Infection is one of the most common causes of swollen lymph nodes.

— For example, it can be acute respiratory diseases, leading to an increase in regional lymph nodes associated with the area in which inflammation occurs, says general practitioner Oksana Khamitseva.

As a rule, the focus of the disease is located near enlarged lymph nodes. So, with infections of the upper respiratory tract, the lymph nodes in the neck become inflamed, with a sexual infection – in the groin.

Generalized viral and bacterial infections

If only one category of lymph nodes is affected, then they speak of local inflammation. If the nodes that are not adjacent to each other increase, then we are talking about a generalized inflammation of the lymph nodes.

This widespread inflammation can be caused by infections – bacterial, viral, fungal, which affect the entire body. It can be tuberculosis, some infectious skin diseases, rubella, chickenpox, cytomegalovirus, mononucleosis, HIV and others.

Autoimmune diseases

Autoimmune connective tissue diseases such as arthritis and systemic lupus erythematosus can also cause swollen lymph nodes. In such diseases, the body begins to attack its own cells. Due to the increasing load on the lymph nodes, their inflammation occurs.

Tumor processes

Swollen lymph nodes can also signal tumor processes in the body. As we wrote above, lymph nodes prevent the reproduction of cancer cells, but in some cases, tumor cells can get stuck in them and multiply. Tumor processes can lead to the development of leukemia, lymphogranulomatosis, lymphoma.

Hypersensitivity of the body

Allergic reactions can also provoke inflammation of the lymph nodes. In addition, their increase may be associated with hypersensitivity to certain drugs.

How lymph nodes are treated

The treatment of lymphadenopathy is varied and always depends on its cause. An increase in lymph nodes is a signal of inflammation, so you need to look for its source.

Most often, inflammation of the lymph nodes occurs as a secondary process, that is, a reaction to another disease:

• if this is associated with acute respiratory infections, then it is necessary to treat the respiratory tract infection itself, be it a bacterium or a virus;
• if it is associated with a generalized infection (mononucleosis, HIV), then long-term specific therapy is selected here;
• cat-scratch disease (felinosis) is treated with special antibiotics;
• Sepsis is stopped only in the hospital by intravenous administration of various drugs, including antibiotics, and ionic solutions.
• autoimmune diseases (systemic lupus erythematosus, Kawasaki disease, etc.) are treated by a rheumatologist, prescribing hormones or cytostatics for long courses under constant supervision.

Lymphadenopathy can also be caused by cancer. Conventionally, they can be divided into 3 sections:

1. leukemia, when the primary malignant focus is in the bone marrow;
2. lymphomas, when the foci are located directly in the lymph nodes;
3. metastases, when the focus is located in the internal organ, and cancer cells affect the lymph nodes in the path of lymph outflow.

— In the case of leukemia, a bone marrow transplant is possible. With lymphoma, it is useless to do this, you can only use various options for radiation, chemotherapy, genetic engineering methods. And if lymphadenopathy is caused by metastases, then, as a rule, the tumor of the corresponding organ is removed, entering healthy tissues and capturing the “package” of affected lymph nodes, says our expert Oksana Khamitseva.

How to maintain the health of the lymphatic system at home

According to physician Oksana Khamitseva, the health of the lymphatic system primarily depends on two components: good lymphatic drainage and normal functioning of the immune system. This is not difficult to achieve:

• regular physical activity;
• avoid tight, constricting clothing;
• smoking and alcohol cessation;
• courses of multivitamins 2 times a year;
• food high in protein and fiber in the diet;
• adequate fluid intake.

Popular questions and answers

General practitioner Oksana Khamitseva answers popular questions about lymph nodes.

Which lymph node is responsible for what?

– Each internal organ is supplied with lymph nodes, arteries and veins. If we talk about those lymph nodes that we can feel:

• Submandibular: increase with rhinitis, pharyngitis, tonsillitis, inflammation of the teeth and gums.
• Cervical: inflamed with acute respiratory infections, conjunctivitis, otitis media.
• Parotid: react to otitis media, acute respiratory infections.
• Occipital: increased with head and neck infections, acute tonsillitis, infectious mononucleosis.
• Axillary: may also be associated with mononucleosis, mastitis, breast cancer, HIV, cat scratch disease.
• Elbows: felinosis, HIV.
• Inguinal: mumps, generalized infections, inflammation of the urogenital organs.

What to do if the lymph nodes are inflamed?

– If you have lymphadenitis, you need to see a doctor, because you do not know what it can be connected with. If you notice an increase in lymph nodes in the head and neck, there are signs of acute respiratory infections (runny nose, sore throat, cough, fever), then you can independently start taking vitamins, antiviral drugs, NSAIDs, symptomatic treatments for colds.

If you notice an increase in lymph nodes, which is objectively not related to the infectious process, then doing something without a doctor’s recommendation can be dangerous. Even taking vitamins, if the process is autoimmune, will spur the immune system to even more aggressive inflammation.

Why is inflammation of the lymph nodes dangerous?

— Complications of lymphadenitis include:

• transfer of infection to nearby tissues: bones, subcutaneous fat, skin;
• blockage by blood clots of veins adjacent to inflamed lymph nodes;
• violation of lymphatic drainage, edema, “elephantiasis” of the limbs.

What can not be done with enlarged lymph nodes?

– If you notice an increase in lymph nodes, then it is strongly not recommended to ignore it, heat or apply ice, make lotions without the permission of a doctor. Also, do not smear with anti-inflammatory ointments (you will reduce one lymph node and decide that you are cured, and if it is an oncology?), squeeze and massage the lymph node.

The patient does not know in which direction the lymph flows from this or that lymph node, and if you make the wrong movements, stagnation can be provoked.

Which doctor treats lymph nodes?

— All roads lead to a therapist. After examination and examination, a specialist can identify what lymphadenitis is associated with, treat acute respiratory infections or refer to an ENT doctor, an infectious disease specialist if an infectious process is detected. If an autoimmune disease is detected, your doctor is a rheumatologist, and in case of suspicion of leukemia or lymphoma, an oncologist.

Sources:

1. Semioshko N.V. Lymph nodes adjacent to the celiac trunk // BBC 28.706 Ya431 V 38. – 2014. – P. 111. http://sno.grsmu.by/conference/mk47.pdf#page=111
2. Pogrelchuk O.E., Danko E.S. Blood and lymph. Hematopoiesis // In the world of scientific discoveries. – 2018. – S. 219-221. https://www.elibrary.ru/download/elibrary_36443065_39723184.pdf
3. Dvoretsky L.I. Differential diagnosis in lymphadenopathy // Handbook of a polyclinic doctor. – 2005. – no. 2. – S. 3-10. https://www.elibrary.ru/item.asp?id=18967212

Belarusian State Medical University

1.

Lateral cervical lymph nodes

, nodi lymphatici cervicales laterales . Located in the lateral region of the neck. Represented by the following groups:

2.

Superficial lymph nodes

, nodi lymphatici superficiales . They lie along the external jugular vein. Collect lymph from the lower part of the auricle and the neck area below the parotid gland. The efferent vessels end in the deep cervical lymph nodes. See page 257, Fig. B.

3.

Upper deep lymph nodes

, nodi lymphatici profundi superiores . They include three groups and collect lymph from neighboring areas of the neck, as well as from the lymph nodes of the head. Their efferent vessels form the jugular trunk. Rice. A.

4.

Lateral lymph nodes

, nodi lymphatici laterales . Located outside the internal jugular vein. Rice. A.

5.

Anterior lymph nodes

, nodi lymphatici anteriores . They lie in front of the internal jugular vein. Rice. A.

6.

Jugular-bigastric knot

, nodus jugulodigastricus . The most cranial of the deep cervical nodes. Palpable with inflammation of the tonsils, tongue and pharynx. Rice. A.

7.

Lower deep lymph nodes

, nodi lymphatici profundi inferiores . Consist of two groups. They end in the efferent vessels from the lymph nodes of the organs of the neck and head, and they are also regional for neighboring areas. The efferent vessels of the lower deep nodes join the jugular trunk.

8.

Jugular-scapular-hyoid knot

, nodus juguloomohyoideus . Located between the scapular-hyoid muscle and the internal jugular vein. Collects lymph from the tongue. Rice. A.

9.

Lateral lymph nodes

, nodi lymphatici laterales . Located on the lateral side of the internal jugular vein. Rice. A.

10.

Anterior lymph nodes

, nodi lymphatici anteriores . Located in front of the internal jugular vein. Rice. A.

11.

Supraclavicular lymph nodes

, nodi lymphatici supraclaviculares . Located above the collarbone. Rice. A.

12.

Extension units

, nodi accessorii .

13.

Retropharyngeal lymph nodes

, nodi lymphatici retrotropharyngeales . Located along the outer edge of the longus capitis muscle at the level of the lateral mass of the atlas. Rice. A, Fig. B.

14.

UPPER LIMB

, membrum superius .

15.

Axillary lymphatic plexus

, plexus lymphaticus axillaris . It is formed by lymphatic vessels connecting 20-30 axillary lymph nodes. Rice. B.

16.

Axillary lymph nodes

, nodi lymphatici axillares . They are located in the same topographic region of the upper limb. Rice. AT

17.

Apical lymph nodes

, nodi lymphatici apicales . Lie medial to the subclavian vein between the upper edge of m. pectoralis minor and the apex of the axillary fossa. Collects lymph from the upper lateral part of the chest and other axillary lymph nodes. The efferent vessels form the subclavian trunk, which opens on the left into the thoracic duct or the left subclavian vein, on the right – joins the right subclavian vein or the jugular trunk. Rice. AT

18.

Shoulder lymph nodes

, nodi lymphatici brachiales . They lie along the axillary artery and collect lymph from the upper limb. Rice. B.

19.

Subscapular lymph nodes

, nodi lymphatici subscapulares . Located along a.subscapularis and collect lymph from the back of the chest, shoulder joint and lower back of the neck. Rice. B.

20.

Thoracic lymph nodes

, nodi lymphatici pectorales . Located at the lower edge m. pectorales minor and collect lymph from the anterior and lateral walls of the body to the level of the navel. Rice. B.

21.

Central lymph nodes

, nodi lymphatici centrales . They are located in the fatty tissue of the armpit and collect lymph from the shoulder, subscapular and thoracic lymph nodes. Rice. B.

22.

Interthoracic lymph nodes

, nodi lymphatici interpectorales . They are located between the pectoralis major and minor muscles and collect lymph from the mammary gland. The efferent vessels end in the apical lymph nodes. Rice. B.

23.

Deltoid – thoracic (subclavian) lymph nodes

, nodi lymphatici eltopectorales (infraclaviculares) . They are located in the sulcus of the same name along the lateral saphenous vein and collect lymph from the skin of the hand. Rice. B.

24.

Shoulder lymph nodes

, nodi lymphatici brachiales . Single lymph nodes along the vessels of the shoulder.