Scheme of the lymph nodes of the abdominal cavity. Parietal lymph nodes of the retroperitoneum

Lymph nodes are one of the most important organs of the lymphatic system, they play the role of filters, preventing various microorganisms from entering the bloodstream. .

The location of the lymph nodes is conceived by nature very rationally, so that they serve as a barrier to bacteria, viruses, and malignant cells. The lymphatic system is not closed in a circle, like the cardiovascular system, the fluid (lymph) moves through it in only one direction. Through the lymphatic capillaries and vessels, it gathers and moves from the periphery to the center,
vessels are collected in large ducts, and then flow into the central veins.

Lymph nodes are located in clusters along the blood vessels and their branches through which the lymph is filtered, as well as near the internal organs. Knowing where the lymph nodes are located, everyone can evaluate their size and density. Monitoring the state of your lymph nodes allows you to note even their minor changes, which in turn contributes to the timely diagnosis of many diseases.

By location, lymph nodes can be divided into two large groups:

Internal
External

internal lymph nodes

Internal lymph nodes are located in groups and chains along large vessels, next to the most important human organs.

Visceral knots

They collect lymph from the organs in the abdominal cavity.

Allocate:

splenic nodes. They lie at the gates of the spleen, receive lymph from the left half of the body of the stomach and its bottom.
Mesenteric nodes - located directly in the mesentery of the intestine, receive lymph, respectively, from their part of the intestine.
Gastric - left gastric, right and left gastro-omental.
Hepatic - along the large hepatic vessels.

Parietal or parietal

These are retroperitoneal nodes, which include para-aortic and paracaval. They are located along the aorta and the inferior vena cava in the form of clusters of various sizes, interconnected by lymphatic vessels. Three clusters were distinguished among them: left, right and intermediate lumbar clusters.

external lymph nodes

External lymph nodes are those that are close to the surface of the body, often just under the skin, sometimes deeper, under the muscles. They are characterized by the fact that for their examination it is not necessary to resort to complex diagnostic manipulations. It is enough to examine and feel in order to suspect a particular pathology.

Everyone needs to know the location of the lymph nodes of the external level, this will help to independently identify changes in them in the early stages in order to consult a doctor. The external ones include those that collect lymph from the head, neck, arms and legs, the mammary gland, partly the organs of the chest, abdominal cavity, and small pelvis.

Superficial lymph nodes are the following large groups:

Lymph nodes of the head and neck.
Supraclavicular and subclavian nodes.
Axillary lymph nodes.
Elbows
Inguinal

The cervical, supra- and subclavian, axillary and inguinal lymph nodes are of the greatest importance in the diagnosis. Where the lymph nodes of these groups are located will be discussed below.

Lymph nodes of the head and neck

Lymph nodes on the head are several small clusters:

Parotid superficial and deep
Occipital
mastoid
and chin
Facial

Below in the figure you can see the lymph nodes on the head and on the face, the location of which is important to know for the correct diagnosis of diseases and in cosmetology practice. Knowing where the lymph nodes are located is the basis for many lymphatic drainage procedures, in particular the Asahi rejuvenating massage. The group of facial nodes is located deep enough in the fiber, rarely becomes inflamed and has no diagnostic value in medical practice.

The lymph nodes of the neck are divided as follows:

Anterior cervical

superficial;
deep.

Lateral cervical

superficial;
deep top and bottom.

Supraclavicular
Additional

It's called. This is a wake up call that should not be ignored.

Axillary lymph nodes

Lymph nodes on the hands are an integral part of the examination. Elbow and axillary lymph nodes are easily accessible.
Of great clinical importance are, the location of which caused the outflow in them not only of lymph from the upper limb, but also from the organs of the chest and mammary gland. They are located in the fatty tissue of the armpit, divided into 6 groups, due to their anatomical location in the cavity.

For a more accurate understanding of where the axillary lymph nodes are located, a diagram of their location is presented.

Such a detailed scheme with the division of nodes into groups is important in oncological practice. Based on the defeat of nodes from specific groups, postoperative staging of breast cancer is based. In normal clinical practice, such a detailed division into groups is not of great importance, especially since it is almost impossible to probe deeply located nodes.

The elbow lymph nodes are of lesser importance, as they are collectors only from the lower part of the arm, the elbow joint, they increase only with systemic diseases of the lymphatic system and a direct infection of the hand or forearm. Their increase is easily noticeable, and therefore does not require complex diagnostic techniques.

Inguinal lymph nodes

The inguinal lymph nodes in women and men are located the same way, they are divided into deep and superficial. Superficial ones are easily felt under the skin in the inguinal fold, between the pubic bone and the leg, even normally they can be felt in the form of small moving peas up to 5 mm in size.

The location of the lymph nodes in the groin is conceived by nature in such a way as to collect lymph in them not only from the lower limb, but also from the pelvic organs (uterus and ovaries in women and the prostate in men) and external genital organs.

The causes of inflammation of the inguinal lymph nodes in men and women may be of a different nature.

Below is a picture that shows all groups of lymph nodes in the pelvis and inguinal region.

In addition to the inguinal, there are also lymph nodes on the legs, the principle of location of which does not differ from the same on the hands.

These are also large joints, in this case the knee. The nodes are located in the tissue of the popliteal fossa, increase mainly in infectious processes below the knee, purulent wounds, erysipelas.

Method of examination of lymph nodes

For the diagnosis of lymphadenopathy, examination and palpation (palpation) are used. Only superficial lymph nodes are available to these techniques, deeper ones must be examined using the ultrasound diagnostic method.

Examination of the lymph nodes is carried out necessarily from both sides at the same time, since it is necessary to compare the affected lymph node with a healthy one. Note the number of enlarged nodes in each examined group.

In addition, their density, soreness, mobility in relation to the skin, to each other are determined. Also, in the diagnosis of inflammation, examination of the skin over the node is of great importance, redness, elevated local temperature can indicate a purulent process in the node.

Examination of the lymph nodes of the head

Palpation is carried out from top to bottom, starting with the occipital nodes on the head. Palpation is carried out with the pads of half-bent fingers. Feeling should be soft and smooth without pressure, you need to slightly roll over the knots.

First, the occipital lymph nodes are felt, the location of which is easy to determine by placing your fingers on the muscles of the neck, in the place where they are attached to the head. After the ear or mastoid lymph nodes are palpated, they are located behind the auricle near the mastoid process. Then the parotid and submandibular lymph nodes are examined.

The location of the submandibular nodes, their characteristics are determined by bent fingers, which are led under the lower jaw and, as it were, slightly press the nodes to the bone. The chin lymph nodes are examined in the same way, only closer to the center line, that is, under the chin.

Examination of the lymph nodes of the neck

After examining the lymph nodes of the head, they begin to feel the lymph nodes of the neck. Only superficial and supraclavicular lymph nodes are available for palpation. The location of the hands during palpation of the cervical lymph nodes is as follows: gently press half-bent fingers to the lateral surface of the neck along the posterior, and then the anterior edges of the sternocleidomastoid muscle. It is there that the superficial groups of the cervical lymph nodes are located. The brushes should be held horizontally.

The supraclavicular lymph nodes are located above the collarbones, between the legs of the sternocleidomastoid muscle. The pads of half-bent fingers are placed on the area above the collarbone and lightly pressed.

Normally, the supraclavicular nodes are not palpable, however, with gastric cancer, there may be a single metastasis in the left supraclavicular region (Virchow's metastasis), in addition, an increase in the left supraclavicular nodes indicates an advanced stage of ovarian cancer in women, bladder, testicles and prostate cancer in men, sometimes cancer pancreas.

An increase in the right supraclavicular lymph nodes indicates a tumor located in the chest. After the supraclavicular, the subclavian lymph nodes are palpated in the same way.

▪ FIGURE 92-1 Illustration of the upper gastrointestinal tract depicting the lymph nodes of stomach, liver, gallbladder, pancreas, and spleen: 1, celiac; 2 gastric (right and left); 3, gastroepiploic (right and left); 4, pyloric; 5, superior pancreatic; 6, inferior pancreatic; 7, perisplenic; 8, superior pancreaticoduodenal; 9, inferior pancreaticoduodenal; 10, cystic.

▪ FIGURE 92-2 Illustration of the retroperitoneum depicting the retroperitoneal lymph nodes: 1, celiac; 2, superior mesenteric; 3, inferior mesenteric; 4, para-aortic; 5, postaortic; 6, paracaval; 7, precaval; 8, postcaval; 9, aortocaval.

▪ FIGURE 92-3 Illustration of the colon with its arterial anatomy depicting the lymph nodal system of the colon: 1, superior mesenteric; 2, inferior mesenteric; 3, ileocolic; 4, right colic; 5, middle colic; 6, left colic; 7, sigmoid; 8, superior rectal; 9, paracolic; 10, prececal; 11, retrocecal; 12, appendicular.

▪ FIGURE 92-4 Illustration of the frontal view of the pelvis showing the pelvic lymph nodes: 1, median common iliac; 2, intermediate common iliac; 3, lateral common iliac; 4, subaortic common iliac; 5, common iliac nodes of promontory; 6, medial external iliac; 7, intermediate external iliac; 8, lateral external iliac; 9, femoral (medial); 10, femoral (intermediate); 11, femoral (lateral); 12, obturator.

▪ FIGURE 92-5 Illustration of the lateral view of the pelvis showing the pelvic lymph nodes: 1, superior gluteal; 2, nodes along internal iliac branches; 3, sacred; 4, external iliac; 5, prevesical; 6, paravaginal; 7, lateral vesicular; 8, parauterine; 9, perirectal.

▪ FIGURE 92-6 Representative axial contrast-enhanced MDCT images of the abdomen and pelvis at various levels demonstrating the normal location of the abdominal lymph nodes. A: 1, retrocrural. B: 2A, Perigastric nodes. C: 2, Gastrohepatic ligament. D: 3, Portohepatic; this image also shows an accessory spleen ( black arrow) at the splenic hilum that can mimic an enlarged lymph node. However, the accessory spleen shows attenuation and enhancement characteristics similar to native spleen. E: 4, Pancreaticoduodenal. F: 5, Perisplenic. G: 6, Mesenteric. H: 7, Celiac. I: 8, Superior mesenteric; 4, pancreaticoduodenal. J: 9, aortocaval. K: 10, Para-aortic; 11, retrocaval; 12, paracaval. L: 13, external iliac. M: 14, Internal iliac. N: 15, obturator. O: 16, Common iliac. P: 17, Superficial inguinal; 18, deep inguinal.

Atlas of human anatomy

Lymph nodes of the abdominal cavity

Parietal nodes are concentrated in the lumbar region. Among them are the left lumbar lymph nodes (nodi lymphatici lumbales sinistri), which include lateral aortic, preaortic and postaortic nodes, intermediate lumbar nodes located between the portal and inferior vena cava, and right lumbar nodes (nodi lymphatici lumbales dextri), including lateral caval, precaval and postcaval lymph nodes. Classification is carried out depending on the position of the nodes in relation to the aorta and inferior vena cava.

Internal nodes are located in several rows. Some of them are located on the path of the lymph from the organs along the large intravascular vessels and their branches, the rest are collected in the area of the gates of the parenchymal organs and near the hollow organs. Lymph from the stomach enters the left gastric nodes (nodi lymphatici gastrici sinistri) located in the region of the lesser curvature of the stomach, left and right gastro-omental nodes (nodi lymphatici gastroomentales sinistri et dextri) lying in the region of the greater curvature of the stomach, hepatic nodes (nodi lymphatici hepatici), following along the hepatic vessels, pancreatic and splenic nodes, located in the gates of the spleen, pyloric nodes, heading along the gastroduodenal artery, and into the cardiac nodes, forming the lymphatic ring of the cardia. From the duodenum and pancreas, lymph flows into the pancreatoduodenal nodes, which run along the same vessels, and part of the lymph from the pancreas is sent to the pancreatic-splenic lymph nodes (nodi lymphatici pancreaticolienales). Lymph from the jejunum and ileum enters the superior mesenteric nodes nodi lymphatici mesenterici superiores. The efferent vessels of the superior mesenteric nodes carry lymph to the lumbar and celiac nodes. (nodi lymphatici coeliaci). Lymph from the colon, up to the descending colon, is directed to the ileocolic-intestinal nodes (nodi lymphatici ileocolici), left, middle and right colonic nodes and to the left and right gastroepiploic nodes. Of these nodes, the efferent vessels supply lymph to the superior mesenteric and lumbar nodes. Lymph from the descending and colon and sigmoid colon is taken by the left colonic nodes, and the efferent vessels carry it further to the lower mesenteric and lumbar nodes. From the liver, lymph is collected mainly in the hepatic, celiac, pyloric and right gastric nodes. Then it enters the lower and upper diaphragmatic nodes (nodi lymphatici phrenici inferiores et superiores), and from there - to the nodes of the mediastinum (nodi lymphatici mediastinales). Lymph from the kidneys is sent to the renal nodes, from where the efferent vessels carry it to the lumbar nodes.

See also:
lymphatic system
- Lymphatic vessels and nodes
Lymph nodes of the lower limb
Lymph nodes of the pelvis
Lymph nodes of the chest cavity
Lymph nodes of the head and neck
Lymph nodes of the upper limb
Organs of the immune system
The lymph nodes
Spleen
Bone marrow
Thymus
Lymphoid tissue of the walls of the respiratory and digestive systems

The lymph nodes of the abdominal cavity are also divided into parietal and splanchnic.

Parietal nodes are concentrated in the lumbar region. Among them, there are left lumbar lymph nodes (nodi lymphatici lumbales sinistri), which include lateral aortic, preaortic and postaortic nodes, intermediate lumbar nodes located between the portal and inferior vena cava, and right lumbar nodes (nodi lymphatici lumbales dextri), including lateral caval, precaval and postcaval lymph nodes. Classification is carried out depending on the position of the nodes in relation to the aorta and inferior vena cava.

Internal nodes are located in several rows. Some of them are located on the path of the lymph from the organs along the large intravascular vessels and their branches, the rest are collected in the area of the gates of the parenchymal organs and near the hollow organs. Lymph from the stomach enters the left gastric nodes (nodi lymphatici gastrici sinistri), located in the region of the lesser curvature of the stomach, left and right gastro-omental nodes (nodi lymphatici gastroomentales sinistri et dextri), located in the region of the greater curvature of the stomach, hepatic nodes (nodi lymphatici hepatici), following along the hepatic vessels, pancreatic and splenic nodes, located in the gates of the spleen, pyloric nodes, heading along the gastroduodenal artery, and into the cardiac nodes, forming the lymphatic ring of the cardia. From the duodenum and pancreas, lymph flows into the pancreaticoduodenal nodes, which run along the same vessels, and part of the lymph from the pancreas goes to the pancreatic-splenic lymph nodes (nodi lymphatici pancreaticolienales). Lymph from the jejunum and ileum enters the superior mesenteric nodes (nodi lymphatici mesenterici superiores). The efferent vessels of the superior mesenteric nodes carry lymph to the lumbar and celiac nodes (nodi lymphatici coeliaci). Lymph from the large intestine, up to the descending colon, is sent to the ileocolic-intestinal nodes (nodi lymphatici ileocolici), left, middle and right colonic nodes and to the left and right gastro-omental nodes. Of these nodes, the efferent vessels supply lymph to the superior mesenteric and lumbar nodes. Lymph from the descending and colon and sigmoid colon is taken by the left colonic nodes, and the efferent vessels carry it further to the lower mesenteric and lumbar nodes. From the liver, lymph is collected mainly in the hepatic, celiac, pyloric and right gastric nodes. Then it enters the lower and upper diaphragmatic nodes (nodi lymphatici phrenici inferiores et superiores), and from there to the nodes of the mediastinum (nodi lymphatici mediastinales). Lymph from the kidneys is sent to the renal nodes, from where the efferent vessels carry it to the lumbar nodes.

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The human lymphatic system is a complex plexus of special tissues and organs. Complex anatomy reveals to a person some of the mysteries of the formation of certain deviations in the process of life. Knowing the location of the lymph nodes of the retroperitoneal space and the abdominal cavity will help in understanding the causes of diseases, the characteristics of the pain syndrome that occurs during inflammation.

Structure Features

The system is part of the cardiovascular network. It forms the flow of lymph - a substance that carries fluid to all tissues and organs, providing complete and proper nutrition. Consists of lymphatic vessels, ducts and capillaries, as well as nodes through which fluid flows and is filtered.

Lymph is “pure water” that has no shade. Without this liquid, it would be impossible to fully nourish the tissues with water and useful insoluble substances. Lymph is closely related to blood flow, but it does not move as fast as arterial fluid.

The nodes included in the system are classified as immune organs, the main function of which is to protect a person through the filtration of carried liquids. Immunity cells - lymphocytes - multiply in the lymph nodes. They are responsible for the destruction of pathogenic microorganisms, bacteria, viruses. If there is a failure in the production of this flora, severe immunodeficiency develops, including HIV or AIDS.

In the abdominal and retroperitoneal space, as in other compartments of the human body, the nodes are located one by one or in groups. Normally, they have a pink tint and a soft structure, while retaining elasticity and even kidney-shaped shape. In old age, they expand slightly, becoming segment-like or ribbon-like. This happens due to the fusion of neighboring lymph nodes, but the pathological process is not considered.

The largest nodes of the abdominal cavity reach a size of 15 mm, while small conglomerates do not exceed 0.5 mm in diameter. With age, formed groups can reach large sizes - up to 50 mm. Children have less immune links.

Group classification

The lymphatic system is located in the direction of the blood vessels, branches off from each organ and is very extensive. Along its course are large and small knots that prevent the spread of infections and cleansing body fluids every minute.

There are two types of nodes: parietal ones are in the walls of the cavities, and visceral ones are next to the organs. The whole system can be divided into several subgroups of nodes:

upper limbs;
chest;
heads;
pelvis
abdominal cavity;
lower limbs.

The size of the lymph nodes may vary, but their structure is usually identical. The position depends on the group. The cervical elements are more amenable to palpation. With inflammation, the pain in them is determined quite accurately, and with the help of visualization, an increase can be identified - additional diagnostics are not required.

Lymph nodes in the abdominal cavity are more difficult to visualize and amenable to diagnosis. To clarify their increase, ultrasound is necessary; if oncological processes and other diseases are suspected, CT, MRI can be prescribed. Pain in these elements is not amenable to precise description and is often confused with appendicitis, diseases of the stomach.

The structure of the lymph nodes

Outside, the immune links are covered by a thin membrane consisting of connective cells. The parenchyma is the main elements of each organ of the lymphatic system. It consists of reticular cells, in which there are several structures:

cortical substance - located in the zone of the periphery;
brain tissue - located in the center of the capsule.

The cortical region includes a superficial zone containing follicles, as well as a region of the deep cortex (paracortical). It connects the medulla and cortical layer. It is in this area that T-lymphocytes are produced, which are necessary to fight all diseases and viruses.

From the capsule inside the node, into the parenchyma, bundles of connective tissue depart - trabeculae. They look like small plates and partitions that form the skeleton. In this area, lymphatic fluid passes through the sinuses of the cortex and medulla. The main function of these membrane membranes is to purify water from foreign elements.

The structure of the protective links is not extremely complex, but the slightest failure in it can lead to severe autoimmune processes. Damage to the filtering membranes is a path to the development of fatal immunodeficiencies for humans.

Anatomy of the lymphatic system of the retroperitoneal zone

To facilitate the diagnosis, treatment and study of the lymphatic system, all nodes in the abdominal cavity are divided into several subgroups:

Celiac. There are from 10 to 15 of them, located at the base of the celiac trunk. Most often, their size does not exceed 10 mm in diameter, but sometimes links up to 20 mm are found. They are classified as visceral elements, although some studies of the 20th century insist on the opposite classification - parietal.
Gastric. These elements are located on the line of curvature of the stomach - large and small. Also, groups of immune links are located in the pyloric region.
Upper and lower pancreatic. Immune links are located along the perimeter of the pancreas, above and below.
Splenic. The elements are grouped in the organ gate area.
Hepatic. Affect the area of the gallbladder and the gate of the liver.
Mesenteric. They are located between the sheets of the mesentery of the small intestine.
Large intestine. They are located mainly next to the lymphatic vessels, the intestinal loop.
Lumbar. Rarely grouped, represented by single structures located along the aorta.
diaphragm lower. Localized at the crura of the diaphragm.
Epigastric lower. Located at the beginning of the epigastric artery.

Each node has a unique function that is responsible for the purification of fluids entering a nearby organ or structure. If a person suffers from a disease, for example, of the stomach, then the gastric nodes become inflamed first of all. But with a long and acute course of the disease, damage to distant links is possible.

Para-aortic lymph nodes, located in the abdominal cavity near the stomach, intestines and pancreas, are most often exposed to the growth of cancer cells. They have metastases. In the para-aortic nodes, pathological formations may appear, emanating from the prostate, ovaries, uterus, and bladder.

Causes of inflammation of the abdominal nodes

If the size of the lymphatic element increases, this indicates the development of the disease and inflammation. The pathological process can begin with the active production of lymphocytes, which is associated with the activation of the immune system to fight the disease of the organ located nearby. An increase in protective links is characteristic of many diseases and infections:

lymphadenitis - purulent inflammation of the node, accompanied by pain, redness of the skin;
tuberculosis - the upper links included in the network of the abdominal lymphatic system may suffer;
HIV - elements increase on the abdomen, in the umbilical zone, in the upper parts of the body;
venereal diseases - not only the inguinal links are affected, but also the lower nodes of the abdominal system;
oncological diseases - the links of the peritoneum increase and hurt when the organs located in this cavity are damaged;
infectious diseases - salmonella, dysentery, shigellosis;
autoimmune diseases and infections - mononucleosis, histiocytosis;
intra-abdominal inflammation that can affect the organs of the reproductive system - diseases of the appendages, uterus, prostate.

It is impossible to determine the presence of a particular disease only by the state of the nodes. To confirm the diagnosis, a series of examinations is required.

Enlargement of lymph nodes is never spontaneous and requires the close attention of doctors. This condition does not always hide dangerous and incurable diseases. Timely examination helps to identify the initial stage of the violation and quickly eliminate it.

System Diagnostics

In addition to ultrasound and MRI, if infections, viruses and oncological processes are suspected, additional examination methods are prescribed:

laboratory tests of blood, urine;
x-ray - it can be used to exclude peritonitis in the abdominal cavity;
laparoscopy - is prescribed in the absence of sufficient information from other examinations. Using this procedure, biological material can be taken and sent for histological examination to exclude the presence of cancer cells.

The attending physician, an oncologist, an infectious disease specialist, surgeons, or all specialists together, is engaged in deciphering the data received.

lower epigastric lu, nodi lymphatici epigastnci inferiores, lie on the inner surface of the anterior abdominal wall along the vessels of the same name. They receive lymph from the diaphragm, the diaphragmatic surface of the liver. The efferent vessels empty into lumbar And celiac l.u.

Visceral l.u . abdominal cavity are located mainly along the unpaired visceral branches of the abdominal aorta and their branches. They are named after the names of the vessels and receive lymph from the organs that supply blood to this vessel.

Visceral L.U. include:

celiac lu, nodi lymphatici coeliaci, are located around the celiac trunk. They take lymph from the regional nodes of the stomach, abdominal part of the esophagus, liver, pancreas, spleen.

The efferent vessels of the celiac lo. flow into the lumbar lumen, intestinaltrunk or cistern of the thoracic duct.

Rice. 12. Regional lymphaticabdominal nodes

1 - pre-intestinal lu; 2- ileocolic L. at.; 3 - mesenteric (upper) lu; 4 - mesenteric-colic L.s.; 5 - lower mesenteric L.s.; 6 - left colonic L.s.; 7 - sigmoid L.s.

Superior mesenteric L.s., nodi lymphatici mesenterici, is the most numerous group of visceral lymph nodes. Their number ranges from 60 to 400. They are located between the sheets of the small intestine along the superior mesenteric artery and its branches. Nodes are arranged in groups. yukstakishechnye l.s. are located near the wall of the small intestine, between the mesenteric edge and the vascular arches. Upper (central) l.s. lie in the root of the mesentery of the small intestine around the trunk of the superior mesenteric artery. Mesenteric l.u. receive lymph from the entire small intestine, as well as from the caecum with the appendix, ascending colon, transverse colon.

Inferior mesenteric lu, nodi lymphatici mesenterici inferiores, are located along the inferior mesenteric artery. They receive lymph from the descending colon, sigmoid, upper rectum.

The efferent vessels of the superior mesenteric and inferior mesenteric L.s.flow into the celiac lumen, intestinal trunk or lumbar l.s.

Numerous groups of visceral lymph nodes are located along the branches of the celiac trunk, superior and inferior mesenteric arteries,

which will be described in the presentation of the outflow of lymph from individual organs.

X. LYMPH OUTFLOW FROM THE ABDOMINAL CAVITY

STOMACH.

The lymphatic system of the stomach begins with capillaries and vessels located in all layers of its wall. The efferent lymphatic vessels are directed to the regional lymph nodes located along the vessels of the stomach along its lesser and greater curvature, as well as in the region of the hilum of the spleen and liver (Fig. 13).

Regional L.s. stomach are:

Gastric l.u., (right and left) nodi lymphatici gastrici (dextri et sinistri), are located at the lesser curvature of the stomach along the vessels of the same name.

Rice. 13. Outflow of lymph from the stomach

1 - celiac lo.; 2 - left gastric L.s.; 3 - splenic L.s.; 4 - left gastro-omental louses; 5 - right gastric omental louses; 6 - right gastric lo.

Lymphatic ring of the cardia anulus lymphaticus cardiae - lo, located in the region of the cardial part and around the cardiac opening of the stomach.

Pyloric l.u., nodi lymphatici pylorici, located in the area of the pylorus.

Gastro-omental l.u., (right and left), nodi lymphatici gastroomentales (dextri et sinistri), are located at the greater curvature of the stomach along the vessels of the same name.

Pancreatic l.u., (upper and lower) nodi lymphatici pancreatici (superiores et inferiores), lie along the upper and lower edges of the pancreas.

Splenic lo., nodi lymphatici splenici (lienales), localized in the hilum of the spleen.

Pancreatoduodenal l.u., (upper and lower), nodi lymphatici pancreaticoduodenales superiores et inferiores, located between the head of the pancreas and the duodenum.

24Hepatic lu, nodi lymphatici hepatici, are located in the thickness of the hepatoduodenal ligament along the common hepatic artery and portal vein.