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52 Cards in this Set

  • Front
  • Back
Brachiocephalic Main Two Branches
1) RIght Common Carotid - Divides at thyroid cartilage. Carotid sheath holds the common carotid medially, jugular laterally, and vagus between/post.
-Carotid Body - At carotid bifurcation and tied into visceral afferent system of vagus and glossopharyngeal chemoreceptors. Detects low levels of oxygen/high Co2 (high H+), and low blood pH and will kick start brain to start breathing
-Carotid Sinus - Superior to carotid body at proximal part of internal carotid. Has pressure receptors tied into afferent branches of CN IX which transmit to medulla oblongata to control BP by changing HR. Can sense a head injury and respond to the dropped BP by increasing the HR

2) Right Subclavian - Divides into 4 branches (proximal) vertebral artery, internal thoracic, thyrocervical trunk, and costacervical trunk
Thyrocervical Trunk of the Right Subclavian
The trunk divides into 3 main branches
1) Inferior Thyroid - supplies thyroid gland, trachea, and breaks off to ascending cervical art. which supplies vertebrae and neck muscles
2) Transverse Cervical - Supplies trapezius, serratus, and rotator cuff
3) Suprascapular - Supplies scalupa supraspinatus/infraspinatis muscles, subscapularis, terres major, and sternocleidomastoid muscle
Internal Thoracic/Costacervical Trunk
1a) Gives rise to anterior intercostal arties of the ribs which ANAS with thoracic aorta posterior intercostal arteries in the costal groove
1b) GIves rise to superior epigastric artery which supplies diaphragm, rectus, abdominus muscles. It ANAS with inferior epigastric artery (external iliac) inferiorly of anterior rib cage

2) Costacervical Trunk - Leads to arteries that supply the back of the neck and supreme intercostal arteries which supply first two intercostal spaces
Vertebral Artery
-1st branch of the subclavian
-Runs superiorly and enters neck at 6th cervical vertebrae foramen transversalis
-Continues to enter foramen magnum and contributes to the basilar artery of the circle of willis
Internal Carotid
-goes from carotid canal, over petrous, through cavernous sinus, and super/medial to ant. clinoid process between CN1/2. Broken into 4 segments

A) Cervical Portion - Before canal

B)Petrous Portion (2 branches) within canal
-Corticotympanic - Supplies tympanic cavity
-Artery of the Pterygoid Canal (Vidian art.) goes from middle cranial fossa to pterygopalatine fossa. ANAS w/maxillary

C) Cavernous Portion (4 branches) that break off within the cavernous sinus (proximal)
-Inferior Hypophyseal supplies pituitary gland
-Ganglionic supplies CN V
-Cavernous sinus branch (GT)
-Anterior Meningeal supplies ant. cranial fossa dura mater

D)Cerebral Portion (5 branches) - after cavernous sinus
-Opthalmic Artery goes through optic canal and branches to lacrimal gland, ethmoidal, trochlear muscle of eye to supplies retina, ethmoid, skin and nose of forehead
-Superior Hypophyseal artery supplies pituitary gland as well
-Posterior Communicating - part of circle of willis and ANAS with posterior cerebral (branch of basilar) and anterior cerebral
-Anterior Cerebral (GT and part of COW)
-Middle Cerebral - Continuation of internal carotid after COW. Supply major portion of the lateral aspect of the cerebral hemisphere and has a branch called Anterior Choroidal supplies choroid plexus where CSF is made
Closer Look at the Opthalmic Artery
Several Branches
1) Lacrimal - also gives off central retina artery
2)Central Retina - gives off short/long ciliary art
3) Supraorbital goes through super. orbital fissure to forehead and eyelid
4)Muscular goes to extrinsic eye muscles
5)Ant/Post Ethmoidal go to ant/post ethmoidal foramen to supplies air cels and nasal septum
6) Supratrochlear (Term) supplies forehead and ANAS with supraorbital
7) Dorsal Nasal (Termin - GT)
Circle of Willis (1)
Formed at brain base around the optic chiasm to ensure that artery blackage in one branch to the brain is compensated by flow from the other
-2 main arteries, basilar and internal carotid. Think of it as a pentagon
1. Vertebral arteries unit to form the basilar which splits to form L/R posterior cerebral artery (base of the COW)
2) Internal carotid splits to form 3 branches
-Posterior communicating artery connects it to the posterior cerebral artery to form lower pentagon side
-Anterior cerebral arteries form the upper pentagon sides and then continue upward. At the top side of the pentagon the anterior cerebral are conneted by a small anterior communicating artery. From the ACA the ant. cerebral continue separate
-After the carotid splits to form post. communicating and ant. cerebral it is called the middle cerebral
Problems with Brain Circulation
1) Basilar Artery Aneuryism - A dilation of the artery caused by a structural defect. The wall is weak and prone to rupturing
2) Cerebral Infarct - A release of a clot from the plaque causes a infarct or bloodless area where cells die. Can be treated with aspirin to prevent clots
Abdomen and Thoracic Cavities
This part covers artery supply to abdominal viscera and parietal walls and venous drainage to these and the thoracic cavity
-Once the aorta passes the diaphgram it is in the abdomen.
-It will be the aorta until it splits to the common iliacs, then external iliacs, then femoral
-3 types of venous draining
1) Caval - Goes directly back to the vena cava
2) Portal - two venous capillary systems that interconnect w/o first passing through an arterial segment. Diverges through the liver w/o going straight to the caval system
Artery Supply to the Abdomen Overview
Unpaired - anterior
Celiac trunk - 3 BV that supply foregut
superior mesenteric -inferior to celiac, supply midgut
inferior mesenteric - Supplies hindgut
median sacral (posterior)

Paired
1) Inferior Phrenic
2) Middle Suprarenal
3) Renal - Supply adrenal glands, kidneys
4)Testicular/Ovarian
5)Lumbar (4 pairs) - Go posteriolateral to supply lower back
6) Common Iliac (where no longer called aorta)
Unpaired Abdominal Arterial Vessles
1)Celiac Trunk - has 3 branches which supply the stomach, spleen, liver, duodenum, gall bladder, peancreas, and esophagus

2)Superior Mesenteric - Supply jejunum, ileun, cecum, and 2/3 of transverse colon until Cannon's Ring

3)Inferior Mesenteric Artery - Supply 1/3 transverse colon, descending, sigmoid colon, rectum
Celiac Trunk
-Comes off just caudal to aortic hiatus of diaphragm at T12 (T10 Vena, T8 esophagus)

1) Left Gastric Artery -supply esophagus and stomach
a) Cardio-esophageal - distal esophagus and cardiac stomach
b)Ventral Branch - anterior stomach surface (greater curve) and ANAS with left gastro-epiploeic artery
c) Dorsal Branch - posterior stomach surface (lesser curve), ANAS with right gastric artery

2)Splenic Artery - Largest branch, go through pancreas to spleen
a)Pancreatic - Supplies pancreas
b)Left Gastro-epiloeic - Supply left side of great curve stomach, ANAS with right gastro-epiloeic
c) Short Gastric - Supplies fundic stomach (great curve)
d) Splenic Branch - ends at spleen

3) Common Hepatic Artery
a) Gastroduodenal Artery -
1) Supraduodendal (GT)
2) Right gastro-epiploeic (gastro-omental) - Right side of greater curve, ANAS with left gastro-epiploeic
3) Superior Pancreaticoduodenal Artery - Supply pancreatic head, proximal duodenum, and ANAS with part of superior mesonteric artery

b) Right Gastric Artery supply pyloric stomach and ANAS with left gastric artery

c) Hepatic Artery Proper - supplies liver and gallbladder
1) Right Hepatic - right liver lobe and form cystic artery
2) Left Hepatic - left liver lobe
Superior Mesenteric Artery
- has several ANAS loops called arterial arcades which give off straight arteries called vasa recta to the organ

1) Inferior Pancreaticoduodenal Artery - supply pancreatic head, lower duodenum and ANAS with superior pancreaticoduodenal

2) Jejunal/Ileal - Supply jejunum and iliac portions of SI

3) Ileocolic Artery - Supply cecum, appendix, some ascending colon

4) Right Colic Artery - supply ascending and proximal transverse colon

5) Middle Colic Artery - supply proximal 2/3 transverse colon to Cannon's

-Large intestine forms Haustras or Sacculations which are sacs caused by the tenia coli muscle which when constricuted is shorter than the LI
Inferior Mesenteric Artery
-keeps the arterial arcades
1) Left Colic Artery - has ascending/desending branch to supply distal transverse, descending, and sigmoid colon

2) Sigmoid Arteries - 3 separate branches of the IMA that supply the sigmoid

3) Superior Rectal Artery - Supplies proximal rectum
Median Sacral Artery
-arises post part of aorta right before the bifurcation
-supplies sacrum, coccyx, lower lumbar vertebrae
Aortic Aneuryism
-Forms below level of renal artery in the abdominal artery
-Is a pulsating enlargement or tender mass
-Symptoms are back, abb, or groin pain
Paired Arteries of Abdominal Aorta
1) Inferior Phrenic - supplies diaphragm
2) Suprarenal - Supply adrenal gland
3) Rental - kidney
4) Testicular/OVarian
5)Lumbar - 4 pairs from aorta and 1 pair from internal iliac (supply L5)
a) Dorsal Branch - supply back muscle
b)Spinal Branch - supply vertebral column and spinal roots
c) Rest of it supplies anterolateral abdominal wall
6) Common Iliacs of the lower trunk
Venous Drainage Overview
3 main systems
1) Caval - Through IVC,
2) Portal - Spleen, stomach, pancreas, duodenum, ileum, jejunum, colon, cecum empty to portal vein, go through liver, and come out hepatic vein
3) Azygos - Right side of spinal column drains into the IVC
Veins Draining to the IVC
-All of the paired arteries of the abdominal aorta have similar named returning veins directly into the IVC

1) External/Internal Iliacs => Common Iliac Vein=> IVC
2) Lumbar Veins (1-4)
3) Gonadal Veins
4) Renal Veins
5) Suprarenal Veins
6) Inferior Phrenic Vein
7) Hepatic Vein (from portal system)
Azygos/Hemiazygos Drainage
-Collects from intercostal veins (thoracic ribs) and lumbar vein 5
-Coming off the common iliac are the ascending lumbar veins which collect lumbar vein 5
-They will migrate to the diaphragm and become the azygos vein (right side) and hemiazygos vein (left side)

1) Azygos - Collect right intercostal vein 3-12, hemiazygos, and accessory hemiazygos vein. Drain into superior vena cava
2) Hemiazygos - Collect ascending lumbar vein and left intercostal vein 9-12 and then crosses spinal column to join azygos
3) Accessory Hemiazygos Vein - Collect left intercostal vein 4-8 and then cross spinal column to join azygos vein
4) Left Superior Intercostal Vein - Collect intercostal vein 1-3 and drains into left brachiocephalic vein
5) Right Superior Intercostal Vein - Collect intercostal vein 1-3 and drain into right brachiocephalic vein
Portal System
-Veins of abdominal viscera collect at portal vein, go through the liver, exit as the hepatic vein, and enter the IVC right before the diaphragm
-Includes the stomach, gall bladder, pancreas, liver, spleen, and GI tract

Formation
1) Inferior Mesenteric - Left colic, sigmoid, superior rectal form inferior mesenteric vein which joins with the splenic vein
2) Splenic Vein - Made by a collection of the short gastric, pancreatic, left gastro-epiploeic, which from splenic and join with the superior mesenteric to form the portal vein

3) Superior Mesenteric - Forms by the inferior pancreaticoduodenal vein, middle and right colic, ileocolic vein, jejunal and ileal veins, right gastro-epiploeic

4) Directly to Portal Vein - As the veins come together to make the portal vein they are joined directly by the cystic, superior pancreaticoduodenal, and the left/right gastric
External Carotid
S-superior thyroid
A-ascending pharyngeal
L-lingual - 4 branches for tongue
F-facial - 9 for neck and face
O-occipital - 5 branches
P-posterior auricular
M-maxillary
S-superficial temporal
Superior Thyroid
-first artery off of the external carotid, just above the thyroid cartilage. Turns and passes deep to supply the infrahyoid muscles

Branches
1) Infrahyoid - sternohyoid, omohyoid, sternothyroid (a)
2) Sternocleidomastoid - GT
3) Superior Laryngeal - Upper larynx (a)
4) Cricothyroid - cricothyroid ligament (a)
Ascending Pharyngeal
-Smallest branch, arises posteriorly

1)Pharyngeal - middle constrictors
2)Palatine - soft palate and tonsils
3)Prevertebral - longus capitus and colli, vagus
4)Inferior Tympanic - enter tympanic cavity through small petrous crack
5)Meningeal - enter jugular foramen, supply dura mater
Lingual Artery
-arises opposite tip of the greater horn and 4 branches

1) Suprahyoid (a)- GT
2) Dorsal Lingual - posterior tongue, tonsil, soft palate, epiglottis
3) Sublingual - sublingual gland and myohyoid muscle
4)Deep Lingual - underside of tongue, genioglossus
Facial Artery
-2 branches, cervical and facial

1) Cervical
a) Ascending Palatine - Soft palate and palatine glands
b) Tonsilar - tonsils and tongues
c) Glandular - submandibular gland
d) Submental - chin and lip

2) Facial - comes off cervical branch at submental juntion
a) Inferior Labial - lower lip
b) Superior Labial - upper lip
c) Lateral Nasal - nose
d) Angular - lacrimal sac, ANAS with opthalmic artery
e) Muscular - Neck/face
Occipital Artery
1) Muscular - Digastric and sylohyoid
2) Sternocleidomastoid
3) Meningeal - Dura of posterior cranial fossa
4) Terminal - Occipital bone
Posterior Auricular
-posterior to external auditory meatus

1) Sylomastoid/Posterior Tympanic - tympanic cavity via the stylomastoid foramen
2) Auricular - rear of ear
3) Occipital - Occipital bone and scalp
Maxillary Artery (1)
-at the mandibular condyle the external carotid divides to the superficial temporal and maxillary artery

-Maxillary has 3 segments
1) Mandibular - Before lateral pterygoid
2) Pterygoid - Passing over the lateral pterygoid
3) Pterygopalatine - after the lateral pterygoid
Maxillary Artery - Mandibular Segment
-Before the lateral pterygoid

1) Deep auricular - supplies tympanic membrane and external auditory meatus
2) Anterior Tympanic - Goes through petrotympanic fissure to supply tympanic membrane and TMJ
3) Middle Meningeal - goes through foramen spinosum to supply dura mater, compact bone, and diploe (accessory meningeal through ovale for CN V and dura mater)
4) Inferior Alveolar - goes into the mandibular foramen and splits into 3
a) Mylohyoid - GT
b) Incisor (a) - GT
c) Mental - comes out the mental foramen to supply chin/skin
Maxillary Artery - Pterygoid Segment
-supply muscle and arteries with the same name

1) Masseteric - Masseter M.
2) Deep temporal - temporalis muscle
a) Anterior Temporal
b) Posterior Temporal
3) Pterygoid - Lateral and Medial Pterygoid M.
4) Buccal - Buccinator Muscle
Maxillary Artery - Pterygopalatine Segment
-after the lateral pterygoid. Possible gateways are pterygoid canal, greater palatine canal, foramen rotundum, sphenopalatine foramen, inferior orbital fissure, pharyngeal canal

1) Greater Palatine Artery - goes through pretygopalatine canal, greater palatine supplies hard palate, lesser palatine supplies soft palate

2) Posterior Superior Alveolar - Goes through posterior superior alveolar canal to supply posterior maxillary teeth

3)Infraorbital - Goes through anterior superior alveolar canal to supply the anterior maxillary teeth

4) Artery of the Pterygoid Canal - ANAS with a branch of the internal carotid. Supplies the pharynx and auditory tube

5) Pharyngeal Artery -

6)Sphenopalatine - Enters sphenopalatine canal to supply the lateral and septal nose.
a) Lateral Branch
b) Septal Branch - ANAS with greater palatine as it exits the incisive foramen. Called the nasopalatine as it runs down
Superficial Temporal
-originates the parotid gland

1)Transverse Facial - skin of face, masseter, parotid. Below zygomatic bone
2) Anterior Auricular - ear (pinna)
3) Zygomaticoorbital - obicularis oculi. Above zygomatic arch
4) Middle Temporal - Temporalis Muscle
5) Frontal - Forehead
6) Parietal - Parietal bone, forms loop with frontal artery
Cerebrospinal Fluid
-acts to cushion the brain
-Made in one of four choroid plexus which are held in the 4 brain ventricles
-Choroid plexus has a layer of cubodal epithelial cells surrounding capillaries and CT.
-They filter the clear, cell-less plasma from the blood and it circulates in the sub-arachinoid space surrounding the brain and spinal cord
-Returns to the venous drainage through the arachnoid granulations (villi) which project into the superior sagittal sinus
Vertebral Venous Plexus and Vertebral Vein
-Basilar venous plexus units with the occipital sinus through the foramen magnum at the vertebral venous plexus
-Vertebral venous plexus units with veins of deep, dorsal neck muscles and forms with the vertebral vein that runs from atlas to C6-7 through the transverse foramen
-Merges with the internal jugular at the subclavian/brachiocephalic intersection
Veins of the Cranium - Posterior and Superior Group
1) Superior Sagittal Sinus - Runs along falx cerebri from foramen cecum to the internal occipital protuberance. Collects from cerebral veins, diploe, emissary veins from the parietal foramen, and dura mater veins. Turns into the transverse sinus at the confluence of sinuses

2) Transverse Sinus - Continuation of superior sagittal and straight sinus and moves across the occipital. When it crosses the tentorium cerebelli it becomes the sigmoid sinus. Also collects from the superior petrosal sinus, pericranial emissaries, cerebellar/cerebral/diploic veins

3)Straight Sinus - Collects the superior/inferior sagittal sinus

4)Inferior Sagittal Sinus - courses the posterior 2/3 of the falx cerebri and receives falx veins

5)Sigmoid SInus - Continuation of the transverse sinus. Joins inferior petrosal sinus at the jugular foramen to become the internal jugular

6)Confluence of Sinuses - Joining of the occipital, superior sagittal, transverse, and straight sinuses
Venous Drainage of Skull and Meninges
-Outer layers of the cranium include pia mater, subarachnoid space, arachnoid mater, dura mater, and compact bone/diploe
-Arachnoid, pia, and dura mater are the 3 meninges or brain membranes
-Venous dural sinuses are between the two layers of the dura mater above the subarachnoid space and pia mater

1) Emissary Vein - Pass through skull foramen to connect the sinuses with the extracranial veins

2) Diploic Veins - Venous channels through the diploe that communicate with the venous sinuses at the sutures. Also confluent with the meningeal veins and pericranial
a) Frontal - to superior sagittal sinus
b) Anterior Temporal - to sphenoparietal sinus
c) Posterior Temporal - through mastoid foramen to transverse sinus
d) Occipital - to transverse sinus

3) Cerebellar Veins - Drain the cerebellum and empty into the dural venous sinuses

4) Cerebral Veins
a) External
1) Superior - Drain superior, lateral, and medial hemispheric surfaces and empty into the superior sagittal sinus
2) Middle - Drain lateral hemispheric surfaces and empty into the sphenoparietal or cavernous sinuses
3) Inferior - Drain inferior surfaces of the hemispheres and empty into many dural sinuses
b) Internal Cerebral Above - formed in the deep hemisphere and collect to make the great vein of Galen
Anterior Inferior Group of Cranium Veins
1) Superior Petrosal Sinus - Drains cavernous sinus to the transverse/sigmoid sinus. Receives blood from the cerebellar vein, inferior cerebral vein, and tympanic cavity vein

2) Inferior Petrosal Sinus - Connected by the basilar venous plexus. It connects the cavernous sinus to the sigmoid sinus to make the internal jugular vein. Receives blood from the medulla, pons, and cerebellum

3) Cavernous Sinus - A pair just to the left and right of the sella turcica of the sphenoid bone
-Drains to the superior/inferior petrosal sinus
-Collects blood from the superior/inferior ophthalmic veins, superficial middle cerebral vein, inferior cerebral vein, sphenoparietal sinus (drain middle meningeal veins)
-ANAS with the pterygoid plexus through the foramen ovale, lacerum, or vesalius. Also ANAS with itself via the intercavernous sinus and basilar venous plexus
-Within it is held CN V(1/2), CN 3, CN 4, and CN 6, internal carotid artery
-Cavernous sinus thrombosis is a bacterial infection caused by retrograde flow to the sinus. Cause loss of vision, paralysis, and life threatening
Superficial Veins of the Face
-diffuse network collected by 5 trunks which pass downward on face. Similar paths and names as the facial artery branches

1) Facial - Starts off as the angular v. in the middle corner of the eye when the supraorbital and frontal unit. As it runs down the middle of the face it will collect from the nasal v., superior/inferior labial v., and as it collects from the deep facial connecting the pterygoid plexus it becomes the facial. As it collects the submental it will become the common facial and lead to the internal jugular. It will send the posterior facial vein to the external jugular

2) Posterior Auricular - Drains from behind the ear. ANAS with occipital v. and superficial temporal v. Connects with retromandibular v. to make the external jugular (has valves)

3) Occipital - Drains occipital region, pierces trapezius attachment, and connects to dural sinus by emissary vein

4) Superficial Temporal - Same distribution as artery. Drains transverse facial, lateral eye, zygomatic region, anterior auricular, middle temporal

5) Retromandibular - Formed by union of the maxillary v. and superficial temporal v. Splits to have 2 divisions. Posterior Retromandibular joins the Posterior Auricular to form the external jugular. Anterior retromandibular joins facial to form the common facial
Deep Veins
1) Maxillary Vein - Drains pterygoid plexus and meets up with superior temporal v. to make retromandibular v.

2) Pterygoid Plexus - Between the temporalis and the two pretygoid muscles in the infratemporal fossa. -Collects drainage from the maxillary artery including nasal cavity and paranasal sinuses, oral cavity, infraorbital and inferior ophthalmic veins.
-Connects to the facial v. by the deep facial v., the retromandibular v. by the maxillary v., and the cavernous sinus through the foramen ovale, lacerum, and vesalius
-major route of infection
Venous Drainage of Teeth and Oral Cavity
Teeth - Anterior Superior and Posterior Superior Alveolar v. or maxilla and inferior alveolar v. of mandible go to the pterygoid plexus. Infraorbital v. and sphenopalatine vein also go to the pterygoid plexus.

Lingual - Same as the artery. Dorsal lingual goes to the internal jugular. The deep lingual and sublingual join at the ranine to go to the internal jugular.
-Ranine V - Accompanies the hypoglossal nerve
Veni Comitans - Pair of veins that straddle an artery
Jugulars
1) Anterior Jugular - Short vein, collects from superior and middle thyroid v. and returns it to the external jugular. Posterior to neck muscles

2) Internal Jugular - Formed by the union of the sigmoid sinus and the inferior petrosal. Joins subclavian v. to make brachiocephalic v. and that goes to the superior vena cava
-The follow veins drain into it: common facial, superior thyroid, middle thyroid, , lingual (dorsal and veni comitans), pharyngeal vein

External Jugular - formed by connection of posterior retromandibular and posterior auricular. Drains into the subclavian. Has 4 valves
These drain into it:
1) Posterior External Jugular - superficial sub-occipital region
2) Anterior Jugular - ANAS with each other at the jugular venous arch and then join external jugular near subclavian
3) Transverse Cervical Vein - drains superficial and deep neck around trapezius
Heart Circulation - Arteries
Anatomy
-Coronary sulcus separates right atrium and ventricle, and the anterior interventricular sulcus separates the ventricles

Circulation - When the aortic valve (valsalva) closes, some of the oxygenated blood goes to the

1) Right Coronary Artery - travels down coronary sulcus to diaphragm surface then splits
a) Posterior Interventricular - Runs down dorsal surface of interventricular sulcus to supply both ventricles
b) Marginal - supplies right atrium and SA node and right ventricle
2) Left Coronary Artery - Passes pulmonary trunk and to interventricular sulcus and divides
a) Anterior Interventricular - Supplies ventral ventricles in interventricular sulcus and ANAS with dorsal interventricular branch
b) Circumflex - follows left coronary sulcus and goes dorsal to posterior interventricular branch almost. Supplies left atrium and ventricle
Heart Circulation - Veins
-Small, middle, and great cardiac veins empty into the coronary sinus

-Coronary sinus meets up with the inferior vena cava and empties into the sinus venarum which leads to the right atrium.
-Sinus venarium is separated from rest of the heart by the crista terminalis
-The sinus venarium is the part of the right atrium that takes blood from the SVC, IVC, and coronary sinus
Lymphatics Overview
Functions
1) Transport excess fluid to blood through channels/nodes
2) Make Abs and lymphocytes as part of immune system
3) Provide pathway to spread infection/tumor
4) conduct fat from intestines to blood venous system

General Info:
1) Flow from positive pressure of ab to negative pressure of thoracic cavity
2) Flow from lymph channel to nodes to lymph ducts to venous return
Lymph Drainage Below Neck (Left Side)
Left Drainage
1) The thoracic duct begins as the cysterna chyli and drains the lower limbs, abdominal walls and visceral organs, pelvic walls, and thoracic wall and in thoracic cavity it is joined by the
2) Left Bronchomediastinal trunks - drains viscera of thorax
3) Left Subclavian trunks- Drains upper limbs
4) Left Jugular trunks - Drain head and neck

-All collect at the thoracic duct which empties into the conflience (intersection) of the internal jugular and subclavian
Lymph Drainage Below Neck (Right Side)
On the right side the bronchomediastinal (lungs and bronchi) join the right subclavian trunk and right jugular trunk to make the right lympatic duct which enters at the internal jugular/right subclavian confluence (right subclavian if one choice)
Lymphatics of Head and Neck
-Regional lymph nodes associated with a organ are sites of primary filtration. These filter to collecting lymph nodes (superficial/deep) which leads to deep cervical nodes which are associated with the internal jugular vein. They eventually turn into the Lt/Rt jugular trunks

1) Horizontal Superficial Ring- Where neck becomes the head. Collect submental nodes, submandibular nodes, parotid nodes, retroauricular nodes, and occipital
2) Horizontal Deep - Around neck visceral structure. Collects retropharyngeal, tracheal, laryngeal, and infrahyoid nodes

3. Deep Cervical Vertical Chain - Collect from horizontal superficial and deep horizontal and run along internal/ext jugular. Turn into jugular trunks. Superficial cervical nodes collect from superficial (ext. jug) and deep cervical nodes collect from deep (int. jugular).

Superficial ring associated with superficial cervical node (ext. jug) and deep ring associated with deep cervical node (int jug). All superficial go to deep and to jugular trunk

Between superficial/deep ring is superficial cervical node (ext jug), after is the deep cervical node (int jug)
Superficial Horizontal Nodes
1. Submental - At submental triangle and mylohyoid muscle. Collects lower lip, tip of tongue, anterior mouth floor. Drains either to submandibular or jugulo-omohyoid (deep cervical)

2. Submandibular - Over gland in the middle mandible. Collects from submental, maxillary teeth, vestibular gingiva, hard palate, cheek, nose, upper lip, posterior mouth floor, back tongue. Drains to jugulodigastric of deep cervical

3a. Parotid Node (Superficial) - Around parotid capsule and temporal/facial arteries. Collects eyelids, temples, upper cheek, and auricle of ear. Drains to deep parotid or a deep cervical

3b) Parotid Nodes (Deep) - Within parotid gland receives from superficial parotid, middle ear, external auditory meatus, soft palate, posterior nasal cavity. Drains to jugulo-diagastric node or another deep cervical

4) Mastoid Nodes (Retroauricular) - Over mastoid process receives scalp and auricle drainage. Goers to deep cervical

5) Occipital - On trapezius below nuchal line near occipital artery. Receives scalp and drains to deep cervical node
Deep Cervical (Jugular) Lymph Nodes
-Nodes inferior to deep ring at neck root and follow rt/lt internal jugular

1) Jugulo-DIgastric - At angle of mandible and SCM muscle. Principle superior node.

2) Jugulo-omohyoid - principle inferior large node. At inferior belly of omohyoid. Afer this cervical chain is the jugular trunk

-These eventually receive ALL lymphatic flow from head and neck
Horizontal Deep Ring
-Surrounds visceral structure in neck and goes directly to deep cervical chain (nodes/jugular trunk)

1. Retropharyngeal - Btw post. pharynx and vertebrae and receives nasal cavity, soft palate, middle ear. Drains to jugulo-digastric

2. Paratracheal Group - ant/lat to trachea, larynx, and infrahyoid. Receive trachea, larynx, pharynx, and esophagus. Drain to deep cervical nodes.
Tongue Lymph
Unusual, lymphatic channels can cross over midline of tongue which allows lesions on lateral border to metastaize to the other side.