Lymphology is understanding the lymphatic system

Review: New developments in clinical aspects of lymphatic disease. An abstract by Professor Mortimer PS, Rockson SG:

The lymphatic system is fundamentally important to cardiovascular disease, infection and immunity, cancer and probably obesity - the four major challenges in healthcare in the 21st century.


This Review will consider the manner in which new knowledge of lymphatic genes and molecular mechanisms has demonstrated that lymphatic dysfunction should no longer be considered a passive bystander in disease but rather an active player in many pathological processes and, therefore, a genuine target for future therapeutic developments. The specific roles of the lymphatic system in oedema, genetic aspects of primary lymphoedema, infection (cellulitis/erysipelas), Crohn's disease, obesity, cancer, and cancer-related lymphoedema are highlighted.


PMID: 24590276 [PubMed - indexed for MEDLINE] PMCID: PMC3938261 [Available on 2015/1/1


Professor Mortimer is a consultant dermatologist at St George's University Hospitals NHS Foundation Trust. His clinical interests are in lymphovascular medicine and especially lymphoedema. His research interests include breast cancer-related lymphoedema, the genetic basis of lymphatic anomalies/lymphoedema and lymphangiogenesis in melanoma.

The lymphatic system has:
  • The spleen and thymus gland
  • Lymphatic capillaries, lymph vessels, and ducts
  • Lymph nodes (they are not glands as they do not secrete)
  • Lymphocytes T and B cells, white blood cells for immune purposes
  • Palatine tonsils and tonsils
  • Peyer`s patches in the ileum of the small intestine

We are 70% water. When unwanted fluid is collected from between the cells and enters the lymphatic system, it is then known as lymph fluid. From all over the body waste fluid has been collected by capillaries and carried along through vessels, via the lymph nodes for filtration, similar to your household waste pipes and a wastewater treatment plant.


Cleaned waste fluid travels up towards cysterna chyle a lymph collection sac at the base of the largest lymphatic vessel called the thoracic duct, which lies next to your spine. It then passes up through the diaphragm and enters into the blood circulation via a large vein, just above the heart. The clean lymph fluid now mixes back into our blood. Our body can collect, clean and filter up to 2.5 litres per day. 


However, if there is a blockage, disruption or lack of muscle movement the body will show signs of fluid retention seen as swelling called oedema.


Functions of the spleen

  • Produces lymphocytes (WBC) in its lymph nodules and acts with the immune response.
  • Destroys worn-out erythrocytes (RBC) and unwanted micro-organisms.
  • Controls the quality and quantity of the blood in circulation.
  • It acts as a reservoir for blood cells of all kinds.
  • It produces erythrocytes and granulocytes during fetal life and on certain. occasions in adult life i.e. after severe hemorrhaging.

Stress is toxic to our bodies!

Stress directly affects the spleen and protein levels in the lymphatic system which affects your heart rate and blood pressure. During stress, the spleen releases extra blood into the circulation and an extra protein called p34, which is a distinct Lactate DeHydrogenase (or LDH or LD).


LD is of medical significance because it is found extensively in body tissues, such as blood cells and heart muscle, as with other proteins it is used as a tissue-function marker as it is released during tissue damage and is a marker of common injuries and disease. This protein has been found in high levels in many human cancers and has been demonstrated to be an effective serum cancer marker. (Lymhoscintography)



The thymus

  • A large lobed structure behind the upper part of the sternum/chest.
  • Largest in early life it shrinks in adulthood to a fraction of its original size.
  • It secretes a hormone called Thymosin that causes pre-T-cells to mature in the Thymus into T-cells, these are also called T Lymphocytes.
  • Many lymphocytes are formed here but most never leave the gland.

In the fetus and infant, the thymus seems to control the development of the lymph nodes and lymphoid tissue. If it is absent, death will result because of the failure of the immune processes. In adults, it is a source of fresh lymphocytes for immunity.

Lymph fluid moves naturally by

  • muscle tissue and bicuspid valves
  • autonomic nervous system
  • intrinsic contraction

Additional factors

  • contraction of muscles
  • breathing (diaphragm)
  • pulsation of arteries
  • external compression


Cell walls open up to collect waste

Lymph capillaries, vessels and how lymph moves

  • Lymph capillaries underneath the skin are tiny compared to lymphatic vessels throughout the body
  • Lymph vessels resemble veins in structure but have thinner walls and valves in shorter distances
  • Valves are non-moving but determine the direction of flow, preventing the return of waste fluid to guarantee transport
  • Vessel contractions are supported by moving skeletal muscle and joint pump, arterial respiratory pressure changes and negative pressure in central veins
  • They can also be influenced by external pressure i.e. lymphatic massage

Shoulder muscles help pump fluid up and away from your hand, so it is essential to get your muscles moving postoperatively.


Functions of a lymph node

  • Filters and cleans lymph fluid by removing unwanted metabolic waste, toxins, bacteria, viruses, micro-organisms, infected cells and other foreign particles from the body
  • Produces new lymphocytes helping the lymphatic system fight infection, often preventing infection from passing into the blood.
  • Regulates the concentration of protein in the lymph fluid
  • There are between 700 – 1,000 nodes in the human body 3-500 can be found in the abdomen. Excessive swelling of the abdomen means these lymph nodes are struggling to remove waste fluid


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