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1. Lymph : Thoracic Duct

2. Sympathetic nervous system from http://www.bartleby.com/107/214.html

Embryologically Lymph come from the veins (? / venous structure) .

Histology of Lymph gland is important

The thoracic duct (ductus thoracicus) (Fig. 599) conveys the greater part of the 1
lymph and chyle into the blood. It is the common trunk of all the lymphatic
vessels of the body, excepting those on the right side of the head, neck, and
thorax, and right upper extremity, the right lung, right side of the heart, and the
convex surface of the liver. In the adult it varies in length from 38 to 45 cm. and
extends from the second lumbar vertebra to the root of the neck. It begins in the
abdomen by a triangular dilatation, thecisterna chyli, which is situated on the
front of the body of the second lumbar vertebra, to the right side of and behind
the aorta, by the side of the right crus of the diaphragm. It enters the thorax
through the aortic hiatus of the diaphragm, and ascends through the posterior
mediastinal cavity between the aorta and azygos vein. Behind it in this region
are the vertebral column, the right intercostal arteries, and the hemiazygos veins
as they cross to open into the azygos vein; in front of it are the diaphragm,
esophagus, and pericardium, the last being separated from it by a recess of the
right pleural cavity. Opposite the fifth thoracic vertebra, it inclines toward the left
side, enters the superior mediastinal cavity, and ascends behind the aortic arch
and the thoracic part of the left subclavian artery and between the left side of the
esophagus and the left pleura, to the upper orifice of the thorax. Passing into the
neck it forms an arch which rises about 3 or 4 cm. above the clavicle and
crosses anterior to the subclavian artery, the vertebral artery and vein, and the
thyrocervical trunk or its branches. It also passes in front of the phrenic nerve
and the medial border of the Scalenus anterior, but is separated from these two
structures by the prevertebral fascia. In front of it are the left common carotid
artery, vagus nerve, and internal jugular vein; it ends by opening into the angle
of junction of the left subclavian vein with the left internal jugular vein. The
thoracic duct, at its commencement, is about equal in diameter to a goose-quill,
but it diminishes considerably in caliber in the middle of the thorax, and is again
dilated just before its termination. It is generally flexuous, and constricted at
intervals so as to present a varicose appearance. Not infrequently it divides in
the middle of its course into two vessels of unequal size which soon reunite, or
into several branches which form a plexiform interlacement. It occasionally
divides at its upper part into two branches, right and left; the left ending in the
usual manner, while the right opens into the right subclavian vein, in connection
with the right lymphatic duct. The thoracic duct has several valves; at its
termination it is provided with a pair, the free borders of which are turned toward
the vein, so as to prevent the passage of venous blood into the duct.
 The cisterna chyli (receptaculum chyli) (Fig. 600) receives the two lumbar 2
lymphatic trunks, right and left, and the intestinal lymphatic trunk. The lumbar
trunks are formed by the union of the efferent vessels from the lateral aortic
lymph glands. They receive the lymph from the lower limbs, from the walls and
viscera of the pelvis, from the kidneys and suprarenal glands and the deep
lymphatics of the greater part of the abdominal wall. The intestinal
trunk receives the lymph from the stomach and intestine, from the pancreas and
spleen, and from the lower and front part of the liver.

Tributaries.—Opening into the commencement of the thoracic duct, on either 3

side, is a descending trunk from the posterior intercostal lymph glands of the
lower six or seven intercostal spaces. In the thorax the duct is joined, on either
side, by a trunk which drains the upper lumbar lymph glands and pierces the
crus of the diaphragm. It also receives the efferents from the posterior
mediastinal lymph glands and from the posterior intercostal lymph glands of the
upper six left spaces. In the neck it is joined by the left jugular and left
subclavian trunks, and sometimes by the left bronchomediastinal trunk; the
last-named, however, usually opens independently into the junction of the left
subclavian and internal jugular veins.

FIG. 599– The thoracic and right lymphatic ducts. (See enlarged image)

The right lymphatic duct (ductus lymphaticus dexter) (Fig. 601), about 1.25 4
cm. in length, courses along the medial border of the Scalenus anterior at the
root of the neck and ends in the right subclavian vein, at its angle of junction with
the right internal jugular vein. Its orifice is guarded by two semilunar valves,
which prevent the passage of venous blood into the duct.

Tributaries.—The right lymphatic duct receives the lymph from the right side of 5
the head and neck through the right jugular trunk; from the right upper
extremity through the right subclavian trunk; from the right side of the thorax,
right lung, right side of the heart, and part of the convex surface of the liver,
through the right bronchomediastinal trunk. These three collecting trunks
frequently open separately in the angle of union of the two veins.

FIG. 600– Modes of origin of thoracic duct. (Poirier and Charpy.) a. Thoracic
duct. a’.Cisterna chyli. b, c’ Efferent trunks from lateral aortic glands. d. An
efferent vessel which pierces the left crus of the diaphragm. e. f. Lateral aortic
glands. h. Retroaortic glands. i. Intestinal trunk. j. Descending branch from
intercostal lymphatics. (See enlarged image)

FIG. 601– Terminal collecting trunks of right side. a. Jugular trunk. b. Subclavian
trunk. c.Bronchomediastinal trunk. d. Right lymphatic trunk. e. Gland of internal
mammary chain. f. Gland of deep cervical chain. (Poirier and Charpy.) (See
enlarged image)

2. Sympathetic nervous system

The cranial and sacral sympathetics are often grouped together owing to the
resemblance between the reactions produced by stimulating them and by the effects
of certain drugs. Acetyl-choline, for example, when injected intravenously in very
small doses, produces the same effect as the stimulation of the cranial or sacral
sympathetics, while the introduction of adrenalin produces the same effect as the
stimulation of the thoracolumbar sympathetics. Much of our present knowledge of
the sympathetic nervous system has been acquired through the application of
various drugs, especially nicotine which paralyzes the connections or synapses
between the preganglionic and postganglionic fibers of the sympathetic nerves.
When it is injected into the general circulation all such synapses are paralyzed; when
it is applied locally on a ganglion only the synapses occurring in that particular
ganglion are paralyzed.

The Cranial Sympathetics—The cranial sympathetics include sympathetic

efferent fibers in the oculomotor, facial, glossopharyngeal and vagus nerves, as well
as sympathetic afferent in the last three nerves.

The thoracolumbar sympathetics are characterized by the presence of 21

numerous ganglia which may be divided into two
groups, central and collateral.
The central ganglia are arranged in two vertical rows, one on either side of
the middle line, situated partly in front and partly at the sides of the vertebral
column. Each ganglion is joined by intervening nervous cords to adjacent
ganglia so that two chains, the sympathetic trunks, are formed. The collateral
ganglia are found in connection with three great prevertebral
plexuses, placed within the thorax, abdomen, and pelvis respectively.

Connections with the Spinal Nerves.—Communications are established between

the sympathetic and spinal nerves through what are known as the gray and white
rami communicantes (Fig. 799); the gray rami convey sympathetic fibers into the
spinal nerves and the white rami transmit spinal fibers into the sympathetic. Each
spinal nerve receives a gray ramus communicans from the sympathetic trunk, but
white rami are not supplied by all the spinal nerves. The fibers which reach the
sympathetic through the white rami communicantes are medullated; those which
spring from the cells of the sympathetic ganglia are almost entirely non-
medullated.

The ganglion cells of the sympathetic system are derived from the cells of the
neural crests. The ciliary, sphenopalatine, otic, and submaxillary ganglia which are
found on the branches of the trigeminal nerve are formed by groups of cells
which have migrated from the part of the neural crest which gives rise to the
semilunar ganglion. Some of the cells of the ciliary ganglion are said to migrate
from the neural tube along the oculomotor nerve.