Lymphatics of the stomach and liver

Hi everyone! This is Joao from Kenhub, and welcome to this tutorial where we are going to look at the lymphatics of the stomach and liver. As you may already be aware, the lymphatic system forms a vital part of your body’s immune system and the transport of nutrients and waste.

This network is made up of lymph vessels which transport lymph around the body and also lymph nodes. The lymph nodes contain white blood cells which filter the lymph as it travels through the node so that any potential pathogens can be identified and cleared. In the abdomen, lymph nodes tend to cluster around major arteries supplying abdominal viscera.

As I mentioned, we will be looking then at lymph nodes surrounding the stomach, also another organ, the liver, and those lymph nodes that surround some other abdominal structures.

We will finish off this tutorial with the return of filtered lymph to peripheral circulation in the thorax. So let’s not keep ourselves waiting. Let’s dive right into the lymph nodes that surround the stomach and liver.

We’ll make a start here at the cardia of the stomach. The liver has been pulled to side so you have a clear view of the superior parts of the stomach. This region is a small depression close to the junction between the stomach and esophagus, and as we can see if we take a closer look, it has its own set of lymph nodes highlighted here in green that will be draining into the celiac lymph nodes.

Next, we have the left gastric lymph nodes highlighted now in green, which drain lymph from the superior two-thirds of the stomach. And they also follow here the left gastric artery near the lesser curvature of the stomach.

The most distal portion of the stomach – right here before it meets the duodenum – is known as the pylorus. The lymph node superior to the pylorus are then called the suprapyloric lymph nodes. These drain lymph from the distal stomach and the beginning of the duodenum and then into the celiac lymph nodes.

There are also some lymph nodes located inferiorly to the pylorus. These nodes are unsurprisingly called the subpyloric lymph nodes. Part of the greater omentum has been retracted here – keep that in mind – so we can see them these lymph nodes right here. These nodes also drain lymph from the distal stomach and beginning of the duodenum and then into the celiac lymph nodes.

The greater curvature of the stomach has two groups of lymph nodes. The first of these are the right gastroomental lymph nodes which you see right here. They line the inferior portion of the greater curvature and drain lymph from more distal parts of the stomach as well as the greater omentum and the greater curvature of the stomach.

Now the left gastroomental nodes line the lateral surface of the greater curvature here and drain more proximal parts of the stomach. Lymph in both the left and right gastroomental lymph nodes travel to the celiac lymph nodes.

Now, we’ll just divert briefly from our main image to this one here where we have cut through to then look behind the stomach. Towards the tail of the pancreas, we can find the splenic lymph nodes. These are typically tucked into the hilum of the spleen where the splenic artery begins to branch out. Unsurprisingly, these lymph nodes drain lymph from the spleen and tail of the pancreas.

Now our next set of lymph nodes – the pancreatic lymph nodes here – drain lymph from regions of the stomach supplied by branches of the splenic artery which is this artery right here. Pancreatic lymph nodes near the head of the pancreas also drain lymph from the duodenum. These are then specifically referred to as the pancreaticoduodenal lymph nodes.

Now, were moving back to our main image right here where we’ll focus on the liver. Here we have the hepatic lymph nodes. The hepatic lymph nodes are located near the proper hepatic artery right here, and as you probably guessed, yes, they serve to drain lymph from the liver.

Now that we’ve examined the lymph nodes surrounding the stomach and liver, let’s take a look at the lymph nodes surrounding the other abdominal structures that are relevant to this tutorial.

First of all, we have the celiac lymph nodes which are positioned just inferior to the diaphragm around the celiac trunk. I’ve actually mentioned this a few times in this tutorial already and this is because they receive lymph from all the other lymph nodes around the stomach, which ultimately drains into a structure known as the cisterna chyli, which is located on the posterior abdominal wall just to the right of the abdominal aorta, and from there, lymph passes into the thoracic duct and travels along the aorta to the thorax.

Filtered lymph in the thoracic duct will then empty into the brachiocephalic vein between the internal jugular and the left subclavian veins to return to peripheral circulation.

And now that we’ve covered all the lymph nodes relevant to this tutorial, let’s take a quick look at clinical notes. One thing is that the organization of lymph nodes in the abdomen has a major impact on the spread of cancer throughout the digestive organs. For example, cancer in the esophagus and stomach tends to spread to lymph nodes around the left gastric artery and lesser curvature and it may reach celiac lymph nodes.

Colorectal cancer can sometimes metastasize to the hepatic lymph nodes presumably from incoming blood in the portal vein.

And before we finish this tutorial, I would like to do a quick recap of what we just learned.

In this tutorial, we looked at the lymph nodes surrounding the stomach and liver starting with the cardia of the stomach which is in the superior part of the stomach. We also talked about the left gastric lymph nodes which drain the superior two-thirds of the stomach.

In our list, we also covered the suprapyloric lymph nodes and then follow that, we looked at the subpyloric lymph nodes. We moved then into the right and left gastroomental lymph nodes which drain lymph from the pancreas and parts of the stomach and duodenum. Then onto the splenic lymph nodes which drain lymph from organs receiving blood from the splenic artery. Then we looked at the pancreatic lymph nodes and right after that, of course, we looked into the hepatic lymph nodes.

Lymph from all of these nodes drains into the celiac lymph nodes which we see here and eventually returns to circulation through the thoracic duct shown in this image.

And that brings us to the end of this tutorial. Thank you so much for watching, and I hope to see you on the next one.