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Anatomy and Physiology INJURIES OF LYMPH VESSELS Wounds of thoracic duct DISEASES OF LYMPH VESSELS Lymphangitis: Varieties Lymphangiectasis Filarial disease Lymphangioma DISEASES OF LYMPH GLANDS Lymphadenitis: Septic; Tuberculous; Syphilitic Lymphadenoma Leucocythæmia TUMOURS. #Surgical Anatomy and Physiology.# Lymph is essentially blood plasma, which has passed through the walls of capillaries.
In the glands of the groin, for example, associated with various forms of irritation about the external genitals, different types of chronic lymphadenitis are met with; they do not frankly suppurate as do the acute types, but are attended with a hyperplasia of the tissue elements which results in enlargement of the affected glands of a persistent, and sometimes of a relapsing character.
An example of this kind is to be seen in a wound perforating the tibial fascia, where the injury is inflicted by means of a horse being kicked by another animal shod with sharp shoe-calks. Cases of this kind invariably result in a septic lymphangitis, and frequently lymphadenitis also occurs, for the inguinal lymph glands are so situated that their becoming contaminated is almost certain.
The first indication is to discover and deal with the source of infection, and in the indolent forms of lymphadenitis this will usually be followed by recovery. In the acute forms following on pyogenic infection, the best results are obtained from the hyperæmic treatment carried out by means of suction bells.
A similar enlargement is met with in the axilla in cases of chronic interstitial mastitis, and in the groin as a result of chronic irritation about the external genitals, such as balanitis. Sometimes the lymphadenitis is of an acute character, and the tendency is towards the formation of an abscess.
The trite phrase that "the tissues are bathed in lymph" should make clear the reason for the frequent occurrence of infectious lymphangitis and lymphadenitis.
Lymphangiomas are met with in the abdomen in the form of omental cysts. #Lymphadenitis.# Inflammation of lymph glands results from the advent of an irritant, usually bacterial or toxic, brought to the glands by the afferent lymph vessels. These vessels may share in the inflammation and be the seat of lymphangitis, or they may show no evidence of the passage of the noxa.
In suppuration of the axillary glands the abscess may be quite superficial, or it may be deeply placed beneath the strong fascia and pectoral muscles, according to the group of glands involved. The diagnosis of septic lymphadenitis is usually easy.
The characters of the lymphadenitis vary with the nature of the irritant. Sometimes it is mild and evanescent, as in the glandular enlargement in the neck which attends tonsillitis and other forms of sore throat.
It is exceptional for the irritant to reach the gland through the blood-stream. It is possible for gonococci to lie latent in the inguinal glands for long periods, and only give rise to lymphadenitis if the glands be subsequently subjected to injury. The glands most frequently affected are those in the neck, axilla, and groin.
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