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    Sistem Limfatik

    Retty Ratnawati

    Laboratorium Ilmu FaalFK. UNIBRAW

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    LYMPH NODE

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    Berkaitan dengan:

    Keseimbangan cairan tubuh Pertahanan tubuh

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    Fluid leaves capillaries by diffusion andfiltration

    Escaped proteins

    If lymph flow blocked = tissue swelling or edema

    Specialized lymphatic capillaries in vili of small intestine transport lipids - they are called

    lacteals , and the fluid is called chyle .

    Formation of lymph

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    Functions of Lymphatic System

    1. Draining interstitial fluid2. Transporting dietary lipids3. Protection

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    Lymphatic Vessels Begin as closed ended lymph capillaries in tissue

    spaces between cells NOT A CIRCULATING FLUID

    Interstitial fluid drains into lymphatic capillaries,forming lymph.

    Lymph capillaries merge to form lymphatic vessels Lymphatic vessels carry lymph into and out of

    lymph nodes and finally back to the vascularsystem.

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    Lymphatic vessels

    Resemble veins (same 3 layers) Found throughout body except :

    Avascular tissues Central nervous system Splenic pulp Bone marrow

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    COMPOSITION

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    FACTORS THAT ASSIST LYMPH TOMOVE THROUGH THE VESSELS

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    LYMPHATIC CAPILLARIES

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    Body Fluid Compartment

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    Body Fluid Volume

    Intracellular 40 % (42 liter in 70 kg

    young adult)

    Interstitial 15 %

    (10.5 liter in 70 kg young adult)

    Plasma 5 %

    (3.5 liter in 70 kg young adult)

    Transcellular 1-3 %

    (Cerebrospinal) (Aqueous humor)

    Extracellular 20 % (14 liter in 70 kg

    young adult)

    Body fluid 60% (45-75)

    water

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    Electrolyte Composition of Body Fluid

    Electrolytes Plasma(mEq/L)

    Interstitial Fluid(mEq/Kg H2O)

    IntracellularFluid (mEq/Kg

    H2O)Cation:Na+ 142 145 10

    K+ 4 4 159Ca2+ 5 3 1Mg2+ 2 2 40Total 153 154 210Anion:

    Cl- 103 117 3HCO3- 25 28 7Protein 17 - 45Others 8 9 155Total 153 154 210

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    Daily Intake and Output of Water(in ml/day)

    Normal ProlongedHeavy Exercise

    IntakeFluid ingested 2100 ?

    From metabolism 200 200Total intake 2300 ?Output

    Insensible-Skin 350 350Insensible-Lungs 350 650Sweat 100 5000Feces 100 100Urine 1400 500

    Total output 2300 6600

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    Add pure water

    Normal Add pure water

    ICF ECFICF ECF

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    Add isotonic saline

    Normal Add isotonic saline

    ICF ECF ICF ECF

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    Add pure NaCl

    Normal Add pure NaCl

    ICF ECF ICF ECF

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    Ingestion of 1Lof water

    Increasedextracellularfluid volume

    Cardiovascularstretch receptor

    Decreased ADHrelease fromposteriorpituitary

    Osmoreceptor

    Decreasedplasmaosmolarity

    Decreasedcollecting ductwaterpermiability

    Decreased waterreabsorption

    Increased waterexcretion

    Normal fluidvolume

    Decreasedplasma ADH

    Increased ADH

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    Dehydration

    Decreasedextracellularfluid volume

    Cardiovascularstretch receptor

    Increased ADHrelease fromposteriorpituitary

    Osmoreceptors

    Increasedplasmaosmolarity

    Increasedcollecting duct

    waterpermiability

    Increased waterreabsorption

    Decreased water

    excretion

    Normal fluidvolume

    Increased plasmaADH

    Thirst

    Increased

    water intake

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    Decreasedeffectivearterial bloodvolume

    Kidney

    Angiotensinogen

    Renin

    Angiotensin I

    Liver

    Convertingenzyme

    Lungs

    Angiotensin II

    Blood vessels Adrenal cortex Brain

    Vasoconstrictor Aldosteron secre.

    Sodium reabs.Blood pressure > H2O reabsorption

    ADH secretion Thirst

    Water intake

    Normal effective arterial blood volume

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    IncreasedPotasium intake

    Increased plasma[K+]

    Direct effect on adrenal

    cortex

    Increased [K+] in body cell(including kidney cells)

    Increased aldosteronesecretion

    Increased plasmaaldosterone

    Increase luminal membrane permiablility toNa+ and K+ & Increase basolateralmembrane Na+/K+-ATPase activity incollecting duct principal cells.

    Increased potasiumsecretion

    Increased potasiumexcretion

    Normal potasium

    level

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    Starling Hypothesis

    The balance of hydrostatic and oncotic pressures across thecapillary endothelium

    Mean capillary hydrostatic pressure (Pc): 25 mmHg (40 10)

    Interstitial fluid hydrostatic pressure (P IF ): 0 mmHgCapillary oncotic pressure ( c): 28 mmHg

    Interstitial fluid oncotic pressure ( IF ): 3 mmHg

    Arterial end of capillary:

    Pc= 40 mmHg; P IF= 0 mmHg c= 28 mmHg; IF= 3 mmHgNet Filtration= 40-0-28+3= 15

    Venous end of capillary:

    Pc= 10 mmHg; P IF= 0 mmHg c= 28 mmHg; IF= 3 mmHgNet Absorption= 10-0-28+3= -15

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    Definition of Edema:

    An increase in the interstitial compartement of

    extracellular fluid volume (Harrisons).

    Causes of Extracellular Edema1. Increased capillary pressure2. Decreased plasma proteins

    3. Increased capillarypermiability4. Blockage of lymph return

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    1. Increased capillary pressure Excessive kidney retention

    High venous pressure Decreased arteriole resistance

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    2. Decreased plasma proteins Loss of protein in urine

    Loss of protein from denuded skin Failure of produce protein

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    3. Increased capillary permiability Immune reaction Toxin Bacteria infection Vitamin deficiency (exp. Vit C)

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    4. Blockage of lymph return Cancer Paracyte infection (Filaria) Surgery Congenital absence or abnormal of

    Lymphatic vessels

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