Sistem Limfatik

M. Rasjad Indra Laboratorium Ilmu Faal FK. UNIBRAW

Berkaitan dengan:

Keseimbangan cairan tubuh Pertahanan tubuh

Body Fluid Compartment

Body Fluid Volume

Body fluid 60% (45-75) water Intracellular 40 % (42 liter in 70 kg young adult) Interstitial 15 % (10.5 liter in 70 kg young adult) Extracellular 20 % (14 liter in 70 kg young adult) Plasma 5% (3.5 liter in 70 kg young adult) Transcellular 1-3 % (Cerebrospinal) (Aqueous humor)

Electrolyte Composition of Body Fluid

Electrolytes Plasma (mEq/L) Interstitial Fluid (mEq/Kg H2O) Intracellular Fluid (mEq/Kg H2O) 10 159 1 40 210 3 7 45 155 210

Cation: Na+ K+ Ca2+ Mg2+ Total Anion: ClHCO3Protein Others Total

142 4 5 2 153 103 25 17 8 153

145 4 3 2 154 117 28 9 154

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

Normal Intake Fluid ingested From metabolism Total intake Output Insensible-Skin Insensible-Lungs Sweat Feces Urine Total output Prolonged Heavy Exercise ? 200 ? 350 650 5000 100 500 6600

2100 200 2300 350 350 100 100 1400 2300

Add pure water

Normal Add pure water

ICF

ECF ICF ECF

Add isotonic saline

Normal Add isotonic saline

ICF

ECF

ICF

ECF

Add pure NaCl

Normal Add pure NaCl

ICF

ECF

ICF

ECF

Decreased ADH release from posterior pituitary

Decreased plasma ADH Cardiovascular stretch receptor Osmoreceptor Decreased collecting duct water permiability Decreased plasma osmolarity

Ingestion of 1L of water

Increased extracellular fluid volume

Normal fluid volume Increased water excretion

Decreased water reabsorption

Increased ADH release from posterior pituitary Increased plasma ADH

Cardiovascular stretch receptor Osmoreceptors

Increased collecting duct water permiability

Dehydration

Decreased extracellular fluid volume Increased plasma osmolarity

Thirst

Increased water intake

Increased water reabsorption

Normal fluid volume Decreased water excretion

Angiotensinogen Kidney Renin Angiotensin I Decreased effective arterial blood volume

Liver

Lungs Converting enzyme

Angiotensin II

Blood vessels

Adrenal cortex

Brain

Vasoconstrictor

Aldosteron secre.

ADH secretion

Thirst

Blood pressure >

Sodium reabs.

H2O reabsorption

Water intake

Normal effective arterial blood volume

Increased plasma [K+]

Direct effect on adrenal cortex Increased aldosterone secretion Increased plasma aldosterone

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

Increased Potasium intake Normal potasium level

Increase luminal membrane permiablility to Na+ and K+ & Increase basolateral membrane Na+/K+-ATPase activity in collecting duct principal cells.

Increased potasium secretion

Increased potasium excretion

Starling Hypothesis
The balance of hydrostatic and oncotic pressures across the capillary endothelium
Mean capillary hydrostatic pressure (Pc): 25 mmHg (40 10) Interstitial fluid hydrostatic pressure (PIF): 0 mmHg Capillary oncotic pressure (c): 28 mmHg

Interstitial fluid oncotic pressure (IF): 3 mmHg

Arterial end of capillary: Pc= 40 mmHg; PIF= 0 mmHg Venous end of capillary: Pc= 10 mmHg; PIF= 0 mmHg

c= 28 mmHg; IF= 3 mmHg

Net Filtration= 40-0-28+3= 15

c= 28 mmHg; IF= 3 mmHg

Net Absorption= 10-0-28+3= -15

Definition of Edema:
An increase in the interstitial compartement of extracellular fluid volume (Harrisons).

Causes of Extracellular Edema

1. 2. 3. 4.
Increased capillary pressure Decreased plasma proteins Increased capillary permiability Blockage of lymph return

 1. Increased capillary pressure

Excessive kidney retention High venous pressure Decreased arteriole resistance

 2. Decreased plasma proteins

Loss of protein in urine Loss of protein from denuded skin Failure of produce protein

 3. Increased capillary permiability

Immune reaction Toxin Bacteria infection Vitamin deficiency (exp. Vit C)

 4. Blockage of lymph return

Cancer Paracyte infection (Filaria) Surgery Congenital absence or abnormal of Lymphatic vessels