sistem limfatik
TRANSCRIPT
Sistem LimfatikSistem Limfatik
M. Rasjad IndraM. Rasjad Indra
Laboratorium Ilmu FaalLaboratorium Ilmu Faal
FK. UNIBRAWFK. UNIBRAW
Berkaitan dengan:Berkaitan dengan:
• Keseimbangan cairan tubuhKeseimbangan cairan tubuh
• Pertahanan tubuhPertahanan tubuh
Body Fluid Compartment
Body Fluid VolumeBody Fluid Volume
Intracellular40 %
(42 liter in 70 kgyoung adult)
Interstitial15 %
(10.5 liter in 70 kg young adult)
Plasma5 %
(3.5 liter in 70 kgyoung adult)
Transcellular1-3 %
(Cerebrospinal)(Aqueous humor)
Extracellular20 %
(14 liter in 70 kgyoung adult)
Body fluid60% (45-75)
water
Electrolyte Composition of Body FluidElectrolyte Composition of Body Fluid
Electrolytes Plasma(mEq/L)
Interstitial Fluid(mEq/Kg H2O)
IntracellularFluid (mEq/Kg
H2O)Cation:Na+ 142 145 10K+ 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
Daily Intake and Output of Daily Intake and Output of Water (in ml/day)Water (in ml/day)
Normal ProlongedHeavy Exercise
IntakeFluid ingested 2100 ?From metabolism 200 200
Total intake 2300 ?Output
Insensible-Skin 350 350Insensible-Lungs 350 650Sweat 100 5000Feces 100 100Urine 1400 500
Total output 2300 6600
Add pure waterAdd pure water
• NormalNormal • Add pure waterAdd pure water
ICF ECFICF ECF
Add isotonic salineAdd isotonic saline
• NormalNormal • Add isotonic salineAdd isotonic saline
ICF ECF ICF ECF
Add pure NaClAdd pure NaCl
• NormalNormal • Add pure NaClAdd pure NaCl
ICF ECF ICF ECF
Ingestion of 1L of water
Increased extracellular fluid volume
Cardiovascular stretch receptor
Decreased ADH release from posterior pituitary
Osmoreceptor
Decreased plasma osmolarity
Decreased collecting duct water permiability
Decreased water reabsorption
Increased water excretion
Normal fluid volume
Decreased plasma ADH
Dehydration
Decreased extracellular fluid volume
Cardiovascular stretch receptor
Increased ADH release from posterior pituitary
Osmoreceptors
Increased plasma osmolarity
Increased collecting duct water permiability
Increased water reabsorption
Decreased water excretion
Normal fluid volume
Increased plasma ADH
Thirst
Increased water intake
Decreased effective arterial blood volume
Kidney
Angiotensinogen
Renin
Angiotensin I
Liver
Converting enzyme
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
Increased Potasium intake
Increased plasma [K+]
Direct effect on adrenal cortex
Increased [K+] in body cell (including kidney cells)
Increased aldosterone secretion
Increased plasma aldosterone
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
Normal potasium level
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 (Пc): 28 mmHg
Interstitial fluid oncotic pressure (ПIF): 3 mmHgArterial end of capillary::
Pc= 40 mmHg; PIF= 0 mmHg
Пc= 28 mmHg; ПIF= 3 mmHg
Net Filtration= 40-0-28+3= 15
Venous end of capillary:
Pc= 10 mmHg; PIF= 0 mmHg
Пc= 28 mmHg; ПIF= 3 mmHg
Net Absorption= 10-0-28+3= -15
Definition of Definition of Edema:Edema:
An increase in the interstitial compartement of extracellular fluid volume (Harrison’s).
Causes of Extracellular EdemaCauses of Extracellular Edema
1.1. Increased capillary pressureIncreased capillary pressure
2.2. Decreased plasma proteinsDecreased plasma proteins
3.3. Increased capillary Increased capillary permiabilitypermiability
4.4. Blockage of lymph returnBlockage of lymph return
• 1. Increased capillary pressure1. Increased capillary pressure– Excessive kidney retentionExcessive kidney retention– High venous pressureHigh venous pressure– Decreased arteriole resistanceDecreased arteriole resistance
• 2. Decreased plasma proteins2. Decreased plasma proteins– Loss of protein in urineLoss of protein in urine– Loss of protein from denuded Loss of protein from denuded
skinskin– Failure of produce proteinFailure of produce protein
• 3. Increased capillary 3. Increased capillary permiabilitypermiability– Immune reactionImmune reaction– ToxinToxin– Bacteria infectionBacteria infection– Vitamin deficiency (exp. Vit C)Vitamin deficiency (exp. Vit C)
• 4. Blockage of lymph return4. Blockage of lymph return– CancerCancer– Paracyte infection (Filaria)Paracyte infection (Filaria)– SurgerySurgery– Congenital absence or Congenital absence or
abnormal of Lymphatic vesselsabnormal of Lymphatic vessels