sistem limfatik

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Sistem Limfatik Sistem Limfatik M. Rasjad Indra M. Rasjad Indra Laboratorium Ilmu Faal Laboratorium Ilmu Faal FK. UNIBRAW FK. UNIBRAW

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Page 1: Sistem Limfatik

Sistem LimfatikSistem Limfatik

M. Rasjad IndraM. Rasjad Indra

Laboratorium Ilmu FaalLaboratorium Ilmu Faal

FK. UNIBRAWFK. UNIBRAW

Page 2: Sistem Limfatik

Berkaitan dengan:Berkaitan dengan:

• Keseimbangan cairan tubuhKeseimbangan cairan tubuh

• Pertahanan tubuhPertahanan tubuh

Page 3: Sistem Limfatik

Body Fluid Compartment

Page 4: Sistem Limfatik

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

Page 5: Sistem Limfatik
Page 6: Sistem Limfatik
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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

Page 8: Sistem Limfatik

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

Page 9: Sistem Limfatik

Add pure waterAdd pure water

• NormalNormal • Add pure waterAdd pure water

ICF ECFICF ECF

Page 10: Sistem Limfatik

Add isotonic salineAdd isotonic saline

• NormalNormal • Add isotonic salineAdd isotonic saline

ICF ECF ICF ECF

Page 11: Sistem Limfatik

Add pure NaClAdd pure NaCl

• NormalNormal • Add pure NaClAdd pure NaCl

ICF ECF ICF ECF

Page 12: Sistem Limfatik

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

Page 13: Sistem Limfatik

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

Page 14: Sistem Limfatik

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

Page 15: Sistem Limfatik

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

Page 16: Sistem Limfatik

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

Page 17: Sistem Limfatik
Page 18: Sistem Limfatik

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

Page 19: Sistem Limfatik

• 1. Increased capillary pressure1. Increased capillary pressure– Excessive kidney retentionExcessive kidney retention– High venous pressureHigh venous pressure– Decreased arteriole resistanceDecreased arteriole resistance

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• 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

Page 21: Sistem Limfatik

• 3. Increased capillary 3. Increased capillary permiabilitypermiability– Immune reactionImmune reaction– ToxinToxin– Bacteria infectionBacteria infection– Vitamin deficiency (exp. Vit C)Vitamin deficiency (exp. Vit C)

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• 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

Page 23: Sistem Limfatik
Page 24: Sistem Limfatik