7/30/2019 Sistem Limfatik Psik

1/40

Sistem Limfatik

Retty Ratnawati

Laboratorium Ilmu FaalFK. UNIBRAW

7/30/2019 Sistem Limfatik Psik

2/40

7/30/2019 Sistem Limfatik Psik

3/40

7/30/2019 Sistem Limfatik Psik

4/40

LYMPH NODE

7/30/2019 Sistem Limfatik Psik

5/40

7/30/2019 Sistem Limfatik Psik

6/40

7/30/2019 Sistem Limfatik Psik

7/40

Berkaitan dengan:

Keseimbangan cairan tubuh Pertahanan tubuh

7/30/2019 Sistem Limfatik Psik

8/40

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

7/30/2019 Sistem Limfatik Psik

9/40

Functions of Lymphatic System

1. Draining interstitial fluid2. Transporting dietary lipids3. Protection

7/30/2019 Sistem Limfatik Psik

10/40

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.

7/30/2019 Sistem Limfatik Psik

11/40

7/30/2019 Sistem Limfatik Psik

12/40

7/30/2019 Sistem Limfatik Psik

13/40

Lymphatic vessels

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

Avascular tissues Central nervous system Splenic pulp Bone marrow

7/30/2019 Sistem Limfatik Psik

14/40

7/30/2019 Sistem Limfatik Psik

15/40

7/30/2019 Sistem Limfatik Psik

16/40

COMPOSITION

7/30/2019 Sistem Limfatik Psik

17/40

FACTORS THAT ASSIST LYMPH TOMOVE THROUGH THE VESSELS

7/30/2019 Sistem Limfatik Psik

18/40

LYMPHATIC CAPILLARIES

7/30/2019 Sistem Limfatik Psik

19/40

Body Fluid Compartment

7/30/2019 Sistem Limfatik Psik

20/40

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

7/30/2019 Sistem Limfatik Psik

21/40

7/30/2019 Sistem Limfatik Psik

22/40

7/30/2019 Sistem Limfatik Psik

23/40

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

7/30/2019 Sistem Limfatik Psik

24/40

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

7/30/2019 Sistem Limfatik Psik

25/40

Add pure water

Normal Add pure water

ICF ECFICF ECF

7/30/2019 Sistem Limfatik Psik

26/40

Add isotonic saline

Normal Add isotonic saline

ICF ECF ICF ECF

7/30/2019 Sistem Limfatik Psik

27/40

Add pure NaCl

Normal Add pure NaCl

ICF ECF ICF ECF

7/30/2019 Sistem Limfatik Psik

28/40

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

7/30/2019 Sistem Limfatik Psik

29/40

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

7/30/2019 Sistem Limfatik Psik

30/40

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

7/30/2019 Sistem Limfatik Psik

31/40

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

7/30/2019 Sistem Limfatik Psik

32/40

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

7/30/2019 Sistem Limfatik Psik

33/40

7/30/2019 Sistem Limfatik Psik

34/40

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

7/30/2019 Sistem Limfatik Psik

35/40

1. Increased capillary pressure Excessive kidney retention

High venous pressure Decreased arteriole resistance

7/30/2019 Sistem Limfatik Psik

36/40

2. Decreased plasma proteins Loss of protein in urine

Loss of protein from denuded skin Failure of produce protein

7/30/2019 Sistem Limfatik Psik

37/40

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

7/30/2019 Sistem Limfatik Psik

38/40

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

Lymphatic vessels

7/30/2019 Sistem Limfatik Psik

39/40

7/30/2019 Sistem Limfatik Psik

40/40