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

2. Berkaitan dengan:
• Keseimbangan cairan tubuh
• Pertahanan tubuh

3. Body Fluid Compartment

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

7. Electrolyte Composition of Body Fluid
Electrolytes Plasma Interstitial Fluid Intracellular
(mEq/L) (mEq/Kg H2O) Fluid (mEq/Kg
H2O)
Cation:
Na+ 142 145 10
K+ 4 4 159
Ca2+ 5 3 1
Mg2+ 2 2 40
Total 153 154 210
Anion:
Cl- 103 117 3
HCO3- 25 28 7
Protein 17 - 45
Others 8 9 155
Total 153 154 210

8. Daily Intake and Output of Water
(in ml/day)
Normal Prolonged
Heavy Exercise
Intake
Fluid ingested 2100 ?
From metabolism 200 200
Total intake 2300 ?
Output
Insensible-Skin 350 350
Insensible-Lungs 350 650
Sweat 100 5000
Feces 100 100
Urine 1400 500
Total output 2300 6600

9. Add pure water
• Normal • Add pure water
ICF ECF
ICF ECF

10. Add isotonic saline
• Normal • Add isotonic saline
ICF ECF ICF ECF

11. Add pure NaCl
• Normal • Add pure NaCl
ICF ECF ICF ECF

12. Decreased ADH
release from
posterior
pituitary
Decreased
plasma ADH
Cardiovascular
stretch receptor
Osmoreceptor
Decreased
Increased collecting duct
extracellular water
Ingestion of 1L
fluid volume permiability
of water
Decreased
plasma
osmolarity
Decreased water
Normal fluid reabsorption
volume
Increased water
excretion

13. Increased ADH
release from
posterior
pituitary
Increased plasma
ADH
Cardiovascular
stretch receptor
Osmoreceptors
Increased
Decreased collecting duct
extracellular water
Thirst permiability
Dehydration fluid volume
Increased
plasma
osmolarity
Increased
water intake Increased water
reabsorption
Normal fluid
volume
Decreased water
excretion

14. Angiotensinogen
Liver
Kidney Renin
Angiotensin I
Decreased
effective
arterial blood Lungs
volume
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

15. Increased plasma
[K+] Increased [K+] in body cell
Direct effect on adrenal (including kidney cells)
cortex
Increased Increased aldosterone
Potasium intake secretion
Normal potasium
level 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

16. 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 (P IF ): 0 mmHg
Capillary oncotic pressure ( Пc): 28 mmHg
Interstitial fluid oncotic pressure ( П IF ): 3 mmHg
Arterial end of capillary : Venous end of capillary:
Pc= 40 mmHg; PIF= 0 mmHg Pc= 10 mmHg; PIF= 0 mmHg
Пc= 28 mmHg; ПIF= 3 mmHg Пc= 28 mmHg; ПIF= 3 mmHg
Net Filtration= 40-0-28+3= 15 Net Absorption= 10-0-28+3= -15

18. Definition of Edema:
An increase in the interstitial compartement of extracellular
fluid volume (Harrison’s).
Causes of Extracellular Edema
1. Increased capillary pressure
2. Decreased plasma proteins
3. Increased capillary permiability
4. Blockage of lymph return

19. • 1. Increased capillary pressure
– Excessive kidney retention
– High venous pressure
– Decreased arteriole resistance

20. • 2. Decreased plasma proteins
– Loss of protein in urine
– Loss of protein from denuded skin
– Failure of produce protein

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

22. • 4. Blockage of lymph return
– Cancer
– Paracyte infection (Filaria)
– Surgery
– Congenital absence or abnormal of
Lymphatic vessels