ANATOMY AND PHYSIOLO GY
INTEGUMENTARY SYSTEM CENTRAL NERVOUS SYSTEM HUMAN CIRCULATORY MUSCULOSKELETAL SYSTEM HEMATOLOGIC SYSTEM LYMPHATIC SYSTEM
and glands. The derivatives of the integument: Hair: functions include protection & sensing light touch.portion that penetrates into the dermis. Nails are plates of tightly packed.ANAOMY AND PHYSIOLOGY OF THE SKIN
The integument as an organ: The integument as an organ. The integument is the body’s largest organ and accounts for 15% of body weight. the white crescent at the base of the nail is the lunula. the cuticle or eponychium is a narrow band around the proximal edge of the nail and • free edge: -the white end that may extend past the finger. hard.
. At the base of the hair follicle is an onion-shaped structure called the bulb Papilla of the hair and the matrix within the bulb produce new hair. Nails: participate in the grasp & handling of small things.superficial portion that extends out of the skin and the root. the hyponychium secures the nail to the finger. Hair has two main sections: The shaft. nail body: -the visible pink portion of the nail. keratinized epidermal cells. The nail consists of: nail root: -the portion of the nail under the skin. and is an alternative name for skin. nails. Hair is composed of columns of dead. Surrounding the root of the hair is the hair follicle. keratinized cells bound together by extracellular proteins. The integumentary system includes the skin and the skin derivatives hair.
There are five distinct sub-layers of the Epidermis: Stratum corneum: the outermost layer. Divided into two main types: o Eccrine .Oil glands. Stratum lucidum: Only found in the fingertips. and o Apocrine .When a minor burn or abrasion occurs basal cells of the epidermis break away from the basement membrane and migrate across the wound. • Absorption & secretion – The skin is involved in the absorption of water-soluble molecules and excretion of water and sweat. The clot becomes a scab.UV sunlight & precursor molecule in skin make vitamin D. 3. granulation tissue fills the wound and intense growth of epithelial cells beneath the scab. They migrate as a sheet. 2. There are three main types of glands associated with the integument:
1. keratohyalin gives the granular appearance. secrete cerumen (ear wax) into ear canal or sebaceous glands. The Two Layers of Skin: Epidermis – The Epidermis is the thinner more superficial layer of the skin.
. This layer is made up of 3-5 layers of flat dead keratinocytes. warmth or coolness.Sensations like touch. vibration. • Wound healing . blood flow increases and many cells move to the wound. •
Protection – The sin acts as a physical barrier. Cutaneous sensation . Sudoriferous . Located in the dermis.Evaporation of sweat & Regulation of blood flow to the dermis. made of 25-30 layers of dead flat keratinocytes. site of keratin formation. • Ceruminous – Lie in subcutaneous tissue below the dermis. pain. and secrete
sebum. main function is regulation of body temperature by evaporation.
Functions of the skin:
• Thermoregulation .Sweat glands.produces the brown pigment melanin • (C) Langerhan Cells – participate in immune response and • (D) Merkel cells .A clot forms in the wound. pressure. palms of hands.Glands: participate in regulating body temperature. & soles of feet. The epidermis is made up of 4 cell types:
• (A) Keratinocytes – Produce keratin protein a fibrous protein that helps protect the epidermis • (B) Melanocytes . • Vitamin D production . Stratum granulosum: made up of 3-5 layers of keratinocytes. Lamellar granules provide water repellent action and are continuously shed & replaced. • In deep wound healing . The scab falls off and the skin returns to normal thickness.Most common. when the sides meet the growth stops and this is called ‘contact inhibition’.participates in the sense of touch.Responsible for “cold sweat” associated with stress.
provide strength & flexibility to the skin. made up of loose areolar connective tissue with elastic fibers. & blood vessels. contains sweat lands. Stratum basale: The deepest layer. 5. o Macrophages and o Fibroblasts. sebaceous (oil) glands.
Dermis: is the deeper.Fingerlike structures invade the epidermis. o Dermal papillae . Cells produced here are constantly divide & move up to apical surface. • Reticular region of the Dermis – Made up of dense irregular connective & adipose tissue. made up of a single layer of cuboidal or columnar cells. • There are two main divisions of the dermal layer: o Papillary region .The superficial layer of the dermis. blood vessels.
. glands and hair follicles.Stratum spinosum: appears covered in thornlike spikes. nerves. contain capillaries or Meissner corpuscles which respond to touch. The epidermis contains 3 cell types: o Adipocytes. thicker layer composed of connective tissue.
occupying the anterior and middle cranial fossae in the skull and extending backwards over the tentorium cerebelli. extending beneath the tentorium cerebelli and occupying most of the posterior cranial fossa. • The Cerebellum overlies the pons and medulla. • The Diencephalon (not shown above) includes the thalamus. tracts of synaptic connections. It is mainly concerned with motor functions that regulate muscle tone.the fibres within the structure connect one cerebral hemisphere with its opposite cerebellar hemisphere. and posture. • The Pons sits in the anterior part of the posterior cranial fossa.
. It is surrounded by the cerebral hemispheres. and forms the central core of the brain.ANATOMY AND PHYSIOLOGY OF THE CENTRAL NERVOUS SYSTEM
The brain can be subdivided into several distinct regions:
The cerebral hemispheres form the largest part of the brain. hyopthalamus. epithalamus and subthalamus. and is responsible for automatic control of the respiratory and cardiovascular systems. the basal ganglia. • The Midbrain (not shown) is located at the junction of the middle and posterior cranial fossae. coordination. • The Medulla Oblongata is continuous with the spinal cord. They are made up of the cerebral cortex. and the ventricles containing CSF.
together with water and other waste substances. and a small tube called a renal tubule.
2 ureters . When the body has taken what it needs from food. and intestines to keep the chemicals and water in balance.ANATOMY AND PHYSIOLOGY OF THE RENAL SYSTEM How does the urinary system work? The body takes nutrients from food and uses them to maintain all bodily functions including energy and self-repair. waste products are left behind in the blood and in the bowel. Their function is to:
• o o o
remove liquid waste from the blood in the form of urine keep a stable balance of salts and other substances in the blood produce erythropoietin. depending on factors such as the amount of foods and fluid consumed. Urinary system parts and their functions: 2 kidneys . and how much fluid is lost through sweating and breathing. a hormone that aids the formation of red blood
cells The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries. skin. removes a type of waste called urea from the blood. Urea. such as meat.narrow tubes that carry urine from the kidneys to the bladder. forms the urine as it passes through the nephrons and down the renal tubules of the kidney. Urea is produced when foods containing protein. Adults eliminate about a quart and a half of urine each day. The urinary system. called a glomerulus.a pair of purplish-brown organs located below the ribs toward the middle of the back. in working with the lungs. are broken down in the body.
the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra.
urethra . and contract and flatten to empty urine through the urethra. a kidney infection can develop. It is held in place by ligaments that are attached to other organs and the pelvic bones. away from the kidneys. If urine backs up. About every 10 to 15 seconds small amounts of urine are emptied into the bladder from the ureters. bladder . normal urination occurs. which squeezes urine out of the bladder.
2 sphincter muscles .alert a person when it is time to urinate. The bladder's walls relax and expand to store urine. hollow organ located in the lower abdomen. or empty the
. At the same time. The typical healthy adult bladder can store up to two cups of urine for 2 to 5 hours.
nerves in the bladder .circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.Muscles in the ureter walls continually tighten and relax forcing urine downward. or is allowed to stand still.a triangle-shaped. When all the signals occur in the correct order.
The brain signals the bladder muscles to tighten.the tube that allows urine to pass outside the body.
The term tricuspid refers to the three flaps of tissue that make up the valve. • Blood flows into the pulmonary artery. for example o organs like the lungs and intestine that add materials to the blood and o organs like the lungs and kidneys that remove materials from the blood and deposit them back in the external environment. with a schematic view of the pathway of blood through the lungs and internal organs. two draining each lung. • Contraction of the ventricle then closes the tricuspid valve and forces open the pulmonary valve. The heart and pulmonary system The heart is located roughly in the center of the chest cavity. Link to discussion of the control of the heartbeat. and intestines passes through the liver before it is returned to
. carrying blood to the right and left lungs. Note that the blood draining the stomach. Oxygenated blood is shown in red.ANATOMY OF THE HUMAN CIRCULATORY SYSTEM The Main Features
• o o o o • o o •
A liquid. the pericardium. to transport nutrients wastes oxygen and carbon dioxide hormones Two pumps (in a single heart) one to pump deoxygenated blood to the lungs. • Here the blood gives up carbon dioxide and takes on a fresh supply of oxygen [More]. deoxygenated blood in blue. spleen. blood. the other to pump oxygenated blood to all the other organs and tissues of the
body. It is covered by a protective membrane. • The capillary beds of the lungs are drained by venules that are the tributaries of the pulmonary veins. It flows through the tricuspid valve into the right ventricle. • A system of blood vessels to distribute blood throughout the body • Specialized organs for exchange of materials between the blood and the external environment. Deoxygenated blood from the body enters the right atrium. • This branches immediately. carry oxygenated blood to the left atrium of the heart
Below: the human heart. • Four pulmonary veins.
. [Graphic of this hepatic portal system]
The coronary system From the left atrium.the heart.
Although the coronary arteries arise within the heart. • The first branches from the aorta occur just beyond the aortic valve still within the heart. They supply blood to the network of capillaries that penetrate every portion of the heart. • Contraction of the ventricle closes the mitral valve and opens the aortic valve at the entrance to the aorta. • Two openings lead to the right and left coronary arteries. Here surplus or harmful materials picked up from those organs can be removed before the blood returns to the general circulation.
The capillaries drain into two coronary veins that empty into the right atrium. they pass directly out to the surface of the heart and extend down across it.
• Blood flows through the mitral valve (also known as the bicuspid valve) into the left ventricle. which supply blood to the heart itself.
the obvious of these being the knee-cap. These are found on the body as the Skull. and offer attachment points for muscles. • Irregular bones are not specific to any one function. relatively flat. pelvis and sternum.ANATOMY AND PHYSIOLOGY OF MUSCULOSKELETAL SYSTEM
. humerous and (Despite their relative length) the phalanges in the finger. they are found in the face. they are found in the wrist and foot (Carpals and Tarsals respectively) as this is where the loads on the body are normally applied. Long bones. As such. A sixth type known as “Wormian” bones is also found. • Short bones are very strong and are very good at resisting deformation through shock. • sesamoid bones are small and oval. which are found during growth of the skull in children. They provide protection for organs. but probably more importantly. long bones are the main lever arms of the appendecular skeleton. flat bones. and are located within tendons to aid its motion around a joint. running. and are found in a variety of roles within our bodies. such bones are the femur. through walking. as their name describes. these will not be discussed. in the spinal column. There are 5 main bone types in the human skeleton. or patella. irregular bones and sesamoid bones. or lifting and throwing. • Flat bones are. short bones.
However. In an X-ray of a bone. a variation on a theme. their bone structure is significantly more flexible than adults.These varieties in size and shape are all due to the different functions these bones carry out. rather than their developmental stage.. in the event of a fracture. the bones must not be over loaded. there will be a joint of sorts. and it is possible to estimate a child’s age from the size of these regions. Found in the fingers. the skeleton is first laid down as cartilage. and this manufactures red blood cells. They must all be strong enough to support us. and calcium are stored. There are a number of different types of Synovial joint. where two bones meet. the bone will bend and splinter. and light-weight enough so we can move. This means that. In the case of exercise and sport. • Condyliond: Also known as Ellipsoid joints. called compact bone. It is not the age. or size of the child that is important.
. at the femur-hip interface. resulting in pain. and looser. This is where vital minerals. cushioning coating to prevent the bones from wearing each other away. these are typically. Because children have a greater percentage of cartilage in their bones than adults. such as where the radius and the ulna meet. or Medullar cavity. The most common joint is the Synovial joint. This is achieved by having the hardest area of bone. This provides a frictionless. Within the medullar cavity is yellow bone marrow. This is a complex process involving the gradual removal of cartilage by cells from outside which invade it. top of page Synovial Joints. rather than snap. that provides the attachment for ligaments and tendons. At the point of contact with other bones is found Articular cartilage. These Epiphyseal plates are part of the development process of the bone. on the outside. Red marrow is found within the cancellous bone at each end. • Hinge joints: As their name indicates. these joints provide movement in one plane. This is a protective layer round the bones. it is possible to see where cartilage is still present (At the Epiphyseal plates). offering movement in a number of planes. in a number of axes. this is where curved facia meet. Ball and Socket: For example. Found at the join between humerous and ulna (loosely speaking) • Pivot joints: These allow rotation of one bone around another.. it is replaced by bone in a process known as ossification. are plates. forming a rigid cylinder called the Diaphysis. and are discussed in more detail later. these are the places where growth in length is still taking place. These joints are freely moving. other cells of a different kind then follow and lay down the bone which eventually replaces the cartilage that has been removed. This is where the head of the bone fits into a socket on the other bone. or else longitudinal growth may be reduced. At any point in the body. On the very outside of the bone is found the periosteum. Failure of the cartilage is what causes arthritis. top of page Skeletal Development In the foetus. they all follow a similar structure. known as cancellous bone inside the head. like a door hinge. Between the cancellous bone and the interior of the shaft. and allow efficient transfer of muscular force from one muscle to bone and to bone. allowing a wise range of motion. spongy tissue. and stunted growth in later life. Weight training should not be carried out by children until their development has slowed. but as development continues.
this secretes Synovial fluid into the joint. improper loading can exaggerate this curve in certain regions. cervical (7 vertebrae). bony protrusions around the joint. The vertebrae are irregular in shape. which is a lateral curve in the spine. the appendecular skeleton and the axial skeleton. that cushions the two bones. resulting in. yet are similar in shape. These offer a “bridge” for the tendon to move over. where the thoracic region is exaggerated. little pads known as bursae can be found. the one plane that should be straight. This can be diagnosed as being many things. Quite simply. or scoliosis. top of page The Spinal Column The Skeleton can be split into two distinct areas. The appendicular skeleton comprises the limbs. each of which requiring extensive explanation. the most well known example is at the base of the thumb. Between each vertebrae is a intervertebral disc.
The ends of the bones in Synovial joints are shaped to fit each other in such a way as to limit their movement in the directions required. Stretching is important to athletes. By carrying loads too far from their trunk. joint and muscle and joint disorders. Surrounding the whole joint is the “Joint Capsule”. which aids in reducing friction. The spine is made up of a curved stack of 33 irregular bones. reducing friction and wear between the tendon and the bone itself.. Preventing injury of the spine is simple. or ROM. However. with the ligaments. thus restricting mobility. the greater its ROM will be. Incorrect posture puts uneven extra loads on the back muscles.. of a joint. they tend to shorten slightly. in later life.
. Within this capsule is the Synovial membrane from which the joint gets its name. sacral (5 fused vertebrae) and coccygeal (4 fused vertebrae). joint capsule and face of bones. • Saddle joints: These joints allow a greater range of movement than condyloid joints. There are a number of other factors that also affect the range of motion. like the knee. the warmer the joint is. and reduces wear on the bone face. This is because as muscles become more and more trained. which aids movement. Found between the Carpals in the hands. where the lumbar region is excessively curved. the shape of fit of the bones and the tendons restrict mobility of the joint to within required constraints. The joint structure itself. Two adjacent vertebrae. Kyphosis. good muscle structure also add to the stability of many joints. As we age. yet thousands of people injure their back every year through bad practices. that attach the bones together. resulting in conditions such as. and the axial comprises the ribs. our body’s ability to function decreases. and allow little lateral movement only. in certain joints. like where the point of the elbow fouls the humerous. that can cause much pain. The most obvious restrictions are structural. this places great emphasis on doing a proper warm-up before exercise. this can cause distortion of the spine. This can lead to. As was mentioned in the description of the structure of the joint. It is attached to the periosteum. limiting its movement. with the spinal cord running down the “neural arch” or the vertebrae. Temperature plays a major role in ROM. thoracic (12 vertebrae). Older people don’t have the same strength as the young. lower back pain. This contributes to the control and stability of the joint. this includes flexibility. This stack can be divided into 5 regions which are. On the surface of the bone is the Articular cartilage. Range and direction of movement is aided and controlled by ligaments. This is a fibrocartilaginous disc. The spine is curved to enable it to absorb shock more easily. The Spinal column is what will be discussed here. however. tough and stretch resistant. Lordosis. known as vertebrae. from the top. and spinal column. the levering action of the bones places great load on the lower back. Lumbar (5 vertebrae). Between tendons and bone.Gliding joints: Found between two flat parts of bone. along with the ligaments. and all the soft tissue between them make up one “Motion segment”.
to protect. In doing so. It becomes apparent from study that the skeletal system of our bodies is vital not just for support or movement. Good practice now is probably the best insurance we can have against joint injury and “Aches and pains” in later life
.top of page Conclusion The Skeleton has 2 main functions. these parts of our bodies require many features. some of which have been discussed herein. support and provide a means of motion. but for our comfort and growth.
Contained inside all bones. Two kinds of bone marrow. the inflammatory and immune responses.
Blood 1. 1300 ml in pulmonary circulation 400 ml arterial 60 ml capillary 840 ml venous 3000 ml in systemic circulation 550 ml arterial 300 ml capillary 2150 ml venous
. Distribution 1. collectively referred to as formed elements of blood or blood components: erythrocytes.HEMATOLOGIC SYSTEM: ANATOMY AND PHYSIOLOGY The structures of the hematologic or hematopoietic system include the blood. spleen. Centrifugation of blood results in separation into top layer of plasma. other flat bones 2. one source of lymphocytes and macrophages 2. Majority of formed elements is erythrocytes. red and yellow 1. Bone Marrow 1. middle layer of leukocytes and platelets. The hematologic system also plays an important role in hormone transport. 1. specific types of cells. Primary function is hematopoiesis (the formation of blood cells) 3. volume of leukocytes and platelets is negligible. 3. The major function of blood is to carry necessary materials (oxygen. and blood-forming organs (bone marrow. Hematocrit 1. Found in ribs. lymph nodes. collectively one of the largest organs of the body (4%-5% of total body weight) 2. blood vessels. Carries out hematopoiesis. and bottom layer of erythrocytes. and thrombocytes. 2. Red (functioning) marrow 1. does not contribute to hematopoiesis 4. Yellow marrow: red marrow that has changed to fat. and acid-base balance. occupies interior of spongy bones and center of long bones. Reflects portion of blood composed of red blood cells 2. All blood cells start as stem cells in the bone marrow. nutrients) to cells and to remove carbon dioxide and metabolic waste products. found in long bones. and thrombocytic components of blood. Composed of plasma (55%) and cellular components (45%) 2. temperature regulation. these mature into the different. 3. myeloid. leukocytes. 1. 3. and thymus gland). fluid-electrolyte balance. vertebral column. 2. liver. 3. production site of erythroid. 2.
Average life span 120 days 2.Plasma 1. Hgb abnormalities. fibrinogen. bilirubin 2. yellow in color because of pigments 2. which play a major role in defense against microorganisms. serum globulins. folic acid. involved in regulation of intravascular plasma volume and maintenance of osmotic pressure 2. vitamin B12. released as reticulocytes (immature cells). Production 1. Serum globulins: alpha. leukocytes (white blood cells [WBCs]). Beta: role in transport of iron and copper 3. and thrombocytes (platelets). liver. gamma 1. Start in bone marrow as stem cells. second portion is protein 2. Normal blood contains 12-18 g Hgb/100 ml blood. prothrombin. Fibrinogen. Immature RBCs destroyed in either bone marrow or other reticuloendothelial organs (blood.
. connective tissue. function of antibodies 3. chiefly sacs of hemoglobin 2. beta. produced by kidneys and stimulated by hypoxia 3. spleen. Iron: freed from Hgb during bilirubin formation. Premature destruction: may be caused by RBC membrane abnormalities. plasminogen (see Coagulation)
Cellular Components Cellular components or formed elements of blood are erythrocytes (red blood cells [RBCs]). and lymph nodes) 3. Bilirubin: byproduct of Hgb released when RBCs destroyed. plasminogen 1. which function in hemostasis. which are responsible for oxygen transport. Iron. prothrombin. 1. Erythrocytes Bioconcave disc shape. Two portions: iron carried on heme portion. excreted in bile 5. Hemolysis (destruction) 1. lungs. liver. Alpha: role in transport of steroids. Normal age RBCs may be destroyed by gross damage as in trauma or extravascular hemolysis (in spleen. Liquid part of blood. transported to bone marrow via transferrin and reclaimed for new Hgb production 6. no nucleus. RBCs are responsible for oxygen transport via hemoglobin (Hgb) 1. Erythropoietin stimulates differentiation. Cell membrane is highly diffusible to O2 and CO2 3. and other factors required for erythropoiesis 1. higher (14-18 g) in men than in women (12-14 g) 4. Albumin: largest of plasma proteins. pyridoxine (vitamin B6). Mature cells removed chiefly by liver and spleen 4. Contains plasma proteins such as albumin. Gamma: role in immune response. Consists of serum (liquid portion of plasma) and fibrinogen 3. lipids. mature into erythrocytes 2. bone marrow) 1. extrinsic physical factors (such as the enzyme defects found in G6PD) 7.
macrophages. produced by bone marrow: give rise to histiocytes (Kupffer cells of liver). Mononuclear cells: monocytes and lymphocytes: large nucleated cells 1. 3. and plug formation Release substances involved in coagulation
. produced primarily in lymph tissue (B cells) and thymus (T cells) (see also Immune Response) 1. Eosinophils and basophils are reservoirs of histamine. 2. Fragments of megakaryocytes formed in bone marrow Production regulated by thrombopoietin Essential factor in coagulation via adhesion. basophils. and neutrophils
1. Thrombocytes (platelets) 1. Basophils: involved in prevention of clotting in microcirculation and allergic reactions 3. produce substances against foreign cells. and heparin 4. aggregation. immature neutrophils: band cells (bacterial infection usually produces increased numbers of band cells) 1. play a role in immune
1. largest leukocyte 2. Neutrophils: involved in short-term phagocytosis 1. serotonin. Lymphocytes: immune cells. response Monocytes: involved in long-term phagocytosis. Leukocytes: granulocytes and mononuclear cells: involved in protection from bacteria and other foreign substances 1. mature neutrophils: polymorphonuclear leukocytes 2.1. 4. and other components of reticuloendothelial system 1. Granulocytes: eosinophils. Eosinophils: involved in phagocytosis and allergic reactions 2.
cytokines. These cisterns enlarge and develop communications (lymphatic vessels) that permit lymph from the lower limbs and abdomen to drain via the cisterna chyli. electrolytes. 2. Intestinal lymph (chyle) transports cholesterol. coagulation and fibrinolytic factors) from the interstitial space and returns them to the circulation. triglycerides and the fat soluble vitamins (A. long-chain fatty acids. lying between the aorta and azygos vein. where it drains into the left internal jugular vein at its confluence with the left subclavian vein. bypassing the liver. This duct is a major lymph channel which passes cephalad on the left of the bodies of the thoracic vertebrae to enter the left side of the neck. D. low-molecular-weightmoieties (polypeptides. located one on either side of the neck and one in each groin. E and K) directly to the circulation. globulins. Development and macroanatomy In the embryo. growth factors) and macromolecules (fibrinogen. the lymphatic system develops from four cystic spaces. into the thoracic duct. Permits the circulation of lymphocytes and other immune cells. albumen. 3.Anatomy and physiology of the lymphatic system
Functions 1. Removes water. Lymph from the head and right arm drains
• allow the entry of molecules up to 1000 kDa in size because the basement membrane is fenestrated. Lymph nodes develop as condensations along the course of these lymphatic highways. About 10 per cent of lymph arising from a limb is transported in deep lymphatic ducts that accompany the main neurovascular bundles. Terminal lymphatics Lymphatic capillaries drain into terminal (collecting) lymphatics which possess bicuspid valves and endothelial cells rich in the contractile protein actin. there are lymphatic watersheds and there is limited capacity for bypass flow when a main collecting duct or lymph trunk is blocked. In health there is net capillary filtration into the interstitial space of 2—4 litres per 24 hours which is removed by the lymphatic system. Superficial ducts form lymph bundles of various sizes which ate located within strips of adipose tissue and tend to follow the course of the major superficial veins. into the right internal jugular vein. against venous flow from the core of the limb to the surface. The area of skin drained by a single terminal lymphatic is termed an areola. spleen. thymus. Lymphatics accompany veins everywhere in the body except in the cortical bony skeleton and central nervous system. Although there is some overlap between adjacent areolata. tenuous or even absent and the endothelium itself possesses intra and intercellular pores. together with the relative impermeability of the blood capillary membrane to molecules over 70 kDa. is conducted. the space expands and the lymphatic capillaries and their pores are held open by these filaments to facilitate increased lymphatic drainage. tonsils) and circulating elements (lymphocytes and other mononuclear immune cells). Disease processes which disturb Starling’s forces lead primarily to oedema that is low in protein. Lymph trunks Terminal lymphatics lead to lymph trunks which have a structure that is similar to veins: a single layer of endothelial cells. lymphoid organs (lymph nodes. Peyer’s patches. Larger collecting lymphatics are innervated and surrounded by smooth muscle. Microanatomy and physiology Lymphatic capillaries Lymphatics originate within the interstitial space either from specialised endothelialised capillaries (initial lymphatics) or from nonendothelialised precapillary channels such as in the liver (spaces of Disse). in epifascial lymph ducts. although the brain and retina possess analogous systems (cerebrospinal fluid and aqueous humour. lying on a basement membrane overlying a media comprised of smooth muscle cells that are innervated with sympathetic. The distribution of fluid and protein between the vascular and interstitial spaces depends on the balance of hydrostatic and oncotic pressures between the two compartments (Starling’s forces). Valves partition the lymphatic into segments termed lymphangions which are believed to contract sequentially in order to propel lymph into the lymph trunks. The lymphatic system comprises lymphatic channels. respectively). • The abluminal surface of the endothelium is intimately related to the interstitial matrix through anchoring collagen and elastic filaments. In the resting state initial lymphatic capillaries are collapsed. • are much larger (50 micron).via a separate lymphatic trunk. however. Initial lymphatics capillaries are unlike arteriovenous capillaries in that they: • are blind-ended. the right lymphatic duct. whereas
. parasympathetic and sensory nerve endings. The majority of lymph. When interstitial fluid volume and pressure increase.
Pressures of up to 30—50 mmHg have been recorded in normal lymph trunks and up to 200 mmHg in severe lymphoedema. in that they increase their contractility and stroke volume.diseases which primarily impair lymphatic drainage lead to high-protein oedema (lymphoedema). for example post-mastectomy. • the generation of alternating suction and propulsive forces through the sequential contraction and relaxation of lymphangions separated by valves that prevent retrograde flow. Lymphangions respond to increased lymph flow in much the same way as the heart responds to increased venous return. The pathophysiological importance of this observation remains uncertain. In contradistinction to arteriovenous capillaries. therefore. the larger the particles the greater the lymphatic uptake. certain prostaglandins and thromboxanes.
. they have been reported to be absent in some cases of lymphoedema. Lymphovenous communications were first observed on lymphangiography and were thought to act as safety valves that would allow decompression of a hypertensive lymphatic system. haem-containing proteins and oxygen-derived free radicals. It is believed that prograde lymphatic flow depends on two mechanisms: • transient increases in interstitial pressure secondary to muscular contraction and external compression. serotonin. Transport in the thoracic and right lymph ducts is also dependent on the changes in intrathoracic pressure that occur with respiration. Contractility is also enhanced by noradrenaline. While lymphscintigraphy may reveal lymphovenous communications in normal limbs. have an adverse effect on lymphatic function. Mechanisms of lymph transport Whereas resting pressures in the interstitial fluid compartments of the skin and subcutaneous tissues are negative (—2 to —6 mmH2O) pressures within lymphatics are positive. Cardiac and respiratory disease may. Lymphatics modulate their own contractility through the production of nitric oxide. Transport of particles Particles enter the initial lymphatics through interendothelial openings and vesicular transport through intraendothelial pores. and endothelin-1. indicating that lymph flows against a small pressure gradient. as well as changes in central venous pressures through the cardiac cycle. Large particles are actively phagocytosed by macrophages and transported through the lymphatic system intracellularly. Contractility appears to be inhibited by haemoglobin.