Lymph outflow

Introduction Lymph: commonly known as lymph, the composition is the same as the tissue fluid, because it is exuded by blood through the micro-vessels, so it does not contain red blood cells, and the protein is one-fourth of the blood. Lymph has a role in preventing pathogen infection. Once infected, the lymph will ooze out of the capillaries and accumulate in the lymphatics to prevent infection.

Cause

Capillary lymphangioma is a mass formed by the development of primitive lymphatic vessels. It is a congenital malformation and belongs to the nature of hamartoma. It is a borderline between tumor and malformation. In the mesoderm, when the primitive lymphatic sac is formed, a misconfiguration occurs, causing the primitive lymphatic sac to fail to communicate with the venous system, or failing to communicate with the lymphatic trunk, or a small number of lymphoid sacs are separated during the formation of the lymphatic system, resulting in A circulatory disorder in the lymphatic system can cause lymphatic outflow.

In addition, the acquired bacteria, viruses, parasitic infections lead to inflammatory reactions can also cause lymphatic exudation into the tissue from the lymphatic vessels.

an examination

Related inspection

Urine routine blood lymphocyte count

The lymph fluid that is introduced into the blood circulation from the lymphatic vessels is about 120 ml per hour, wherein the lymph fluid that is introduced into the blood through the thoracic duct is about 100 ml per hour, and the lymph fluid that enters the blood from the right lymphatic duct is about 20 ml per hour. The average daily production of lymph is about 2-4L, which is roughly equivalent to the total amount of human plasma. It is worth pointing out that the lymph contains a total of about 195 g of protein. Therefore, the return of lymph to the blood is important for preserving plasma volume and plasma protein. Abnormal lymphatic outflow can be detected by checking blood counts, urine routines, or counting blood lymphocytes.

Differential diagnosis

Lymphatic outflow symptoms need to be identified as follows.

(1) Structure and permeability of capillary lymphatic vessels

The endothelial cells of the capillary lymphatic vessels are connected to the peripheral connective tissue by binding filaments. At the beginning of the capillary lymphatic vessels, the edges of the endothelial cells cover each other, forming a one-way flap that can only be opened into the lumen, preventing entry into the lymphatic vessels. The tissue fluid flows back into the interstitial space. The collagen filaments between the collagen fibers and the capillary lymphatic vessels in the interstitial space can open the edges of the overlapping endothelial cells, causing a large gap between the endothelial cells, facilitating the entry of the tissue fluid into the capillary lymphatic vessels.

(two) the formation and reflux of lymph fluid

The lymph fluid is derived from the tissue fluid and is absorbed by the blind end of the slightly enlarged lymphatic vessels. The motility is absorbed by the pressure difference between the tissue fluid and the lymphatic fluid in the capillary lymphatic vessels. As the pressure difference increases, the rate of lymph production increases. Once the tissue fluid enters the lymphatics, it becomes lymph, and its composition is very similar to the tissue fluid there. The capillary lymphatic vessels are meshed with each other and gradually merge into a larger collection of lymphatic vessels. The contractile activity of the smooth muscles of the lymphatic wall and the valves in the lymphatic vessels together constitute a "lymphatic pump", which can promote lymphatic drainage.

Normal adults have about 120 ml of lymph fluid per hour entering the bloodstream in a quiet state. About 20 ml of lymph fluid from the right head and neck, right arm and right chest was introduced into the vein via the right lymphatic duct, and the remaining 100 ml of lymph was introduced into the vein through the thoracic duct. The human body produces about 2 to 4 L of lymph fluid per day, which is roughly equivalent to the total amount of plasma in the whole body.

(3) Factors affecting lymph production and reflux

The pressure difference between the tissue fluid and the lymphatic fluid in the lymphatic vessels is the driving force for the tissue fluid to enter the lymphatics. Therefore, any factor that increases the pressure of tissue fluid can increase the production of lymph. Such as increased capillary blood pressure, decreased plasma colloid osmotic pressure, tissue fluid colloid osmotic pressure and increased capillary permeability. The "lymphatic pump" promotes lymphatic drainage. In addition, rhythmic contraction of peripheral skeletal muscle, pulsation of adjacent arteries, and compression of tissue by external objects can promote lymphatic drainage. Lymphatic and lymph node acute and chronic inflammation, granuloma formation, silkworm body and so on can cause lymphatic system obstruction, causing lymphatic sinus and lymphatic vessel expansion. "Skin-like swelling" is a prominent lesion of the skin during advanced filariasis, which is more common in lower limbs and scrotum. As the silkworm worm blocks the lymphatic vessels, the lymphatic drainage is blocked, lymphedema occurs at the lower end of the obstruction site, and there is a large amount of lymph fluid accumulation in the interstitial space. Because the lymph contains protein, it can stimulate the proliferation of fibrous tissue, and the proliferating fibrous tissue can aggravate the retention of lymph. The result of repeated action, resulting in subcutaneous tissue hyperplasia, rough skin thickening, similar to the skin of young elephants, it is called "like skin swelling."

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