PHYSIOLOGY II LECTURE

TOPICS: CIRCULATIONS
(ARTERIAL, ARTERIOLAR, CAPILLARY, VENOUS AND LYMPHATIC CIRCULATIONS)
BY
FEYITIMI, Abdul-Rahuf Aderemi
Department of Medical Physiology,
College of Medicine and Health Sciences
(CMHS),
University of Rwanda.

Phone: +250791703685
Email: [email protected]
OUTLINE
• Introduction • Venous circulation

• The blood vessels • Basic principles of circ. function

• The circulations • Regulation of circulation

• Volume of blood in circulation • Overview of the lymphatic system

• Pressure in the various portions • Lymphatic circulation

• Velocity of blood flow • Regulation of lymph flow

• Arterial and arteriolar circulation • Seminar presentation

• Capillary circulation

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INTRODUCTION
• Blood flow (F) is the volume of blood passing each point of the vessel in one
unit time. Units: mL/min, L/min or mL/s.
• The circulatory system supplies O2 and substances absorbed from the
gastrointestinal tract to the tissues.
• Then, it returns CO2 to the lungs and other products of metabolism to the
kidneys, functions in the regulation of body temperature, and distributes
hormones and other agents that regulate cell function.
• The normal total circulating blood volume is about 8% of the body weight
(5600 mL in a 70-kg man). About 55% of this volume is plasma.

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THE BLOOD VESSELS
• Blood vessels are the part of circulatory system that transports blood throughout the
human body.
• There are three major types of blood vessels which are:
- Arteries carries blood away from the heart and delivers oxygenated blood to the
organs.
- Capillaries enable the actual exchange of water and chemicals between the blood
and the tissues.
- Veins carry blood from the capillaries back toward the heart, located within the body.
• More than 60 percent of all the blood in the circulatory system is usually in the veins
and because the veins are so compliant, it is said that the venous system serves as a
blood reservoir for the circulation.

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THE BLOOD VESSELS
• The vessel walls contain four major elements:
• The endothelial cells play very little part in the total elasticity of the walls but perform
an important role in the regulation of smooth muscle tone via release of vasoactive
molecules.
• The elastin fibres are easily stretched (about six times more easily than rubber).
• They produce an elastic tension automatically as the vessel expands, and without
biochemical energy expenditure.
• The collagen fibres are much stiffer than the elastin fibers. However, these fibers are
slack, and do not exert their tension until the vessel has been stretched. Thus, the
more the vessel expands, the stiffer it becomes.
• The smooth muscle serves to produce an active tension, contracting under
physiological control, and changing the diameter of the lumen of the vessel.

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THE BLOOD VESSELS
• Arterioles are the major site of the resistance to blood flow, and small changes in
their caliber cause large changes in the total peripheral resistance.
• Capillaries-lined with a single layer of endothelial cells, which is surrounded by
a basal lamina.
• Venules and veins. Like the capillaries, the venules are thin-walled structures
and contains the largest percentage of blood in the cardiovascular system
(unstressed volume).
• These variations have profound effects on their resistance and capacitance
properties.

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THE BLOOD VESSELS
Table 1: Characteristics of various of blood vessels
in humans.

Fig. 1: The artery and microvasculature.

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THE BLOOD VESSELS
• The greater the amount of elastic tissue in a blood vessel, the greater the elasticity
and the smaller the compliance.
• All blood vessels are distensible: The walls of blood vessels are not rigid, but
rather they stretch in response to increased transmural pressure.
• The distensibility nature of the arteries allow them to accommodate the pulsatile
output of the heart.
• The most distensible by far of all the vessels are the veins.
• Slight increases in venous pressure cause the veins to store 0.5 to 1.0 litre of extra
blood.

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THE BLOOD VESSELS
• The compliance or capacitance of a blood vessel describes the volume of blood
the vessel can hold at a given pressure.
• Compliance is related to distensibility and is given by the following equation:
• C = V/P where
C = Compliance or capacitance (mL/mm Hg)
V = Volume (mL)
P = Pressure (mm Hg)

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THE BLOOD VESSELS
INNERVATION OF BLOOD VESSELS
• The innervation of the small arteries and arterioles allows sympathetic stimulation
to increase resistance to blood flow and thereby to decrease rate of blood flow
through the tissues.
• The innervation of the large vessels, particularly of the veins, makes it possible
for sympathetic stimulation to decrease the volume of these vessels.
• This can push blood into the heart and thereby play a major role in regulation of
heart pumping.

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THE BLOOD VESSELS

Fig. 2: Sympathetic innervation of the blood vessels.

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THE CIRCULATIONS
• Major circulations are:
• Systemic circulation (greater circulation)
• Pulmonary circulation (lesser circulation)
• Blood vessels are the part of circulatory system that transports blood
throughout the human body. Circulations of blood vessels are:
• Arterial and arteriolar circulations,
• Capillary circulation and
• Venous circulation.
• Also, a special circulation is the lymphatic circulation that carries lymph to
different part of the body.

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 THE CIRCULATIONS • Human being has a closed system of
blood vessels.
• From the left ventricle, blood is
pumped through the arteries and
arterioles to the capillaries.
• Blood equilibrates with the interstitial
fluid in the capillaries.
• Capillaries enable the actual exchange
of water and chemicals between the
blood and the tissues.
• The capillaries drain through venules
and veins and back to the right atrium.
• Some tissue fluids enter another
system of close vessel, the lymphatics.
• The lymphatics drain lymph via the
Fig. 3: Arrangement of blood vessels in the
thoracic duct and the right lymphatic
cardiovascular system.
duct into the venous system.

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THE CIRCULATIONS
• What move blood forward:

1. Pumping action of the heart (systemic circulation)

2. Diastole recoil of the wall of the arteries.

3. Compression of the veins by skeletal muscle during exercise.

4. Negative pressure in the thorax during inspiration.

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VOLUME OF BLOOD IN CIRCULATION
• Volumes of Blood in the Different Parts of the Circulation:
• About 84% of the entire blood volume of the body is in the systemic circulation.
• 16% is in the heart and lungs.
• Of the 84% in the systemic circulation:
• Approx 64% is in the veins,
• 13% is in the arteries, and
• 7% is in the systemic arterioles and capillaries.
• The heart contains 7% of the blood, and the pulmonary vessels, 9%.

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Fig. 4: Distribution of blood in different parts of the circulatory system.

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PRESSURES IN THE VARIOUS PORTIONS
OF THE CIRCULATION
• Pressures in the various portions of the circulation
• The mean pressure in the aorta is high, averaging about 100 mm Hg.
• The arterial pressure alternates between a systolic pressure level of 120 mm Hg
and a diastolic pressure level of 80 mm Hg (heart pumping is pulsatile).
• As the blood flows through the systemic circulation, its mean pressure falls
progressively to about 0 mm Hg.
• This point is at the termination of the superior and inferior venae cavae.
• The pressure in the systemic capillaries varies from as high as 35 mm Hg near
the arteriolar ends to as low as 10 mm Hg near the venous ends.
• The average “functional” pressure in most vascular beds is about 17 mm Hg.

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PRESSURES IN THE VARIOUS PORTIONS
OF THE CIRCULATION
• The pulse pressure is approx. 5 mm Hg at the arteriolar end and zero at the
venous end.
• The plasma leaks through the minute pores of the capillary walls.
• Even though nutrients can diffuse easily through these same pores to the
outlying tissue cells.
• Pulmonary artery systolic pressure averages about 25 mm Hg and diastolic
pressure averages about 8 mm Hg.
• The mean pulmonary arterial pressure is only 16 mm Hg.
• The mean pulmonary capillary pressure averages only 7 mm Hg.

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VELOCITY OF BLOOD FLOW IN
CIRCULATION
• Velocity of blood flow in circulation
• The same volume of blood flow (F) must pass through each segment of the
circulation each minute.
• The velocity of blood flow (V) is inversely proportional to vascular cross-sectional
area (A):
• V=F
• Thus, under resting conditions, the velocity averages about 33 cm/sec in the aorta
but is only 1/1000 as rapid in the capillaries—about 0.3 mm/sec (0.03 cm/sec).
A
• However, because the capillaries have a typical length of only 0.3 to 1 millimeter.
• The blood remains in the capillaries for only 1 to 3 seconds, that is the transit time
from the arteriolar to the venular end of an average-sized capillary.

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ARTERIAL AND ARTERIOLAR CIRCULATION

• The function of the arteries is to transport blood under high pressure to the
tissues.
• For this reason, the arteries have strong vascular walls, and blood flows at a high
velocity in the arteries.
• The arterioles act as control conduits through which blood is released into the
capillaries.
• Arterioles have strong muscular walls that can close the arterioles completely or
can, by relaxing, dilate the vessels severalfold.
• Thus, having the capability of vastly altering blood flow in each tissue in response
to its needs.

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CAPILLARY CIRCULATION
• Blood does not flow continuously in the capillaries, but the flow is intermittent
(vasomotion).
• This is achieved by intermittent contraction of metarterioles and precapillary
sphincters (and sometimes small arterioles).
• At any one time, only 5% of the circulating blood is in the capillaries.
• This 5% is the most important part of the blood volume.
• It is the only pool from which O2 and nutrients can enter the interstitial fluid and
into which CO2 and waste products can enter the bloodstream.
• Exchange across the capillary walls is essential to the survival of the tissues.

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VENOUS CIRCULATION
• Blood flows through the blood vessels, including the veins, primarily because of
the pumping action of the heart.
• However, venous flow is aided by the heartbeat, the increase in the negative
intrathoracic pressure during each inspiration, and contractions of skeletal
muscles that compress the veins (muscle pump).
• The pressure in the venules is 12 to 18 mm Hg. It falls steadily in the larger veins
to about 5.5 mm Hg in the great veins outside the thorax.
• The pressure in the great veins at their entrance into the right atrium (central
venous pressure) averages 4.6 mm Hg, but fluctuates with respiration and heart
action.

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BASIC PRINCIPLES OF CIRCULATORY
FUNCTION
• Basic principles of circulatory function:
• (1) Blood flow to most tissues is controlled according to the tissue need by
microvessels.
• Active: Blood flow: 20 – 30 X rest value.
• This time, the heart cannot increase CO > 4 – 7 X greater than resting level.
• (2) Cardiac output is the sum of all the local tissue flows.
• The heart acts as an automaton, responding to the demands of the tissues,
however, it often needs help in the form of special nerve signals to make it pump
the required amounts of blood flow.
• (3) Arterial pressure regulation is generally independent of either local blood flow
control or cardiac output control, but it depends on nervous reflexes.

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REGULATION OF CIRCULATION
• There are three (3) levels of control:
• 1. Local control by microvessels
• 2. Nervous control
• 3. Hormonal control
• The nervous signals especially:
• (a) increase the force of heart pumping,
• (b) cause contraction of the large venous reservoirs to provide more blood to the
heart, and
• (c) cause generalized constriction of the arterioles in many tissues so that more
blood accumulates in the large arteries to increase the arterial pressure.
• Over more prolonged periods— hours and days— the kidneys play an additional
major role.

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REGULATION OF CIRCULATION
CONTROL OF BLOOD VESSELS BY VASOMOTOR CENTRE
• Under normal conditions, the vasoconstrictor area of the
vasomotor centre transmits signals continuously to the
sympathetic vasoconstrictor nerve fibres over the entire body.
• This causes slow firing of these fibres at a rate of about one
half to two impulses per second.
• This continual firing is called sympathetic vasoconstrictor
tone.
• These impulses normally maintain a partial state of
contraction in the blood vessels, called vasomotor tone.

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REGULATION OF CIRCULATION
• Hormones that regulate arterial blood pressure are vasoactive, they are
broadly classified as vasoconstrictors and vasodilators.
Vasoconstriction
• Vasoconstriction is the narrowing of the blood vessels resulting from
contraction of the muscular wall of the vessels, especially in large arteries
and small arterioles.
• In vasoconstriction, the walls of the blood vessels shrink to reduce the size
of the area that blood can flow through.
• Vasoconstriction is an important mechanism for controlling haemorrhage
and acute blood loss, and a procedure by which the body averts
orthostatic hypotension.

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REGULATION OF CIRCULATION
• When vessels constrict, the flow of blood is
restricted or decreased, increasing vascular
resistance and increasing blood pressure.

• Vasoconstriction results from the increased

concentration of calcium ions within vascular
smooth muscle cells.

• Substances that cause vasoconstriction are known

as vasoconstrictors.
Fig. 4: Vasodilation process.

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REGULATION OF CIRCULATION
Vasodilation
• Vasodilation is the widening of blood vessels, as a result of relaxation of
smooth muscle cells within the vessel walls, particularly large veins, large
arteries, and smaller arterioles.
• Dilation of blood vessels increases blood flow and decreases vascular
resistance.
• Dilation of majorly the arterioles decreases blood pressure.

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 REGULATION OF CIRCULATION

• The primary function of vasodilation is to

increase blood flow in body tissues that need it
most.

• Vasodilation involves lowering intracellular

calcium concentration or by dephosphorylating
the light chain of myosin.

• Substances that cause vasodilation are called

vasodilators.
Fig. 5: Vasodilation process.

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Classification of vasoactive substances
 Vasodilators  Vasoconstrictors
• Acetylcholine • Renin
• Adenosine • Angiotensin II
• Atrial Natriuretic Peptide • Aldosterone
• Brain Natriuretic Peptide • Vasopressin
• Dopamine (kidney) • Norepinephrine
• Vasoactive Intestinal Peptide (VIP) • Epinephrine
• Prostacyclin • Thromboxane
• Epinephrine (liver, skeletal muscle) • Thyroid hormones
• Nitric oxide • Endothelins
• Bradykinin • Dopamine
• Urodilatin

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REGULATION OF CIRCULATION
• Norepinephrine is a catecholamine which functions as a hormone and a
neurotransmitter.
• It exerts its actions by binding to and activating noradrenergic receptors, all or
which are coupled to G-protein receptors.
• The general function of norepinephrine is to mobilize the brain and body for
action.
• It is a vasoconstrictor.

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REGULATION OF CIRCULATION
• Epinephrine is a hormone produced majorly by the adrenal glands.
• Epinephrine plays an important role in fight-or-flight response by acting on the
alpha- and beta- adrenergic receptors.
• It is a vasoconstrictor.
• Epinephrine also causes vasodilation in muscles, increasing blood flow to the
muscles when needed.

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REGULATION OF CIRCULATION
• Acetylcholine is an autocrine or paracrine hormone synthesized and
secreted by airway bronchial epithelial cells.
• Acetylcholine is also a neurotransmitter at autonomic synapses, and a
neuromodulator in the brain.
• Acetylcholine in the serum exerts a direct effect on vascular tone by binding
to muscarinic receptors present on vascular endothelium.
• The endothelial cells respond by increasing production of nitric oxide,
causing vasodilation.

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REGULATION OF CIRCULATION
Bradykinin
• Bradykinin is a peptide which is a mediator of inflammation that causes
blood vessels to dilate, and cause blood pressure to fall.
• Bradykinin is a potent endothelium-dependent vasodilator, leading to a drop
in blood pressure.
• Adenosine is a purine nucleoside which is ubiquitous in nature.
• Adenosine functions in biochemical processes as ADP and AMP, and in the
unphosphorylated form as a vasodilator.
• Adenosine exerts its actions through four receptor subtypes which are
coupled to G-proteins.
• Adenosine is a potent vasodilator in most vascular beds, but
vasoconstriction is produced in renal afferent arterioles and hepatic veins.

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REGULATION OF CIRCULATION
• Atrial natriuretic peptide (ANP) is a 28-amino acid polypeptide synthesized
and stored in the atrial muscle cells.
• ANP is a powerful vasodilator, and released into the bloodstream in response
to high blood volume when the atria are stretched.
• Vasoactive Intestinal Peptide (VIP) stimulates contractility in the heart, causes
vasodilation, and lowers arterial blood pressure.
• Nitric oxide (NO) is also known as endothelium-derived relaxing factor, is a
gasotransmitter found in the CNS,
• It is also released from endothelial cells.
• It is a potent vasodilator which relaxes the smooth muscles of the vessels,
resulting in increased blood flow.

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OVERVIEW OF THE LYMPHATIC SYSTEM
• The lymphatic system is a network of drainage system that drain excess
tissue fluid called lymph.
• The lymphatic system represents an accessory route through which fluid
can flow from the interstitial spaces into the blood.
• The lymphatic system returns the small amounts of excess protein to the
circulation, and fluid that leak from the blood into the interstitial spaces.
• It protects the body from invaders, maintains the fluid level in the body, and
absorbs dietary fat from the intestine.

36
OVERVIEW OF THE LYMPHATIC SYSTEM
• On average, about one tenth of the fluid filtered at the arterial ends of
the capillaries enters the lymphatic capillaries.
• This fluid (lymph) returns to the blood through the lymphatic system
rather than through the venous capillaries.
• The total quantity of all this lymph is normally only 2 to 4 litres each day.

37
COMPOSITION
• The lymphatic system is composed of
• (1) Lymphatic vessels (lymphatics) and plexuses
• (2) Lymph nodes and other lymphoid organs.
• Almost all tissues of the body have special lymph channels that drain excess
fluid directly from the interstitial spaces into the bloodstream.
• Exceptions: the superficial portions of the skin, the central nervous system, the
endomysium of muscles, and the bones.
• However, they have minute interstitial channels called prelymphatics.

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Fig. 1: The lymphatic system.

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• FUNCTIONS
• (1) Fluid balance: The lymphatic vessels transport fluids that have escaped from the
blood vascular system back to the bloodstream. About 30 litres (L) of fluid pass from
the blood capillaries into the interstitial spaces each day, whereas only 27 L pass
from the interstitial spaces back into the blood capillaries. The remaining 3 L is
passed to the lymphatics before getting to the venous system.

• (2) Fat absorption: Lacteals are special lymphatic vessels located in the lining of the
small intestine. Fats enter the lacteals and pass through the lymphatic vessels to
the venous circulation.

40
 FUNCTIONS
• (3) Body defense: The lymphoid tissues and organs house phagocytes
and lymphocytes, which play important roles in body defense and resistance to
disease.
• The lymphatic system functions as an “overflow mechanism” to return excess
proteins and excess fluid volume from the tissue spaces to the circulation.
• Therefore, the lymphatic system also plays a central role in controlling:
• (1) the concentration of proteins in the interstitial fluids,
• (2) the volume of interstitial fluid, and
• (3) the interstitial fluid pressure.

41
 LYMPH
• Lymph is tissue fluid that enters the lymphatic vessels and drains into the venous
blood via the thoracic and right lymphatic ducts.
• Lymph is derived from interstitial fluid that flows into the lymphatics.
• It contains clotting factors and clots on standing in vitro.
• Therefore, lymph as it first enters the terminal lymphatics has almost the same
composition as the interstitial fluid.
• The protein concentration in the interstitial fluid of most tissues averages about 2
g/dL, and the protein concentration of lymph flowing from these tissues is near this
value.
• Lymph formed in the liver has a protein concentration as high as 6 g/dL, and lymph
formed in the intestines has a protein concentration as high as 3 to 4 g/dL.
• Its protein content is generally lower than that of plasma, which contains about 7 g/dL.

42
 LYMPH
• Because about two thirds of all lymph normally is derived from the liver and
intestines, the thoracic duct lymph, which is a mixture of lymph from all areas of
the body, usually has a protein concentration of 3 to 5 g/dL.
• The amount of protein returned to the blood from the lymphatics in 1 d is equal to
25–50% of the total circulating plasma protein.
• After a fatty meal, thoracic duct lymph sometimes contains as much as 1 to 2
percent fat.
• Finally, even large particles, such as bacteria, can push their way between the
endothelial cells of the lymphatic capillaries and in this way enter the lymph.

43
 LYMPH
• About 100 milliliters per hour of lymph flows through the thoracic duct of a resting
human.
• Approximately another 20 milliliters flows into the circulation each hour through
other channels, making a total estimated lymph flow of about 120 ml/hr or 2 to 3
liters per day.
• Normal lymph flow is very little at interstitial fluid pressures more negative than the
normal value of −6 mm Hg.

44
LYMPHATICS
• Lymphatic vessels COLLECT fluid from interstitial space and DRAIN it back into
the bloodstream.
• It can be divided into two types: (1) initial lymphatics and (2) collecting
lymphatics.
• (1) Initial lymphatics: Collect fluid from the interstitial space and drain it into the
collecting lymphatics.
• They lack valves and smooth muscle in their walls, are found in regions such as
the intestine or skeletal muscle.
• (2) Collecting lymphatics: Propel the lymph along the vessels and drain it into the
vein.
• They have valves and smooth muscle in their walls.

45
LYMPHATICS
• Essentially, all the lymph vessels from the lower part of the body eventually empty
into the thoracic duct.
• Thoracic duct in turn empties into the blood venous system at the juncture of the left
internal jugular vein and left subclavian vein.
• Lymph from the left side of the head, the left arm, and parts of the chest region also
enters the thoracic duct before it empties into the veins.
• Lymph from the right side of the neck and head, the right arm, and parts of the right
thorax enters the right lymph duct (much smaller than the thoracic duct).
• The right lymph duct empties into the blood venous system at the juncture of the
right subclavian vein and internal jugular vein.

46
Fig. 2: The lymphatic system.

47
LYMPHATICS
• The reason for the mechanism of the entrance of protein into the lymphatic
capillaries is the presence of a special structure.
• The endothelial cells of the lymphatic capillary attached by anchoring filaments to
the surrounding connective tissue.
• At the junctions of adjacent endothelial cells, the edge of one endothelial cell
overlaps the edge of the adjacent cell.
• The overlapping edge is free to flap inward, thus forming a minute valve that
opens to the interior of the lymphatic capillary.

48
Fig. 3: Special features of the lymphatic capillaries and collecting lymphatics.

49
LYMPHOID ORGANS
• Lymphoid organs are the part of the lymphatic system that are directly involved in
the immune system. They include:
(1) Lymph nodes (2) the spleen, (3) thymus gland, (4) tonsils, and (5) Peyer’s patches of the
intestine, as well as (5) bits of lymphoid tissue scattered in the epithelial and connective
tissues (6) bone marrow
• They produce lymphocytes, as is the case with the thymus and bone marrow.
• They also house lymphocytes and other white blood cells that are ready to
respond to pathogens, as is the case with lymph nodes, the spleen and tonsils.

50
Fig. 4: Lymphoid organs.

51
 LYMPHOID ORGANS
Efferent lymphatics

Medullary sinus
• Lymph nodes: protect the body by removing
foreign material such as bacteria and tumour cells Deep cortex with
from the lymphatic stream. lymph sinus
Outer cortex with
• Also, they store lymphocytes that function in the germinal centre

immune response. Subcapsular space

• Lymphocytes enter the circulation principally

Afferent lymphatics
through the lymphatics, and there are appreciable
numbers of lymphocytes in thoracic duct lymph. Fig. 5: Lymph node.

52
A B

C D

Fig. 6: Lymphoid organs or tissue (A) The spleen (B) Thymus (C) Tonsil (D) Peyer’s patches. 53
LYMPHOID ORGANS
• Mucosa-associated lymphatic tissue
• Peyer’s patches and the tonsils are part of the collection of small lymphoid
tissues referred to as mucosa-associated lymphatic tissue (MALT)
• MALT acts as a guard to protect the upper respiratory and digestive tracts from
the never-ending attacks of foreign matter entering these cavities.

54
LYMPHATIC CIRCULATION
• Fluid efflux normally exceeds influx across the capillary walls, but the extra fluid
enters the lymphatics and drains through them back into the blood.
• This keeps the interstitial fluid pressure from rising and promotes the turnover of
tissue fluid.
• The normal 24-h lymph flow is 2 to 4 L.
• The lymphatics can carry proteins and large particulate matter away from the
tissue spaces, neither of which can be removed by absorption directly into the
blood capillaries.
• This return of proteins to the blood from the interstitial spaces is an essential
function without which we would die within about 24 hours.

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LYMPHATIC CIRCULATION
• Lymph channels excess fluid directly from the interstitial spaces into the
bloodstream.
• Most of the fluid filtering from the arterial ends of blood capillaries flows among
the cells.
• Finally, the fluid is reabsorbed back into the venous ends of the blood capillaries.
• About one tenth of the fluid instead enters the lymphatic capillaries and returns to
the blood through the lymphatic system rather than through the venous capillaries.

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LYMPHATIC CIRCULATION
• The initial lymphatic vessel drains the interstitial space.
• The fluid enter the initial lymphatic vessel through loose junctions between the
endothelial cells that form their walls.
• The fluid is passed to the collecting lymphatic vessel under the influence of
muscle contractions of the organs and contraction of arterioles and venules in
the region.
• The collecting lymphatic vessel becomes stretched with fluid, the smooth
muscle in the wall of the vessel automatically contracts.
• Furthermore, each segment of the lymph vessel between successive valves
functions as a separate automatic pump.

57
LYMPHATIC CIRCULATION
• That is, even slight filling of a segment causes it to contract, and the fluid is
pumped through the next valve into the next lymphatic segment.
• The valves and smooth muscle in the walls collecting lymphatic vessels
contract in a peristaltic fashion, propelling the lymph along the vessels.
• The process continuing all along the lymph vessel until the fluid is finally
emptied into the blood circulation.
• In a very large lymph vessel such as the thoracic duct, this lymphatic pump can
generate pressures as great as 50 to 100 mm Hg.

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LYMPHATIC CIRCULATION

• Flow in the collecting lymphatics is further aided by:

• Movements of skeletal muscle,
• The negative intrathoracic pressure during inspiration, and
• The suction effect of high velocity flow of blood in the veins in which the
lymphatics terminate.
• However, the contractions are the principal factor propelling the lymph.

59
REGULATION OF LYMPH FLOW
• Normal lymph flow is very little at interstitial fluid pressures more negative than the
normal value of −6 mm Hg.
• Then, as the INTERSTITIAL FLUID pressure rises to 0 mm Hg (atmospheric
pressure), flow increases more than 20-fold.
• Therefore, any factor that increases interstitial fluid pressure also increases lymph
flow if the lymph vessels are functioning normally.
• Such factors include the following:
• • Elevated capillary hydrostatic pressure
• • Decreased plasma colloid osmotic pressure
• • Increased interstitial fluid colloid osmotic pressure
• • Increased permeability of the capillaries

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 REGULATION OF LYMPH FLOW
• However, when the interstitial fluid
pressure becomes 1 or 2 mm Hg greater
than atmospheric pressure (>0 mm Hg),
lymph flow fails to rise any further at still
higher pressures.

(B) The activity of the lymphatic ducts.

Fig. 7: Relative lymph flow and interstitial
fluid pressure.

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PATHOPHYSIOLOGY
• The lymphatic system consists of a network of lymphatic plexuses and vessels,
lymph nodes, and other lymphoid organs such as the spleen and tonsils.
• The lymphatic system helps to absorb dietary fat from the intestine, protects
the body from foreign invaders, and maintains extracellular fluid volume by
returning excess tissue fluid to the blood.
• Lymph moves through lymphatic vessels and finally drains into the venous
system through the thoracic duct and the right lymphatic duct.

62
PATHOPHYSIOLOGY
• Significance of Negative Interstitial Fluid Pressure (NIFP)
• This serves as a means for holding the body tissues together.
• The tissues are held together by the negative interstitial fluid pressure, which is a
partial vacuum.
• When the tissues lose their negative pressure, fluid accumulates in the spaces and
the condition known as oedema occurs.

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 PATHOPHYSIOLOGY Table 1: Factors affecting ISF volume
and oedema.

• Oedema is the accumulation of interstitial

fluid in abnormally large amounts.
• Causes of increased interstitial fluid volume
and oedema are summarized in Table 1.

64
PATHOPHYSIOLOGY
• Oedema caused by lymphatic obstruction is called lymphedema, and the edema fluid
has a high protein content.
• If it persists, it causes a chronic inflammatory condition that leads to fibrosis of the
interstitial tissue.
• One cause of lymphedema is radical mastectomy, during which removal of the
axillary lymph nodes leads to reduced lymph drainage.
• In filariasis, parasitic worms migrate into the lymphatics and obstruct them.
• Fluid accumulation plus tissue reaction lead in time to massive swelling, usually of
the legs or scrotum (elephantiasis).

65
SEMINAR PRESENTATION

• TOPIC: Cerebral circulation

• This topic is to be presented by each group, and it will be evaluated and scored
accordingly.

• Time and format will be communicated through the class representatives.

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