Microcirculation

It describes the circulation of blood in the smallest type of blood vessels the capillary which
has a wall made up of a single layer of endothelial cells. This has two ends arteriolar end and venous
end. Between the arteriolar end and the beginning of the capillary there is precapillary sphincter
metarteriole, this serves as a switch determining the blood flow to the capillary bed.
All the substances cross the capillary walls by the simple diffusion.
Lipid soluble substances O2 and CO2 cross the capillary wall by diffusing through the
endothelial cells.
Water soluble substances amino acids, glucose and ions cross the capillary wall by diffusing
through the aqueous pores between the endothelial cells.
Proteins have large molecular size so they cannot cross the cross the capillaries, except the
glomerular capillaries where the gaps are large enough for the proteins to diffuse between
them.
Fluids movement mainly depends on the osmotic pressure Starling Force.
The fluid exchange process is basically determined by two types of pressures:
1- Hydrostatic pressure.
2- Effective osmotic pressure AKA oncotic pressure or colloid osmotic pressure, which
depends on the protein concentration.

Starling Equation: describes the movement of fluids across a capillary wall.
Jv = Kf [ (Pc Pi) ( c i) ]
Jv Fluid movement.
Kf Hydraulic conductance: it indicates the water permeability across the capillary wall. The
glomerular capillaries have the highest Kf, whereas the cerebral capillaries have the lowest Kf.
Pc Capillary hydrostatic pressure: is a force favoring filtration out of the capillary. The value of
Pc is closer to the arterial pressure. Pc is more affected by changes in the venous pressure except
in glomerular capillaries. Pc declines along the length of the capillaries, therefore Pc is higher at
the arteriolar end of the capillary.
Pi Interstitial hydrostatic pressure: is a force opposing filtration. Pi is normally equal to zero,
or it may be slightly negative.
c Capillary oncotic pressure: is the force opposing filtration. And it depends on the protein
concentration.
Protein concentration c Filtration
i Interstitial oncotic pressure: is a force favoring filtration. It is determined by the interstitial
fluid protein concentration.
Filtration force is indicated by the + sign.
Absorption force is indicated by the - sign.
Pc and c are the major forces, Pc favors filtration out of the capillary but c favors the
absorption.

Lymph
The lymphatic system takes the lymph from the interstitial spaces and returns it into the large veins
unidirectional movement.
Lymph in interstitial spaces Thoracic duct Large veins
The lymph flow is promoted by:
1- Contraction of smooth muscle cells in the lymph vessels.
2- Compression of lymph vessels by the activity of the surrounding skeletal muscles.
Edema: is the increase in the interstitial fluid volume due to increased filtration out of the capillaries.
This is due to:
1- Increased Kf: due to destruction of the capillary wall or release of cytokines and histamines.
2- Increased Pc: due to arteriolar dilation, venous constriction, heart failure or increased ECF
volume.
3- Decreased c: due to less plasma proteins malnutrition or nephrotic syndrome.
Other causes:
Long standing.
Removal of lymph nodes.
Parasitic infection of lymph nodes.