Editing Lymph

{{Short description|Fluid that circulates throughout the lymphatic system}}
{{Use dmy dates|date=May 2021}}
{{Infobox lymph
| Name        = Lymph
| Latin       = lympha
| Image       = Illu lymph capillary.png
| Caption     = Diagram showing the formation of lymph from [[interstitial fluid]] (labeled here as "Tissue fluid"). Note how the tissue fluid is entering the blind ends of [[lymph capillaries]] (shown as deep green arrows).
| Image2      =
| Caption2    =
| source   = Formed from [[interstitial fluid]]
}}

'''Lymph''' ({{etymology|la|{{Wikt-lang|la|lympha}}|water}})<ref>{{cite Merriam-Webster|lymph |access-date=29 May 2010}}</ref> is the fluid that flows through the [[lymphatic system]], a system composed of [[lymph vessel]]s (channels) and intervening [[lymph node]]s whose function, like the [[venous system]], is to return fluid from the tissues to be recirculated. At the origin of the fluid-return process, [[interstitial fluid]]—the fluid between the cells in all [[body tissue]]s<ref>[http://www.anaesthesiamcq.com/FluidBook/fl2_1.php Fluid Physiology: 2.1 Fluid Compartments]</ref>—enters the [[lymph capillary|lymph capillaries]]. This lymphatic fluid is then transported via progressively larger lymphatic vessels through lymph nodes, where substances are removed by tissue [[lymphocyte]]s and circulating lymphocytes are added to the fluid, before emptying ultimately into the right or the left [[subclavian vein]], where it mixes with central [[venous blood]].

Because it is derived from interstitial fluid, with which blood and surrounding cells continually exchange substances, lymph undergoes continual change in composition. It is generally similar to [[blood plasma]], which is the fluid component of blood. Lymph returns [[protein]]s and excess interstitial fluid to the [[bloodstream]]. Lymph also transports fats from the [[digestive system]] (beginning in the [[lacteal]]s) to the blood via [[chylomicron]]s.

Bacteria may enter the lymph channels and be transported to [[lymph node]]s, where the bacteria are destroyed. [[Metastasis|Metastatic]] cancer cells can also be transported via lymph.

==Etymology==
The word ''lymph'' is derived from the name of the [[Religion in ancient Rome|ancient Roman deity]] of fresh water, [[Lympha]].

==Structure==
[[Image:Homa limfo 001.jpg|thumb|Human lymph, obtained after a [[thoracic duct]] injury]]
Lymph has a composition similar but not identical to that of [[blood plasma]]. Lymph that leaves a lymph node is richer in [[lymphocyte]]s than blood plasma is. The lymph formed in the [[human digestive system]] called [[chyle]] is rich in [[triglyceride]]s (fat), and looks milky white because of its lipid content.

==Development==
[[File:Capillary Microcirculation.svg|thumb|250 px|Formation of interstitial fluid from blood. [[Starling force]]s are labelled: the hydrostatic pressure is higher proximally, driving fluid out; oncotic forces are higher distally, pulling fluid in.]]

Blood supplies [[nutrient]]s and important [[metabolite]]s to the cells of a [[Tissue (biology)|tissue]] and collects back the waste products they produce, which requires exchange of respective constituents between the blood and tissue cells. This exchange is not direct, but instead occurs through an intermediary called [[interstitial fluid]], which occupies the spaces between cells. As the blood and the surrounding cells continually add and remove substances from the interstitial fluid, its composition continually changes. Water and [[solutes]] can pass between the interstitial fluid and blood via [[diffusion]] across gaps in [[capillary]] walls called [[intercellular cleft]]s; thus, the blood and interstitial fluid are in [[dynamic equilibrium]] with each other.<ref name="Gray">{{Cite web |url=http://theodora.com/anatomy/the_lymphatic_system.html |title=The Lymphatic System |work=Human Anatomy (Gray's Anatomy) |access-date=12 October 2012}}</ref>

Interstitial fluid forms at the [[arteriole|arterial]] (coming from the heart) end of capillaries because of the higher pressure of blood compared to [[vein]]s, and most of it returns to its [[venule|venous]] ends and [[venule]]s; the rest (up to 10%) enters the [[lymph capillary|lymph capillaries]] as lymph.<ref name=grays>{{cite book |last= Warwick|first= Roger|author2=Peter L. Williams |others= illustrated by Richard E. M. Moore|title= Gray's anatomy|orig-year= 1858|edition= Thirty-fifth|year= 1973|publisher= Longman|location= London|pages= 588–785|chapter= Angiology (Chapter 6)}}</ref> (Prior to entry, this fluid is referred to as the '''lymph obligatory load''', or LOL, as the lymphatic system is effectively "obliged" to return it to the cardiovascular network.<ref>{{cite book
 | title=Applied Anatomy & Physiology for Manual Therapists
 | first1=Pat | last1=Archer | first2=Lisa A. | last2=Nelson
 | year=2012 | page=604 | publisher=Wolters Kluwer Health
 | isbn=9781451179705
 | url=https://books.google.com/books?id=Z3VG56tZkQoC&pg=PT604 }}</ref>) The lymph when formed is a watery clear liquid with the same composition as the interstitial fluid. However, as it flows through the lymph nodes it comes in contact with blood, and tends to accumulate more cells (particularly, lymphocytes) and proteins.<ref name=sloop>{{cite journal |last= Sloop|first= Charles H.|author2=Ladislav Dory |author3=Paul S. Roheim |date=March 1987|title=Interstitial fluid lipoproteins|journal= Journal of Lipid Research|volume= 28|issue= 3|pages= 225–237|doi= 10.1016/S0022-2275(20)38701-0|url= http://www.jlr.org/cgi/reprint/28/3/225.pdf|access-date=7 July 2008 |pmid= 3553402|doi-access= free}}</ref>

==Functions==
===Components===
Lymph returns [[protein]]s and excess interstitial fluid to the [[bloodstream]]. Lymph may pick up bacteria and transport them to lymph nodes, where the bacteria are destroyed. [[Metastasis|Metastatic]] cancer cells can also be transported via lymph. Lymph also transports fats from the [[digestive system]] (beginning in the [[lacteal]]s) to the blood via [[chylomicron]]s.

===Circulation===
{{Main|Lymphatic system}}
Tubular vessels transport lymph back to the blood, ultimately replacing the volume lost during the formation of the interstitial fluid. These channels are the lymphatic channels, or simply ''lymphatics''.<ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=4217 |title=Definition of lymphatics |access-date=6 July 2008 |work=Webster's New World Medical Dictionary |publisher= MedicineNet.com}}</ref>

Unlike the cardiovascular system, the lymphatic system is not closed.  In some amphibian and [[reptile|reptilian]] species, the lymphatic system has central pumps, called [[lymph heart]]s, which typically exist in pairs,<ref name="Hedrick">{{cite journal | last1=Hedrick | first1=Michael S. | last2=Hillman | first2=Stanley S. | last3=Drewes | first3=Robert C. | last4=Withers | first4=Philip C. | title=Lymphatic regulation in nonmammalian vertebrates | journal=Journal of Applied Physiology | volume=115 | issue=3 | date=1 July 2013 | issn=8750-7587 | doi=10.1152/japplphysiol.00201.2013 | pages=297–308|pmid=23640588|url=https://journals.physiology.org/doi/full/10.1152/japplphysiol.00201.2013| url-access=subscription }}</ref><ref>{{cite journal |last1=Banda |first1=Chihena H. |last2=Shiraishi |first2=Makoto |last3=Mitsui |first3=Kohei |last4=Okada |first4=Yoshimoto |last5=Danno |first5=Kanako |last6=Ishiura |first6=Ryohei |last7=Maemura |first7=Kaho |last8=Chiba |first8=Chikafumi |last9=Mizoguchi |first9=Akira |last10=Imanaka-Yoshida |first10=Kyoko |last11=Maruyama |first11=Kazuaki |last12=Narushima |first12=Mitsunaga |title=Structural and functional analysis of the newt lymphatic system |journal=Scientific Reports |date=27 April 2023 |volume=13 |issue=1 |page=6902 |doi=10.1038/s41598-023-34169-w |pmid=37106059 |language=en |issn=2045-2322|doi-access=free |pmc=10140069 }}</ref> but humans and other mammals do not have a central lymph pump. Lymph transport is slow and sporadic.<ref name=Hedrick/> Despite low pressure, lymph movement occurs due to [[peristalsis]] (propulsion of the lymph due to alternate contraction and relaxation of [[smooth muscle]] tissue), valves, and compression during contraction of adjacent skeletal muscle and [[arterial]] [[pulse|pulsation]].<ref name=Shayan2006>{{cite journal  |author1=Shayan, Ramin |author2=Achen, Marc G. |author3=Stacker, Steven A. | year = 2006  | title = Lymphatic vessels in cancer metastasis: bridging the gaps | volume = 27  | issue = 9  | pages = 1729–38  | doi = 10.1093/carcin/bgl031  | pmid = 16597644  | journal = Carcinogenesis | doi-access = free  }}</ref>

Lymph that enters the lymph vessels from the interstitial spaces usually does not flow backwards along the vessels because of the presence of valves. If excessive [[hydrostatic pressure]] develops within the lymph vessels, though, some fluid can leak back into the interstitial spaces and contribute to formation of [[edema]].

The flow of lymph in the [[thoracic duct]] in an average resting person usually approximates 100ml per hour. Accompanied by another ~25ml per hour in other lymph vessels, the total lymph flow in the body is about 4 to 5 litres per day. This can be elevated several fold while exercising. It is estimated that without lymphatic flow, the average resting person would die within 24 hours.<ref>{{Cite book|title=Guyton and Hall Textbook of Medical Physiology|publisher=Saunders|year=2010|isbn=978-1416045748|pages=186, 187}}</ref>

==Clinical significance==
{{expand section|date=March 2018}}
[[Histology|Histopathological examination]] of the lymph system is used as a screening tool for [[immune system]] analysis in conjunction with pathological changes in other [[organ (anatomy)|organ systems]] and [[clinical pathology]] to assess disease status.<ref name="Elmore11">{{cite journal | last=Elmore | first=Susan A. | title=Enhanced histopathology of the immune system | journal=Toxicologic Pathology | volume=40 | issue=2 | date=16 November 2011 | issn=0192-6233 | doi=10.1177/0192623311427571 | pages=148–156|pmid=22089843|pmc=3465566}}</ref> Although histological assessment of the lymph system does not directly measure immune function, it can be combined with identification of chemical [[biomarker]]s to determine underlying changes in the diseased immune system.<ref name="Elmore18">{{cite book | last=Elmore | first=Susan A. | title=Immunotoxicity Testing | volume=1803 | chapter=Enhanced Histopathology Evaluation of Lymphoid Organs | series=Methods in Molecular Biology | year=2018 | isbn=978-1-4939-8548-7 | issn=1064-3745 | doi=10.1007/978-1-4939-8549-4_10 | pages=147–168|pmid=29882138}}</ref>

==As a growth medium==
In 1907 the zoologist [[Ross Granville Harrison]] demonstrated the growth of frog nerve cell processes in a medium of clotted lymph. It is made up of lymph nodes and vessels.

In 1913, E. Steinhardt, C. Israeli, and R. A. Lambert grew [[vaccinia]] virus in fragments of [[tissue culture]] from guinea pig [[cornea]] grown in lymph.<ref>Steinhardt, E; Israeli, C; and Lambert, R.A. (1913) "Studies on the cultivation of the virus of vaccinia" ''J. Inf Dis. 13, 294–300</ref>

==References==
{{Reflist|2}}

==External links==
* {{Commons category-inline|Lymph fluid}}

{{Lymphatic trunks and ducts}}
{{Arteries and veins}}
{{Authority control}}
{{Portal bar|Biology}}

[[Category:Body fluids]]
[[Category:Lymphatic system]]
[[Category:Lymph fluid| ]]