May 25, 2001

Role of the gut lymphatic system in multiple organ failure

Current Opinion in Critical Care
Edwin A Deitch

Abstract

The central concept of this review is that gut-derived factors contained primarily in the mesenteric lymph rather than the portal blood contribute to distant organ injury. This hypothesis is supported by recent studies indicating that division of the mesenteric lymphatic ducts prevents lung injury after hemorrhagic shock and significantly ameliorates lung injury after thermal injury. The mechanism of hemorrhagic shock-induced lung injury appears to be through mesenteric lymph-induced activation of neutrophils and activation/injury of endothelial cells. This notion is supported by in vitro studies indicating that mesenteric lymph, but not portal vein plasma, collected after a nonlethal episode of hemorrhagic shock activates neutrophils, increases endothelial cell monolayer permeability, and can even cause endothelial cell death. This concept that gut-derived factors contained primarily in the mesenteric lymph rather than the portal system potentiate the development of distant organ (lung) injury, if correct, would help clarify several important issues. First, because the lung is the first organ exposed to mesenteric lymph (i.e., mesenteric lymph enters the subclavian via the thoracic duct), it would help explain the clinical obs...Continue Reading

Mentioned in this Paper

Portal System
Lung
Portal Venous System
Inflammation Mediators
Entire Portal Vein
Entire Trunk of Portal Vein
Neutrophils as Percentage of Blood Leukocytes (Lab Test)
Portal Vein Structure
Mesentery
Structure of Trunk of Portal Vein

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