SINCE THE observations of Starling in 1894,1 a number of studies have demonstrated a marked increase in the flow of lymph in the hepatic hilar lymphatics and thoracic duct in association with experimental ascites,2-5 hepatic venous outflow obstruction,6-8 and experimental cirrhosis.9-11 A similar increase in lymph flow in the thoracic duct has been observed recently in humans with cirrhosis,12-14 or congestive heart failure15; and the marked enlargement of the lymphatics in the hilum of the cirrhotic liver, so familiar to surgeons who have performed operations for portal hypertension, has been documented by a careful histopathologic study.16 Although the cause of the augmented production of hepatic lymph is not certain, the bulk of evidence indicates that it is in large part a mechanical phenomenon resulting from obstruction to the outflow of blood from the liver sinusoid and the consequent spill-over of the plasma portion
ORLOFF MJ, WRIGHT PW, DeBENEDETTI MJ, HALASZ NA, ANNETTS DL, MUSICANT ME, GOODHEAD B. Experimental AscitesVII. The Effects of External Drainage of the Thoracic Duct on Ascites and Hepatic Hemodynamics. Arch Surg. 1966;93(1):119–130. doi:10.1001/archsurg.1966.01330010121015
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