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Fig. 45. Mechanism of vascular-and-interstitial circulation of water

Starling's mechanism is described in detail in the section "Acute circulatory disorders" (p. 145). The interrelations between hydrostatic, hydrodynamic and oncotic pressure in different areas of the capillary and interstitial space ensure an active filtration in the arterial and active resorption in venous ends of (he capillary.

Starling's law explains certain events occurred in practice. In case of hypoproteinemia a fluid leaves a vascular bed that leads to development of edemas. In disturbance of permeability of the capillary membrane proteins get into interstitial space (IS) from vascular bed, in the process the proteins carry away water that also leads to development of edemas. High hydrodynamic pressure in the vessels increases filtration and also leads to edemas.

Hence, a medicinal tactics on prevention and treatment of edemas:

— decrease of hydrodynamic pressure;

— elevation of protein concentration in plasma;

— strengthening of vascular wall (glucocorticoids, vitamins C, E, P).

A conclusion may be drawn that in emaciated patients with hypoproteinemia, in the patients being in a state of shock VCB can be restored only by means of transfusions of colloid solutions (plasma, albumin) and macromolecular solutions.

Histamine, acetylcholine (Ach), lactic acid, folliculin, vitamin B and acidosis contribute to dilatation of pores of capillary endothelium.

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