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Cardiac Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Megan Horsley, Jeffrey Anderson
Chyle is often described as a white, milky-appearing substance composed of chylomicrons and lymph. Lymph fluid from the intestines, as well as the lower extremities and liver, is transported by lymphatic channels that converge into the thoracic duct at the level of the cisterna chyli. The majority of terminal drainage of lymphatic fluid into the venous system is through the thoracic duct and main connection at the junction of the left subclavian and internal jugular veins. The primary purpose of chyle is the absorption and transportation of long-chain triglycerides (LCT) in the intestines. Chyle is formed in the lacteals of the intestines during digestion in response to the presence of intraluminal fat. The chyle binds with LCT to form chylomicrons, which are then absorbed and transported by the intestinal lymphatics to the bloodstream. Chyle is also rich in proteins and is responsible for absorbing fat-soluble vitamins; therefore, high losses are of great nutritional concern. When a person is fasting, the fluid can appear less white, and more yellowish or clear.
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Lymphangiography is another imaging technique that can be used to demonstrate the lymphatic system. The procedure will visualise the subcutaneous vessels of the leg, corresponding to the saphenous vein and then accompanying the iliac vessels and the aorta until they drain into the cisterna chyli. The cisterna chyli in turn drains into the thoracic duct, which lies on the spine behind the aorta and eventually drains into the left subclavian vein.
How should aggressive chyloreflux (e.g., chyluria, chyloascites, chylothorax, chyle leakage) be handled?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Cristobal M. Papendieck, Miguel Amore
The drainage of accumulated chylous fluid is an adjunctive management to surgical treatment. Thoracentesis and paracentesis can relieve symptoms of respiratory failure, but tube thoracostomy is often indicated to obtain continuous drainage. Video-assisted thoracic surgery (VATS) is a technique to allow necessary intervention to manage chylous leakage based on the amount and location of output of the chylous leak. Pleural abrasion and pleurodesis with talc or other agents are effective when output measured through a chest tube is less than 500 mL/day. Fibrin glue can be used when no focal drainage point can be determined with diffuse drainage. Partial pleurectomy is another option to resolve symptoms. However, the ligation of the thoracic duct is often indicated for high-output chylous drainage exceeding 1 L/day, either by VATS or thoracotomy. Alternatively, coil embolization of the thoracic duct may be performed through the cannulation of the cisterna chyli. The Denver pleuroperitoneal shunt has also been used for extreme cases of chylothorax.1, 3
A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization
Published in Egyptian Journal of Anaesthesia, 2018
Vedran Premuzic, Ranko Smiljanic, Drazen Perkov
Thoracic duct, wide only 2–6 mm, transports lymph from the lower part of the body and mixing with fluids from intestines form a mixture called chyle and pours into venous circulation by sometimes multiple branches. Its variations are seen in more than one third of the population. Cisterna chyli is present in only 50% of humans, when absent, there are 2 or more lymph ducts. Clouse relationship with other structures leads of injury during operations, a main cause of traumatic duct injury. Other causes as malignancies and coronary artery bypass are not so common, especially injuries during catheter insertions (<1% of cases). Periprocedural central venous catheter complications are mostly related to pneumo or hematothorax, vascular injury and the catheter tip malposition and very rarely thoracic duct injury which is similar with our experiences. The rate of these complications is higher in patients with prior temporary or permanent central venous catheters on hemodialysis. Patients with chylothorax manifest with onsets of pleuritic pain or dyspnea caused by pleural effusions which can also be absent in cases with low flow chylothorax and manifest only as unspecific pleural effusions on chest X-rays [7].
Relationship Between Early Oral Intake Post Pancreaticoduodenectomy and Chyle Leakage: A Retrospective Cohort Study
Published in Journal of Investigative Surgery, 2021
Zheng Chen, Zhen Zhang, Bin Lin, Wei Feng, Fanlai Meng, Xin Shi
Lymph dissection of the para-aortic area and the number of harvested nodes were the independent risk factors for CL after PD. This finding was consistent with the results of previous studies [18, 29]: the higher the number of lymph nodes dissected, the wider the scope of dissection. Extensive lymph node dissection will lead to more lymphatic vessels being cut and damaged, which will lead to lymphatic leakage after surgery. Because the cisterna chyli and its major branches are located near the pancreatic head and neck, they may be injured during pancreatic resection, especially PD. The key to preventing chylous fistula after surgery is avoiding damage to the cisterna chyli during surgery.
The Association Between the Number of Retrieved Pelvic Lymph Nodes and Ipsilateral Lower Limb Lymphedema in Patients With Gynecologic Cancer
Published in Journal of Investigative Surgery, 2022
Sang Geun Jung, Sang Hee Im, Migang Kim, Min Chul Choi, Won Duk Joo, Seung Hun Song, Chan Lee, Hyun Park
In our study, the cutoff value and association between the number of removed LNs and lymphedema were investigated side-specifically, which have not been reported yet. The lymphatic fluid of one leg flows afferently via the ipsilateral pelvic lymphatic channels to the cisterna chyli located at the lower end of the thoracic duct [10]. Surgical dissection of pelvic LNs can interfere with the lymphatic flow of each pelvic side to a different degree, depending on the extent of disruption. In gynecologic cancers, postoperative LLE occurs commonly on a unilateral limb, even though most potential risk factors, including radiation therapy, affect pelvic and distal lymphatics bilaterally [7, 11].