Thoracic duct lymph flow after pancreatitis: role in circulatory collapse.

We examined the effects of acute hemorrhagic pancreatitis on thoracic duct lymph flow and its protein concentration. Thoracic duct lymph flow increased and the protein concentration decreased. These changes in the lymph were associated with steady decreases in arterial pressure and cardiac output and increase in systemic vascular resistance. The results suggest that the increased lymph flow and decreased protein concentration were due to either an ultrafiltration causing a dilution of the lymph protein concentration or to the heterogeneous origin of thoracic duct lymph such that redistribution of blood flow to the essential beds (eg, kidneys) after arterial hypotension altered the lymph flow and its protein concentration. The increase in filtration and the absence of a compensatory "autotransfusion" during arterial hypotension may be a mechanism contributing to circulatory shock in acute pancreatitis.