User:GreyCanary21/Oncotic pressure

Above, we see that the presence of colloids can increase the flow towards the high concentration of colloids by creating colloid osmotic pressure in an otherwise state of equilibrium.

Oncotic pressure, or colloid osmotic-pressure, is a form of osmotic pressure induced by the proteins, notably albumin, in a blood vessel's plasma (blood/liquid) that displaces water molecules, thus creating a relative water molecule deficit with water molecules moving back into the circulatory system within the lower venous pressure end of capillaries. It has the opposing effect of both hydrostatic blood pressure pushing water and small molecules out of the blood into the interstitial spaces within the arterial end of capillaries and interstitial colloidal osmotic pressure. These interacting factors determine the partition balancing of total body extracellular water between the blood plasma and the larger extracellular water volume outside the blood stream.

In the illustration above, we see how the osmotic pressure changes over the length of the capillary, with oncotic pressure remaining the same. Overall direction of fluid flow in relation to equal bidirectional flow is shown by the orange and black lines, respectively.

It is suspected to have a major effect on the pressure across the glomerular filter. However, this concept has been strongly criticized and attention has been shifted to the impact of the intravascular glycocalyx layer as the major player.

Description

Throughout the body, dissolved compounds have an osmotic pressure. Because large plasma proteins cannot easily cross through the capillary walls, their effect on the osmotic pressure of the capillary interiors will, to some extent, balance out the tendency for fluid to leak out of the capillaries. In other words, the osmotic pressure tends to pull fluid into the capillaries. In conditions where plasma proteins are reduced, e.g. from being lost in the urine (proteinuria), there will be a reduction in oncotic pressure and an increase in filtration across the capillary, resulting in excess fluid buildup in the tissues (edema).

The large majority of oncotic pressure in capillaries is generated by the presence of high quantities of albumin, a protein that constitutes approximately 80% of the total oncotic pressure exerted by blood plasma on interstitial fluid . The total oncotic pressure of an average capillary is about 28 mmHg with albumin contributing approximately 22 mmHg of this oncotic pressure, despite only representing 50% of all protein in blood plasma at 35-50 g/L. Because blood proteins cannot escape through capillary endothelium, oncotic pressure of capillary beds tends to draw water into the vessels. It is necessary to understand the oncotic pressure as a balance; because the blood proteins reduce interior permeability, less plasma fluid can exit the vessel.

Oncotic pressure is represented by the symbol Π or π in the Starling equation and elsewhere. The Starling equation in particular describes general fluid flow by relating oncotic pressure to capillary hydrostatic pressure, interstitial fluid hydrostatic pressure, and interstitial fluid colloid osmotic pressure, as well as several descriptive constants, as shown below:

$\ J_{v}=L_{\mathrm {p} }S([P_{\mathrm {c} }-P_{\mathrm {i} }]-\sigma [\pi _{\mathrm {p} }-\pi _{\mathrm {i} }])$

At the arteriolar end of the capillary, blood pressure starts at about 36 mm Hg and decreases to around 15 mm Hg at the venous end, with oncotic pressure at a stable 25-28 mm Hg. Within the capillary, reabsorption due to this venous pressure difference is estimated to be around 90% that of the filtered fluid, with the extra 10% being returned via lymphatics in order to maintain stable blood volume.

Etymology

'Oncotic' by definition is termed as 'pertaining to swelling', indicating the effect of oncotic imbalance on the swelling of tissues.

The word itself is derived from onco- and -otic; 'onco-' meaning 'pertaining to mass or tumors' and '-otic' meaning 'having a relationship to the ear'.

Physiological impact

In tissues, physiological disruption can arise with decreased oncotic pressure.

Decreased colloidal osmotic pressure, most notably seen in hypoalbuminemia, can cause edema and decrease in blood volume as fluid is not reabsorbed into the bloodstream. Colloid pressure in these cases can be lost due to a number of different factors, but primarily decreased colloid production or increased loss of colloids through glomerular filtration. This low pressure often correlates with poor surgical outcomes.

In the clinical setting, there are two types of fluids that are used for intravenous drips: crystalloids and colloids. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Colloids contain larger insoluble molecules, such as gelatin. There is some debate concerning the advantages and disadvantages of using biological vs. synthetic colloid solutions. Oncotic pressure values are approximately 290 mOsm per kg of water, which slightly differs from the osmotic pressure of the blood that has values approximating 300 mOsm /L. These colloidal solutions are typically used to remedy hypoalbuminemia, but is also suspected to assist in injuries that typically increase fluid loss, such as burns.