Chyle (from the
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
word χυλός ''chylos'', "juice") is a milky
bodily fluid consisting of
lymph
Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the venous system, is to return fluid from the tissues ...
and emulsified
fat
In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.
The term often refers specifically to triglycerides (triple est ...
s, or free
fatty acid
In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...
s (FFAs). It is formed in the
small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as
lacteals. The lipids in the chyle are
colloidally suspended in
chylomicron
Chylomicrons (from the Greek χυλός, chylos, meaning ''juice'' (of plants or animals), and micron, meaning ''small particle''), also known as ultra low-density lipoproteins (ULDL), are lipoprotein particles that consist of triglycerides (85 ...
s.
Clinical significance
A chyle
fistula
A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...
occurs when defect(s) of lymphatic vessel(s) result in leakage of lymphatic fluid, typically accumulating in the thoracic (pleural) or abdominal (peritoneal) cavities, leading to a chylous pleural effusion (
chylothorax) or
chylous ascites, respectively.
Diagnosis of a chyle fistula may be accomplished by analysis of pleural/peritoneal fluid. Identifying the source (localizing the lymphatic defect) is often challenging, but may be accomplished with lymphangiography, which is occasionally associated with a serendipitous therapeutic effect (resolution of the leak), thought to be secondary to a sclerosant effect of the lymphangiography contrast.
Due to the extreme
friability
Friability ( ), the condition of being friable, describes the tendency of a solid substance to break into smaller pieces under duress or contact, especially by rubbing. The opposite of friable is indurate.
Substances that are designated hazardous, ...
of the lymphatic vessels, direct repair of defects is impractical. Therefore, treatment of chyle fistulae relies upon either decreased production of lymphatic fluid to allow for healing of lymphatic defect(s) or permanent diversion of lymphatic fluid away from lymphatic defect(s). Decreased production of lymphatic fluid may be accomplished by dietary restriction (or complete replacement of oral intake with
total parenteral nutrition
Parenteral nutrition (PN) is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding companies. The person receives a nutritional mix ...
), as well as by the medications
octreotide (a synthetic analogue of the hormone
somatostatin)
[{{Cite journal, pmid=15830574, year=2005, last1=Mincher, first1=L, last2=Evans, first2=J, last3=Jenner, first3=MW, last4=Varney, first4=VA, title=The successful treatment of chylous effusions in malignant disease with octreotide, volume=17, issue=2, pages=118–21, journal=Clinical Oncology, doi=10.1016/j.clon.2004.06.016] and
orlistat
Orlistat, sold under the brand name Xenical among others, is a medication used to treat obesity. Its primary function is preventing the absorption of fats from the human diet by acting as a lipase inhibitor, thereby reducing caloric intake. It ...
(a lipase inhibitor that decreases absorption of dietary fats). Permanent diversion of lymphatic fluid may be accomplished by
thoracic duct
In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the ''left lymphatic duct'', ''alimentary duct'', ''chyliferous duct'', and ''Van Hoorne's canal''. The other duct is the righ ...
embolization (a needle-based procedure to occlude the duct by depositing glue/embolic material into it) or by thoracic duct ligation (an open surgical procedure to occlude the duct by suturing tightly around it).
See also
*
Chyme
References
Body fluids
Digestive system
Lymphatic system