The Circulatory System

Objectives
Introduce components of blood Understand difference between venous & arterial blood
Components of each Vessels associated with each

Understand the heart & cardiac cycle Introduce major (great) vessels of the body Understand concept of lymph

Components
Heart Blood vessels
Arteries Arterioles Capillaries Venules Veins

Blood

Circulation vs. Cardiovascular vs. Hematology

Circulation = heart, blood vessels & blood Cardiovascular (CV) = heart & blood vessels
NOT blood

Vascular = blood vessels (not heart) Hematology = study of blood (no heart or blood vessels)

Functions of the circulatory system

Transport
Erythrocytes (red blood cells/RBCs) carry oxygen from lungs, remove CO2 from tissues Nutrients, hormones etc. all carried by the fluid portion of blood (NOT RBCs) Metabolic wastes from body tissues delivered to renals

Protection
White cells (immune cells) Antibodies, inflammatory mediators (cytokines), blood clotting factors

Regulation
Constant flow helps to stabilize fluid and fluid ingredient distribution (mixes everything equally) Buffers pH changes in tissue Buffers temperature changes

Heart
4 chamber double pump muscle
Pumps 5 L/min (2.5+ million liters year)
At roughly 60-70 bpm, heart pumps almost 50 million times / year An RBC takes 1 minute to travel from the heart to your finger or toe and back to the heart!

Roughly size of your fist Contained within parietal pericardium

2-layer tissue
Outer dense fibrous connective tissue Inner serous pericardium Produces serous fluid that surrounds heart proper

Heart
3 layers form the heart proper (organ within the parietal pericardium)
Epicardium (visceral pericardium) *Most superficial
Where cardiac vasculature is located Where you look for the root cause of damage during myocardial infarction

Myocardium (muscle layer)

Cardiac muscle cells
Arranged so that during contraction, chambers squeeze in a particular manner

Thickness reflects amount of force required to pump

Thickest in region of the Left Ventricle
hence out to the rest of the body *Pushes blood to arteries,

Thinnest in the atrial walls

Heart
3 layers form the heart proper (organ within the parietal pericardium)
Epicardium (visceral pericardium) Myocardium (muscle layer) Endocardium (endothelium within the heart & blood vessels) *Deepest layer
Inner lining of the heart chambers Not very porous (acts as a bag to retain blood and prevent leakage between muscle layers)

Cardiac muscle
Myocardium comprises the most mass of the heart
Striated (like skeletal muscle in contractile protein arrangement)
Each cell is much shorter, and usually more thick as well Each cell joined by an intercalated disc *** An area of cell-cell adhesion, as well as gap junctions to permit 1 cell to stimulate the next (forming a chain) Short and stout muscle cells (spreads the metabolic load between many cells)

Intercalated disc with a gap junction

Cardiac muscle
Cardiac muscle cells have less developed sarcoplasmic reticulum Less ability to store calcium than skeletal muscle Damage is repaired by fibrosis
Cannot regenerate cardiac muscle cells

Cardiac muscle
NO neural stimulus for contraction Has pacemaker cells that set off rhythmic depolarizations (electrical pulses) to trigger your heartbeat Known as autorhythmic because your heart does not need your brain to tell it to beat
Note: these pacemaker cells are still neuronstheyre located WITHIN the heart, and NOT associated with the CNS (hence no neural stimulus means NO voluntary/conscious stimulation needed)

Cardiac muscle
Cardiac muscle cells perform Aerobic respiration exclusively (Rely on oxygen) NO anaerobic fermentation (Make their own oxygen for a
small period of time)

If you stop bloodflow to the myocardium, IT WILL DIE

Cardiac muscle
External heart structure: Coronary sulcus: divides atria from ventricles
Think: circumferential

Interventricular sulci: divides left & right ventricles Look for adipose lines

Cardiac muscle
External heart structure: Various sulci serve as routes for cardiac blood vessels
Cardiac muscle reliant on cardiac blood vessels for blood supply (endocardium does not permit fluid or gas exchange within the heart)

Heart
Within the heart proper, 4 chambers & valves
Atria = most superior/cranial chambers
Atrial walls characterized by Pectinate Muscles (gives the look of a wicker basket) Interatrial septum = thin, muscular membrane separating left & right atria Atrioventricular valves separate atria from ventricles

Ventricles = most caudal/inferior

Much more muscular (have to pump blood further)
Characterized by Trabeculae Carneae (NOT pectinate muscles, but similar in look)

Semilunar valves (pulmonary & aortic) separate ventricles from pulmonary & systemic circuits

Valves maintain one-way flow of blood through heart

Papillary muscles: contract during ventricular contraction. If you study the image, it might be somewhat confusing. Bear in mind that the papillary muscles have to contract to hold the bicuspid/tricuspid (AV) valves and prevent them from prolapsing.

Think of a parachute: without someone/something pulling down on the parachute, it would flap around (like a bedsheet or blanket)not much good when you think about how much pressure the ventricles can build.

Heart
Within ventricles endocardium = specialized formation
Trabeculae carneae: little beams of flesh within the ventricle to prevent suction
If the inner wall of the ventricle were flat, as the ventricle contracted, it would have difficulty opening up as the two flat surfaces would adhere together

Heart Conduction
Sinoatrial (SA) node = pacemaker due to cyclic depolarization of specialized neurons
Located in right atrium, near insertion of SVC Depolarization spreads across BOTH atria
BOTH atria contract simultaneously

Impulse then passes down to atrioventricular node (AV node)

Inferior side of the interatrial septum atrioventricular bundle at most superior end of the interventricular septum L/R ventricles In the ventricles, conduction fibers (Purkinje fibers) carry impulse throughout both ventricles

Heart Conduction
Systole = ventricular contraction
Coupled with smooth muscle contraction in the arteries = systolic pressure

Diastole = ventricular relaxation

Heart Conduction
Heart sounds: Vascular ascultation
2 distinct sounds: lub=dub
Lub = Atrioventricular valves closing (ventricles contracting, SYSTOLE) Dub = aortic & pulmonary valves closing (ventricles relaxing, DIASTOLE)

Heart Rate Control

SA node does not rely on CNS input to initiate the cycle, BUT, the CNS still controls RATE of SA node depolarization Heart rate control via ANS
Systole innervation via T1-T4 ganglia to increase heart rate (increase rate of SA node depolarizations) Diastole innervation via VAGUS nerve (X) to decrease heart rate (decrease rate of SA or AV node cycles)
Right Vagus nerve (X) innervates SA node Left Vagus nerve (X) innervates AV node

Both sympathetic & parasympathetic (Vagus nerve X) innervate the SA node, but are derived from different regions of the CNS.
Remember that the BOTH Vagus (X) nerve fibers branch into the heart. This image only depicts the left branch of the Vagus (X).

Blood
Total blood volume 5L
Roughly 8-10% total body weight Thicker viscosity than water (obviouslythere are cells and proteins in it) pH 7.35-7.45 (pH homeostasis is vital) Normally 38C

When you donate blood, 1 unit = 500 ml (10% total blood volume) 2 component groups:
Formed elements (45% total volume) Blood plasma (fluid portion)

Formed Elements of Blood

Blood cells
Erythrocytes (red blood cells, RBCs)
Bi-concave - divited in middle
Increases surface area for gas exchange (O2 and CO2) Permits greater flexibility (allows RBC to flex and squish through tight capillaries)

7.5 m diameter, 2.5 m thick No nucleus, no mitochondria

Produce ATP by anaerobic fermentation exclusively Without nucleus, there is NO DNARBCs retain mRNA for various protein requirements, but are generally born with everything they need to function

Hematopoiesis: formation of blood cells Erythropoiesis: formation of red blood cells, granular leukocytes & platelets Red bone marrow produces 2.5 million cells/day

Despite the fact that mature RBCs have no nuclei, they do originate from a cell type that does have a nucleus. During RBC development or maturation, the nucleus dissolves.

Formed Elements of Blood

Blood cells
Erythrocytes (red blood cells, RBCs)
120 day lifespan
Lifespan reflects number of bends & squishes , hemoglobin function & lack of a nucleus (cannot repair itself) Terminated in the spleen & liver Heme is either recycled into the red bone marrow, or processed by liver into bilirubin and excreted in bile Excess bilirubin in blood = jaundice (yellow skin tone), indicative of cholestasis (liver failure) Bilirubin in bile is transferred into the chyme/fecal material (what makes your poo brown)

Formed Elements of Blood

Blood cells
Erythrocytes (red blood cells, RBCs)
Contain hemoglobin (4 subunit large gas-carrying protein)
Usually 250-300 billion hemoglobin molecules per RBC Allows RBC to capture 1000+ trillion oxygen (O2) molecules When bound to O2, hemoglobin changes color (diffracts light differently) Oxygenated RBC is bright red Deoxygenated RBC is dark purple/red NOTE: venous blood still has oxygenit just doesnt have as much as arterial blood

 Blood cells

Formed Elements of Blood

Leukocytes (white cells)
Larger than RBCs, but fewer in number Have nuclei, have mitochondria Motile (can migrate or move by themselves)
Ameboid motility permits extravasation via diapedesis http://video.google.com/videoplay?docid=142799799667345732&q=diapedesis&total=1&start=0&num= 10&so=0&type=search&plindex=0

Characterized by how they stain

Cannot really see leukocytes without stains Eosin & hematoxylin Granular leukocytes Agranular leukocytes

Formed Elements of Blood

Blood cells
Leukocytes (white cells)
Granular leukocytes (_____phils) *theyre all called something-phils
Granules = vesicles of digestive enzymes, reactive oxidants etc. When attacking an invading pathogen (or autoimmune reaction), will degranulate or exocytose granular contents Will also phagocytose foreign particles and fuse granules with them to kill/digest Neutrophils: most common granular leukocyte (65% total white cell count) first line defenders Eosinophils: larger than neutrophils (eosinophil = stained by eosin) Phagocytic white cells for parasite and antibody-mediated defense Basophils: most rare leukocyte Produce histamine (similar to tissue mast cells) Involved in allergic responses

Formed Elements of Blood

Blood cells
Leukocytes (white cells)
Agranular leukocytes (____cytes)
No granulesrelatively clear cytoplasm Most formed by LEUKOPOIESIS (different than erythrocytes) Development takes place in lymphoid tissue Lymph nodes, tonsils, spleen & thymus Lymphocytes: 30-35% total white cell count B-cells differentiate in BONE MARROW (antibody cells) T-cells differentiate in THYMUS (killer, helper etc.) Monocytes: largest cells in the blood (note: same precursor as erythrocyte) In circulation = monocyte When in tissue (after extravasation) = macrophage Phagocytic digesters Hematopoietic: from same precursor as erythrocytes

Formed Elements of Blood

Blood cells
Platelets (not cells per se)
Originate from megakaryocytes in red bone marrow that fragment into platelets No nuclei (no DNA) Are capable of extravasation and have ameboid motility Very short lifespan (5-7 days) Act to form blood clots by altering their plasma membrane
Release serotonin (5-hydroxytryptamine, 5-HT) during clot formation in order to vasoconstrict in the general vicinity Also neutralize heparin (an anti-coagulant)

Megakaryocytes extend a cellular appendage into the blood stream. The velocity of the blood breaks off the platelets from this appendage (the laminar flow shears off the platelets from the megakaryocytes arms).

Figure 18.1

Blood Plasma
Fluid portion of blood (technically the extracellular matrix of bloodsince blood is a form of connective tissue)
90% water Straw/yellow tone due to presence of proteins, various salts, carbohydrates, lipids, amino acids, vitamins & hormones

Blood Plasma
Plasma proteins ( 7-9% total plasma ingredients)
Plasma albumins (a family of proteins)
60 % total plasma protein content Produced in liver Act as carrier/delivery molecules Influence blood viscosity
Influence blood pressure through viscosity

Plasma globulins
35 % total plasma protein content Alpha () & Beta () globulins produced in liver
Assist in fat/lipid transport throughout the blood

Gamma () globulins produced by lymphoid cells

antibodiesproduced primarily by B-lymphocytes

Blood Plasma
Plasma proteins
Plasma albumins (a family of proteins) Plasma globulins Plasma fibrinogen
4 % total plasma protein content Largest plasma protein Produced in liver Combines with platelet activity to form blood clot

Blood Plasma vs. Serum

Blood plasma is different than blood serum
serum antibodies etc. Recall fibrinogen
Serum = plasma without fibrinogen
Serum = plasma AFTER a clot (anything involved in clot formation removed from plasma) serum = liquid portion after you make cheese from milk

Serum can be harvested by NOT including an anticoagulant in a blood draw (allow blood to clot)

Blood Plasma Proteins

If albumin = 60%, globulin = 35%, fibrinogen = 4%
1% of blood protein content = regulatory proteins, lipoproteins, iron-binding proteins etc.
Recall the ENDOCRINE system

Blood vessels
Tubular network for blood flow
Blood flow is a closed system (components of blood do not readily leave the blood vessels)

3 layers to every blood vessel

Tunica externa (adventitia)
Most superficial layer of loose connective tissue

Tunica media
Smooth muscle layer
In arteries, tunica media layer has very dense elastic fibers

Tunica interna (endothelium)

Simple squamous epithelial tissue with elastic fibers Continous with endocardium

 Arteries

Blood vessels

Tunica media contains elastic fibers (more than veins)

Allows artery to expand when heart expels blood Elastic fibers permit recoil to original shape following expulsion of blood from heart Expansion & recoil (elasticity) acts to smooth out the blood flow (less pulsing)

As arteries reduce in size, they become less elastic

Small arteries, arterioles are less elastic than arteries Small artery = 100 m diameter or less Arteriole = 20-30 m diameter or less Capillary = 7-10 m diameter

 Capillaries

Blood vessels

Fluid, nutrient and gas exchange is only possible across capillaries

Endothelium more loose or porous in a capillary

Over 40 billion capillaries in your body (1800+ square kilometers of coverage)

No cell is more than a few m from a capillary Despite large surface area and extensive network, only 250 ml blood is within the entire capillary network at any one time!

Walls are unique

Simple squamous endothelium

 Capillaries

Blood vessels

3 subtypes of capillaries:
Continuous capillary: tight pores between squamous cells (most common type)
Muscle, lungs, adipose, CNS Remember that in CNS, this is the basis for the bloodbrain barrierincredibly tight capillary network

Fenestrated capillary: fenestrations = windows/pores

Renals, endocrine organs & GI tract Wide pores permits fast transfer of gas and nutrients/waste Covered by a mucoprotein diffusion barrier

Discontinuous capillary: widest pore size

Bone marrow, liver & spleen Pores = sinusoids (sinus-like pores)

Continuous capillary

Fenestrated capillary

Note the diameter of the capillary = 1 cell wide

In discontinuous capillaries, the endothelial cells do not physically connect to one another. These pores are so wide theyre called sinusoids. Discontinuous capillaries are restricted to organs that process LARGE volumes of blood Despite the sinusoidal space, most blood cells cannot easily leave the capillary

Blood vessels
Veins
Carry blood from capillaries BACK to heart
From capillary venule vein

Very LOW pressure (0.02 psi)

Arteries can hold up to 5 psi (in some areas, even more) At this low pressure, blood cannot return to the heart
Relies on 1-way valves (venous valves) and skeletal muscle contractions to propel blood back to heart Varicose veins = veins stretched from standing (stretched veins = pulled valves that dont work correctly

Only find valves in veinsnever in arteries

Low pressure = more volume of blood can be found in the venous network than the arteries

Low pressure in venous network due to the fact that the high arterial pressure (from heart contraction & arterial recoil) is lost at the level of the capillary bed (like trying to blow through a syringeat the other end, very little gets out).
Low pressure in veins therefore requires skeletal muscle contractions to push or milk blood back to the heart.

Very Important Fact

Arteries & veins are named for the DIRECTION in which they carry blood
Artery =blood away from the heart (efferent) Vein = blood towards the heart (afferent)

The terms: arteries & veins have NOTHING to do with the amount of oxygen in the blood
To say that arteries carry oxygen-rich blood is INCORRECT

Cardiac Blood Flow

Recall the heart:
4 chambers
Right atrium & ventricle Left atrium & ventricle
1

Blood flow TO lungs

2 Venous blood from superior & inferior vena cava (SVC & IVC) drawn into right atrium
IVC also has input from coronary sinus

Contraction of R-atrium = blood pumped through tricuspid / right atrioventricular valve into R-ventricle Contraction of R-ventricle = blood pumped into pulmonary trunk
Bifurcates into right/left pulmonary arteries towards lungs

Cardiac Blood Flow

Blood flow FROM lungs
L-atrium receives oxygenated blood from lungs via 2X right/left pulmonary veins L-atrium contracts and pumps blood via bicuspid/mitral or left atrioventricular valve
Valve opening dependent upon L-ventricle RELAXATION

L-ventricle contracts & pumps blood via aortic semilunar valve into ascending aorta

3 4

diastole

Note that despite going over these steps as separate stages, these patterns occur in PAIRS. The atria open to draw blood at the systole same time. Both atria contract at the same time to force blood into dub the ventricles. Both ventricles then contract at the same time to propel blood towards the pulmonary artery or the aorta.
lub

flow chart

Venous blood (body)

Right atrium

Right ventricle

Pulmonary trunk / artery (lungs)

flow chart
Venous blood (body) Right atrium Right ventricle Pulmonary trunk /artery (lungs)

Pulmonary vein

Left atrium

Left ventricle

Ascending aorta (body)

Flow chart in reality

Venous blood (body) Right atrium Left atrium
First simultaneous contraction

Right ventricle

Left ventricle

Second simultaneous contraction

Pulmonary trunk /artery (lungs)

Ascending aorta (body)

Flow chart in reality

Venous blood (body) Right atrium Left atrium

Right ventricle

Left ventricle

Pulmonary trunk /artery (lungs)

Ascending aorta (body)

Specialized Circulatory Subsystems

Pulmonary circulation:
Blood vessels that transfer blood between heart & lungs
Blood vessel-way
R-ventricle pulmonary valve pulmonary trunk L/Rpulmonary arteries pulmonary capillaries (in lungs) pulmonary veins L-atrium

Note how the coronary circulation begins at the right ventricle and ends at the left atrium

Specialized Circulatory Subsystems

Coronary circulation:
Blood vessels that transfer to myocardium of the heart
Interesting that the heart, despite pumping so much blood, has no myocardial access to that blood other than the coronary circulation

Specialized Circulatory Subsystems

Coronary circulation:
Blood route
Ascending aorta aortic/semilunar valve L/Rcoronary arteries
Left coronary artery anterior atrioventricular artery anterior region of both ventricles circumflex artery Circumflex artery L-atrium & L-ventricle Right coronary artery posterior interventricular sulcus Posterior region of both ventricles

From capillaries in myocardium cardiac veins

Anterior interventricular vein (drains from anterior region of heart) Posterior interventricular vein (drains from posterior heart) Merge into coronary sinus R-atrium

Specialized Circulatory Subsystems

Systemic circulation:
Everything OUTSIDE the pulmonary circulation
Includes the coronary circuit as well

From:
Left ventricle aortic valve ascending aorta systemic vasculature capillaries (not within the lungs) venous apparatus right atrium

Specialized Circulatory Subsystems

Portal circulation: vein-capillary-vein
Recall portal circulation in the adenohypophysis (anterior pituitary)
Carries venous blood from hypothalamus into the capillary bed of the adenohypophysis

Hepatic portal blood circuit

Drains blood from the gastrointestinal viscera via hepatic portal vein, into the liver (hepatic) system before emptying into the IVC via the hepatic vein

Fetal Circulation
Fetus receives maternal oxygen & nutrients
Blood does NOT transfer, only plasma & oxygen Transition occurs at placenta
Umbilical cord = between placenta & fetus
Umbilical vein + 2 umbilical arteries

Umbilical vein carries oxygen-rich blood towards liver

1 branch towards portal vein 2nd branch anastomizes with interior vena cava via ductus venosus

Maternal blood then enters right atrium

Most will bypass/shunt into the left atrium via foramen ovale Additional shunt at ductus arteriosus (between pulmonary artery & aorta)

Fetal circulatory system designed to place maternal blood into systemic circulation rather than pulmonary circuit. Uses 2 shunts to limit pulmonary circuit: Foramen ovale Ductus arteriosus (ductus Van Botalli)

Fetal Circulation
fetal collapsed lung
In placenta, lung is filled with fluid
Very difficult to draw in blood due to hydrostatic pressure

First breath following parturition:

Expel the fluid within the bronchioles of the lungs Draw in first breath Establish negative thoracic pressure
Expulsion of fluid from lungs reduces pressure in lungs Reduction in lung pressure allows blood to more easily enter lungs via pulmonary artery As right ventricle is permitted to expand (due to reduced resistance), foramen ovale is forced shut If you clamp the umbilicus, you also reduce pressure in the IVC & right atrium

First breath is at least 20-50X more difficult to mount than subsequent inspirations

Fetal Circulation
Foramen ovale is therefore the first shunt to close following parturition
fossa ovale when fully closed

Ductus arteriosus closure = more gradual

Usually remains partially open for 6 weeks
Increasing levels of vascular oxygen stimulates arterial smooth muscle contraction

Ductus remnant atrophies & becomes non-functional (ligamentum arteriosum)

Ductus venosus closure similar to ductus arteriosus

Remnant = ligamentum venosum Because it remains open, you can cannulate after birth

Fetal Circulation
Fetus pumps blood out of body (back to placenta) via UMBILICAL ARTERY
Paired artery exiting from internal iliac artery Carries metabolic waste, oxygen-poor blood back to placenta for exchange

Circulatory collaterals
Throughout your circulatory system, there are collaterals
Pools or supplies of blood that can be mobilized when called for
GI tract retains 50-70% blood volume during rest
During high activity/trauma, GI tract innervated by sympathetic nervous system is triggered to vasoconstrict (provide more blood for vitals and skeletal muscle)

Within brain: circle of Willis provides a similar function for the brain
Paired carotid arteries, paired vertebral arteries provides at 4 different pathways for arterial blood to enter the brain

Pairs of vessels span many joints

Allows flexion of the joint while maintaining blood flow

Within the mesenteric vasculature, all of the capillaries are gated by precapillary sphincters. When called upon by the sympathetic nervous system, these sphincters will constrict the amount of blood entering the capillary bed, restricting the bloodflow and permitting more arterial blood to be shunted to the vitals.

Follow the Vertebral arteries and the Internal carotid arteries (not labeled). Note the circle of Willis. Any of the 4 arteries can feed into the circle of Willis (cerebral arterial circle) and keep the brain supplied with arterial blood.

Important note: in following the major arteries, do not make the mistake that capillary beds are only at the ends of these arteries. Along literally the entire length of many arteries are branches that provide arterioles / capillary beds for practically every tissue along the way. Remember that practically every cell in your body is mere microns (m) from a capillary bed.

Principle Arteries
Aorta = major systemic artery
Directly from left ventricle = ascending aorta
Right & left coronary arteries are the ONLY branches at this point

Aortic ARCH
Brachiocepalic trunk Further branches into right subclavian artery & right common carotid artery Next branch = Left common carotid artery Third branch = Left subclavian artery Following left subclavian artery, aorta proceeds caudally as the dorsal aorta Past diaphragm = abdominal aorta

Principle Arteries
Arterial blood from brachiocephalic trunk has a number of choices
Vertebral artery = towards cranium via transverse foramen of the cervical vertebrae & enters cranium via foramen magnum Thyrocervical trunk = destined for thyroid Internal thoracic artery = destined for thymus, pericardium, sternum & anterior costals Costovertebral trunk = destined for intercostal muscles, posterior intercostals & spinal meninges Subclavian artery = destined for upper appendage

Principle Arteries
Common carotid arteries will bifurcate into external and internal carotid arteries
External = supplying blood to external cranium Internal = supplying blood to internal cranium (meninges, brain etc.)

At sight of bifurcation = carotid sinus

Site of pressure sensors (baroreceptors) & chemoreceptors (oxygen & CO2) that feed back into medulla oblongata respiration center

Remember: internal carotid arteries are not the only arteries that deliver blood to the brain

Principle Veins
Cranial arterial blood is returned via internal or external jugular veins
External cranium drained by external jugular vein Internal cranium (brain via dural venous sinus)
Dural venous sinus is a unique vein: no valves

Principle Arteries
Towards upper appendage via subclavian artery
Subclavian artery = axillary artery between 1st rib & median edge of the humerus
Past medial side of humerus = Brachial artery Around humerus = anterior & posterior humeral circumflex arteries
Ring of arteries around brachial muscles

Bifurcates into radial & ulnar arteries proximal to cubital fossa

Radial = pulse at the wrist

Principle Veins
From upper appendage
In order to return arterial blood that has passed out of the capillary beds throughout the upper appendage:
Combination of superficial & deep veins
Superficial veins often quite variable in location Deep veins usually follow arteries

Radial & ulnar veins draw blood from palmar region

Both anastomize into brachial vein

Superficial basilic vein draws blood ulnar & medial veins

Eventually anastomize with brachial vein axillary vein

Superficial cephalic vein draws blood from superficial radial region of arm

Appendicular veins (in fact most veins throughout your body) are formed after the arteriesthey are much more variable due to the way they develop during embryonic development.

Superficial & deep veins drain blood from cutaneous/integument vs. muscles vs. bone respectively.

Principle Veins
From upper appendage
Once all upper appendicular veins have anastomized into axillary vein: Axillary vein subclavian vein
Receives venous drainage from cranium as well
External jugular vein Internal jugular vein

Where internal jugular vein merges/anastomizes with subclavian vein = brachiocephalic vein

Principle Arteries
Abdominal:
4 branches from the dorsal/descending/abdominal aorta
Celiac trunk
Splenic artery (to spleen & stomach) L-gastric artery (to lesser curvature of the stomachmost cranial portion) Common hepatic artery Further bifurcates into gastroduodenal artery & proper hepatic artery

Superior mesenteric artery

Branches throughout mesentery (small intestine, upper 2/3 large intestine, pancreas)

Left & right renal arteries Inferior mesenteric artery

Branches throughout distal/terminal mesentery (terminal colon, rectum)

Principle Arteries
Abdominal:
Mesentery = mes enteric
reflection/fold of the peritoneal cavity enteric usually infers gastrointestinal middle of the gastro or intestinal tract Mesenteric artery = artery that branches within the mesentery

Principle Veins
Abdominal veins:
Absorptive viscera do not directly drain into the inferior vena cava
Absorptive viscera drain into hepatic portal vein
All venous blood from GI tract drains into liver via hepatic portal vein Liver processes venous blood, then delivers back to inferior vena cava (cranial to diaphragm) via hepatic vein (NOTE: not the hepatic PORTAL vein)

Lower extremities, renals & reproductive organs are the only organs that directly drain into the IVC

Principle Arteries
Abdominal:
Note: there are additional accessory arteries that are important but often variable
Gonadal artery (testicular/ovarian) usually arise from dorsal aorta
Caudal/distal to renal arteries Variations exist: arise from renal arteries, cranial/proximal to renal arteries etc.

Principle Arteries
Lower appendage:
Common iliac artery is most distal bifurcation of the dorsal aorta (marks termination of aorta)
Further branches into:
Internal iliac arteries (L/R) Supplies pelvic organs (reproductive organs, pelvic diaphragm, urogenital diaphragm, gluteals etc.) Note: reproductive organs excluding ovaries/testicles External iliac arteries (L/R) Once through inguinal ligament = femoral artery

Principle Arteries
Lower appendage:
Femoral artery

Principle Arteries
Lower appendage:
Femoral artery further bifurcates:
Deep femoral artery = supply to the coxal region Femoral artery spirals posterior to become popliteal artery (spans popliteal fossa)
Further bifurcates into anterior & posterior tibial arteries

Principle Veins
Similar to the upper limb, the lower limb drains through a combination of deep and superficial arteries.

The great saphenous vein (most medial & superficial) is a common vein used for coronary bypass surgery.

Circulatory pathophysiology
Atherosclerosis: scar tissue of the arteries
Recall elasticity of arteries (tunica media)
In cases of exaggerated stretching, the endothelial layer tends to suffer damage Circulating immune cells then sense this damage and act to form a scar
Actually start to attack endothelium & place fatty deposits under the scar Once scar & fatty deposits begin to calcify = atherosclerotic plaque Plaque then inhibits/prevents stretch response Inability for artery to respond to stretch = inability to control blood pressure (blood pressure usually risesvelocity rises significantly)

Should really be thought of as a chronic inflammation of the arterial system

 Boundary layer/unstirred layer effect: as the velocity of the fluid within a tube increases, there is a decrease in velocity at the very edge of that tube
Boundary layer immobile (actually an unstirred layer of fluid)makes it very easy for these plaques and particles to collect
When these particles collect, the plaque formation can increase faster
A vicious cycle: formation of initial restriction = increased velocity through that region = greater boundary layer = greater ability for plaque to take hold Plaque formation can eventually starve flow

 Boundary layer has a few non-atherosclerosis effects as well:

Very middle of the blood column = highest velocity
Edges of the blood column = lowest velocity

In larger vessels (arteries), erythrocytes characteristically flow sideways (like a frisbee), due to velocity
In capillaries, due to small diameter and thus slow flow rate, erythrocytes take up rouleaux (cylinder/single file) pattern

Circulatory pathophysiology
Atherosclerosis: scar tissue of the arteries
Note: while this occurs primarily in arteries (due to stretching), this can occur in veins
Saphenous vein grafts for bypass surgery have been shown to develop these same atherosclerotic plaques despite reduced elasticity in a vein

Angioplasty: insertion of a balloon into the region of restriction in order to restore flow. Newer techniques couple a balloon with a stent (wire structure to hold artery open) that is usually coated with anticoagulants/anti-plaque chemicals

Lymphatics & Immunity

Lymphatic system is very closely related to the circulatory system
Blood plasma that seeps from the capillary beds is normally drawn back into the venous blood flow by diffusion/osmosis
Remember that this blood plasma will transfer gasses, nutrients & metabolic wastes to-from circulation-tissue 15% does not return to venous flow
Must be returned to circulation via lymphatic system

If you do not return this fluid, EDEMA

Lymphatics & Immunity

Functions of the lymphatic system
Fat absorption
Intestinal lipid absorption places chylomicrons (intestinal lipid carrier proteins) into the lymphatic system rather than the hepatic portal system
Systemic circulation has first-pass access to intestinal lipids and fat-soluble vitamins (unlike amino acids & glucose)

Returns interstitial fluid to circulation Retains lymphocytes (lymph-based cells) for immunity

Lymphatics & Immunity

Drawbacks:
Because the lymphatic system is such a slow system (low pressure, low fluid velocity), it takes a great deal of time to get these fluids back to central circulation
1 drawback: many carcinomic cells will tend to collect in the lymphatic system if they become mobile
Slow velocity, low pressure = tendency for these cancerous cells to stay within the lymphatics If they take up residence in the lymphoid tissues, they will grow into a tumor

Lymphatics & Immunity

Lymphatic capillaries are intertwined with the vascular capillary bed

Lymphatics & Immunity

Lymphatic capillaries are markedly similar to veins:

One-way valves & requirement for skeletal muscle propulsion (skeletal muscle pump)

Where lymphatics differ from venous system arises with lymph nodes Nodes or collections of reticular tissue along the lymphatic vessel tract Note: lymph does NOT contain erythrocytes

Lymphatics & Immunity

Lymph nodes usually located in characteristic locations along the lymph network

Lymphatics & Immunity

Note how lymph enters the lymph nodes and permeates through the reticular tissue where immature lymphocytes are located. These immature lymphocytes then sample the contents of the lymph and develop tolerance or attack postures.

Recall how lymph (fluid) is extracellular or interstitial fluid. This fluid will be sampled by dendritic cells in the lymph nodes, and presented to T-lymphocytes (immature, learning what to kill in the lymph nodes). If these lymphocytes fail to learn correctly, they are killed. A great number of lymphocytes are killed, only a very small amount are permitted to leave the lymph node and fully mature into functional circulating lymphocytes.

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Lymph drainage is not proportional: right lymphatic duct only drains from upper right torso into right subclavian vein. Thoracic duct drains the rest of the body.

Lymphatics & Immunity

Additional lymphoid organs
In addition to lymph nodes dispersed throughout lymphatic circulation, there are accessory lymphoid organs: Tonsils Thymus Spleen Peyers patches throughout the gastrointestinal tract

Your tonsils are NOT that thing that hangs down from the back of your throat.

Throughout your digestive tract are Peyers patches. Essentially lymph nodes that allows your immune system to sample what youve eaten.