VESSEL PHYSIOLOGY | Capillary | Circulatory System

Blood vessels and circulation

Blood is carried in a closed system of vessels that begins and ends at the heart 5 types of blood vessels Arteries – carries blood away from the heart Arterioles – smallest arteries Capillaries - place for diffusion Venules - smallest veins Veins – carries blood to the heart Lumen – central blood-containing space

Blood Vessels
PART A

Blood Vessel Anatomy

Structure of vessel walls
Walls of arteries and veins contain three distinct layers Tunica intima endothelium and connective tissue Internal elastic membrane Tunica media Smooth muscle, collagen fibers External elastic membrane Controlled by sympathetic nervous system Vasoconstriction/vasodilation

Structure of vessel walls
Tunica externa or adventitia Collagen fibers that protect and reinforce the vessels

Generalized Structure of Blood Vessels

Differences between arteries and veins
Vasavasorum Compared to veins, arteries Have thicker walls Have more smooth muscle and elastic fibers Are more resilient

Arteries
Undergo changes in diameter Vasoconstriction – decreases the size of the lumen Vasodilation – increases the size of the lumen Classified as either elastic (conducting) or muscular (distribution) Small arteries (internal diameter of 30 µm or less) are called arterioles Resistance vessels (force opposing blood flow)

Histological Structure of Blood Vessels

Capillaries
An endothelial tube inside a basal lamina These vessels Form networks Surround muscle fibers Radiate through connective tissue Weave throughout active tissues Capillaries have two basic structures Continuous Fenestrated Sinusoids

Capillaries
Continuous capillaries Retain blood cells and plasma proteins Fenestrated capillaries Contain pores Sinusoids Contain gaps between endothelial cells Allow larger solutes to pass

Continuous Capillaries
Continuous capillaries are abundant in the skin and muscles Endothelial cells provide an uninterrupted lining Adjacent cells are connected with incomplete tight junctions Intercellular clefts allow the passage of fluids

Continuous Capillaries
Continuous capillaries of the brain: Have tight junctions completely around the endothelium Constitute the blood-brain barrier

Continuous Capillaries

Continuous Capillaries

Fenestrated Capillaries
Found wherever active capillary absorption or filtrate formation occurs (e.g., small intestines, endocrine glands, and kidneys) Characterized by: An endothelium riddled with pores (fenestrations) Greater permeability than other capillaries

Fenestrated Capillaries

Fenestrated Capillaries

Sinusoids
Highly modified, leaky, fenestrated capillaries with large lumens Found in the liver, bone marrow, lymphoid tissue, and in some endocrine organs Allow large molecules (proteins and blood cells) to pass between the blood and surrounding tissues Blood flows sluggishly, allowing for modification in various ways

Sinusoids

Sinusoids

Capillary Beds
Collateral arteries Many collateral arteries will fuse giving rise to one arteriole Arteriole Metarterioles Contain smooth muscle Precapillary sphincter Link arterioles to capillaries

Capillary Beds
Thoroughfare channels Arteriovenous anastomoses Connects arterioles to venules Capillaries Venules

Capillary Beds

Capillary Beds

Vascular Components

Venous System: Venules
Venules are formed when capillary beds unite Allow fluids and WBCs to pass from the bloodstream to tissues Postcapillary venules – smallest venules, composed of endothelium and a few pericytes (smooth-muscle cell like) Large venules have one or two layers of smooth muscle (tunica media)

Venous System: Veins

Venous System: Veins
Veins are: Formed when venules converge Composed of three tunics, with a thin tunica media and a thick tunica externa consisting of collagen fibers and elastic networks Capacitance vessels (blood reservoirs) that contain 65% of the blood supply

Veins have much lower blood pressure and thinner walls than arteries To return blood to the heart, veins have special adaptations Large-diameter lumens, which offer little resistance to flow Valves (resembling semilunar heart valves), which prevent backflow of blood Venous sinuses – specialized, flattened veins with extremely thin walls (e.g., coronary sinus of the heart and dural sinuses of the brain)

The Function of Valves in the Venous System

Vascular Anastomoses
Merging blood vessels, more common in veins than arteries Arterial anastomoses provide alternate pathways (collateral channels) for blood to reach a given body region If one branch is blocked, the collateral channel can supply the area with adequate blood supply Thoroughfare channels are examples of arteriovenous anastomoses

Blood Flow
Actual volume of blood flowing through a vessel, an organ, or the entire circulation in a given period: Is measured in ml per min. Is equivalent to cardiac output (CO), considering the entire vascular system Is relatively constant when at rest Varies widely through individual organs

Blood Pressure (BP)
Force per unit area exerted on the wall of a blood vessel by its contained blood Expressed in millimeters of mercury (mm Hg) Measured in reference to systemic arterial BP in large arteries near the heart The differences in BP within the vascular system provide the driving force that keeps blood moving from higher to lower pressure areas

Resistance
Resistance – opposition to flow Measure of the amount of friction blood encounters Generally encountered in the systemic circulation Referred to as peripheral resistance (PR) The important sources of resistance are blood viscosity, total blood vessel length, blood vessel diameter and turbulence

Resistance
Vessel diameter Small diameter will have greater friction of blood against the vessel wall. This will decrease the flow (greater resistance) Most of the peripheral resistance occur in arterioles. Changes in vessel diameter are frequent and significantly alter peripheral resistance Resistance varies inversely with the fourth power of vessel radius if the radius is doubled, the resistance is 1/16 as much

Resistance Factors: Blood Vessel Diameter
Small-diameter arterioles are the major determinants of peripheral resistance Fatty plaques from atherosclerosis: Cause turbulent blood flow Dramatically increase resistance

Resistance
Vessel length Increasing the length of the vessel will increase the cumulative friction and thus will decrease blood flow and pressure (greater resistance).

Resistance
Blood viscosity The higher the viscosity the higher will be the resistance. Thus the flow will decrease Turbulence Is the resistance due to the irregular, swirling movement of blood at high flow rates or to exposure to irregular surfaces. High turbulence decreases the flow

Resistance Factors: Viscosity and Vessel Length
Resistance factors that remain relatively constant are: Blood viscosity – “stickiness” of the blood Blood vessel length – the longer the vessel, the greater the resistance encountered

Blood Flow, Blood Pressure, and Resistance
Blood flow (F) is directly proportional to the difference in blood pressure (ΔP) between two points in the circulation If ΔP increases, blood flow speeds up; if ΔP decreases, blood flow declines Blood flow is inversely proportional to resistance (R) If R increases, blood flow decreases R is more important than ΔP in influencing local blood pressure

Systemic Blood Pressure
The pumping action of the heart generates blood flow through the vessels along a pressure gradient, always moving from higherto lower-pressure areas

Systemic Blood Pressure
Systemic pressure: Is highest in the aorta Declines throughout the length of the pathway Is 0 mm Hg in the right atrium The steepest change in blood pressure occurs in the arterioles

Systemic Blood Pressure

Arterial Blood Pressure
Arterial BP reflects two factors of the arteries close to the heart Their elasticity (compliance or distensibility) The amount of blood forced into them at any given time Blood pressure in elastic arteries near the heart is pulsatile (BP rises and falls)

Arterial Blood Pressure
Systolic pressure – pressure exerted on arterial walls during ventricular contraction Diastolic pressure – lowest level of arterial pressure during a ventricular cycle Pulse pressure – the difference between systolic and diastolic pressure EX: 120-80= 40 (Pulse Pressure)

Arterial Blood Pressure
Mean arterial pressure (MAP) – pressure that propels the blood to the tissues MAP = diastolic pressure + 1/3 pulse pressure EX: for a 120 x 80 BP: MAP= 80 + 40/3 = 80 + 13 = 90 mm Hg

Capillary Blood Pressure
Capillary BP ranges from 20 to 40 mm Hg Low capillary pressure is desirable because high BP would rupture fragile, thin-walled capillaries Low BP is sufficient to force filtrate out into interstitial space and distribute nutrients, gases, and hormones between blood and tissues

Venous Blood Pressure
Venous BP is steady and changes little during the cardiac cycle The pressure gradient in the venous system is only about 20 mm Hg A cut vein has even blood flow; a lacerated artery flows in spurts

Factors Aiding Venous Return
Venous BP alone is too low to promote adequate blood return and is aided by the: Respiratory “pump” – pressure changes created during breathing suck blood toward the heart by squeezing local veins Muscular “pump” – contraction of skeletal muscles “milk” blood toward the heart Valves prevent backflow during venous return

Factors Aiding Venous Return

Maintaining Blood Pressure
Maintaining blood pressure requires: Cooperation of the heart, blood vessels, and kidneys Supervision of the brain

Maintaining Blood Pressure
The main factors influencing blood pressure are: Cardiac output (CO) Peripheral resistance (PR) Blood volume Blood pressure = CO x PR Blood pressure varies directly with CO, PR, and blood volume

Cardiac Output (CO)
Cardiac output is determined by venous return and neural and hormonal controls Resting heart rate is controlled by the cardioinhibitory center via the vagus nerves Stroke volume is controlled by venous return (end diastolic volume, or EDV)

Cardiac Output (CO)
Under stress, the cardioacceleratory center increases heart rate and stroke volume The end systolic volume (ESV) decreases and MAP increases

Cardiac Output (CO)

Maintaining blood pressure through Cardiovascular Regulation
Neural mechanisms – short-term control Endocrine mechanisms – mainly long-term control. Sometimes short-term also

Short-Term Mechanisms: Neural Controls
Neural controls of peripheral resistance: Alter blood distribution in response to demands Maintain MAP by altering blood vessel diameter

Short-Term Mechanisms: Neural Controls
Vasomotor Center A cluster of sympathetic neurons in the medulla that oversees changes in blood vessel diameter Maintains blood vessel tone by innervating smooth muscles of blood vessels, especially arterioles Cardiovascular center – vasomotor center plus the cardiac centers that integrate blood pressure control by altering cardiac output and blood vessel diameter

Short-Term Mechanisms: Neural Controls
It is a integrating center for three reflex arcs: Baroreflexes Chemoreflexes Medullary ischemic reflexes

Short-Term Mechanisms: Neural Controls
Baroreflexes Baroreceptors in: carotid sinuses, aortic arch, right atrium, walls of large arteries of neck and thorax Increased blood pressure stretches the baroreceptors Inhibits the vasomotor center Dilate arteries Decrease peripheral resistance, Decrease blood pressure

Short-Term Mechanisms: Neural Controls
Dilate veins Decrease venous return Decrease cardiac output Stimulate cardioinhibitory center and inhibit cardioacceleratory center Decrease heart rate Decrease contractile force

Short-Term Mechanisms: Neural Controls
Declining blood pressure stimulates the cardioacceleratory and vasomotor centers to: Increase cardiac output Constrict blood vessels Increase peripheral resistance Baroreceptors adapt to chronic high or low BP

Impulse traveling along afferent nerves from baroreceptors: Stimulate cardioinhibitory center (and inhibit cardioacceleratory center)

Sympathetic impulses to heart ( HR and contractility)

Baroreceptors in carotid sinuses and aortic arch stimulated

Inhibit vasomotor center R

CO

Arterial blood pressure rises above normal range Stimulus: Rising blood pressure
Im

Rate of vasomotor impulses allows vasodilation ( vessel diameter)

CO and R return blood pressure to Homeostatic range

ba

lan ce

Homeostasis: Blood pressure in normal range
Im ba lan ce

Stimulus: Declining blood pressure

CO and R return blood pressure to homeostatic range

Cardiac output (CO)

Impulses from baroreceptors: Stimulate cardioacceleratory center (and inhibit cardioinhibitory center) Sympathetic impulses to heart ( HR and contractility)

Arterial blood pressure falls below normal range Baroreceptors in carotid sinuses and aortic arch inhibited

Peripheral resistance (R)

Vasomotor fibers stimulate vasoconstriction

Stimulate vasomotor center

Short-Term Mechanisms: Neural Controls
Chemoreflexes Sensitive to low oxygen, low pH, and high carbon dioxide in the blood Prominent chemoreceptors are the carotid and aortic bodies Their primary role is to adjust respiration to change blood chemistry

Short-Term Mechanisms: Neural Controls
Stimulates vasomotor and cardioacceleratory centers Increase HR Increase CO Reflex vasoconstriction Increases BP Tissue perfusion increases

Short-Term Mechanisms: Neural Controls
Medullary ischemic reflex It is an autonomic response to a drop in perfusion of the brain Cardiovascular center of the medulla oblongata sends sympathetic signals to the heart and blood vessels Cardiovascular center also receives input from higher brain centers Hypothalamus, cortex

Hormonal Control
Hormones that Increase Blood Pressure Increase peripheral resistance Adrenal medulla hormones – NE, E Antidiuretic hormone (ADH) – causes intense vasoconstriction in cases of extremely low BP Endothelium-derived factors – endothelin and prostaglandin-derived growth factor (PDGF) are both vasoconstrictors Angiotensin II

Hormonal Controls
The kidneys control BP by altering blood volume Increased BP stimulates the kidneys to eliminate water, thus reducing BP Decreased BP stimulates the kidneys to increase blood volume and BP

Hormonal Controls
Kidneys act directly and indirectly to maintain long-term blood pressure Direct renal mechanism alters blood volume Increased kidney perfusion increases filtration Indirect renal mechanism involves the reninangiotensin mechanism

Hormonal Controls
Declining BP causes the release of renin, which triggers the release of angiotensin II Angiotensin II is a potent vasoconstrictor that stimulates aldosterone secretion Aldosterone enhances renal reabsorption and stimulates ADH release

Kidney Action and Blood Pressure

Hormonal Controls
Hormones that Decrease Blood Pressure Atrial natriuretic peptide (ANP) – causes blood volume and pressure to decline Nitric oxide (NO) – is a brief but potent vasodilator Inflammatory chemicals – histamine, prostacyclin, and kinins are potent vasodilators Alcohol – causes BP to drop by inhibiting ADH

MAP Increases

Monitoring Circulatory Efficiency
Efficiency of the circulation can be assessed by taking pulse and blood pressure measurements Vital signs – pulse and blood pressure, along with respiratory rate and body temperature Pulse – pressure wave caused by the expansion and recoil of elastic arteries Radial pulse (taken on the radial artery at the wrist) is routinely used Varies with health, body position, and activity

Palpated Pulse

Measuring Blood Pressure
Systemic arterial BP is measured indirectly with the auscultatory method A sphygmomanometer is placed on the arm superior to the elbow Pressure is increased in the cuff until it is greater than systolic pressure in the brachial artery Pressure is released slowly and the examiner listens with a stethoscope

Measuring Blood Pressure
The first sound heard is recorded as the systolic pressure Korotkoff sounds The pressure when sound disappears is recorded as the diastolic pressure

Variations in Blood Pressure
Blood pressure cycles over a 24-hour period BP peaks in the morning due to waxing and waning levels of hormones Extrinsic factors such as age, sex, weight, race, mood, posture, socioeconomic status, and physical activity may also cause BP to vary

Alterations in Blood Pressure
Hypotension – low BP in which systolic pressure is below 100 mm Hg Hypertension – condition of sustained elevated arterial pressure of 140/90 or higher Transient elevations are normal and can be caused by fever, physical exertion, and emotional upset Chronic elevation is a major cause of heart failure, vascular disease, renal failure, and stroke

Hypotension
Orthostatic hypotension – temporary low BP and dizziness when suddenly rising from a sitting or reclining position Chronic hypotension – hint of poor nutrition and warning sign for Addison’s disease Acute hypotension – important sign of circulatory shock Threat to patients undergoing surgery and those in intensive care units

Hypertension
Hypertension maybe transient or persistent Primary or essential hypertension – risk factors in primary hypertension include diet, obesity, age, race, heredity, stress, and smoking Secondary hypertension – due to identifiable disorders, including renal disease, arteriosclerosis, hyperthyroidism, obstruction of renal artery, etc

Blood Flow Through Tissues
Blood flow, or tissue perfusion, is involved in: Delivery of oxygen and nutrients to, and removal of wastes from, tissue cells Gas exchange in the lungs Absorption of nutrients from the digestive tract Urine formation by the kidneys The rate of blood flow to the tissues is precisely the right amount to provide proper tissue function

Velocity of Blood Flow
Blood velocity: Changes as it travels through the systemic circulation Is inversely proportional to the cross-sectional area Total cross-sectional area It is the combined cross-sectional area of all vessel Increased total cross-sectional area will decrease blood pressure and flow

Velocity of Blood Flow

Autoregulation: Local Regulation of Blood Flow
Autoregulation – automatic adjustment of blood flow to each tissue in proportion to its requirements at any given point in time Blood flow through an individual organ is intrinsically controlled by modifying the diameter of local arterioles feeding its capillaries MAP remains constant, while local demands regulate the amount of blood delivered to various areas according to need

Types of autoregulation
Metabolic Controls Declining tissue nutrient and oxygen levels are stimuli for autoregulation Endothelial cells release nitric oxide (NO) Nitric oxide induces vasodilation at the capillaries to help get oxygen to tissue cells Other autoregulatory substances include: potassium and hydrogen ions, adenosine, lactic acid, histamines, kinins, and prostaglandins

Types of autoregulation
Myogenic Controls Inadequate tissue perfusion or excessively high arterial pressure: Are autoregulatory Provoke myogenic responses – stimulation of vascular smooth muscle Vascular muscle responds directly to: Increased vascular pressure with increased tone, which causes vasoconstriction Reduced stretch with vasodilation, which promotes increased blood flow to the tissue

Control of Arteriolar Smooth Muscle

Blood Vessels
PART B

Long-Term Autoregulation
Is evoked when short-term autoregulation cannot meet tissue nutrient requirements May evolve over weeks or months to enrich local blood flow

Long-Term Autoregulation
Angiogenesis Increased of the number of vessels to a region enlargement of existing vessels When a heart vessel becomes partly occluded Routinely in people in high altitudes, where oxygen content of the air is low

Blood Flow: Skeletal Muscles
Local regulation Resting muscle blood flow is regulated by myogenic and general neural mechanisms in response to oxygen and carbon dioxide levels When muscles become active, hyperemia is directly proportional to greater metabolic activity of the muscle (active or exercise hyperemia)

Blood Flow: Skeletal Muscle
Systemic regulation Sympathetic activity increase Arterioles in muscles have cholinergic receptors Muscle blood flow can increase tenfold or more during physical activity as vasodilation occurs Arterioles in organs have alpha and beta receptors Vasoconstriction occur to divert blood to the muscles

Blood Flow: Brain
Blood flow to the brain is constant, as neurons are intolerant of ischemia Metabolic controls – brain tissue is extremely sensitive to declines in pH, and increased carbon dioxide causes marked vasodilation Myogenic controls protect the brain from damaging changes in blood pressure Decreases in MAP cause cerebral vessels to dilate to ensure adequate perfusion Increases in MAP cause cerebral vessels to constrict

Blood Flow: Brain
The brain can regulate its own blood flow in certain circumstances, such as ischemia caused by a tumor increasing systemic blood pressure The brain is vulnerable under extreme systemic pressure changes MAP below 60mm Hg can cause syncope (fainting) MAP above 160 can result in cerebral edema

Blood Flow: Skin
Blood flow through the skin: Supplies nutrients to cells in response to oxygen need Helps maintain body temperature Provides a blood reservoir

Blood Flow: Skin
Blood flow to venous plexuses below the skin surface: Varies from 50 ml/min to 2500 ml/min, depending on body temperature Is controlled by sympathetic nervous system reflexes initiated by temperature receptors and the central nervous system

Temperature Regulation
As temperature rises (e.g., heat exposure, fever, vigorous exercise): Hypothalamic signals reduce vasomotor stimulation of the skin vessels Heat radiates from the skin Sweat also causes vasodilation via bradykinin in perspiration Bradykinin stimulates the release of NO As temperature decreases, blood is shunted to deeper, more vital organs

Blood Flow: Lungs
Blood flow in the pulmonary circulation is unusual in that: The pathway is short Arteries/arterioles are more like veins/venules (thin-walled, with large lumens) They have a much lower arterial pressure (24/8 mm Hg versus 120/80 mm Hg)

Blood Flow: Heart Blood Flow: Lungs
The autoregulatory mechanism is exactly opposite of that in most tissues Low oxygen levels in the alveolus cause vasoconstriction; high levels promote vasodilation This allows for proper oxygen loading in the lungs Small vessel coronary circulation is influenced by: Aortic pressure The pumping activity of the ventricles During ventricular systole: Coronary vessels compress Myocardial blood flow ceases Stored myoglobin supplies sufficient oxygen During ventricular diastole, oxygen and nutrients are carried to the heart

Blood Flow: Heart
Under resting conditions, blood flow through the heart may be controlled by a myogenic mechanism Blood flow remains constant despite wide variation in coronary perfusion pressure During strenuous exercise: Coronary vessels dilate in response to local accumulation of carbon dioxide Decreased oxygen in the blood will cause local release of vasodilators

Capillary Exchange of Respiratory Gases and Nutrients
Oxygen, carbon dioxide, nutrients, and metabolic wastes diffuse between the blood and interstitial fluid along concentration gradients Oxygen and nutrients pass from the blood to tissues Carbon dioxide and metabolic wastes pass from tissues to the blood

Capillary Exchange of Respiratory Gases and Nutrients
Water-soluble solutes pass through clefts and fenestrations Lipid-soluble molecules diffuse directly through endothelial membranes

Capillary Exchange of Respiratory Gases and Nutrients

Capillary Exchange of Respiratory Gases and Nutrients

Capillary Exchange
Flow of water and solutes from capillaries to interstitial space Plasma and interstitial fluid are in constant communication Assists in the transport of lipids and tissue proteins Accelerates the distribution of nutrients Carries toxins and other chemical stimuli to lymphoid tissues

Processes that move fluids across capillary walls
Diffusion of molecules happens through adjacent endothelial cell or through the pores or through channels on the membrane or through the membrane of the endothelial cells Filtration Capillary hydrostatic pressure (CHP) Only small molecules will pass through the pores of the membrane or between adjacent endothelial cells

Processes that move fluids across capillary walls
Reabsorption Through osmosis The higher the solute concentration the greater the solution’s osmotic pressure Blood colloid osmotic pressure (BCOP) or oncotic pressure Is the osmotic pressure of the blood It works against hydrostatic pressure

Capillary Filtration

Forces acting across capillary walls
Capillary hydrostatic pressure (CHP = 35) Blood colloid osmotic pressure (BCOP=25) Interstitial fluid colloid osmotic pressure (ICOP=0) Interstitial fluid hydrostatic pressure (IHP= 0)

Capillary filtration and reabsorption
Processes involved in filtration at the arterial end Net hydrostatic pressure CHP – IHP= 35-0=35 Net colloid osmotic pressure BCOP – ICOP=25-0=25 Net filtration pressure 35-25=10

Capillary filtration and reabsorption
Processes involved in reabsorption at the venous end Net hydrostatic pressure CHP-IHP=18-0=18 Net osmotic pressure BCOP-ICOP=25-0=25 Net filtration pressure 18-25=-7

Net Filtration Pressure (NFP)

Filtration and reabsorption
NFP=(CHP-IHP) – (BCOP-ICOP) IHP=0 ICOP=0 +NFP=fluid moves out of the capillary (arterial side) -NFP=fluid moves into the capillary (venous side)

Circulatory Shock
Circulatory shock – any condition in which blood vessels are inadequately filled and blood cannot circulate normally Results in inadequate blood flow to meet tissue needs

Circulatory Shock
Three types include: Hypovolemic shock – results from largescale blood loss Vascular shock – poor circulation resulting from extreme vasodilation Cardiogenic shock – the heart cannot sustain adequate circulation

Circulatory Pathways
The vascular system has two distinct circulations Pulmonary circulation – short loop that runs from the heart to the lungs and back to the heart Systemic circulation – routes blood through a long loop to all parts of the body and returns to the heart

Differences Between Arteries and Veins
Arteries Delivery Blood pumped into single systemic artery – the aorta Deep, and protected by tissue Fair, clear, and defined Predictable supply Veins Blood returns via superior and interior venae cavae and the coronary sinus Both deep and superficial Convergent interconnections Dural sinuses and hepatic portal circulation

Developmental Aspects
The endothelial lining of blood vessels arises from mesodermal cells, which collect in blood islands Blood islands form rudimentary vascular tubes through which the heart pumps blood by the fourth week of development Fetal shunts (foramen ovale and ductus arteriosus) bypass nonfunctional lungs The ductus venosus bypasses the liver The umbilical vein and arteries circulate blood to and from the placenta

Location Pathways Supply/drainage

Fetal circulation

Developmental Aspects
Blood vessels are trouble-free during youth Vessel formation occurs: As needed to support body growth For wound healing To rebuild vessels lost during menstrual cycles With aging, varicose veins, atherosclerosis, and increased blood pressure may arise

Pulmonary circuit consists of pulmonary vessels
Arteries which deliver deoxygenated blood to the lungs Capillaries in the lungs where gas exchange occurs Veins which deliver oxygenated blood to the left atrium

Pulmonary Circulation

Systemic arteries
Ascending aorta Right and left coronary arteries originate from base of aortic sinus Aortic arch Brachiocephalic trunk Right common carotid Right subclavian Left common carotid Left subclavian Descending aorta Thoracic and abdominal aortas

Systemic Circulation

Systemic arteries
Subclavian Supplies arms, chest, CNS, shoulder and back Internal thoracic Pericardium and anterior chest Vertebral Brain Spinal cord

Systemic arteries
Axillary shoulder Brachial Upper arm Radial Ulnar Superficial and deep palmar archs

Arteries of the chest and upper limb

Arteries of the neck and head
Common carotid artery Internal carotid External carotid

Arteries of the neck and head
Ophthalmic artery Basilar artery Occipital artery Vertebral artery Internal carotid artery External carotid artery Common carotid artery Maxillary artery Facial artery

Clavicle (cut) Subclavian artery Axillary artery (b) Brachiocephalic trunk Internal thoracic artery

External Carotid Neck Esophagus Pharynx Lower jaw face

Arteries of the Brain and Circle of Willis
Ophthalmic artery Basilar artery Occipital artery Vertebral artery Internal carotid artery External carotid artery Common carotid artery Maxillary artery Facial artery

Clavicle (cut) Subclavian artery Axillary artery (b) Brachiocephalic trunk Internal thoracic artery

Internal carotid Ophthalmic eyes Anterior cerebral Frontal and parietal lobes Anterior communicating artery Middle cerebral Mesencephalon and lateral cerebral hemisphere

Arteries of the Brain and Circle of Willis
Vertebral arteries Basilar artery Supply medulla oblongata Pons Cerebellum Basilar artery gives rise to posterior cerebral and posterior communicanting arteries

Circle of Willis

Arteries of the Abdomen
Liver (cut) Inferior vena cava Celiac trunk Hepatic artery proper Common hepatic artery Right gastric artery Gallbladder Gastroduodenal artery Right gastroepiploic artery Duodenum Abdominal aorta (b) Diaphragm Esophagus Left gastric artery Left gastroepiploic artery Splenic artery Spleen Stomach Pancreas (major portion lies posterior to stomach) Superior mesenteric artery

Blood Vessels
PART C

Opening for inferior vena cava

Arteries of the Abdomen
Diaphragm Inferior phrenic artery Middle suprarenal artery Renal artery Superior mesenteric artery

Major Arteries of the Trunk
Descending aorta Thoracic For the thorax Abdominal Celiac trunk Left gastric Splenic Common hepatic

Hiatus (opening) for esophagus Celiac trunk Kidney Lumbar arteries

Abdominal aorta Median sacral artery (c)

Gonadal (testicular or ovarian) artery Inferior mesenteric artery Common iliac artery Ureter

Major Arteries of the Trunk
Superior mesenteric Pancreas, small intestine and proximal 2/3 of the large intestine Suprarenal Renal Gonadals Inferior mesenteric Distal 1/3 of the large intestine

Abdominal aorta
Right and left Common iliacs Internal iliac Organ of pelvic cavity External iliac Femoral Popliteal Anterior tibial Posterior tibial Fibular Dorsal and plantar archs

Arteries of the Lower Limbs

Common iliac artery Internal iliac artery Superior gluteal artery External iliac artery Deep artery of thigh Lateral circumflex femoral artery Medial circumflex femoral artery Obturator artery Femoral artery Adductor hiatus Popliteal artery

Popliteal artery Anterior tibial artery Fibular artery Dorsalis pedis artery (from top of foot) Plantar arch

Anterior tibial artery Posterior tibial artery Fibular artery

Posterior tibial artery Lateral plantar artery Medial plantar artery (c)

Dorsalis pedis artery Arcuate artery Metatarsal arteries (b)

Systemic Veins
Superior vena cava Drains blood from the head and neck Inferior vena cava Drains blood from the remainder of the body

Dural sinuses External jugular vein Vertebral vein Internal jugular vein Superior vena cava Axillary vein Great cardiac vein Hepatic veins Hepatic portal vein Superior mesenteric vein Inferior vena cava Ulnar vein Radial vein Digital veins Common iliac vein External iliac vein Femoral vein Great saphenous vein Popliteal vein Posterior tibial vein Anterior tibial vein Fibular vein Dorsal venous arch (b)

Subclavian vein Right and left brachiocephalic veins Cephalic vein Brachial vein Basilic vein Splenic vein Median cubital vein Renal vein Inferior mesenteric vein

Internal iliac vein

Dorsal digital veins

Venous return from the cranium
Cerebral veins drain the blood into sinuses Superior sagittal sinus Inferior sagittal sinus Occipital sinus Straight sinus Left and right transverse sinuses

Veins of the Brain
Superior sagittal sinus Falx cerebri Inferior sagittal sinus Straight sinus Cavernous sinus Junction of sinuses Transverse sinuses Sigmoid sinus Jugular foramen Right internal jugular vein

(c)

Venous return from the cranium

Veins of the Head and Neck
Ophthalmic vein Superficial temporal vein Facial vein Occipital vein

Left and right transverse sinuses converge to form the sigmoid sinus Sigmoid sinus becomes internal jugular vein

(b)

Posterior auricular vein External jugular vein Vertebral vein Internal jugular vein Superior and middle thyroid veins Brachiocephalic vein Subclavian vein Superior vena cava

Superficial veins of the head and neck
Temporal Facial Maxillary They drain into external and internal jugular veins

Veins of neck and thorax

Internal and external jugular Brachiocephalic trunks Superior vena cava

Veins in the thorax
From lumbar vein Azygos vein (on the right side) Hemiazygos (on the left side) They drain into the brachiocephalic

Veins of the arms
Brachiocephalic Subclavian Cephalic Axillary Brachial Basilic Median cubital Connects basilic and cephalic Brachial divides in radial and ulnar

Internal jugular vein Brachiocephalic veins Right subclavian vein Axillary vein Brachial vein Cephalic vein Basilic vein External jugular vein Left subclavian vein Superior vena cava Azygos vein Accessory hemiazygos vein Hemiazygos vein Posterior intercostals Inferior vena cava Ascending lumbar vein Basilic vein Ulnar vein Deep palmar venous arch Superficial palmar venous arch Digital veins (b)

Veins of the Abdomen
Hepatic veins Inferior vena cava Right suprarenal vein Left suprarenal vein Renal veins Right gonadal vein Left ascending lumbar vein Lumbar veins Left gonadal vein Common iliac vein Internal iliac vein Inferior phrenic vein

Median cubital vein Median antebrachial vein Cephalic vein Radial vein

External iliac vein (b)

Hepatic Portal System
Contains substance absorbed by the stomach and intestines Delivers these compounds to the liver for Storage Metabolic conversion Excretion

Veins of the Abdomen
Hepatic veins Gastric veins Spleen Inferior vena cava Splenic vein Right gastroepiploic vein Inferior mesenteric vein Superior mesenteric vein Small intestine Large intestine Rectum (c) Liver Hepatic portal vein

Hepatic portal system
Capillaries in the digestive system Hepatic portal vein Inferior mesenteric vein Superior mesenteric vein Splenic vein Gastric veins Cystic vein Liver capillaries Hepatic vein

Venous Drainage from the Lower Limb

Common iliac vein Internal iliac vein External iliac vein Inguinal ligament Femoral vein Great saphenous vein (superficial) Great saphenous vein Popliteal vein Popliteal vein Anterior tibial vein Fibular (peroneal) vein Small saphenous vein (superficial) Posterior tibial vein Plantar veins Plantar arch Digital veins (c)

Fibular (peroneal) vein Anterior tibial vein Dorsalis pedis vein Dorsal venous arch Metatarsal veins (b)

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