UNIT TEN

CIRCULATORY SYSTEM

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 VI. The circulatory system
 The circulatory system transports fluids throughout the body.
 The circulatory system consists of two interrelated parts which
function in parallel to transport the body's fluids:
1. Cardiovascular system
2. Lymphatic system
 The heart and blood vessels make up the blood transportation
network, the cardiovascular system
 The lymphatic system which is made up of a network of conduits that
carry a clear fluid called lymph.

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Functions of the circulatory system:
 Distributes nutrients
 Transport and exchange of oxygen and carbon
dioxide
 Removal of waste materials
 Distributes secretions of endocrine glands
 Prevent excessive bleeding
 Prevent infection
 Regulate body temperature.

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 Blood
The only liquid connective tissue
5-6 liters in average adult male and 4-5 liters in adult female
Constituted about 6-8% of the total body weight.
Composed of two portions
 Formed elements (cells and cell fragments)
 Blood plasma-liquid portion and contains dissolved substances
Function

 Transportation- o2,co2, nutrients, hormones and wastes

 Regulation- ph, body temperature and water content of the cell
 Protection- blood loss through clotting
 against disease through phagocytosis and antibody production
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Blood

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 Blood plasma
 The liquid portion of blood
 A straw colored liquid that is about 90 % water
 Consists of proteins, inorganic salts, carbohydrates, lipids, amino
acids, vitamins and hormones
 Contains three types of proteins-
1. Albumin- consists of 60% plasma protein
-help to maintain proper blood osmotic pressure
2. Globulins-36% of plasma protein
-transport lipid and fat soluble vitamins
-alpha, beta and gamma types
-alpha and beta are produced by liver
-gamma produced by lymphocytes
3. Fibrinogen-key protein in formation of blood clot
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 Formed elements (blood cells)
 Have some unusual features for example erythrocytes lack nucleus and organelles
 Platelets- cell fragments
 Most of the formed elements can not divide (replaced by division of precursor cells);
they survive in the blood stream for only a short time

Red blood cells (Erythrocytes)

 the most numerous formed elements
 biconcave discs-discs with depressed centers
 mature RBC lacks nucleus and other organelles ,such as mitochondria (get
energy from anaerobic respiration)
 their cytoplasm is packed with molecules of hemoglobin- the oxygen carrying
protein
 erythrocytes are over 97 % hemoglobin
 live (life span) 100-120 days much longer than other types of blood cells
 they originate from cells in red bone marrow
 function-transport o2 &co2

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 White blood cells (Leukocytes)
 less numerous than erythrocytes
 spherical in shape
 are the only formed elements with complete cells(contain nucleus
and mitochondria)
 can move in ameboid fashion and protects the body from
infectious microorganisms such as bacteria , virus and parasites
 can function out side the blood stream
 originate from bone marrow
 there are five types of leukocytes, divided in to two groups based
on the presence or absence of membrane bounded cytoplasmic
granules

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 Granulocytes (granular leukocytes)
 There are 3 types of granulocytes
 Neutrophils, eosinophils , basophiles- are larger and much shorter lived than erythrocytes
 Functionally , all granulocytes are phagocytic ;they engulf and digest foreign
cells or molecules
 Have variable shaped nuclei
1. Neutrophils
 2-5 lobed nucleus
 the most abundant type of leukocytes (constitutes 60%)
 the granules are membrane walled sacs of digestive enzymes
 destroy bacteria
2. Eosinophils –
 accounts for 1%-4% of all leukocytes
 bilobed nucleus
 play a role in ending allergic reactions and parasitic infections
3. basophiles- accounts 0.5 %
o bilobed nucleus
o release histamine and other mediators of inflammation 11
Agranular leukocytes (agranulocytes)
 There are two types of agranulocytes
 lymphocytes and monocytes
1. Lymphocytes
 20-45% of all leukocytes
 are effective in fighting infectious organisms
 two types:-B cells and T cells
2. Monocytes
 the largest leukocytes
 makes up 4-8% of WBC
 phagocytosis

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 Platelets (Thrombocytes)
 the smallest formed elements
 are fragments of large cells called megakaryocytes
 have no nucleus
 capable of ameboid movement
 blood clotting
 When a blood sample is centrifuged, the heavier formed elements are
packed in to the bottom of the tube, leaving plasma at the top.
 The formed elements constitute approximately 45% of the total blood
volume (hematocrit) the plasma accounts for the remaining 55%
Blood grouping
Grouped based on two typing systems
 ABO typing – (A, B, AB and O groups)
 Rh typing – (Rh positive and Rh negative
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 The Heart
• The heart is located near the center of the thoracic
cavity(mediastinum) between the lungs and is
contained in the pericardial sac.
• The heart has four chambers: right and left atria and
right and left ventricles.
• The atria are receiving chambers that pump blood
into the ventricles (the discharging chambers).

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 The HEART
• The heart, slightly larger than a clenched fist, is a double, self-
adjusting, suction and pressure pump, the parts of which work in
unison to propel blood to all parts of the body.

• The right side of the heart (right heart) receives poorly

oxygenated (venous) blood from the body through the SVC and
IVC and pumps it through the pulmonary trunk to the lungs for
oxygenation.

• The left side of the heart (left heart) receives well-oxygenated

(arterial) blood from the lungs through the pulmonary veins and
pumps it into the aorta for distribution to the body.

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 The pericardium
• is a fibroserous membrane that covers the
heart and the beginning of its great vessels
• composed of two layers:
1. Fibrous pericardium
2. Serous pericardium

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1. Fibrous pericardium-the tough external layer, is
continuous with (blends with) the central tendon of
the diaphragm
2. Serous pericardium -is composed mainly of mesothelium, a
single layer of flattened cells forming an epithelium that
lines both the internal surface of the fibrous pericardium and
the external surface of the heart
• The internal surface of the fibrous pericardium is
lined with a glistening serous membrane, the
parietal layer of serous pericardium. This layer is
reflected onto the heart at the great vessels as the
visceral layer of serous pericardium.
• Pericardial cavity- is the potential space between
opposing layers of the parietal and visceral layers
of serous pericardium.
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The wall of each heart chamber consists of three
layers :
 Endocardium-
Endocardium a thin internal layer (endothelium
and subendothelial connective tissue) or lining
membrane of the heart that also covers its valves.
 Myocardium-
Myocardium a thick, helical middle layer
composed of cardiac muscle.
 Epicardium-
Epicardium a thin external layer (mesothelium)
formed by the visceral layer of serous pericardium

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• The walls of the heart consist mostly of thick
myocardium, especially in the ventricles.
• The muscle fibers are anchored to the fibrous
skeleton of the heart.
This is a complex framework of dense collagen
forming four fibrous rings that surround the
orifices of the valves, a right and left fibrous
trigone (formed by connections between rings),
and the membranous parts of the interatrial and
interventricular septa

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 Relations and external features of the heart
 The heart within the pericardial sac is related anteriorly to
the sternum, costal cartilages, and anterior ends of the 3rd -
5th ribs on the left side.
 The heart and pericardial sac are situated obliquely,
approximately two thirds to the left and one third to the
right of the median plane
 Externally, the atria are demarcated from the ventricles by the
coronary or atrioventricular groove (sulcus), and the right and left
ventricles are demarcated from each other by anterior and posterior
interventricular (IV) grooves
 The heart has an apex, a base ,four surfaces and four
borders
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The apex of the heart :
 Is formed by the inferolateral part of the left
ventricle.
 Lies posterior to the left 5th intercostal space in
adults, usually approximately 9 cm (a hand's
breadth) from the median plane.
The base of the heart :
 Is the heart's posterior aspect (opposite the apex).
 Is formed mainly by the left atrium, with a lesser
contribution by the right atrium.
 Faces posteriorly toward the bodies of vertebrae T6-
T9
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The four surfaces of the heart are the:
 Anterior (sternocostal) surface- formed
mainly by the right ventricle.
 Diaphragmatic (inferior) surface- formed
mainly by the left ventricle and partly by the
right ventricle
 Right pulmonary surface- formed mainly by
the right atrium.
 Left pulmonary surface- formed mainly by the
left ventricle; it forms the cardiac impression
of the left lung.
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The four borders heart are the:
 Right border-formed
border by the right atrium and
extending between the SVC and the IVC.
 Inferior border- formed mainly by the right
ventricle and slightly by the left ventricle.
 Left border- formed mainly by the left
ventricle and slightly by the left auricle.
 Superior border- formed by the right and left
atria and auricles in an anterior view

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 Heart Chambers
 The anterior inter- Anterior
ventricular sulcus, Interventricular
Sulcus
separates the right and
left ventricles
 It continues as the
posterior inter-
ventricular sulcus
which provides a
similar landmark on the
heart’s posterio-
inferior surface Posterior
Interventricular
Sulcus
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 Right atrium
• Forms the right border of
the heart and receives
venous blood from the
SVC, IVC, and coronary
sinus
• Right auricle- the ear-like
conical muscular pouch
that projects from this
chamber and overlaps the
ascending aorta.
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 Right atrium
 Internally, the posterior
walls are smooth, but the Pectinate
anterior walls are ridged Muscle

by bundles of muscle
tissue
 These muscle bundles are
called pectinate muscles
 Posterior wall of right
atrium b/n the two venae
cavae appears smooth.

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• The interatrial septum Fovea
bears a shallow depression, Ovalis

the fovea ovalis.

• This landmark marks the

spot where an opening, the
foramen ovale, existed in
the fetal heart

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• The smooth and rough parts of the atrial wall are separated
Externally by a shallow vertical groove, the sulcus
terminalis or terminal groove
Internally by a vertical ridge, the crista terminalis or
terminal crest
• Right AV orifice through which the right atrium discharges
the poorly oxygenated blood it has received into the right
ventricle.

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 Right ventricle

Papillary
 Forms the largest part of the muscles
anterior surface of the heart
 The right ventricle pumps blood
into the pulmonary trunk, which
routes blood to the lungs for gas
exchange
 The interior of the right ventricle
has irregular muscular elevations -
trabeculae carneae.

Trabeculae
carneae 37
 Cone shaped papillary
muscles project from
the walls in to
ventricular cavity
 Tendinous cords (L.
chordae tendineae)
arise from the apices
of papillary muscles
and attach to the free
edges and ventricular
surfaces of the
anterior, posterior,
and septal cusps.
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 Left atrium
• Rectangular in shape
• forms most of the base of the heart.
• Smaller than the right atrium
• Blood enters the left atrium via four
veins
 Right and left pulmonary veins
 Left auricle - forms the superior part of
the left border of the heart and
overlaps the pulmonary trunk
 Most of the atrial wall – smooth
 Pectinate mm lining the auricle only.
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 Left ventricle
 Forms the apex of the heart, nearly all its left (pulmonary)
surface and border, and most of the diaphragmatic
surface
 Walls that are 2-3 times as thick as that of the right
ventricle.
 Trabeculae carneae - Finer and more numerous than the
right ventricle.
 Papillary muscles that are larger than those in the right
ventricle
 A double-leaflet mitral valve that guards the left AV
orifice.
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 Valves of the heart
The tricuspid valve The mitral valve
 guards the right AV  guards the left AV orifice
orifice  has two cusps, anterior
 has anterior, posterior, and posterior.
and septal cusps  Prevents backward flow
 Prevents backward flow of blood from the left
of blood from the right ventricle back into the
ventricle back into the left atrium
right atrium  located posterior to the
 located posterior to the sternum at the level of
body of the sternum at the 4th costal cartilage.
the level of the 4th and
5th intercostal spaces
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 Semilunar Valves
Pulmonary and aortic valves
 Each have three semilunar cusps: pulmonary valve
(anterior, right, and left) and aortic (posterior, right, and
left).
 Semilunar cusps do not have tendinous cords to support
them and are smaller than the cusps of the AV valves.
 Immediately superior to each semilunar cusp, the walls of
the origins of the pulmonary trunk and aorta are slightly
dilated, forming a sinus.
 The right and the left coronary arteries arise from the right
and left aortic sinuses, but no artery arises from the
posterior aortic sinus.
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 Fibrous Skeleton
• The fibrous skeleton
of the heart lies in
the plane between
the atria and the
ventricles
• It surrounds the four
valves
• It is composed of
dense connective
tissue
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The fibrous skeleton has four functions
It anchors the valve cusps
It prevents over dilation of the valve openings
as blood passes through them
Provides a rigid framework for the attachment
of cardiac muscle tissue.
provides electrical insulation between atria
and ventricles
ensure that muscle impulses are not spread
randomly throughout the heart
prevents all of the heart chambers from
beating at the same time 47
 Heart Sounds
• The closing of the heart valves causes vibrations in the
adjacent blood and heart walls that account for the familiar
“lub-dup” sounds of the heartbeat
• The “lub” is produced by the closing of the AV valves at the
start of ventricular systole
• The “dup” is produced by the closing of the semilunar
valves at the end of ventricular systole
• The mitral valve closes slightly before the tricuspid
closes ,and the aortic valve generally closes just before the
pulmonary valve closes.

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Surface Anatomy of Heart Valves
 pulmonary valve lies behind the medial end of 3rd left costal cartilage
and adjoining part of sternum
 aortic valve lies behind the right half of sternum opposite the 3rd
intercostal space
 mitral valve lies behind the left half of sternum opposite the 4th costal
cartilage
 tricuspid valve lies behind the right half of sternum opposite the
fourth intercostal space

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 ,
The sounds can be
heard(auscultated) at the
following points :

Mitral valve- 5th intercostal

space (ICS) at the apex
Tricuspid valve –right 5th ICS
of right sternal margin
Aortic semilunar valve -2nd
ICS right sternal margin
Pulmonary semilunar valve-
2nd ICS of left sternal margin

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 Conducting System
 Cardiac muscle cells have an intrinsic ability to generate
and conduct impulses that signal the cells to contract
rhythmically.
 These properties are intrinsic to the heart muscle itself and do not
depend on extrinsic nerve impulses
 Even if all nerve connections to the heart are severed, the heart
continues to beat rhythmically

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 Conducting System
 The conducting system of the heart is a series of specialized cardiac
muscle cells that carries impulses throughout the heart musculature,
signaling the heart chambers to contract in proper sequence.

 Stimulated by the sympathetic division of the autonomic nervous

system to accelerate the heart rate and is inhibited by the
parasympathetic division to return to or toward its basal rate.

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 Conducting System
• The components of
the conducting
system are:
 Sinoatrial node
 Internodal fibers
 Atrioventricular
node
 Atrioventricular
bundle
 Right an left
branches
 Purkinje fibers

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 Conducting System
 The impulse that signals
each heartbeat begins at
the sinoatrial (SA) node.
 This is a crescent shaped
mass of muscle cells that
lies in the wall of the
right atrium, below the
entrance of the superior
vena cava.

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 Conducting System
 The sinoatrial
node, the heart’s
own pacemaker,
sets the basic heart
rate by generating
70-80 impulses per
minute

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 Conducting System
 The contraction
signal from the SA
node spreads
myogenically
(through the
musculature) of both
atria.

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 Conducting System
 Some of these
impulses travel along
the internodal
pathway to the
atrioventricular (AV)
node in the inferior
part of the interatrial
septum, where they
are delayed for a
fraction of a second

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 Conducting System
 After this delay,
the impulses race
through the atrio-
ventricular bundle
which enters the
interventricular
septum and
divides into right
and left bundle
branches
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 Conducting System
 About halfway
down the septum,
the Bundle fibers,
become bundles of
Purkinje fibers
which approach the
apex of the heart,
then turn
superiorly into the
ventricular walls
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Arterial Supply of the Heart
• The right and left coronary arteries arise from the
corresponding aortic sinuses
1. The right coronary artery (RCA)- arises from the right
aortic sinus of the ascending aorta and passes to the
right side of the pulmonary trunk, running in the
coronary groove
 Branches : SA nodal, right marginal ,posterior
interventricular artery
 Supply areas:
 The right atrium.
 Most of right ventricle.
 Part of the left ventricle (the diaphragmatic surface).
 Part (usually the posterior third) of the IV septum.
 The SA node (in approximately 60% of people).
 The AV node (in approximately 80% of people).
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2. The left coronary artery (LCA)- arises from the left
aortic sinus of the ascending aorta, passes between
the left auricle and the left side of the pulmonary
trunk, and runs in the coronary groove
• Branches :anterior IV branch and the circumflex
branch
• Supply areas:
o left atrium
o Most of the left ventricle
o Part of the right ventricle
o most of interventricular septum(anterior 2/3)
o RBB
o LBB
o SA node (40%of people)

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Venous Drainage of the Heart
• The heart is drained mainly by veins that empty
into the coronary sinus and partly by small
veins that empty into the right atrium
• The coronary sinus- runs from left to right in
the posterior part of the coronary groove.
o receives the great cardiac vein at its left end
and the middle cardiac vein and small
cardiac veins at its right end.
o The great cardiac vein is the main tributary of
the coronary sinus.
o The great cardiac vein drains the areas of the
heart supplied by the LCA.
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  The middle cardiac vein accompanies the posterior
interventricular branch and small cardiac vein accompanies the
right marginal branch of the RCA.
• Thus these two veins drain most of the areas
commonly supplied by the RCA.
 The oblique vein of the left atrium- descends over the posterior
wall of the left atrium and merges with the great cardiac vein to
form the coronary sinus
The anterior cardiac vein drain blood from right atrium
& ventricle and opens directly into right atrium.
• The smallest cardiac veins (L. venae cordis
minimae)
minimae are minute vessels that begin in the
capillary beds of the myocardium and open directly
into the chambers of the heart, chiefly the atria 64
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 Innervation of the Heart

 The heart is supplied by autonomic nerve fibers from

the cardiac plexus.
 Cardiac plexus is formed of both sympathetic and
parasympathetic fibers
 The sympathetic supply is from the superior five or six
thoracic segments of the spinal cord
 The parasympathetic supply is from the vagus nerves
 Sympathetic stimulation causes increased heart rate;
impulse conduction; force of contraction
 Parasympathetic stimulation slows the heart rate,
reduces the force of the contraction, and constricts the
coronary arteries, saving energy

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 Circulation
 systemic circulation
 pulmonary circulation
• Systemic circulation-is the flow of blood through vessels
from left ventricle to the tissue of the body and back to the
right atrium
– Left ventricle----aorta---arteries----capillaries in tissue---
veins---right atrium
• Pulmonary circulation- is the flow of blood through vessels
from right ventricle to the lungs and back to the left atrium
– Right ventricle---pulmonary trunk---Rt and Lt
pulmonary arteries---Rt &Lt lungs--- Rt & Lt pulmonary
veins---left atrium
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 Blood vessels
• Form a closed delivery system powered by
the pumping heart.
• Are dynamic structures ,that pulsate ,constrict
and relax according to the changing needs of
the body
• There are three types of blood vessels:
1. Arteries
2. Veins
3. Capillaries.
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• Blood under high pressure leaves the heart and
is distributed to the body by a branching system
of thick-walled arteries.
• The final distributing vessels, arterioles, deliver
oxygenated blood to capillaries.
• Capillaries form a capillary bed, where the
interchange of oxygen, nutrients, waste products,
and other substances with the extracellular fluid
occurs.
• Blood from the capillary bed passes into thin-
walled venules, which resemble wide capillaries.
• Venules drain into small veins that open into
larger veins.

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• The largest veins, the superior and inferior
venae cavae, return poorly oxygenated
blood to the heart.
• Arteries branch or diverge as they carry
blood away from the heart.
• Veins converge or serve as tributaries as they
carry blood toward the heart

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 Structure of blood vessels
The walls of blood vessels of the circulatory system have
three coats, or tunics:
i. Tunica intima- an inner lining consisting of a single
layer of extremely flattened epithelial cells, the
endothelium, supported by delicate connective tissue.
 Forms a smooth surface that minimizes the friction of
blood moving .
ii. Tunica media- a middle layer consisting primarily of
circularly arranged smooth muscle between which lie
circular sheets of elastin and collagen fibers.
iii.Tunica adventitia(externa) - an outer connective tissue
layer containing longitudinally arranged collagen and
elastic fibers

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• The walls of blood vessels surround the blood
filled space called the lumen.
• Blood capillaries consist only of the tunica
intima with a supporting basement
membrane.
• The tunica media is the most variable.
– Arteries, veins, and lymphatic ducts are
distinguished by the thickness of this layer relative
to the size of the lumen, its organization, and, in
the case of arteries, the presence of variable
amounts of elastic fibers.
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Arteries
• Arteries are vessels that carry blood away from
the heart.
• All arteries carry oxygen –rich blood except the
palmonary arteries and umblical arteries.
• The blood passes through arteries of decreasing
caliber.
• The different types of arteries are distinguished
from each other on the basis of :
 overall size
 relative amounts of elastic tissue or muscle in the
tunica media
 the thickness of the wall relative to the lumen
 function .
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There are three types of arteries:
1. Large elastic arteries (conducting arteries)
 largest arteriesnear the heart, (2.5cm-1cm in diameter)
 have many elastic layers in their walls.
 Their elasticity enables them to expand when they
receive the cardiac output, minimizing the pressure
change.
 Their large lumen allows them to serve as low
resistance conduits for conducting blood between the
heart and medium –sized muscular arteries.
 Examples of large elastic arteries are the aorta, the
arteries that originate from the arch of the aorta
(brachiocephalic, subclavian, and carotid arteries), and
the pulmonary trunk and arteries.
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2. Medium muscular arteries (distributing arteries)
– 1-0.3 cm ,lie distal to elastic arteries and supply
organ(s)
– have walls that consist chiefly of circularly disposed
smooth muscle fibers.
– Especially thick sheets of elastin lie on each side of of
the tunica media
i. Internal elastic lamina –between tunica media and
tunica intima
ii. External elastic lamina-between tunica media and
tunica externa
– Most of the named arteries, including those observed
in the body wall and limbs such as the brachial or
femoral arteries, are medium muscular arteries.
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3. Small arteries and arterioles
– have relatively narrow lumina and thick muscular
walls.
– The degree of filling of the capillary beds and level of
arterial pressure within the vascular system are
regulated mainly by the degree of tonus (firmness) in
the smooth muscle of the arteriolar walls.
– If the tonus is above normal, hypertension (high
blood pressure) results.
– The small arteries are usually not named and
arterioles can be observed only under magnification.

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 Veins
• Are the blood vessels that return deoxygenated
(venous) blood from the capillary beds to the heart.
• Veins in the systemic circuit carry blood that is
relatively oxygen poor but the pulmonary veins are
atypical in that they carry well-oxygenated blood
from the lungs to the heart.
• Because of the lower blood pressure in the venous
system, the walls (specifically, the tunica media) of
veins are thinner than those of their companion
arteries .
• Normally, veins do not pulsate and do not squeeze
or burst blood when severed
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• There are three sizes of veins:
veins
1. Venules –
– are the smallest veins.
– The smallest venules are called post capillary
venules
– Venules drain capillary beds and join similar
vessels to form small veins.
– Magnification is required to observe venules.
– Small veins are the tributaries of larger veins
that unite to form venous plexuses . Small veins
are unnamed.
unnamed
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2. Medium veins
– drain venous plexuses and accompany medium
arteries.
– Examples of medium veins include the named
superficial veins (cephalic and basilic veins of the upper
limb and great and small saphenous veins of the lower
limb) and the accompanying veins that are named
according to the artery they accompany.
3. Large veins
– are characterized by wide bundles of longitudinal
smooth muscle and a well-developed tunica adventitia.
– An example is the superior vena cava.
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• Veins are more abundant than arteries.
• Although their walls are thinner, their
diameters are usually larger than those of the
corresponding artery.
• Because of veins' larger diameter and ability
to expand, typically only 20% of the blood
occupies arteries, whereas 80% is in the veins.
• In the limbs, and in some other locations where the
flow of blood is opposed by the pull of gravity, veins
have valves that permit blood to flow toward the
heart but not in the reverse direction.

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 Blood Capillaries
• Capillaries are simple endothelial tubes connecting the
arterial and venous sides of the circulation that allow
the exchange of materials with the interstitial or
extracellular fluid (ECF)
• Capillaries are the smallest blood vessels and provide
the linkage between the smallest arteries (arterioles)
and veins (venules)
• Capillaries are generally arranged in capillary beds,
networks that connect the arterioles and venules .
• The blood enters the capillary beds through arterioles
that control the flow and is drained from them by
venules

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• The structure of capillaries is well suited for their
function.
• The endothelial cells are held together by tight
junctions which block the passage of small
molecules ,but intercellular clefts exist.
• Fenestrated capillaries –have pores
(fenestrations) spanning the endothelial cells
• Continuous capillaries –lack pores ,are the
common type
• Sinusoids –are wide ,leaky capillaries . They are
usually fenestrated, and have fewer tight
junctions and the intercellular clefts are wide
open

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Innervation of blood vessels
• Blood vessels are predominantly innervated by
sympathetic nerves that mainly cause
vasoconstriction, but to a lesser extent by
parasympathetic nerve, which are
vasodilators.

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 Some important terms related to the
circulatory system
• Vascular Anastomoses (communication)-
occurs when vessels unite or interconnect .
 Arterial Anastomoses –provide alternate
path way to supply structures distal to the
blockage.
– Provide potential routes in case the usual
pathway is obstructed by compression, the
position of a joint, pathology, or surgical ligation.
– This process is called collateral circulation

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• There are areas, however, where collateral
circulation does not exist, or is inadequate to
replace the main channel.
• Arteries that do not anastomose with adjacent
arteries are anatomical or true terminal or end
arteries.
– Occlusion of an end artery interrupts the blood supply
to the structure or segment of an organ it supplies.
– True terminal arteries supply the retina, for example,
where occlusion will result in blindness.
– While not true terminal arteries, functional terminal
arteries (arteries with ineffectual anastomoses)
supply segments of the brain, liver, kidneys, spleen,
and intestines; they may also exist in the heart.
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• Plexus: a network of interjoining venous vessels (also
applied to nerves and lymphatic vessels). e.g.
– Oesophageal venous plexus
– Rectal venous plexus.
– dorsal venous networks of the hand and foot
• Veins anastomose much more freely than arteries
• Venae comitantes: arteries are usually accompanied
by veins and lymphatic vessels sharing a common
inelastic connective tissue sheath.
– While a one-to-one artery to vein relation applies for
many large vessels; two veins accompany the smaller
arteries.
– These two veins accompanying a single artery are called
venae comitantes.
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Neurovascular bundle:
• vascular bundles may be accompanied by major
nerve trunks forming a neurovascular bundle.
– e.g. Neurovascular bundle of the neck (common
carotid artery, internal jugular vein and vagus nerve).
– Neurovascular bundle of the thigh (femoral artery,
vein and nerve)
Vasa vasorum
• Larger arteries and veins have tiny arteries,veins
and capillaries in their tunica externa.
– These little vessels are called vasa vasorum v.

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Blood vessels of the body
,

96
Arteries

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 AORTA
• All systemic arteries arise from the aorta,
which has three regions:
– Ascending aorta
– Aortic arch
– Descending aorta
• Thoracic aorta
• Abdominal aorta

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• Ascending aorta-passes superiorly from left
ventricle .the right and left coronary arteries arise
from this part
• Arch of aorta- pass posteriorly from ascending aorta
to left and three major arteries arise from it;
brachiocephalic, left common carotid and left
subclavian arteries
• Descending aorta- extends through the thorax
abdomen, abdomen and pelvis up to the point
where it divides in to common iliac arteries

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,

100
• The branches of the descending aorta arise
and course within three vascular planes:
An anterior, midline plane of unpaired visceral
branches to the gut and its derivatives.
Lateral planes of paired visceral branches serving
viscera other than the gut and its derivatives.
Posterolateral planes of paired parietal branches
to the body wall.

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Thoracic Aorta
• The thoracic aorta is the continuation of the arch of the
aorta
• It begins on the left side of the inferior border of the
body of the T4 vertebra and terminates anterior to
the inferior border of the T12 vertebra and enters the
abdomen through the aortic hiatus in the diaphragm .
• Branches :
– esophageal arteries
– Bronchial arteries
– Pericardial branches
– Mediastineal branches
– Posterior intercostal arteries
– Superior phrenic arteries 102
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Abdominal Aorta
• approximately 13 cm in length.
• begins at the aortic hiatus in the diaphragm at
the level of the T12 vertebra and ends at the
level of the L4 vertebra by dividing into the
right and left common iliac arteries.
• each common iliac artery divides into the
internal and external iliac arteries.
• The internal iliac artery enters the pelvis.
• The external iliac artery follows the iliopsoas
muscle and supplies the lower limb
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Vascular Plane class Verte
Abdominal bral
Distribution Branches (Arteries) Level

Anterior midline Unpaired Alimentary Celiac T12

visceral tract Superior L1
mesenteric
Inferior mesentericL3

Lateral Paired Urogenital Suprarenal L1

visceral and Renal L1
endocrine Gonadal (testicular L2
organs or ovarian)

Posterolateral Paired Diaphragm; Subcostal L2

parietal body wall Inferior phrenic T12
(segmental)
Lumbar L1-L4
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• Celiac trunk- that divides immediately in to three arteries
splenic artery –supply spleen
left gastric artery- supply lesser curvature of the stomach
common hepatic artery- supply liver
• Superior mesenteric artery- unpaired vessel, supplies small
intestine (except portion of duodenum), caecum, appendix,
ascending colon and transverse colon
• Inferior mesenteric artery- unpaired vessel arise just before
bifurcation and supplies descending colon, sigmoid colon
and rectum
• Midian sacral artery- arise at bifurcation and supply sacrum
and coccyx

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Abdominal blood flow - mesenteric arteries

108
Arteries of the pelvis
• the two common iliac arteries terminate by dividing into the
internal and external iliac arteries
• the internal iliac artery supplies the gluteal muscles and organs
of pelvic region and gives several branches some of the
branches are
– iliolumbar and lateral sacral arteries-supply the wall of pelvis
– middle rectal artery-supply the internal visceral organs of
the pelvis
– superior, middle and inferior vesicular arteries-supply
urinary bladder
– uterine and vaginal arteries-supply reproductive organs of
females

109
 Cont,
• superior and inferior gluteal arteries –supply
the muscles of the buttock
• internal pudendal artery- supply
muscularature of perineum and external
genitalia and important vessel in sexual
activity

110
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Arteries of the head and neck
1. The brachioephalic artery branches to form
• right common carotid artery-transport blood to
the right side of head and neck
• right subclavian artery-supply blood to right
upper limb
2. Left common carotid artery –branch directly from
aortic arch and transport blood to the left side of
head and neck

112
The common carotid arteries at the level of mandible
branch into:-
• external carotid artery-have several branches that
supply the structure of the face nose and mouth
• Internal carotid artery- pass through the carotid
canal and supply most part of brain
• Vertebral arteries –branch from subclavian arteries,
pass through transverse foramen and foramen
magnum and supplies part of brain
• With in the cranial vault, branches of vertebral
arteries and right and left internal carotid arteries
form a system of vessel called circle of wills
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Arteries of the head and neck

114
Cerebral arterial circle
(circle of wills)

115
Arteries of the upper limb
• the subclavian artery, becomes axilary artery as
it courses the axila
• the axilary artery in turn becomes brachial artery
as it extends in to the arm
• at the elbow brachial artery branches to ulnar
and radial arteries which supply the fore arm and
hand radial artery is used to take pulse on the
wrist
• Superficial palmar arch and Deep palmar arch
formed by radial and ulnar aa

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Arteries to lower limb
• Femoral artery
• Popliteal artery
• Anterior tibial artery
• Posterior tibial artery
• Fibular artery
• Dorsal artery of the foot (dorsal pedal artery)
• Arcuate artery
• Lateral and medial plantar arteries
• Plantar arch

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.

120
Pulse feeling areas in the body
• radial artery-at the wrist
• temporal artery- in front of the ear
• common carotid artery- at the neck
• facial artery- at the lower margin of lower jaw
• brachial artery- at the elbow region
• femoral artery- at the groin region
• popliteal artery- at the back of knee
• dorsalis pedis artery- at the dorsum of the
foot
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MAJOR VEINS
• The superior vena cava returns blood from the
head, neck, thorax & upper limbs to the right
atrium; and inferior vena cava returns blood
from the abdomen, pelvis and lower limbs to
the right atrium

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Veins of head and neck
• Two pairs of major veins that drain blood from
head and neck are
1. External jugular veins –drains blood from
posterior head and neck
2. Internal jugular veins- larger and deeper ,drain
blood from brain anterior head ,face and neck it
joins the subclavian vein on each side to form
the brachiocephalic veins which empty in to the
superior vena cava

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Veins of the thorax
• In the thorax three main veins return blood to
the superior vena cava
1. the right brachiocephalic vein
2. The left brachiocephalic vein; this two drain
blood from the arms, head, neck and upper
thorax
3. The azygos veinous system –receives from
thoracic wall and empty in to SVC
– Azygos
– Haemiazygos
– Accessory hemiazygos 125
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127
VEINS OF THE ABDOMEN AND PELVIS
• blood from the lower limbs , pelvis and abdomen returns
to the heart by IVC
• the external iliac veins drain lower limb and join internal
iliac veins and form common iliac veins .the common iliac
veins combine to form the IVC
• blood from the stomach returns by two routes
1. gonads (testes and ovaries ),kidneys and adrenal glands
directly drain to IVC
2. blood from stomach , intestine , pancreas and spleen
drains to liver through a specialized system of blood
vessels called the hepatic portal system

128
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• A portal system is a vascular system that begins and
ends with capillary beds and has no pumping
mechanism such as the heart b/n them. it begins
with capillaries in the digestive tract and ends with
capillaries in the liver
• Blood entering the liver is rich in nutrients but it also
may contain toxic harmful to the tissue. Toxic
substances are processed by the liver
• Blood from the liver is collected in to hepatic veins ,
which join the IVC
• Portal vein is formed by union of superior mesenteric
and splenic veins
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• Splenic vein is enlarged b/c of the convergence of
the following three tributaries
1. Inferior mesenteric vein- drain from large intestine
2. Pancreatic vein- drain from the pancreas
3. Left gastroepiploic vein-drain from the stomach
• Three additional veins empty in to the portal vein
are
– Right gastric vein-
– Left gastric vein-both of these collect blood from the
lesser curvature of the stomach
– Cystic vein- drain blood from the gallbladder

131
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Veins of the upper limb
• The veins of the UL can be divided in to deep and
superficial groups
• The deep veins follow the arteries and named as the
arteries
• The main deep veins are brachial veins which empty
in to axillary vein
• Superficial veins drain superficial structures of UL &
drain in to deep veins
• The cephalic and basilica veins drain in to axillary vein
.many of the tributaries in the forearm and hand can
be seen through the skin
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Veins of the lower limb
• The lower limb like the upper limb has both deep
and superficial veins
• The deep veins accompany corresponding arteries
and have more valves
• The deep posterior and anterior tibial veins
originate in the foot and course up ward behind
and infront of tibia to back of knee to form the
popliteal vein
• Above the knee the popliteal vein becomes
femoral vein
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• The femoral vein goes up the thigh and receives
blood from deep femoral vein near the groin. just
above this , it receives blood from great
saphenous vein and then becomes the external
iliac vein as it passes under the inguinal ligament
• External and internal iliac veins form the common
iliac vein and at the level of 5th lumbar vertebra,
the two common iliac veins form the IVC
• The superficial veins of the lower limb are small
and great saphenous veins

136
• The small saphenous vein arises from the lateral
side of the foot , courses posteriorly along the
surface of the calf of leg and descends deep to
enter the popliteal vein behind the knee
• The great saphenous vein is the longest vessel in
the body .it originates at the arch of the foot and
ascends superiorly along the medial aspect of the
leg and thigh before draining in to the femoral vein

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 Fetal circulation
• Circulatory system of a fetus, called fetal circulation,
exists only in the fetus.
• It differs from the postnatal (after birth) circulation
because the lungs, kidneys, and gastrointestinal organs do
not begin to function until birth.
• The fetus obtains O2 and nutrients from the maternal
blood and eliminates CO2 and other wastes into it.

• Exchange of materials between fetal and maternal

circulations occurs through placenta, which attaches to
the umbilicus of the fetus by the umbilical cord.

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 Fetal Circulation cont…
• Oxygenated blood from the
placenta enters through
the umbilical vein
• Blood is shunted away from
the liver and directly
toward the inferior vena
cava through the ductus
venosus
• Oxygenated blood in the
ductus venosus mixes with
deoxygenated blood in the
inferior vena cava.
• Blood empties into the
right atrium
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• Most of the blood is
shunted to the left atrium
via the foramen ovale
• Blood flows into the left
ventricle and out the aorta
• A small amount of blood
enters the right ventricle
and pulmonary trunk, but
much of this blood is
shunted to the aorta
through ductus
arteriosus.
• Blood travels to the rest of
the body, and the
deoxygenated blood
returns to the placenta
03/13/2021 143
through umbilical
 FETAL CIRCULATION

PLACENTA  UMBILICAL VEIN  DUCTUS VENOSUS  INFERIOR

 VENACAVA

PORTAL VEIN  HEPATIC VEINS 

RIGHT ATRIUM

FORAMEN OVALAE

LEFT VENTRICLE  LEFT ATRIUM

RIGHT ATRIUM

RIGHT VENTRICLE

UMBILICAL ARTERIES  AORTA  DUCTUS ARTERIOSUS PULMONARY
TRUNK 144
145
 The lymphatic system
 is a network of lymphatic vessels that returns tissue
fluid to the venous system and helps to protect the
body from disease
Function
1. It transports excess interstitial (tissue) fluid which was initially
formed as a blood filtrate back to the blood stream
2. It serves as the route by which an absorbed fat from the intestine
is transported to the blood
3. It helps provide immunological defenses against disease causing
agents
4. Hematopoiesis

146
 Lymph and lymph capillaries
• The smallest vessels in the lymphatic system are lymph
capillaries
• The walls are composed of simple squamous epithelium
• This fluid is formed as a filtrate of plasma through blood
capillaries and is identical in composition to plasma
except for a lower protein concentration
• Adequate venous drainage is needed to prevent the
accumulation of tissue fluid, edema
• Once fluid enters the lymphatic capillaries, it is referred
to as lymph

147
• Lymph- a clear, colorless fluid, similar to blood
plasma but with much less protein
• May also contain bacteria, viruses, cellular debris
or even traveling cancer cells
Lymph vessels
• From capillaries lymph enters into lymph ducts
(the wall is similar to vein)
• Lymph ducts eventually empty in to one of the
principal vessels
• Thoracic duct
• Right lymphatic duct
148
 Cont,
• Thoracic duct – drain lymph from the lower
extremity, abdomen, thoracic region, left
upper extremity and left side of head and
neck and drains in to left sub clavian vein
• Right lymphatic duct – drains lymph from the
right upper extremity , right thoracic region
and right side of head and neck and empties in
to right sub clavian vein

149
150
Lymph nodes
• Lymph filters through the reticular tissue of lymph
nodes
• Lymph nodes are small oval bodies enclosed with
in fibrous connective tissue capsules
• Afferent lymph vessels carry lymph to the lymph
nodes
• Efferent lymph vessels carry lymph away from
lymph nodes

151
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,

153
 Cont,
• Usually occur in clusters in specific regions of
the body, some of the principal groups are
• Popliteal, ingunal nodes
• Cubital , axillary nodes
• Thoracic and cervical node in the chest and
neck respectively
• Peyer’s patch in the small intestine

154
Lymph organs
• Spleen and thymus are lymphoid organs
Spleen
• Spleen is found posterior and lateral to the
stomach
• It is not a vital organ in adult, but it assists other
body organs in producing lymphocytes, filtering
the blood and destroying old erythrocytes.
• In an infant it is an important site for
erythrocyte production

155
,

156
Thymus
• Found in the anterior thorax deep to
manubriun
• It is much larger in fetus and child than an
adult
• Its important site for immunity
• It changes undifferentiated lymphocytes in T
lymphocytes
• It houses lymphocytes

157
 .

Thank You !!

158