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CIRCULATORY SYSTEM
 The Circulatory System
2
 Transports fluids throughout the body
 It consists of two interrelated parts:

1. Cardiovascular system
 The heart and blood vessels make up the blood
transportation network, the cardiovascular system
2. Lymphatic system
 It is made up of a network of conduits that carry a clear
fluid called lymph.
 Anatomically it is composed of extracellular tissue
fluid /lymph/, lymphoid tissue, lymphatic vessels and
other lymphatic structures
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 Functions of the circulatory system:
3

 Distributes nutrients
 Transport and exchange of oxygen and carbon
dioxide
 Removal of waste materials- urea
 Distributes secretions of endocrine glands
 Prevent excessive bleeding
 Prevent infection
 Regulate body temperature, PH, electrolyte.
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 Cardiovascular system
4

 Major components:
 Blood
 Cardio (heart ) &
 vascular (blood Vessels)

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 Covering of the heart (The
pericardium)
5

 Is a fibroserous membrane that covers the heart and

the beginning of its great vessels
 Composed of two layers:
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
 lines both the internal surface of the fibrous
pericardium and the external surface of the heart.
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6

 Serous pericardium composed of two layers:

a. The parietal layer - lines the internal surface
of the fibrous pericardium.
b. The visceral layer or epicardium - lines the
surface of the heart
 They are separated by the fluid-filled
pericardial cavity.

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Covering of the heart
(The pericardium)

7 CS
 Pericardial cavity-
8

 Is the potential space between the parietal and

visceral layers of serous pericardium
 Contains thin film of serous fluid that enables the
heart move freely and beat in a frictionless env’t.
 Function of the pericardium:
Protects and anchors the heart
Prevents overfilling of the heart with blood
Allows for the heart to work in a relatively
friction-free environment

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9 CS
 The HEART
10
o The heart is a rounded cone-shaped hollow muscular organ.
o It is slightly larger than a clenched fist.
o Weighs between 250 and 350 grams
o The right side of the heart (right heart)
 Receives poorly oxygenated blood from the body through the

SVC and IVC and

 Pumps blood through the pulmonary trunk to the lungs for

oxygenation.
o The left side of the heart (left heart)
Receives well-oxygenated blood from the lungs through the
pulmonary veins and
Pumps this blood into the aorta for CS distribution to the
 Location
11

 Located in the central region

of thoracic cavity in the
mediastinum
 the area between the lungs.

 About two-thirds of heart lies

to the left of the median plane
 Anterior to the vertebral
column, posterior to the
sternum

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 Walls of the heart
12

 The heart has four chambers.

 The wall of each heart chamber consists of three layers :
 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.
 The muscle fibers are anchored to the fibrous skeleton of
the heart.
 Epicardium-
Epicardium a thin external layer (mesothelium) of the heart
 formed by the visceral layer of serous pericardium
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 Walls of the
heart

13 CS
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 External features of the heart
15
• Externally, the heart has:
 An apex (inferolateral)

 A base (posterior aspect)

 Four surfaces (sternocostal, diaphragmatic,
Right and left pulmonary)
 Four borders (right, inferior, left & superior)
 Grooves

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16 CS
The apex of the heart :
17

 Directed downwards, forwards and to

the left from the midline
 Is formed by the tips of left ventricle.
 Lies posterior to the left 5th intercostal
space in adults, usually approximately 9
cm (a hand's breadth) from the median
plane.
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  The base of the heart :
18

 Is formed mainly by the left

atrium, with a lesser
contribution by the right
atrium.
 Faces posteriorly toward the

bodies of vertebrae T6-T9.

 Located posteriorly opposite

to:
 T5-T8 at supine position
 T6-T9 at erect position CS
The four surfaces of the heart are
19
the:

1. Anterior (sternocostal) surface-

formed mainly by the right
ventricle.
2. Diaphragmatic (inferior) surface-
formed mainly by the left ventricle
and partly by the right ventricle
3. Right pulmonary surface- formed
mainly by the right atrium
4. Left pulmonary surface- formed
mainly by the left ventricle
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The four borders heart:
20

1. Right border-formed
border by the right atrium and extending
between the SVC and the IVC
2. Inferior border- formed mainly by the right ventricle and
slightly by the left ventricle
3. Left border- formed mainly by the left ventricle and slightly
by the left auricle
4. Superior border- formed by the right and left atria and
auricles in an anterior view
• hidden anteriorly by SVC, aorta & pulmonary trunk

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Groove/sulcus
21

1. Atrioventricular groove/Coronary sulcus

• Externally, the atria are demarcated from the
ventricles by the coronary sulcus.
1. Anterior and posterior interventricular groove
 the right and left ventricles are demarcated from
each other by anterior and posterior
interventricular (IV) grooves
 Sulci contain blood vessels of cardiac muscle

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 External features of heart ; anterior veiw
22

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 Internal anatomy of heart
23

Chambers
Four chambers
1. Right atrium- receiving blood
from systemic circuit
2. Right ventricle- pumps blood
to pulmonary circuit
3. Left atrium- blood receiving
chamber from pulmonary circuit
4. Left ventricle- pumps blood to Septa
• Interatrial septum - separates
systemic circuit atria
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• Interventricular septum -
 Right atrium: internal features
24

 The interior of the right atrium is divided into anterior &

posterior parts by the crista terminalis.
1. Anterior part
• Is rough and are composed of bundles of muscle
tissue called pectinate muscles
• Arise from crista terminalis and run towards AV
orifice
• Capable of contraction
2. Posterior part (Sinus venarum cavarum)
 Internally, the posterior wall of right atrium b/n the
two venae cavae appears smooth
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25 CS
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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
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27

The inlets (opening) of the right atrium receives

venous blood from:
 Three major veins
 SVC
 IVC
 Coronary sinus
 Three smaller veins
 Anterior cardiac veins
 Venae cordis minimi
 sometimes right marginal vein

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28 CS
 Right ventricle

29

 Forms the largest part of the anterior surface of the heart

 The interior of the right ventricle has irregular muscular

elevations - trabeculae carneae.

 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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 Right ventricle…..
30

 Receive blood from right atrium and pump into

pulmonary trunk
 Superiorly tapers into a cone, conus arteriosus
(infundibulum)
 Internal structure
 Inflow part – rough due to muscular ridges
called trabeculae carneae
 Outflow part –
 Is smooth
 Pulmonary trunk arise from it
 separated from inflow part by
supraventricular crest

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31 CS
 Left atrium
32

 Rectangular in shape and forms most of

the base of the heart.
 Smaller than the right atrium

 Blood enters the left atrium via four veins

 2 right and 2 left pulmonary veins

 Thicker than right atrium
 Interiorly, the wall has two parts:
 Large postetrior part – smooth
 Small anterior part- rough due to the
presence of pectinate muscles
 Pectinate muscle- lining the
auricle. CS
 Left ventricle
33

 The left ventricle forms the apex of the heart, nearly all
its left (pulmonary) surface and border, and most of the
diaphragmatic surface
 The wall of LV is 2-3 times as thick as that of the right
ventricle due to work load.
 Internally it: has smooth upper part and rough lower
part
 Trabeculae carneae are finer and more numerous
than the right ventricle.
 Papillary muscles that are larger than those in the right
ventricle CS
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 Valves of the heart
35
The tricuspid valve
 Guards the right AV orifice
 Has three cusps: anterior,
posterior, and septal
 Prevents backward flow of
blood from the right
ventricle back into the right
atrium
 Located posterior to the
body of the sternum at the
level of the 4th intercostal
spaces
The mitral valve
 Guards the left AV orifice
 has two cusps: anterior
and posterior.
 Prevents backward flow of
blood from the left ventricle
back into the left atrium
 Located posterior to the
sternum at the level of the
4th costal cartilage.
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 Semilunar Valves
36

Pulmonary and aortic semilunar valves

 Each seminular valve have three semilunar cusps:
 pulmonary valve- anterior, right, and left
 Aortic valve -posterior, right, and left
 Semilunar cusps
 Do not have tendinous cords to support them
 Are smaller than the cusps of the AV valves

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 Fibrous Skeleton of the heart
38

 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
39

I. It anchors the valve cusps

II. It prevents over dilation of the valve openings
as blood passes through them
III. Provides a rigid framework for the attachment
of cardiac muscle tissue.
IV. Provides electrical insulation between atria and
ventricles
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 Surface Anatomy of Heart
40
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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 Conducting System of the heart
41

 It is a series of specialized cardiac muscle cells that

carries impulses throughout the heart musculature
 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

 Stimulated by the sympathetic division of the autonomic

nervous system to accelerate the heart rate

 inhibited by the parasympathetic division to return to

or toward its basal rate. CS

 Conducting System
42

 The components of
the conducting
system are:
 Sinoatrial node
 Internodal fibers
 Atrioventricular
node
 Atrioventricular
bundle
 Right and left
branches
 Purkinje fibers
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 Conducting System
43

The sinoatrial node

 This is a crescent

shaped mass of muscle

cells that lies in the wall
of the right atrium,
below the entrance of
the SVC
 The heart’s own

pacemaker
 Sets the basic heart rate

by generating 70-80
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impulses per minute
 Conducting System
44

 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
45

 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
46

 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 CS
Arterial Supply of the Heart
47

• 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 artery
 right marginal artery
 posterior interventricular artery CS
48

 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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49

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2. The left coronary artery (LCA)-
50

• 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 SA node (40%of people)
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51 CS
Venous Drainage of the Heart

52

• 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 It receives venous blood from:
o the great cardiac vein at its left end and
o the middle cardiac vein and small cardiac veins at its right
end

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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.
o The middle cardiac vein accompanies the posterior
interventricular branch and small cardiac vein
accompanies the right marginal branch of the RCA.
o Thus these two veins drain most of the areas commonly
supplied by the RCA.

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 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
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 Innervation of the Heart

56

 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
58

 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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59 CS
 Blood vessels
60

• 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
• Venules drain into small veins that open into larger veins

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62 • 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
63

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
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 the presence of variable amounts of elastic fibers

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 Arteries

66

• Arteries are vessels that carry blood away from the heart
• All arteries carry oxygen rich blood except the pulmonary arteries and
umbilical arteries
• 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:
67

1. Large elastic arteries (conducting arteries)

 largest arteries near the heart, (1cm-2.5cm in diameter)
 have many elastic layers in their walls
 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)
69

– 0.3-1 cm in diameter, 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
the tunica media
i. Internal elastic lamina –between tunica media
and tunica intima
ii. External elastic lamina-between tunica media
and tunica externa
– Eg. the brachial or femoral arteries, are medium
muscular arteries
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70

3. Small arteries and arterioles

– have relatively narrow lumina and thick
muscular walls
– The small arteries are usually not named and
arterioles can be observed only under
magnification

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 Veins
71

• Are the blood vessels that return deoxygenated blood

from the capillary beds to the heart
• Veins in the systemic circuit carry blood that is
relatively oxygen poor except pulmonary veins
• Because of the lower blood pressure in the venous
system, the walls (specifically, the tunica media) of
veins are thinner than those of their corresponding
arteries
• Normally, veins do not pulsate and do not squeeze
or burst blood when severed
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 72

• 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 unnamed.
unnamed
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73
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), brachial vein , femoral vein, etc
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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• The walls of veins are thinner, their diameters

are usually larger than those of the corresponding
arteries.
• 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, veins
have valves that permit blood to flow toward the
heart but not in the reverse direction.
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 Blood Capillaries
76

• Capillaries are simple endothelial tubes connecting

the arterial and venous sides of the circulation
• allow the exchange of materials with the

interstitial or extracellular fluid (ECF)

• Capillaries 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 .

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 Types of capillaries
77

• 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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79

Innervations 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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 Blood vessels of the body
80

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 Arteries
81

AORTA
 All systemic arteries arise from the aorta, which has three
regions:
 Ascending aorta : the right and left coronary arteries

arise from this part

 Aortic arch: three major arteries arise from it;

brachiocephalic, left common carotid and left

subclavian arteries
 Descending aorta

 Thoracic aorta
 Abdominal aorta
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 ,
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 Thoracic Aorta
83

• The thoracic aorta is the continuation of the arch of the aorta

• It begins on the left side of the inferior border of the T4 vertebra
and terminates anterior to the inferior border of the T12
vertebra
• enters the abdomen through the aortic hiatus in the diaphragm
• Branches of thoracic aorta :
– esophageal arteries

– Bronchial arteries(the left bronchial artery)

– Pericardial branches

– Mediastineal branches

– Posterior intercostal arteries (3 rd -11th )

– Superior phrenic arteries CS

84

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 Abdominal Aorta
85

• 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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86

 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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 Vascular Plane class Abdominal Vertebr
Distribution Branches al
87
(Arteries) Level

Anterior Unpaired Alimentary Celiac T12

midline visceral tract Superior L1
mesenteric
Inferior L3
mesenteric
Lateral Paired Urogenital Suprarenal L1
visceral and Renal L1
endocrine Gonadal L2
organs (testicular or
ovarian)
Posterolateral Paired Diaphragm; Subcostal L2
parietal body wall Inferior phrenic T12
(segmental Lumbar
CS L1-L4
)
88

 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 CS
89

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Abdominal blood flow - mesenteric arteries

90

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Arteries of the pelvis
91

 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
 gives several branches to pelvic wall and visceral
organs CS
 Branches of the internal iliac arteries
92
 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
 Superior and inferior gluteal arteries –supply the muscles of
the buttock
 Internal pudendal artery- supply muscularature of perineum
and external genitalia and importantCSvessel in sexual activity
93

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Arteries of the head and neck
94

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
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The common carotid arteries at the level of mandible
branch into:-
95

 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 unit and form
a system of vessel called circle of wills
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 Arteries of the head and neck
96

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 Cerebral arterial circle
97
(circle of wills)

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Arteries of the upper limb
98

 the subclavian artery, becomes axilary artery as it

courses the axilla
 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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99 CS
 Arteries to lower limb
100
• 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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101

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 Pulse feeling areas in the body
102

 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
103

 The superior vena cava returns blood from:

 the head
 neck to the right atrium
 thorax &
 upper limbs
 inferior vena cava returns blood from :
 the abdomen
 pelvis to the right atrium
 lower limbs

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 Veins of head and neck
104

 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
106
superior vena cava:
1. the right brachiocephalic vein
• drain blood from the right side of arms, head, neck

and upper thorax

2. The left brachiocephalic vein;
• drain blood from the left sides of arms, head, neck

and upper thorax

3. The azygos veinous system –receives venous
blood from thoracic wall and empty in to SVC.
 Azygos
 Haemiazygos
 Accessory hemiazygos CS
107

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 VEINS OF THE ABDOMEN AND PELVIS
108

 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 abdomen 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
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 Portal circulation
110

 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
spleenic veins
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111

 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
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 Veins of the upper limb
114
 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.
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 Veins of the lower limb
116

 The lower limb like the upper limb has both deep and
superficial veins
 The deep veins of lower limb
 are accompany with the corresponding arteries and

have more valves

 The deep posterior and anterior tibial veins originate in
the foot and course upward behind and in front of tibia
to back of knee to form the popliteal vein
 Above the knee the popliteal vein becomes femoral
vein.
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117

 The femoral vein goes up the thigh and receives blood

from deep (profunda) 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 unit to form the common
iliac vein
 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
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 The small saphenous vein
 arises from the lateral side of the foot,
118
 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 by the union of the

veins of great toe and dorsal venous arch of the foot

 ascends superiorly along the medial aspect of the leg and

thigh
 drain in to the femoral vein

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 The lymphatic system

120
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 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 CS
 Lymph and lymph capillaries
121

 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
 Once fluid enters the lymphatic capillaries, it is

referred to as lymph
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  Lymph- a clear, colorless fluid, similar to blood
122
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

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 Cont,
123

 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 subclavian 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

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Lymph nodes
125

 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

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 Cont,
127

 Lypmh nodes usually occur in clusters in

specific regions of the body, some of the
principal groups are
 Popliteal, inguinal nodes

 Cubital , axillary nodes

 Thoracic and cervical node in the chest and

neck respectively
 Peyer’s patch in the small intestine

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 Lymph organs
128

 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
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 ,
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 Thymus
130

 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

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Thank you

CS