Blood Vessels

I. Structure of Blood Vessels Walls

A. Three layers
1. Tunica intera
a. Inner most layer
b. Endothelium
i. Simple squamous
c. Some larger essels hae subendothelium
i. !oose connectie tissue
ii. Basement membrane
". Tunica media
a. #iddle layer
b. $ircularly arranged smooth muscle
c. $hemical and nerous control of degree of contraction
i. Sympathetic %S
d. $hange in diameter
i. Vasoconstriction
ii. Vasodilation
&. Tunica e'terna
a. #ade of collagen fibers
b. (unction
i. )rotection
ii. *einforcement
iii. Anchor to surrounding tissue
c. Accessory tissues
i. %ere fibers
ii. !ymphatic essels
iii. Elastic net+or,
i. Tiny blood essels +ithin layer-asa asorum

II. Arterial System
A. $lassification based on si.e and function
1. Elastic /conducting0 arteries
a. $haracteristics
i. Thic,-+alled
ii. %ear heart
iii. !argest diameter
i. #ore elastic
. !arge lumen
b. )roperties
i. 1ampen B) changes associated +ith heart contraction
ii. )assie accommodation results in smooth flo+ of blood
c. 1.2 - ".3 cm
". #uscular arteries-distributing arteries
a. 1istal to elastic arteries
b. 1elier blood to specific organs
c. Thic, media layer
i. #ore smooth muscle
d. 2.& - 1.2 cm
&. Arterioles
a. 1etermine flo+ into capillary beds
b. #ostly smooth muscle
c. 12 4m - 2.& cm
5. $apillaries
a. Smallest blood essels
i. 6 - 12 4m
b. Tunica interna only
c. E'change of materials

B. Types of capillary
1. $ontinuous
a. 7ninterrupted endothelial cells
b. Incomplete tight 8unctions
i. Intercellular clefts
". (enestrated
a. Endothelial cells hae oal pores
i. (enestrations
b. )ores permit greater permeability
&. Sinusoidal
a. #odified9 lea,y capillaries
b. !arge molecules can pass through

$. $apillary beds

1. $apillaries act as net+or,s-capillary beds
". #icrocirculation
a. Arteriole to enule
&. )arts of a capillary bed
a. Vascular shunt
i. $onnects arteriole +ith enule
b. True capillaries
1. Sequence of blood moement through capillary bed
1. Terminal arteriole
". #etateriole
a. True capillaries branch off
i. )re-capillary sphincter controls blood flo+ into capillary
&. Thoroughfare channel
a. $apillaries re8oin
5. )ost-capillary enule


III. Venous System
A. Types of essels
1. Venules
a. 6 - 122 4m
b. $haracteristics ary +ith si.e
i. !ittle muscle
ii. Thin e'terna
". Veins
a. (ormed from enules
b. Thinner +alls and less muscle than arteries
c. !ittle muscle in media
i. #ostly elastin
d. E'terna is thic,est +all layer
B. $apacitance essels
1. Veins act as reseroirs
a. !arge lumens
b. !o+ blood pressure allo+s +alls to thin
". Venous ales
a. )reent bac,flo+
b. (olds of interna


IV. )hysiology of $irculation
A. Terms
1. Blood flo+-olume flo+ing through a gien structure per unit time /ml:min0
". Blood pressure-force per unit area /mm ;g0
&. *esistance-opposition to flo+< generally encountered in the systemic circuit-peripheral
resistance /)*0
a. Sources of resistance
i. Blood iscosity-thic,ness related to formed elements
ii. Total blood essels length-longer the essels9 the greater the resistance
iii. Blood essel diameter-flo+ is inersely related to diameter< the larger
the diameter9 the less resistance /1:r50
b. In healthy humans9 diameter is the greatest source of resistance
B. *elationship bet+een flo+9 pressure and resistance


Blood (lo+ /(0 = >):)* /1ifference in blood pressure bet+een t+o points:peripheral
resistance

V. Systemic Blood )ressure
A. Bac,ground
1. ;eart pumping generates blood flo+
". )ressure results +hen flo+ opposed by resistance
&. Blood flo+s along a pressure gradient
a. (rom higher to lo+er pressure
i. ;ighest in aorta
ii. !o+est in right atrium
B. Arterial blood pressure

1. (actors affecting arterial pressure
a. Stretching of arteries near heart
i. $ompliance
ii. 1istensibility
b. Volume of blood forced into the arteries near heart
". $hanges associated +ith systole
a. Aorta is stretched by blood leaing left entricle
i. ?inetic energy
b. Blood moes to+ard periphery because peripheral pressure is lo+er than aortic
pressure
i. Systolic pressure@ 1"2 mm ;g
&. $hanges associated +ith diastole
a. Semilunar ale closes
b. Aorta recoils
c. )ressure is maintained by reducing olume
i. 1iastolic pressure@ A2 - 62 mm ;g
5. )ulse pressure
a. 1ifference bet+een systolic and diastolic pressure
3. #ean arterial pressure /#A)0
a. 1iastolic pressure B 1:& pulse pressure
$. $apillary blood pressure
1. 52 mm ;g entering
". "2 mm ;g e'iting
1. Venous blood pressure
1. $haracteristics
a. *elatiely steady throughout cardiac cycle
b. Cradient from enules to ena caa
i. "2 mm ;C /D2 from aorta to arterioles0
". Venous return
a. Venous pressure is too lo+ to promote adequate return
b. %eed additional functional modifications
&. (unctional modification
a. *espiratory pump
i. Abdominal /entral body caity0 pressure increases squee.e local eins
ii. Bac,flo+ is preented by ales
iii. Blood is forced to+ard the heart
i. $hest caity pressure decreases
. Thoracic eins e'pand
i. Blood enters right atrium
b. #uscular pump /more important0
i. $ontraction of s,eletal muscle surrounding eins compress ein
ii. Bac,flo+ is preented by ales
iii. Blood moes in direction of heart

VI. *egulation of Blood )ressure
A. (actors influences blood pressure
1. $ardiac output
". )eripheral resistance
&. Blood olume
B. Blood pressure = $ardiac output E )eripheral resistance
1. $ardiac output is directly related to blood olume
". Blood pressure is directly related to $F9 BV and )*
$. $F = Stro,e olume E ;*

1. (actors that enhance $F


1. *educe parasympathetic control
a. *educe effect of agus nere
i. ;* increases
". Increase sympathetic actiity
a. Increases contractility of heart
i. *educes ESV
ii. Increases stro,e olume
b. *eleases Epi into blood stream from adrenal medulla
i. Increases heart rate
&. Increase actiity of respiratory and muscular pumps
a. Increases enous return
i. Increases E1V
ii. Increases stro,e olume
E. %eural control of blood pressure
1. Short-term mechanisms
". %erous control of peripheral resistance
a. Alter blood distribution
b. Alter blood essel diameter

&. Vasomotor center

a. *egulation of blood essel diameter
b. Vasomotor fibers
i. Sympathetic efferents
ii. Innerate smooth muscle of blood essels
iii. )rimarily arterioles
i. *elease %E
. Vasoconstrictor
c. Vasomotor tone
i. Tonic asoconstriction
5. Baroreceptors

a. 1etect changes in arterial blood pressure
i. )ressure sensitie mechanoreceptors
ii. When B) rises9 receptors are stretched
b. !ocated in carotid sinuses9 aortic arch and +alls of all large essels
c. Stretching increases signaling to asomotor center
i. Inhibits asomotor center
ii. $auses dilation of arteries and eins
d. Arteriole dilation reduces peripheral resistance
e. Venodilation shifts blood to enous reseroirs
i. Venous return decreases
ii. $ardiac output declines
f. Baroreceptors also send efferent signals to cardiac centers in the medulla
i. Inhibit sympathetic %S
ii. Stimulate parasympathetic %S
iii. ;* and contractile force decrease
g. *espond to acute changes in blood pressure
i. $arotid sinus refle' protects blood supply to brain
ii. Aortic refle' maintains supply to systemic circuit
3. $hemoreceptors

a. *espond to changes in F" and $F" concentrations and p;
b. !ocated in carotid and aortic arch and carotid sinus
c. )rimarily inoled in control of respiratory rate and depth /see *espiration
!ecture0
(. $hemical control of blood pressure
1. Short-term
". !eels of F" and $F" /see *espiration !ecture0
&. Blood-borne chemicals

a. Adrenal medulla hormones
i. %E and E)I /nicotine is a monoamine agonist0
ii. %E is a asoconstrictor
iii. E)I increase cardiac output by increasing cardiac muscle contractility
b. Atrial natriuretic peptide /A%)0
i. Atrial peptide hormone
ii. *educes blood pressure by antagoni.ing aldosterone
iii. Increases +ater e'cretion from ,idney
c. Antidiuretic hormone /A1;0
i. )osterior pituitary hormone
ii. Increases blood pressure by increasing +ater absorption by distal tubule
iii. At high concentrations9 causes asoconstriction
d. Angiotensin II
i. #ediated by release of renin by GCA of ,idney tubule
ii. When amount of blood entering ,idney tubule is too lo+9 renin is
released
iii. *enin cataly.es the conersion of angiotensinogen into angiotensin II
i. Angiotensin II causes asoconstriction of systemic arterioles
. Increases B)
i. Angiotensin II also causes release of aldosterone from adrenal corte'
ii. Aldosterone increases absorption of +ater by ,idney tubules
e. Endothelium-deried factors
i. Endothelin-asoconstrictor
ii. )rostaglandin-deried gro+th factor /)1C(0-asoconstrictor
iii. %itrous o'ide /%F0-fast acting9 local asodilator
f. Inflammatory chemicals-asodilators
i. ;istamine9 etc. /see Immune !ecture0
ii. Increase capillary permeability
g. Alcohol
i. *educes blood pressure
ii. Inhibits A1; release-increases loss of +ater in urine
iii. Increases asodilation /s,in0 by depressing asomotor center
C. *enal regulation of blood pressure
1. !ong-term mechanisms for blood pressure regulation
". ?idney controls blood olume by regulating +ater loss in urine
&. Blood olume affects cardiac output ia@
a. Venous pressure
b. Venous return
c. E1V
d. Stro,e olume
5. Blood pressure change parallels change in blood olume
a. Increase in olume increases B)
i. ?idney responds by eliminating +ater to reduce olume
b. 1ecrease in olume decreases B)
i. ?idney responds by absorbing +ater to increase olume

3. 1irect action of the ,idney
a. Alteration to rate of fluid filtration from blood stream to ,idney tubules
i. Increased B) increases amount of filtrate entering tubules
ii. (iltrate entering is greater than the amount that can be processed
iii. (luid leaes body in the form of urine
i. Blood olume decreases and therefore B)
b. Indirect renal mechanisms

i. *enin-angiotensin mechanism /see aboe0
ii. Aldosterone also causes )ost. )ituitary to release A1;
iii. A1; promotes +ater reabsorption from by ,idney


VII. Tissue )erfusion
A. Blood flo+ is distributed to body tissue in an e'acting fashion
1. At rest
a. Brain@ 1&H
b. ;eart 5H
c. ?idney@ "2H
d. Abdominal organs@ "5H
". 1uring e'ercise@
a. S,in9 muscles and heart increase
b. *emaining tissues either remain same or decrease
B. Blood flo+ elocity

1. Inersely proportionate to cross-sectional area of blood essels to be filled
a. (lo+ is fastest through essels +ith smallest cross-sectional area
i. Aorta has a cross-sectional area /".3 cm"0 and an aerage elocity of 52-
32 cm:s
ii. $apillaries hae a total cross-sectional area of 5322 cm" and a ery
slo+ flo+ /2.2& cm:s0
$. Blood flo+ through indiidual organs is intrinsically controlled /i.e.9 autoregulation0
1. 1iameter of arterioles feeding a gien organ is controlled by that organ
1. Intrinsic control mechanisms
1. #etabolic controls-!eels of nutrients9 particularly o'ygen9 act
as autoregulation stimuli
". #yogenic controls
a. E'cessie or inadequate blood pressure can damage or cause the death of an
organ
b. Such blood pressure changes stimulate myogenic responses

VIII. $apillary 1ynamics

A. Cases and nutrients diffuse from capillary to interstitial fluid
1. Water-soluble solutes pass through clefts and fenestrations
". !ipid-soluble diffuse through the plasma membranes of capillary epithelial cells

B. (orces responsible for the direction and amount of fluid crossing capillary +alls
1. ;ydrostatic and osmotic pressure
a. (orces oppose
$. ;ydrostatic pressure
1. (orce e'erted by a fluid against a essel +all
a. In the capillary bed
i. ;ydrostatic pressure is the same as capillary blood pressure
". $apillary hydrostatic pressure /;)c0 forces fluid through capillary +all
a. Creater at arterial end /&3 mm ;g0
b. !o+er at enous end /1A mm ;g0
&. ;)c is opposed by interstitial fluid hydrostatic pressure /;pif0
a. ;pif is assumed to be .ero
i. Interstitial fluid is +ithdra+n by lymphatic tissue
5. %et effectie hydrostatic pressure is equal to ;)c /;)c - ;pif0
1. Fsmotic pressure
1. %et moement of +ater from an area of lo+ to high solute concentration
a. Solute concentration in relatiely high in capillary blood
i. ;igh concentration of plasma proteins
ii. $apillary colloid osmotic pressure /F)c0
iii. "D mm ;g
b. Interstitial osmotic pressure /F)if0 is much lo+er
i. 2.1 to 3 mm ;g
c. %et osmotic pressure
i. Appro'imately "3 mm ;g
E. %et filtration pressure /%()0
1. *eflects interaction bet+een hydrostatic and osmotic pressure
". Arterial end
a. %() = /;)c - ;pif0 - /F)c - F)if0
i. &3 - "3 = 12 mm ;g
&. Venous end
a. %() = /;)c - ;pif0 - /F)c - F)if0
i. 1A - "3 = -6 mm ;g


Circulatory System
I. )ulmonary $irculation
A. (unction
1. Cas e'change only
B. Sequence
1. )ulmonary trun,
a. Bifurcates into rt. and lt. pulmonary arteries
". )ulmonary arteries


a. In the lungs9 arteries subdiide into lobar arteries
i. Three in right
ii. T+o in left
&. !obar arteries branch to form arterioles
5. (urther branching to form pulmonary capillaries
3. $apillaries drain into enules
D. Venules 8oin to form t+o pulmonary eins per lung
A. (our pulmonary eins drain into left atrium


II. Ferie+ of Systemic $irculation
A. Aorta and #a8or Arteries of the Systemic $irculation

B. Aortic arch /branches in sequence relatie to lt. entricle0
1. $oronary arteries
". Brachiocephalic
a. *. common carotid
i. *. internal carotid
ii. *. e'ternal carotid
b. *. subclaian
i. *. ertebral
ii. *. a'illary
&. !. common carotid
a. !. internal carotid
b. !. e'ternal carotid
5. *. subclaian
a. !. ertebral
b. !. a'illary
$. Thoracic aorta /aboe the diaphragm0
1. )arietal branches
". Visceral branches
1. Abdominal aorta /belo+ diaphragm0
1. )arietal branches
". Visceral branches
&. *. common iliac
5. !. common iliac

III. Arteries of ;ead and %ec,

A. Brachiocephalic artery branches off aortic arch
1. *. subclaian artery branches off brachiocephalic artery
". *. ertebral artery branches off *. subclaian artery
&. *. ertebral 8oins +ith !. ertebral to form Basilar artery
a. Basilar artery is part of $ircle of Willis /see belo+0
5. Basilar artery diides to form *. and !. posterior cerebral arteries
a. Supply occipital and inferior temporal lobes of brain
B. After *. subclaian artery branches9 Brachiocephalic artery is the *. common carotid
artery
$. *. common carotid bifurcates to form *. e'ternal and internal carotid arteries
1. *. e'ternal carotid branches as it runs superiorly
1. Superior thyroid
a. Supplies thyroid and laryn'
". !ingual
a. Supplies tongue
&. (acial
a. Supplies s,in and muscles of anterior face
5. Fccipital
a. Supplies posterior scalp
3. *. e'ternal carotid splits
a. #a'illary
i. Supplies upper and lo+er 8a+
b. Superficial temporal
a. Supplies most of scalp
E. *. Internal carotid
1. Enters the s,ull and serices the brain
". Fpthalmic branches off
a. Supplies eyes9 orbits9 forehead and nose
&. *. internal carotid diides to form
a. *. anterior cerebral artery
i. Supplies medial surface of brain
b. *. middle cerebral artery
i. Supplies lateral parts of temporal and parietal lobes
(. $ircle of Willis

1. *. and !. posterior communicating arteries connect posterior cerebral arteries +ith *.
and !. anterior cerebral arteries
". Anterior communicating artery connects *. and !. anterior cerebral arteriors


IV. Arteries of 7pper !imb and Thora'


A. After giing rise to the *. ertebral artery9 *. subclaian courses laterally and gies
off branches to nec, /do not need to ,no+ these essels0
B. *. subclaian artery passes under claicle
1. %ame changes to a'illary artery
$. A'illary artery gies off a number of branches
1. Thoracoacromial
a. Supplies superior shoulder and pectoral region
". !ateral thoracic
a. Supplies lateral chest +all and breast
&. Subscapular
a. Supplies scapula9 latissimus dorsi and thora' +all
5. Anterior and posterior circumfle' arteries
a. Supply deltoid and shoulder 8oint
1. As a'illary artery enters arm9 name changes to brachial artery
E. Brachial artery gies off a branch
1. 1eep brachial artery
a. Supplies triceps brachii /posterior arm0
". Brachial artery supplies anterior fle'or muscles of arm
(. Brachial artery splits to form t+o arteries
1. *adial artery
a. Supplies lateral muscles of forearm
". 7lnar artery
a. Supplies medial muscles of forearm
/1o not need to ,no+ arteries of +rist and hand0
C. Arteries of the thora' +all
1. Internal thoracic artery branches off the subclaian artery
a. As the internal thoracic artery descends it gies off anterior intercostals arterires
i. Supplies anterior intercostals spaces
". $ostocerical trun, gies rise to the first t+o posterior intercostals arteries
&. The thoracic aorta gies rise to the ne't nine pairs
a. Supplies posterior intercostals spaces and deep muscles of bac,9 ertebral columns and
spinal cord


V. Arteries of the Abdomen

A. Abdominal artery lies belo+ the leel of the diaphragm
B. As abdominal aorta descends it gies the inferior phrenic arteries
1. Supply the diaphragm
$. Abdominal aorta descends and gies off the celiac trun,

1. $eliac trun, diides into three branches
1. $ommon hepatic
a. Cies off branches to stomach9 small intestine and pancreas
b. After giing off gastroduodenal artery9 common hepatic becomes hepatic artery
i. *ight gastroepiploic branches off gastroduodenal artery
ii. Supplies stomach
c. ;epatic splits into right and left branches
i. Supplies lier
". Splenic
a. Sends branches to stomach and pancreas
b. Splenic terminates in the spleen
c. !eft gastroepiploic branches of splenic artery
i. Supplies stomach
&. !. gastric artery
a. Supplies stomach and inferior esophagus
E. Abdominal aorta descends and gies off the suprarenal arteries


1. Supply adrenal glands
(. Abdominal aorta descends and gies off the superior mesenteric artery
1. Superior mesenteric gies off branches that supply mesenteric organs
a. Intestinal
i. Supply large intestine
b. Ileocolic
i. Supply appendi'9 colon
c. *. and middle colic
i. Supply transerse colon
C. Abdominal aorta descends and gies off the paired renal arteries
1. Supply ,idneys on each side of the body
;. Abdominal aorta descends and gies off the gonadal arteries /Testicular or oarian0
I. Abdominal aorta descends and gies off the inferior mesenteric artery
1. Inferior mesenteric gies off branches that supply distal part of the colon
a. !. colic
b. Sigmoidal arteries
c. Superior rectal arteries
G. Abdominal aorta descends and gies off the lumbar arteries
1. Supply posterior abdominal +all
?. Aorta terminates giing rise to three arteries
1. #edian sacral
". *. and !. common iliacs

VI. Arteries of )elis and !eg

A. $ommon iliac diides into t+o branches
1. Internal iliac
a. Supply pelis and isceral organs
i. Bladder9 rectum9 uterus and agina /prostate and ductus deferns0
b. 1iides to sere muscles of gluteal muscles and e'ternal genitalia
". E'ternal iliac
B. As e'ternal iliac enters thigh it becomes the femoral artery
$. (emoral artery gies off branches as it descends do+n the thigh
1. 1eep femoral artery
a. Seres posterior thigh
b. 1eep femoral artery gies off branches that supply head and nec, of femur
i. !ateral and medial circumfle' arteries
1. (emoral artery descends and passes through adductor hiatus and enters popliteal fossa
E. (emoral artery becomes the popliteal artery
1. Supplies ,nee region

(. )opliteal artery diides
1. )osterior tibial artery
a. Cies off peroneal artery
i. Supplies lateral muscles of the leg
". Anterior tibial artery
a. Supplies e'tensor muscles
/1o not need to ,no+ arteries of an,le or foot0

VII. #a8or Veins of the Systemic $irculation

A. Superior ena caa runs from union of brachiocephalic eins /!. and *.0 to *. atrium
B. Veins that drain into *. brachiocephalic ein
1. *. internal 8ugular ein
". *. ertebral ein
&. *. subclaian ein
a. *. e'ternal 8ugular ein empties into *. subclaian ein
I!eft side corresponds to right side
$. Inferior ena caa runs from 8unction of common iliac eins to *. atrium
1. Veins that drain into inferior ena caa
1. ;epatic eins /*. and !.0
". *. suprarenal ein
&. *enal eins /*. and !.0
5. *. gonadal ein
3. !umbar eins

VIII. Veins of ;ead and %ec,

A. 1rainage of blood from brain
1. #ost eins drain into dural /meningial0 sinuses
a. Superior sagittal
b. Straight
c. $aernous
d. Transerse
". #ost blood from the brain drains into internal 8ugular eins
B. 1eep eins of the face drain into inferior 8ugular eins

1. (acial
". Superficial temporal

IE. Veins of 7pper !imbs and Thora'

A. A.ygous system drains thoracic tissues
1. A.ygous ein drains into superior ena caa
a. )osterior intercostal eins drain into a.ygous
". A.ygous eins that drain into a.ygous ein
a. ;emia.ygous
b. Accessory hemia.ygous ein
B. 1eep drainage of upper limb
1. 1istal eins of the arm drain into ulnar and radial eins
". 7lnar and radial eins unite to form brachial ein
&. As brachial ein enters shoulder9 it becomes a'illary ein
5. At leel of first rib9 a'illary ein becomes subclaian ein
$. Superficial drainage of upper limb
1. #edian ein of the forearm lies bet+een ulna and radius
a. $onnects either to basilic or cephalic eins
". $ephalic ein 8oins +ith a'illary ein
&. Basilic ein 8oins +ith brachial ein
5. #edian cubital ein connects basilic and cephalic eins
a. $ommonly used to obtain blood samples

E. Veins of Abdomen

A. ;epatic portal system
1. #ultiple hepatic eins carry blood from lier to inferior ena caa
". $ystic eins drain gall bladder and 8oin the hepatic eins
B. ;epatic portal ein receies drainage from digestie iscera
a. ;epatic portal ein carries blood to lier
i. %utrients are remoed
$. Visceral eins draining into hepatic portal ein
1. Superior mesenteric
". Inferior mesenteric
a. 1rains large intestine and rectum
i. Goins splenic
&. Splenic
a. 1rains spleen9 parts of the stomach9 and pancreas
i. Goins superior mesenteric
1. Fther eins draining into inferior ena caa
1. !umbar eins
a. *. and !. ascending lumbar eins
". Conadal eins
a. *.@ oariaries or testes on right side of body
i. 1rains directly into ena caa
b. !.@ oariaries or testes on left side of body
i. 1rains into !. renal ein
&. Suprarenal
a. *@ right adrenal gland
i. 1rains directly into ena caa
b. !@ left adrenal gland
i. 1rains into left renal ein
5. *enal eins
a. 1rain ,idneys

E. $ommon iliacs 8oin to form inferior ena caa

EI. Veins of )elis and !o+er !imbs

A. Anterior and posterior tibial eins 8oins to form popliteal
B. Aboe the ,nee the popliteal becomes the femoral ein
$. As the femoral ein enters the pelis it becomes the e'ternal iliac
1. E'ternal iliac 8oins +ith internal iliac to form common iliac
E. Saphenous eins
a. Creat
i. 1rains medial aspects of the leg
ii. !ongest ein in the body
iii. Empties into femoral ein
b. Small
i. 1rains deep fascia of calf
ii. Empties into popliteal ein