Chapter 20 The Cardiovascular System: Blood Vessels and Circulation

1. Structure and Function of Blood Vessels

Blood is carried through the body via blood vessels. An artery is a blood vessel that
carries blood away from the heart, where it branches into ever-smaller vessels. The smallest
arteries, vessels called arterioles, further branch into tiny capillaries, where nutrients and
wastes are exchanged, and then combine with other vessels that exit capillaries to form
venules, small blood vessels that carry blood to a vein, a larger blood vessel that returns
blood to the heart. Arteries and veins transport blood in two distinct circuits: the systemic
circuit (цепь) and the pulmonary circuit. Systemic arteries provide blood rich in oxygen to
the body’s tissues. The blood returned to the heart through systemic veins has less oxygen,
since much of the oxygen carried by the arteries has been delivered to the cells. In the
pulmonary circuit, arteries carry blood low in oxygen to the lungs for gas exchange.
Pulmonary veins then return freshly oxygenated blood from the lungs to the heart to be
pumped back out into systemic circulation.
The pulmonary circuit moves blood from the right side of the heart to the lungs and
back to the left side of the heart. The systemic circuit moves blood from the left side of the
heart to the head and body and returns it to the right side of the heart to repeat the cycle.
Cardiovascular Circulation

Structure of the blood vessels

Arteries and arterioles have thicker (толще) walls than veins and venules because of
the higher pressure of the blood that flows through them. Many veins of the body,
particularly those of the limbs, contain valves (клапаны) that assist the unidirectional
(одностороннему) flow of blood toward the heart. This is critical because blood flow
becomes sluggish (вялым) in the extremities, as a result of the lower pressure and the effects
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of gravity. Their walls are considerably thinner and their lumens are correspondingly larger
in diameter, allowing more blood to flow with less vessel resistance.

Lumen - interior of a tubular (трубчатой) structure such as a blood vessel or a portion

of the alimentary (пищеварительного) canal through which blood or other substances
travel.
Since blood passes through the larger vessels relatively quickly, there is limited
opportunity for blood in the lumen of the vessel to provide nourishment to or remove waste
from the vessel’s cells. Besides, the walls of the larger vessels are too thick (толстые) for
nutrients to diffuse through to all of the cells. Larger arteries and veins contain small blood
vessels within their walls known as the vasa vasorum “vessels of the vessel”- to provide
them with this critical exchange. The restriction of the vasa vasorum to the outer layers of
arteries is thought to be one reason that arterial diseases are more common than venous
diseases, since its location makes it more difficult to nourish the cells of the arteries and
remove waste products. There are also minute nerves within the walls of both types of
vessels that control the contraction and dilation of smooth muscle. These minute nerves are
known as the nervi vasorum.
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Arteries - is a blood vessel that takes blood away from the heart to one or more parts
of the body. All arteries have relatively thick walls that can withstand the high pressure of
blood ejected from the heart. Those close to the heart have the thickest walls, containing a
high percentage of elastic fibers that allow them to expand. This type of artery is known as
an elastic artery.
Arteriole - very small artery that distribute blood to capillary beds, the sites of
exchange with the body tissues. The importance of the arterioles is that they will be the
primary site of both resistance and regulation of blood pressure. The precise (точный)
diameter of the lumen of an arteriole at any given moment is determined by neural and
chemical controls, and vasoconstriction and vasodilation in the arterioles are the primary
mechanisms for distribution of blood flow.
Capillary - is a microscopic channel that supplies blood to the tissues, a process called
perfusion. Exchange of gases and other substances occurs between the blood in capillaries
and the surrounding cells and their tissue fluid (interstitial fluid).
Venule - small vessel leading from the capillaries to veins.
Vein - is a blood vessel that conducts blood toward the heart. Because they are
low-pressure vessels, larger veins are commonly equipped with valves that promote the
unidirectional flow of blood toward the heart and prevent backflow toward the capillaries
caused by the inherent low blood pressure in veins as well as the pull of gravity. Contain
approximately 64 percent of the blood volume at any given time.
Approximately 21 percent of the venous blood is located in venous networks within
the liver, bone marrow, and integument (покров). This volume of blood is referred to as
venous reserve. Through venoconstriction, this “reserve” volume of blood can get back to
the heart more quickly for redistribution to other parts of the circulation.

Comparison of Arteries and Veins

Distribution of Blood Flow

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2. Blood Flow, Blood Pressure, and Resistance

Blood Flow - movement of blood through a vessel, tissue, or organ that is usually
expressed in terms of volume per unit of time. It is initiated by the contraction of the
ventricles of the heart.
Resistance - any condition or parameter that slows or counteracts the flow of blood.
Blood pressure (BP) - is the pressure of circulating blood against the walls of blood
vessels or the chambers of the heart. Most of this pressure results from the heart pumping
blood through the circulatory system. Blood pressure is usually expressed in terms of
the systolic pressure (maximum pressure during one heartbeat) over diastolic
pressure (minimum pressure between two heartbeats) in the cardiac cycle. It is measured in
millimeters of mercury (mmHg). The term blood pressure without any specific descriptors
typically refers to systemic arterial blood pressure—that is, the pressure of blood flowing in
the arteries of the systemic circulation. In clinical practice, this pressure usually obtained
using the brachial artery of the arm.
Arterial blood pressure consists of: systolic and diastolic pressures, pulse pressure,
and mean arterial pressure.
Systolic pressure is the higher value (typically around 120 mm Hg) and reflects
(отражает) the arterial pressure resulting from the ejection of blood during ventricular
contraction, or systole.
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Diastolic pressure is the lower value (usually about 80 mm Hg) and represents the
arterial pressure of blood during ventricular relaxation, or diastole.
Pulse pressure - represents the force that the heart generates each time it contracts.
difference between the systolic and diastolic pressures. For example, an individual with a
systolic pressure of 120 mm Hg and a diastolic pressure of 80 mm Hg would have a pulse
pressure of 40 mmHg.
Mean arterial pressure (MAP) - is an average calculated blood pressure in an
individual during a single cardiac cycle. Normally, the MAP within the range of 70–110 mm
Hg. If the value falls below 60 mm Hg for an extended time, blood pressure will not be high
enough to ensure circulation to and through the tissues, which results in ischemia, or
insufficient blood flow. A condition called hypoxia, inadequate oxygenation of tissues,
commonly accompanies ischemia.
MAP = Diastolic Pressure + 1/3 (Systolic Pressure – Diastolic Pressure)
MAP = 80 + 1/3 (120-80) = 93,3
Pulse - alternating expansion (попеременное расширение) and recoil (отдача) of an
artery as blood moves through the vessel; an indicator of heart rate.
Pulse Rate indicates heart rate, recorded as beats per minute. Both the rate and the
strength of the pulse are important. The pulse strength indicates the strength of ventricular
contraction and cardiac output. If the pulse is strong, then systolic pressure is high. If it is
weak, systolic pressure has fallen. Pulse can be palpated manually by placing the tips of the
fingers across an artery that runs close to the body surface and pressing lightly. This
procedure is normally performed using the radial artery in the wrist or the common carotid
artery in the neck.
The technique of measuring blood pressure requires the use of a sphygmomanometer
(a blood pressure cuff attached to a measuring device) and a stethoscope.
Pulse Sites
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Variables Affecting Blood Flow and Blood Pressure

Five variables influence blood flow and blood pressure:
• Cardiac output
• Compliance
• Volume of the blood
• Viscosity of the blood
• Blood vessel length and diameter
Сardiac output (CO), also known as heart output - is the volume of blood being
pumped by a single ventricle of the heart, per unit time (usually measured per minute).
Cardiac output (CO) is the product of the heart rate (HR), i.e. the number of heartbeats per
minute (bpm), and the stroke volume (SV), which is the volume of blood pumped from the
left ventricle per beat; thus giving the formula: CO=HR x SV.
Values for cardiac output are usually denoted as L/min. For a healthy individual
weighing 70 kg, the cardiac output at rest averages about 5 L/min; assuming a heart rate of
70 beats/min, the stroke volume would be approximately 70 mL.
Any factor that causes cardiac output to increase, by elevating heart rate or stroke
volume or both, will elevate blood pressure and promote blood flow. These factors include
sympathetic stimulation, the catecholamines epinephrine and norepinephrine, thyroid
hormones, and increased calcium ion levels. Conversely, any factor that decreases cardiac
output, by decreasing heart rate or stroke volume or both, will decrease arterial pressure and
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blood flow. These factors include parasympathetic stimulation, elevated or decreased

potassium ion levels, decreased calcium levels, anoxia, and acidosis.
Compliance is the ability of any compartment to expand to accommodate increased
content. The greater the compliance of an artery, the more effectively it is able to expand to
accommodate surges in blood flow without increased resistance or blood pressure. Veins are
more compliant than arteries and can expand to hold more blood.
Blood Volume. A typical adult has a blood volume of approximately 5 liters. Low
blood volume, called hypovolemia. Hypervolemia, excessive fluid volume.
Viscosity - is the thickness of fluids that affects their ability to flow.
Vessel Length and Diameter. The length of a vessel is directly proportional to its
resistance. Vascular Tone - contractile state of smooth muscle in a blood vessel.
The effect of vessel diameter on resistance is inverse: Given the same volume of
blood, an increased diameter means there is less blood contacting the vessel wall, thus lower
friction and lower resistance, subsequently increasing flow. A decreased diameter means
more of the blood contacts the vessel wall, and resistance increases, subsequently decreasing
flow.

! Arteriosclerosis is the thickening, hardening, and loss of elasticity of the walls

of arteries. This process gradually restricts the blood flow to one's organs and tissues and can
lead to severe health risks brought on by atherosclerosis, which caused by the buildup of
fatty plaques, cholesterol, and some other substances in and on the artery
walls. Atherosclerosis is the primary cause of coronary artery disease (CAD) and stroke.

Venous System
The pumping action of the heart propels the blood into the arteries, from an area of
higher pressure toward an area of lower pressure. If blood is to flow from the veins back into
the heart, the pressure in the veins must be greater than the pressure in the atria of the heart.
Two factors help maintain this pressure gradient between the veins and the heart. First, the
pressure in the atria during diastole is very low, often approaching zero when the atria are
relaxed (atrial diastole). Second, two physiologic “pumps” increase pressure in the venous
system.
In medium and large sized veins the flow of blood is maintained by one-way
(unidirectional) venous valves to prevent backflow. In the lower limbs this is also aided
by muscle pumps, also known as venous pumps that exert pressure on intramuscular veins
when they contract and drive blood back to the heart.
Skeletal muscle pump - effect on increasing blood pressure within veins by
compression of the vessel caused by the contraction of nearby skeletal muscle. It helps the
lower-pressure veins counteract the force of gravity, increasing pressure to move blood back
to the heart. The contraction of skeletal muscles surrounding a vein compresses the blood
and increases the pressure in that area. This action forces blood closer to the heart where
venous pressure is lower. Note the importance of the one-way valves to assure that blood
flows only in the proper direction. Valves inferior to the contracting muscles close; thus,
blood should not seep (просачиваться) back downward toward the feet.
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Respiratory Pump - increase in the volume of the thorax during inhalation that
decreases air pressure, enabling venous blood to flow into the thoracic region, then
exhalation increases pressure, moving blood into the atria. It aids blood flow through the
veins of the thorax and abdomen.
3. Capillary Exchange

The primary force driving fluid transport between the capillaries and tissues is
hydrostatic pressure. Capillary hydrostatic pressure (CHP) - force blood exerts against a
capillary. The pressure that drives (стимулирует) reabsorption—the movement of fluid from
the interstitial fluid back into the capillaries—is called osmotic pressure. Whereas
hydrostatic pressure forces fluid out of the capillary, osmotic pressure draws fluid back in.

4. Homeostatic Regulation of the Vascular System

In order to maintain homeostasis in the cardiovascular system and provide adequate

blood to the tissues, blood flow must be redirected continually to the tissues as they become
more active. Only the brain receives a more or less constant supply of blood in any other
activity.
Three homeostatic mechanisms ensure adequate blood flow, blood pressure,
distribution, and ultimately perfusion: neural, endocrine, and autoregulatory
mechanisms.
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Neurological regulation of blood pressure and flow depends on the cardiovascular

centers located in the medulla oblongata; baroreceptors in the aorta and carotid arteries and
right atrium; associated chemoreceptors that monitor blood levels of oxygen, carbon dioxide,
and hydrogen ions. This receptors responds to changes in BP - decrease/increase HR and
stroke volume, control vessel tone.
Endocrine control over the cardiovascular system involves the catecholamines,
epinephrine and norepinephrine (increase heart rate and force of contraction, while
temporarily constricting blood vessels to organs not essential for flight-or-fight responses
and redirecting blood flow to the liver, muscles, and heart), as well as several hormones that
interact (взаимодействовать) with the kidneys in the regulation of blood volume.
Autoregulation mechanisms is a local, self-regulatory mechanisms that allow each
region of tissue to adjust (регулировать) its blood flow—and thus (таким образом) its
perfusion. These local mechanisms include chemical signals and myogenic controls.

Circulatory Shock

Circulatory Shock - also simply called shock; a life-threatening medical condition in

which the circulatory system is unable to supply enough blood flow to provide adequate
oxygen and other nutrients to the tissues to maintain cellular metabolism.
 Hypovolemic shock in adults is typically caused by hemorrhage, although in
children it may be caused by fluid losses related to severe vomiting or diarrhea. Other causes
for hypovolemic shock include extensive burns, exposure to some toxins, and excessive
urine loss related to diabetes insipidus or ketoacidosis.
 Cardiogenic shock results from the inability of the heart to maintain cardiac
output. Most often, it results from a myocardial infarction (heart attack), but it may also be
caused by arrhythmias, valve disorders, cardiomyopathies, cardiac failure, or simply
insufficient flow of blood through the cardiac vessels.
 Vascular shock occurs when arterioles lose their normal muscular tone and
dilate dramatically. A common cause is sepsis (or septicemia), also called “blood
poisoning,” which is a widespread bacterial infection that results in an organismal-level
inflammatory response known as septic shock. Neurogenic shock - type of shock that
occurs with cranial or high spinal injuries that damage the cardiovascular centers in the
medulla oblongata or the nervous fibers originating from this region. Anaphylactic shock is
a severe allergic response that causes the widespread release of histamines, triggering
vasodilation throughout the body
 Obstructive shock - type of shock that occurs when a significant portion of the
vascular system is blocked.
5. Circulatory Pathways

The right ventricle pumps deoxygenated blood into the pulmonary trunk and right
and left pulmonary arteries, which carry it to the right and left lungs for gas exchange.
Oxygenated blood is transported by pulmonary veins to the left atrium and after to the left
ventricle which pumps this blood into the aorta. The main regions of the aorta are the
ascending aorta, aortic arch, and descending aorta, which is further divided into the
thoracic and abdominal aorta. The coronary arteries branch from the ascending aorta.
After oxygenating tissues in the capillaries, systemic blood is returned to the right atrium
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from the venous system via the superior vena cava, which drains most of the veins superior
to the diaphragm, the inferior vena cava, which drains most of the veins inferior to the
diaphragm, and the coronary veins via the coronary sinus. The hepatic portal system
carries blood to the liver for processing before it enters circulation.

Pulmonary Circulation

In the pulmonary loop, deoxygenated blood exits the right ventricle of the heart and
passes through the pulmonary trunk. The pulmonary trunk splits into the right and left
pulmonary arteries. These arteries transport the deoxygenated blood to arterioles and
capillary beds in the lungs. There, carbon dioxide is released and oxygen is absorbed.
Oxygenated blood then passes from the capillary beds through venules into the pulmonary
veins. The pulmonary veins transport it to the left atrium of the heart.

Overview of Systemic Arteries

Blood high in oxygen concentration is returned from the pulmonary circuit /сёркэт/
(цикл) to the left atrium via the four pulmonary veins. From the left atrium, blood moves
into the left ventricle, which pumps blood into the aorta. The aorta and its branches—the
systemic arteries—send blood to every organ of the body.
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Aorta

Aorta – is a largest artery in the body, originating from the left ventricle and
descending to the abdominal region where it bifurcates (раздваивается) into the common
iliac arteries at the level of the fourth lumbar vertebra; arteries originating from the aorta
distribute blood to virtually (практически) all tissues of the body.
The aorta consists of the ascending aorta, the aortic arch, and the descending aorta,
which passes through the diaphragm and a landmark that divides into the superior thoracic
and inferior abdominal components.
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Coronary Circulation
The first vessels that branch from the ascending aorta are the paired coronary
arteries. The coronary arteries encircle (окружают) the heart, forming a ring-like structure
that divides into the next level of branches that supplies blood to the heart tissues.
Aortic Arch Branches
There are three major branches arising from the aortic arch:
Brachiocephalic artery: single vessel located on the right side of the body; the first
vessel branching from the aortic arch; gives rise to the right subclavian artery and the right
common carotid artery; supplies blood to the head, neck, upper limb, and wall of the
thoracic region.
Left common carotid artery: right common carotid artery arises from the
brachiocephalic artery and the left common carotid artery arises from the aortic arch; each
gives rise to the external and internal carotid arteries; supplies the respective sides of the
head and neck.
Left subclavian artery: right subclavian artery arises from the brachiocephalic artery
while the left subclavian artery arises from the aortic arch; gives rise to the internal thoracic,
vertebral, and thyrocervical arteries; supplies blood to the arms, chest, shoulders, back, and
central nervous system.

When blood flow is interrupted, even for just a few seconds, a transient ischemic
attack (TIA), or mini-stroke, may occur.
Arteries Supplying the Head and Neck

Given the central role and vital importance of the brain to life, it is critical that blood
supply to this organ remains uninterrupted.
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The internal carotid arteries along with the vertebral arteries are the two primary
suppliers of blood to the human brain. The common carotid artery gives rise to the external
and internal carotid arteries. The external carotid artery remains superficial and gives rise to
many arteries of the head. The internal carotid artery first forms the carotid sinus and then
reaches the brain via the carotid canal and carotid foramen, emerging into the cranium via
the foramen lacerum. The vertebral artery branches from the subclavian artery and passes
through the transverse foramen in the cervical vertebrae, entering the base of the skull at the
vertebral foramen. The subclavian artery continues toward the arm as the axillary artery.
Both the carotid and vertebral arteries branch once they enter the cranial cavity, and
some of these branches form a structure known as the arterial circle (or circle of Willis)
which supplies blood to numerous structures within the face, lower jaw, neck, esophagus,
and larynx.
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Thoracic Aorta and Major Branches

The thoracic (descending) aorta spans (охватывает) from the level of T4 to T12,
traveling within the mediastinum to the left of the vertebral column. It leaves the thorax via
the aortic hiatus in the diaphragm, and becomes the abdominal aorta. As it passes through
the thoracic region, the thoracic aorta gives rise to several branches, which are collectively
referred to as visceral branches and parietal branches.
Arteries of the Thoracic Region
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Abdominal Aorta and Major Branches

After crossing through the diaphragm at the aortic hiatus, the thoracic aorta is called
the abdominal aorta. It beginning at the level of the T12 vertebrae to level of the L4 vertebra,
where it bifurcates into the right and left common iliac arteries that supply the lower body.
Before this division, the abdominal aorta gives rise to several important branches.

The aorta divides at approximately the level of vertebra L4 into a left and a right
common iliac artery but continues as a small vessel, the median sacral artery, into the
sacrum (крестец). The common iliac arteries provide blood to the pelvic region and
ultimately to the lower limbs. They split into external and internal iliac arteries
approximately at the level of the lumbar-sacral articulation. Each internal iliac artery sends
branches to the urinary bladder, the walls of the pelvis, the external genitalia, and the medial
portion of the femoral region. In females, they also provide blood to the uterus and vagina.
The much larger external iliac artery supplies blood to each of the lower limbs.
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Major Branches of the Aorta into the thoracic and abdominal regions
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Arteries Serving the Upper Limbs

As the subclavian artery exits the thorax into the axillary region, it is renamed the
axillary artery. Although it does branch and supply blood to the region near the head of the
humerus (via the humeral circumflex arteries), the majority of the vessel continues into the
upper arm, or brachium, and becomes the brachial artery.
The arterial supply to the upper limb is delivered via five main vessels (proximal to
distal):
- Subclavian artery
- Axillary artery
- Brachial artery
- Radial artery
- Ulnar artery
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Arteries Serving the Lower Limbs

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The main artery of the lower limb is the Femoral Artery. It is a continuation of the
external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the
femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.
It gives off several smaller branches as well as the lateral deep femoral artery that in
turn gives rise to a lateral circumflex artery. These arteries supply blood to the deep
muscles of the thigh as well as ventral and lateral regions of the integument. The femoral
artery also gives rise to the genicular artery, which provides blood to the region of the knee.
As the femoral artery passes posterior to the knee near the popliteal fossa, it is called the
popliteal artery. The popliteal artery branches into the anterior and posterior tibial arteries.

Overview of Systemic Veins

Systemic veins return low in oxygen concentration blood to the right atrium. The
right atrium receives all of the systemic venous return. Most of the blood flows into either
the superior vena cava or inferior vena cava. Systemic venous circulation from above the
diaphragm will generally flow into the superior vena cava; this includes blood from the head,
neck, chest, shoulders, and upper limbs. The exception to this is that most venous blood flow
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from the coronary veins flows directly into the coronary sinus and from there directly into
the right atrium. Inferior the diaphragm, systemic venous flow enters the inferior vena cava,
that is, blood from the abdominal and pelvic regions and the lower limbs.

Superior Vena Cava (верхняя полая вена) – large systemic vein; drains blood from
most areas superior to the diaphragm; empties into the right atrium. It is a thin-walled, low
pressure vessel.
On both the left and right sides, the subclavian vein forms when the axillary vein
passes through the body wall from the axillary region. It fuses with the external and internal
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jugular veins from the head and neck to form the brachiocephalic vein. Each vertebral vein
also flows into the brachiocephalic vein close to this fusion. Each internal thoracic vein,
also known as an internal mammary vein, drains the anterior surface of the chest wall and
flows into the brachiocephalic vein.
Veins of the Thoracic and Abdominal Regions
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Veins of the Head and Neck

Blood from the brain and the superficial facial vein flow into each internal jugular
vein. Blood from the more superficial portions of the head, scalp, and cranial regions,
including the temporal vein and maxillary vein, flow into each external jugular vein. Blood
from the external jugular vein empties into the subclavian vein.
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Venous Drainage of the Brain

Circulation to the brain is both critical and complex. Many smaller veins of the brain
stem and the superficial veins of the cerebrum lead to larger vessels referred to as
intracranial sinuses. These include the superior and inferior sagittal sinuses, straight sinus,
cavernous sinuses, left and right sinuses, the petrosal sinuses, and the occipital sinuses.
Ultimately, sinuses will lead back to either the inferior jugular vein or vertebral vein. Most of
the veins on the superior surface of the cerebrum flow into the largest of the sinuses, the
superior sagittal sinus.
Veins Draining the Upper Limbs
The digital veins in the fingers come together in the hand to form the palmar venous
arches. From here, the veins come together to form the radial vein, the ulnar vein, and the
median antebrachial vein. The radial vein and the ulnar vein parallel the bones of the
forearm and join together at the antebrachium to form the brachial vein, a deep vein that
flows into the axillary vein in the brachium.
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The venous system of the upper limb drains deoxygenated blood from the arm,
forearm and hand. It can be subdivided into the superficial system and the deep system.
The major superficial veins of the upper limb are the cephalic and basilic veins. They
are located within the subcutaneous tissue of the upper limb.
The deep venous system of the upper limb is situated underneath the deep fascia. It is
formed by paired veins, which accompany and lie either side of an artery. In the upper
extremity, the deep veins share the name of the artery they accompany.
IV access: central venous accesses are all those whose tip reaches the superior vena
cava, the right atrium or the inferior vena cava. Peripheral line may be placed in the arm,
commonly either the wrist or the median cubital vein at the elbow 14 gage cannula – large,
16 common, 22 – pediatric.

 Axillary vein - the major vein in the axillary region; drains the upper limb and
becomes the subclavian vein.
 Brachial vein - deeper vein of the arm that forms from the radial and ulnar
veins in the lower arm; leads to the axillary vein.
 Basilic vein - superficial vein of the arm that arises from the median
antebrachial vein, intersects with the median cubital vein, parallels the ulnar vein, and
continues into the upper arm; along with the brachial vein, it leads to the axillary vein.
 Radial vein - vein that parallels the radius and radial artery; arises from the
palmar venous arches and leads to the brachial vein.
Veins Flowing into the Superior Vena Cava
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Inferior Vena Cava

It is the largest vein of the human body that drains blood from areas inferior to the
diaphragm. The vein that collects deoxygenated blood from the abdomen, pelvis and lower
limbs and carries it to the right atrium of the heart.
Venous Flow into Inferior Vena Cava
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Veins Draining the Lower Limbs

The veins of the lower limb drain deoxygenated blood and return it to the heart.

Major Veins Serving the Lower Limbs

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Hepatic portal system

Is the venous system that returns blood from the digestive tract and spleen to the liver
(where raw nutrients in blood are processed before the blood returns to the heart). The liver
receives blood from the normal systemic circulation via the hepatic artery. It also receives
and processes blood from other organs, delivered via the veins of the hepatic portal system.
All blood exits the liver via the hepatic vein, which delivers the blood to the inferior vena
cava Instead of entering the circulation directly, absorbed nutrients and certain wastes (for
example, materials produced by the spleen) travel to the liver for processing. They do so via
the hepatic portal system.

Drug metabolism: Many drugs that are absorbed through the GI tract are substantially
metabolized by the liver before reaching general circulation. This is known as the first pass
effect. As a consequence, certain drugs can only be taken via certain routes. For
example, nitroglycerin cannot be swallowed because the liver would deactivate the
medication, but it can be taken under the tongue or transdermally (through the skin) and thus
is absorbed in a way that bypasses the portal venous system.

Questions
1. What is the main component of interstitial fluid? Interstitial fluid contains water and
dissolved solutes and proteins. - The solutes are sugar, salts, acids, hormones,
neurotransmitters, wastes and electrolytes.
2. The endothelium is found in the - Tunica intima.
3. Nervi vasorum control - Both vasoconstriction and vasodilation.
4. Closer to the heart, arteries would be expected to have a higher percentage of - Elastic
fibers.
5. Which of the following best describes veins? - Thin walled, large lumens, low
pressure, have valves.
6. An especially leaky type of capillary found in the liver and certain other tissues is
called - Sinusoid capillary.
7. In a blood pressure measurement of 110/70, the number 70 is the - Diastolic pressure.
8. A healthy elastic artery - Is compliant.
9. Which of the following statements is true? - As blood volume decreases, blood
pressure and blood flow also decrease.
10.Slight vasodilation in an arteriole prompts - Huge decrease in resistance.
11.Venoconstriction increases which of the following? - All of the above: blood pressure
within the vein, blood flow within the vein, return of blood to the heart.
12.Hydrostatic pressure is - The pressure exerted by fluid in an enclosed space.
13.Net filtration pressure is calculated by – subtracting (вычитание) the blood colloid
osmotic pressure from the capillary hydrostatic pressure.
14.Which of the following statements is true? - In one day, more fluid exits the capillary
through filtration than enters through reabsorption.
15.Clusters of neurons in the medulla oblongata that regulate blood pressure are known
collectively as - The cardiovascular center.
16.In the myogenic response - Vascular smooth muscle responds to stretch.
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17.A form of circulatory shock common in young children with severe diarrhea or
vomiting is - Hypovolemic shock.
18.The coronary arteries branch off of the - Ascending aorta.
19.Which of the following statements is true? - The radial and ulnar arteries join to form
the palmar arch.
20.Arteries serving the stomach, pancreas, and liver all branch from the - Celiac trunk.
21.The right and left brachiocephalic veins. - all of the above are true: drain blood from
the right and left internal jugular veins, drain blood from the right and left subclavian
veins, drain into the superior vena cava.
22.The hepatic portal system delivers blood from the digestive organs to the – Liver.
23.Which of the following statements is true? - One umbilical vein carries oxygen-rich
blood from the placenta to the fetal heart.
24.Arterioles are often referred to as resistance vessels. Why? - Arterioles are known as
resistance vessels because they are the primary site of resistance to blood flow in the
circulatory system. The walls of the arterioles are composed of smooth muscle and
elastic tissue, which allows for the regulation of blood flow through the vessel by
contracting or relaxing the smooth muscle. This allows for the control of blood
pressure and flow to different organs and tissues, making them an important
component of the circulatory system.
25.Cocaine use causes vasoconstriction. Is this likely to increase or decrease blood
pressure, and why? - Vasoconstriction reduces the volume or space inside affected
blood vessels. When blood vessel volume is lowered, blood flow is also reduced. At
the same time, the resistance or force of blood flow is raised. This causes higher blood
pressure.
26.A blood vessel with a few smooth muscle fibers and connective tissue, and only a very
thin tunica externa conducts blood toward the heart – Venule.
27.You measure a patient's blood pressure at 130/85. Calculate the patient's pulse
pressure and mean arterial pressure. Determine whether each pressure is low, normal,
or high - The patient's pulse pressure is 130 - 85 = 45 mm Hg. Generally, a pulse
pressure should be at least 25 percent of the systolic pressure, but not more than 100
mm Hg. Since 25 percent of 130 = 32.5, the patient's pulse pressure of 45 is normal.
The patient's mean arterial pressure is 85 + 1/3 (45) = 85 + 15 = 100. Normally, the
mean arterial blood pressure falls within the range of 70 - 110 mmHg, so 100 is
normal.
28.True or false? The plasma proteins suspended in blood cross the capillary cell
membrane and enter the tissue fluid via facilitated diffusion. Explain your thinking -
False. The plasma proteins suspended in blood cannot cross the semipermeable
capillary cell membrane, and so they remain in the plasma within the vessel, where
they account for the blood colloid osmotic pressure.
29.A patient arrives in the emergency department with a blood pressure of 70/45
confused and complaining of thirst. Why? A. This blood pressure is insufficient to
circulate blood throughout the patient's body and maintain adequate perfusion of the
patient's tissues.
30.Identify the ventricle of the heart that pumps oxygen-depleted blood and the arteries of
the body that carry oxygen-depleted blood - The right ventricle (RV) pumps oxygen-
poor blood through the pulmonary valve (PV) into the main pulmonary artery (MPA).
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From there, the blood flows through the right and left pulmonary arteries into the
lungs.
31.What organs do the gonadal veins drain? - The gonadal veins are paired structures that
drain the gonads: ovaries in the female and the testes in the male. In males it is called
the testicular vein (or internal spermatic vein) and in females it is called the ovarian
vein.
32.What arteries play the leading roles in supplying blood to the brain? - There are two
paired arteries which are responsible for the blood supply to the brain; the vertebral
arteries, and the internal carotid arteries. These arteries arise in the neck, and ascend to
the cranium.