j





j




 


ñ



   

There are three main categories of blood vessels that form a closed system of
tubes leading from the heart, to the tissues, and back to the heart: arteries,
capillaries, and veins.

 j 



 j


      

An artery is a blood vessel that carries blood away from the heart
and toward the tissues. Each artery has a wall consisting of three
layers surrounding a hollow center called the lumen.

 


   
  

Tunica intima -- The innermost coat of all blood vessels is the
tunica interna (intima). It consists of a simple squamous
endothelium lying on its basement membrane and a thin
connective tissue component called the internal elastic
lamina.

Tunica media -- The middle coat, known as the tunica media,

consists of two components: elastin fibers, and smooth
muscle. These tissues are arranged circumferentially about
the artery and longitudinally through the length of the vessel.

Tunica adventitia -- The outermost coat, the tunica externa

(adventitia) consists of two components: elastin fibers and
collagen fibers. These fibers form a connective tissue wrap
for the vessel.

ñ
 

 
 
  

The structure of arteries gives them two important functional

properties: elasticity and contractility.

Elasticity is the ability to return to a resting length after being

stretched.

Vascular smooth muscle is innervated by the sympathetic nervous

system. In response, the cells shorten and thicken. This is
contractility.

c 225
    
 

As blood is ejected into the large arteries, their walls expand to

accommodate the increased blood flow. As the ventricles relax, the
elastic recoil of the arterial wall forces the blood forward through the
system. It is this pressure exerted by arteries during diastole of the
ventricles that maintains blood pressure and therefore blood flow
through the body.

  

 
 
 


In response to a sympathetic message, smooth muscle of the

artery contracts and narrows the vessel lumen diameter
(vasoconsriction).

When the sympathetic message is removed, the arterial smooth

muscle relaxes and vessel lumen diameter increases (vasodilation).

ñ

 
   
  


There are two types of arteries based on size:

1. elastic (conducting) arteries
2. muscular (distributing) arteries



jjj




  
   

Elastic arteries contain primarily elastin fibers in the tunica

media. They are also called conducting arteries because
they are large arteries that conduct blood away from the
heart.

Elastic arteries are the ones that accommodate blood

surging from the left ventricles during systole. They are the:
aorta
brachiocephalic
right and left common carotid arteries
right and left subclavian arteries
right and left vertebral arteries
right and left common iliac arteries.

       
 

The stretched elastic fibers of the elastic arteries momen-

tarily store some of this energy and therefore function as
pressure reservoirs. During diastole, the elastic fibers recoil,
converting their stored energy into kinetic energy and thus
c 226
 pushing blood forward in the vascular the system in a more-
or-less continuous fashion.

À 

jjj




 
    

Muscular arteries are medium-to-small arteries that have

more smooth muscle than elastin in their tunica media and
are thus more capable of vasoconstriction and vasodilation
than are elastic arteries. They are also known as distributing
arteries since they branch from the larger, more elastic
arteries and distribute blood to the various regions of the
body.

  

 

Because of their greater contractility, muscular arteries are
used to direct blood flow to various parts of the body accord-
ing to their moment-to-moment needs. This is called blood
shunting. For example, vasoconstricting arteries in the skin
while vasodilating those in the gut would cause an increased
blood flow to the gut.

¦ 
j




    


 

There is usually more than one muscular artery supplying a

particular region or tissue. Union of these vessels is called
an anastomosis.

Anastomoses provide alternative routes for blood to reach a

tissue, so that if one source is injured, another source
continues to supply the area.

  
  


The alternate route of blood flow to a particular tissue,

flowing through anastomoses, is called that tissue¶s
collateral circulation. This alternate route would not be used
unless the preferred route was compromised in some way
(i.e.--coronary artery blockage).

c 227
  j




   
 

An arteriole is a very small, generally microscopic artery that

delivers blood to the capillaries. Arterioles branch from the
muscular arteries and begin to lose wall thickness. The smallest of
arterioles consists of nothing more than the endothelium and a
single layer of scattered smooth muscle cells.

  
  


 

 




During vasoconstriction, blood flow through capillaries serviced by

a particular arteriole will decrease and may even cease completely,
depending upon intensity of contraction. During times of high
metabolic demand within a tissue, the arterioles supplying the
tissue may be completely vasodilated, allowing a large blood flow
through the capillary bed.

· 



     

Capillaries are countless microscopic vessels that connect the

arterial tree with the venous tree and allow for exchange of
substances between the blood and the interstitial fluid. They are
composed of a single layer of simple squamous epithelium (the
endothelium) resting on a thin basement membrane.

      



Capillaries are found in the immediate vicinity of almost every cell

of the body, but their distribution varies with the activity level of the
tissue.

Tissues with high metabolic rates (brain, muscle, liver, kidneys,

etc.) require more oxygen and nutrients and therefore have more
extensive capillary networks.

In tissues with lower metabolic needs (tendons, ligaments, etc.)

There are fewer capillaries. (This is one of the reasons that
sprained or torn tendons and ligaments heal slowly.)

Some tissues (cartilage, epidermis, visceral epithelia, cornea, lens)

have no blood supply at all. (This helps explain why a paper cut
does not bleed and why cartilage injuries do not heal.)

c 228
   


   

The primary function of capillaries is to permit the movement of

nutrients and wastes between the blood and tissue cells via the
interstitial fluid.

   

    

 

   

First, since capillaries consist of only a simple squamous layer of

epithelium and a basement membrane, a substance need pass
through only a single layer to move from one fluid compartment to
another.

Secondly, capillaries branch from arterioles, forming extensive

networks (beds), allowing for greatly increased surface area for
diffusion and filtration and thereby allowing for the rapid exchange
of large quantities of materials.

      

At the origin of each capillary from an arteriole, there is a ring of

smooth muscle called the precapillary sphincter that controls the
flow of blood entering it. Sympathetic nerves innervate it. In this
way, the nervous system can control blood flow through individual
capillaries.

 





Blood flows through capillaries in an intermittent fashion rather than

continuously because of alternating contraction and relaxation of
the precapillary sphincters. This process is called vasomotion. It
occurs at a resting rate of 5 - 10 times/minute and can be made
faster or slower, according to the needs of the tissue at any given
moment.

  
 
 
 


 
   

continuous -- Continuous capillaries have a continuous, uninter-
rupted endothelium with intercellular clefts found between
adjacent cells. They are found in skeletal muscle,
connective tissues, and the lungs.

fenestrated --Fenestrated capillaries are the same as continuous,

except that the endothelial cells have 70 - 100 nm (10-9)
fenestrae or pores in their plasma membranes. They are
located in kidneys, small intestinal epithelium, and endocrine
glands.

c 229
   sinusoid  Sinusoids have larger diameters, more tortuous routes,
large gaps separating cells, and a lining of cells adapted to
the functions of the organ where they are found (phagocytic
cells in liver and spleen, etc.)









  



When several capillaries unite, they form venules that collect their
blood. Venules ultimately unite to form veins, which are composed
again of the same three basic tunics as the arteries.

     

 
 

The primary differences are, when compared to the companion

artery:
1. The lumen is larger.
2. The tunica media is thinner, and
3. The tunica externa is thicker.

 
   


The structure of veins allows them to be very distensible and

capable of accommodating a large volume of blood, again based
on the body¶s need at the moment. This makes the venous system
an important blood reservoir.

  
    

Because blood pressure has dropped greatly in the venous tree,

veins are equipped with semilunar valves, particularly in the lower
extremities. These valves prevent backflow of blood and keep it
moving toward the heart.

 
jj

  

 
 

At any given time, blood of the body is distributed in different

proportions to the different areas. At rest, about 60% of total blood
volume is located in the veins. Because veins contain so much
blood at rest, they are known as blood reservoirs, storage depots
for blood that can be rapidly moved to the heart for redistribution
throughout the circulation.

c 230
 
  

 



For example, as muscular activity increases, there is increased

sympathetic stimulation to veins. This results in vasoconstriction,
reducing the volume of blood they hold and redirecting it back to
the heart for redistribution to the muscles, whose arteries are
vasodilated. The principal blood reservoirs are the veins of the
liver, spleen, and skin.

  
 


 



 
    
 
 ñ



1. greatest cross-sectional area of the vascular tree

2. greatest total length of the vascular tree and therefore the
greatest resistance to flow

  



   

The 5% of blood that is in the capillary beds at any one time is the
only blood that exchanges materials with interstitial fluid.

ñ
    !  !  !



    

diffusion, vesicular transport, and bulk flow

  



 


  " 

 

simple diffusion

ñ
 

   
  

 
#
 
$ 




All plasma solutes (oxygen, carbon dioxide, glucose, amino acids,

ions, hormones, wastes, etc.) freely pass the endothelium by
following their concentration gradient.

ñ
 

   

  

 
#
 
$


Proteins, particularly plasma proteins, are too large to cross the

endothelium.

c 231
 

j
j

     



Vesicular transport is responsible for a small quantity of materials

that pass through the capillary membrane. Some large substances
in plasma are taken up by capillary endothelial cells by endocytosis
(active transport processes), and then passed into the interstitial
fluid by exocytosis (secretion).

% 
  
 
    

 
 
 

This method is used primarily for large, lipid-insoluble molecules

like antibodies. For example, movement of antibodies from
maternal blood to fetal blood crosses the placenta by vesicular
transport.

· jj


j

   



Bulk flow is the mechanism whereby regulation of the relative

volumes of blood and interstitial fluid occurs. It is a passive
process that involves the movement of large numbers of ions,
molecules, or particles in the same direction.

The substances move in unison in response to various pressures

and move at rates far greater than can be accounted for by
diffusion and vesicular transport alone.

     





Bulk flow occurs because some forces (pressures) push fluid (water
and solutes) out of capillaries into the interstitial space, resulting in
filtration of the fluid.

&    
  
!
  
 
   
 

Fluid does not build up in the interstitium because opposing

pressures draw the fluid, with its solutes, back into the capillary.
This process is known as reabsorption of the fluid.

  

   
  

  
  
  

Normally, filtration is almost equal to reabsorption, a state of near

equilibrium known as Starling¶s law of the capillaries.
c 232
  
  

 



! 


 
  
  


  ' 

Blood volume, and therefore blood pressure, would decrease.

ñ

     

 


Bulk flow is dependent upon 4 pressures that determine the

direction of net fluid flow (filtration or reabsorption):
1. blood hydrostatic pressure
2. blood osmotic pressure
3. interstitial fluid hydrostatic pressure
4. interstitial fluid osmotic pressure

  




blood hydrostatic pressure ± Blood hydrostatic pressure (BHP) is

the fluid pressure within capillaries, tending to push fluid out.

On the arterial end it equals 35 mmHg.

On the venous end it equals 16 mmHg.

interstitial fluid hydrostatic pressure ± Interstitial fluid hydrostatic

pressure (IFHP) is the pressure of interstitial fluid pressing
on the outside of the capillary wall. This pressure can
become an inward force, but it is a negligible pressure under
normal circumstances, so consider it to be equal to 0 mmHg.

blood colloid osmotic pressure ± Blood colloid osmotic pressure

BCOP) is generated by plasma proteins trapped within the
capillaries (albumin plays major role). This pressure acts to
move fluid into the capillary by osmosis. It equals 26 mmHg.

interstitial fluid osmotic pressure ± Interstitial fluid osmotic pressure

(IFOP) is the force of osmosis created by small amounts of
protein that have leaked into the interstitium and pull fluid out
of the capillary. It equals only about 1 mmHg.

 
  
  
 


  
 
   
   (

 
  
  




   

Whether fluids enter or leave the capillary depends on how the

pressures relate to each other; if outward forces are greater than
inward forces, the net flow is out of the capillary (filtration).

c 233
 If inward forces are greater than outward forces, the net flow of fluid
is into the capillary (reabsorption).

The term net filtration pressure (NFP) is used to show the direction
of fluid movement. It is calculated as:

NFP = (BHP + IFOP) - (BCOP + IFHP)

Outward - Inward

On the arterial end of a capillary:

NFP = (35+1) - (26+ 0)

= (36) - (26)
= + 10 mm Hg ( net movement out = filtration)

On the venous end of a capillary:

NFP = (16+1) - (26+0)

= (17) - (26)
= -9 mm Hg ( net movement in = reabsorption)

About 85% of the fluid filtered from the arterial ends of capillaries is
reabsorbed at their venous ends. The balance, including the
escaped plasma proteins, is returned to the blood via the lymphatic
system.

On a daily basis, about 20 liters of blood are filtered out of

capillaries, 17 liters are reabsorbed, and 3 liters enters the
lymphatic system.


 


 j

j 

  
 



 
 
)

   
  

     




The volume (mL) of blood that flows through any tissue in a given
period of time (min) is blood flow (ml./min).

The velocity of blood flow (in cm/sec) is inversely related to the

cross-sectional area of the blood vessels. In other words, blood
flows slowest where the total cross sectional area is greatest.

Each time an artery branches, the total cross sectional area of all
the branches is greater than that of the original vessel. On the
other hand, as venules combine to form veins, the total cross
sectional area decreases.
c 234
 aorta -- area = 3-5 sq. cm., velocity = 40 cm/sec
capillaries -- area 4500-6000, velocity = < 0.1 cm/sec
vena cava -- area 14,000 velocity = 5-20 cm/sec

Thus, the velocity of blood flow decreases from the aorta to arteries
to arterioles to capillaries and increases from the capillaries to the
venules to veins to the vena cava.

Because blood moves at its slowest through the capillary beds,

there is adequate time for the exchange between the plasma and
the interstitial fluid to occur.

Circulation time is the time required for blood to pass from the right
atrium back to the right atrium. This is usually about 1 minute at
rest.

 


 







  


CO = SV x HR
= 5.25 liters/ minute (the volume of blood circulating
through systemic or pulmonary vessels each minute)

 

 


   ! 

 
 

  


1. blood pressure = flow from higher to lower pressures

2. resistance (opposition) = the force of friction as blood
moves along blood vessels

(
 
   
 


CO = mean (average) arterial blood pressure (MABP)

resistance (R)

  

 #Ú $

Blood pressure (BP) (also known as blood hydrostatic

pressure or BHP) is the fluid pressure exerted by the blood
on the inside wall of a blood vessel.

c 235
    
 

    

!



! 



 

The principal determinant of blood pressure (BP) is cardiac

output (CO). There is a direct relationship between BP and
CO. If all other factors remain the same, an increase in CO
causes an increase in BP and a decrease in CO causes a
decrease in BP. Factors that influence CO, then also alter
BP.

CO, and therefore BP, also depends on the total blood

volume (BV). There is a direct relationship between BP and
BV. If BV drops (hemorrhage, dehydration, 3rd space fluid
shifts), then BP drops. If BV rises (water retention), then BP
rises.

As blood leaves the aorta, passing into the systemic circu-

lation, BP falls progressively to 0 mm Hg by the time it
returns to the right atrium. However, as the blood is
channeled into the arterial circuit, the diameters of the
individual vessels decrease, total cross-sectional area
increases, and as a result, resistance increases. On the
venous end of the system, even though BP is low, as
capillaries become venules, then veins, diameters increase,
total cross sectional area decreases, and resistance
decreases, allowing blood flow to continue.

À 




j


   

Resistance is the opposition to blood flow principally as a

result of friction between blood and the walls of the blood
vessels.

  
     

1. blood viscosity
2. total blood vessel length
3. blood vessel radius

   
     

 

There is a direct relationship between resistance and BP:

an increase in resistance will cause an increase in BP, and
a decrease in resistance will cause a decrease in BP.

c 236
  


Viscosity is a measure of the thickness of a fluid.

 
 
 
 
 

1. ratio of RBCs to plasma volume

2. number of plasma proteins in the plasma

 
  


*Ú


Conditions such as dehydration, polycythemia (too many

RBCs) or severe burns (where there is a lot of tissue fluid
loss) would increase the RBC:plasma ratio. This would
increase blood viscosity and therefore resistance to flow. As
a result, BP would rise.

 
  


 
 

A depletion of plasma proteins (liver disease) would

decrease blood viscosity, and therefore resistance. As a
result, BP would fall.

  
     
 

  


Resistance to blood flow is directly proportional to the total

length of the blood vessel through which blood flows. In
other words, the longer the vessel, the greater its resistance
to flow and vice versa.

   
 !"  
 
  
 
  

 # 
$

An obese person has a greatly increased number of blood

vessels because of the amount of adipose tissue that must
be serviced. As a result, the total length of his or her
vascular tree is greatly increased and this person tends to
have a higher blood pressure because of the greater
resistance to blood flow.

  
     

  
  

Resistance is inversely proportional to the fourth power of

the radius of the blood vessel. In other words, the smaller
the diameter of the vessel, the greater the resistance it offers
to blood flow.
c 237
 &
   
  
  
) 


      






 

   

If the radius of a blood vessel decreases by ½, its resistance

to blood flow increases 16 times (½ x ½ x ½ x ½ = 1/16).

 

  "   


   






capillaries

  
     #(+*$   




  
     

Systemic vascular resistance (SVR) refers to all the vascular

resistance offered by all systemic blood vessels. It can also
be called total peripheral resistance (TPR).

 

 
 


(+*

A major function of arterioles, because of their smooth

muscle and sympathetic innervation, is to control SVR by
altering their state of vasoconstriction and vasodilation.



 

 
 (+* 



 

In vasoconstriction the diameter of arterioles decreases,

resistance increase, and therefore BP increases.



 
 
 (+* 


 

In vasodilation, the diameter of arterioles increases,

resistance decreases, and therefore BP decreases.

·


j

  
 u

Venous return is the volume of blood flowing back to the heart from
the veins of the systemic circulation. It depends on the pressure
gradient between the venules (16 mm Hg) and the right atrium (0
mm Hg).

Although pressure differences are small, venous return keeps pace

with cardiac output because resistance of the veins is low.
c 238
 (Remember, too, that cross-sectional area is decreasing, so
velocity of flow in the veins increases as they approach the heart.)

 

 



 

skeletal muscles -- To boost venous return, skeletal muscles work
as ³pumps´ because veins, particularly in the extremities, are
strategically placed between opposing muscle groups.
Movement of the muscles provides a ³milking´ action for the
veins, moving blood forward towards the heart.

venous valves -- Vein, particularly those in the lower extremities,
are equipped with venous valves (semilunar- like) that allow
one-way blood flow only. As the body moves, the skeletal
muscles ³milk´ the veins, forcing blood towards the heart.
When blood moves backward, the valves fill with blood and
close, preventing backflow.

respiration -- The action of breathing also aids blood flow back to
the heart. During inspiration, thoracic cavity pressure is less
than abdominal cavity pressure. This adds to the pressure
gradient in the inferior vena cava and thus aids blood flow
towards the thorax and thus the heart.

 j




There are several interconnected negative feedback systems that control BP by

adjusting SV, HR, SVR, and BV. Some work instantaneously to cope with sud-
den drops in BP, while others act more slowly to provide long-term regulation of
BP.

Even while BP remains steady, needs arise that require blood to be redistributed
to tissues undergoing rapid metabolism.

  

j

 jj 

j

À jj 

j

 
j
j
 

j

À 

j

 



  






  



The cardiovascular center of the medulla as well as local

systems regulates blood flow and BP to the tissues of the
body.

c 239
    
     
 

 



The cardiovascular center consists of 3 groups of neurons in

the medulla that regulates HR, contractility of the ventricles,
and blood vessel diameter.

ñ
 

 

 
 
)  
   



 

cardioacceleratory center -- The cardioacceleratory center or

CAC increases heart rate and contractility, working
through the sympathetic nervous system.

cardioinhibitory center -- The cardioinhibitory center or CIC

decreases heart rate and contractility, working
through the parasympathetic nervous system.

vasomotor center ± The vasomotor center controls blood

vessel diameter, particularly in the arterioles, using
the sympathetic nervous system.

   
 
 

 
  
 


The CV center receives input from higher brain centers, such

as the cerebral cortex, the limbic system, and the
hypothalamus.

It receives input from baroreceptors, which monitor BP in the

right atrium, aorta, and common carotid arteries, and from
chemoreceptors in the aorta and common carotid carotids
that monitor H+, carbon dioxide, and oxygen in the blood.

Output from the CV center flows along the vagus (X) nerve
to the heart (parasympathetic) and to the thoracic spinal cord
where it stimulates sympathetic fibers that pass to the heart
and blood vessels.

To accomplish vasomotor tone, increased sympathetic

activity to blood vessels promotes vasoconstriction while
decreased activity allows vasodilation. These actions alter
resistance and therefore BP.

c 240
   
   "!
 "! 
 #  
Ú $ "    


 

 

Neural regulation of the heart is dependent upon 3 reflexes

and sensory input from the baroreceptors and
chemoreceptors.

In the carotid sinus reflex and aortic reflex, increased BP in

the carotid arteries and aorta is detected by baroreceptors
and passed to the CV center by cranial nerve IX
(glossopharyngeal) or cranial nerve X (vagus).

In response the CV center increases parasympathetic

outflow to the heart, via cranial nerve X (vagus), resulting in
decreased HR and contractility, decreased CO, and
therefore, decreased BP.

If there is decreased BP, the CV center decreases parasym-

pathetic outflow to the heart and increases sympathetic
outflow, resulting in increased HR and increased contrac-
tility, increased CO, and therefore increased BP.

In addition, there is increased sympathetic outflow to the

arteriolar smooth muscle, resulting in increased vasocon-
striction, which increases SVR and therefore BP.

In the right atrial reflex, increased BP in the vena cavae and

right atrium, as a result of increased venous return,
stimulates baroreceptors which signal the CV center via the
vagus nerve.

In response, the CV center increases sympathetic outflow to

increase HR and contractility in order to handle the
increased venous return.

Chemoreceptors work in much the same way: decreased

oxygen, or increased carbon dioxide and H+ result in
increased sympathetic outflow to increase HR and
contractility, thus raising BP and blood flow to the tissues.

· 
j

 

  !  


 
 

  

 ,  




 





  



c 241
 norepinephrine and epinephrine -- Epinephrine and norepinephrine
increase HR, contractility, and vasoconstriction, all of which
would increase blood pressure.

angiotensin II -- Angiotensin II increases vasoconstriction and
indirectly acts to raise BV via actions of aldosterone and
thirst, thus raising blood pressure.

histamine -- Histamine, released during inflammatory responses,
causes vasodilation, and can elicit a life-threatening
reduction in blood pressure if the response is body wide
(anaphylactic shock, for instance).

antidiuretic hormone -- Antidiuretic hormone increases vasocon-
striction and blood volume, thus raising blood pressure.

atrial natriuretic peptide -- Atrial natriuretic peptide increases loss of
sodium and water into the urine, thus lowering blood
pressure. It also promotes vasodilation, which decreases
peripheral resistance and thereby reduces blood pressure.

 j
jj

   
 
#
 

$

Autoregulation (local control) refers to a local, automatic adjustment

in blood flow to a given tissue to match its needs at the moment,
irrespective of nervous control.

    




 
 


Oxygen is the primary stimulus for this action. With prolonged

periods of vasoconstriction to a particular tissue, the tissue level of
oxygen drops perilously low.

 
  
 
 
  
  

Tissue cells secrete vasoactive factors that cause the precapillary

sphincters of the area to relax. This allows blood flow through the
capillary bed to replenish the oxygen supply.

E. BLOOD VESSEL ROUTES

You should be able to trace blood from the left ventricle to any given region or
organ of the body through appropriate arteries, then return that blood to the right
atrium via the appropriate veins. Of particular importance, be sure you can
describe the great vessels of the heart, the immediate branches of the aorta, and
the vessels that join to form the venae cavae. Keep in mind that most vessels
c 242
 are named for the body region through which they pass and that if you have
learned the name for the artery supplying a body region, you have also learned
the name of the pertinent vein. Use your text and the study guide in your lab
manual to help you identify the vessels.

When thinking about blood vessel routes, think about the path blood takes as it
flows through vessels to some destination in the body. This is like giving
directions to someone on how to drive somewhere. Name the vessels through
which blood flows to get to a body part. The following is by no means a complete
listing of blood vessels.



j
j



ARTERIAL BLOOD SUPPLY TO THE LEFT UPPER EXTREMITY

left ventricle U ascending aorta U aortic arch U left subclavian artery U axillary artery U
brachial artery U ulnar artery or radial artery U superficial and deep palmar arches U
palmar metacarpal and palmar digital arteries

DEEP VENOUS RETURN FROM THE LEFT UPPER EXTREMITY

palmar digital and palmar metacarpal veins U superficial or deep palmar venous arches U
radial or ulnar veins U brachial vein U axillary vein U subclavian vein U left brachiocephalic
vein U superior vena cava U right atrium

SUPERFICIAL VENOUS RETURN FROM THE LEFT UPPER EXTREMITY

palmar digital and palmar metacarpal veins U dorsal venous network U (2 paths)
1 - cephalic vein U subclavian vein U brachiocephalic vein U superior vena cava
2 - basilic vein U brachial vein U axillary vein U subclavian vein U brachiocephalic
vein U superior vena cava U right atrium
____________________________________________________________________________________

ARTERIAL BLOOD SUPPLY TO THE RIGHT UPPER EXTREMITY

left ventricle U ascending aorta U aortic arch U brachiocephalic artery U right subclavian
artery U axillary artery U brachial artery U ulnar artery or radial artery U superficial and
deep palmar arches U palmar metacarpal and palmar digital arteries

DEEP VENOUS RETURN FROM THE RIGHT UPPER EXTREMITY

palmar digital and palmar metacarpal veins U superficial or deep palmar venous arches U
radial or ulnar veins U brachial vein U axillary vein U subclavian vein U right
brachiocephalic vein U superior vena cava U right atrium

SUPERFICIAL VENOUS RETURN FROM THE RIGHT UPPER EXTREMITY

palmar digital and palmar metacarpal veins U dorsal venous network U (2 paths)
1 - cephalic vein U subclavian vein U brachiocephalic vein U superior vena cava
2 - basilic vein U brachial vein U axillary vein U subclavian vein U brachiocephalic
vein U superior vena cava U right atrium
c 243


j
j



ARTERIAL BLOOD SUPPLY TO THE LOWER EXTREMITIES

left ventricle U ascending aorta U aortic arch U thoracic aorta U abdominal aorta U common
iliac artery U external iliac artery U femoral and deep femoral arteries U popliteal artery U
anterior tibial or posterior tibial arteries U dorsal pedal artery or lateral and medial plantar
arteries U plantar arch U digital arteries

DEEP VENOUS RETURN FROM THE LOWER EXTREMITIES

digital and metacarpal veins U dorsal venous arch and plantar veins U dorsal pedal vein U
anterior tibial vein U popliteal vein U femoral vein U external iliac vein U common iliac vein
±> inferior vena cava U right atrium

SUPERFICIAL VENOUS RETURN FROM THE LOWER EXTREMITIES

digital and metacarpal veins U dorsal venous arch and plantar veins U small and great
saphenous veins U femoral vein U external iliac vein U common iliac vein U inferior vena
cava U right atrium

j


ARTERIAL BLOOD SUPPLY TO THE LEFT BRAIN

left ventricle U ascending aorta U aortic arch U left common carotid artery U left internal
carotid artery U circle of Willis

left ventricle U ascending aorta U aortic arch U left subclavian artery U left vertebral artery
U basilar artery U circle of Willis

ARTERIAL BLOOD SUPPLY TO THE RIGHT BRAIN

left ventricle U ascending aorta U aortic arch U brachiocephalic artery U right common
carotid artery U right internal carotid artery U circle of Willis

left ventricle U ascending aorta U aortic arch U brachiocephalic artery U right subclavian
artery U right vertebral artery U basilar artery U circle of Willis

VENOUS RETURN FROM THE BRAIN

dural sinuses U internal jugular vein U brachiocephalic vein U superior vena cava U right
atrium

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ARTERIAL BLOOD SUPPLY TO THE LEFT HEAD AND NECK

left ventricle U ascending aorta U aortic arch U left common carotid artery U left external
carotid artery U (a number of branches that supply the head and neck)

ARTERIAL BLOOD SUPPLY TO THE RIGHT HEAD AND NECK

left ventricle U ascending aorta U aortic arch U brachiocephalic artery U right common
carotid artery U right external carotid artery U (a number of branches that supply the head
and neck)

VENOUS RETURN FROM THE HEAD AND NECK

various branches draining the head and neck U right external jugular vein U subclavian
vein U brachiocephalic vein U superior vena cava U right atrium

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ARTERIAL BLOOD SUPPLY TO LEFT ANTERIOR THORACIC WALL

left ventricle U ascending aorta U aortic arch U left subclavian artery U internal thoracic
artery U 11 anterior intercostal arteries

ARTERIAL BLOOD SUPPLY TO THE RIGHT ANTERIOR THORACIC WALL

left ventricle U ascending aorta U aortic arch U brachiocephalic artery U right subclavian
artery U internal thoracic artery U 11 anterior intercostal arteries

ARTERIAL BLOOD SUPPLY TO THE LEFT POSTERIOR THORACIC WALL AND THORACIC
VISCERA

left ventricle U ascending aorta U aortic arch U thoracic aorta U (several branches given off
as the aorta passes respective structures)
1. right and left bronchial arteries
2. 11 pairs of posterior intercostal arteries
3. a series of esophageal arteries

VENOUS RETURN OF THE THORACIC WALL AND THE THORACIC VISCERA

intercostal veins and esophageal veins U azygos veins U superior vena cava U right atrium

blood from the bronchial arteries joins the flow from the pulmonary blood flow

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c 245
 ARTERIAL BLOOD SUPPLY TO PAIRED ORGANS OF THE ABDOMINAL CAVITY

left ventricle U ascending aortaU aortic arch U thoracic aorta U abdominal aorta U (several
branches given off as the aorta passes respective structures)
1. right and left inferior phrenic arteries
2. right and left superior, middle, and inferior suprarenal arteries
3. right and left renal arteries
4. right and left gonadal arteries (gonads originated near the kidneys)
5. a series of lumbar arteries to the body wall

VENOUS RETURN FROM THE PAIRED ORGANS OF THE ABDOMINAL CAVITY

paired venous branches corresponding to the arterial supply join the inferior vena cava U
right atrium

ARTERIAL BLOOD SUPPLY TO THE UNPAIRED ORGANS OF THE ABDMINAL CAVITY

left ventricle U ascending aorta U thoracic aorta U abdominal aorta U 3 branches from
superior to inferior:
1. celiac trunk gives rise to three branches:
a. common hepatic artery to the liver
b. splenic artery to the spleen
c. left gastric artery
2. superior mesenteric artery supplies all of the small intestine and the large
intestine to the splenic flexure
3. inferior mesenteric artery supplies the large intestine from the splenic
flexure to the rectum

VENOUS RETURN FROM THE UNPAIRED ORGANS OF THE ABDOMINAL CAVITY

blood from the large intestine from the splenic flexure to the rectum empties into the
inferior mesenteric vein U splenic vein
blood from the rest of the large intestine, the small intestine, and the pancreas U
superior mesenteric vein

the splenic vein and the superior mesenteric vein unite to form the hepatic portal vein

the gastric veins join the hepatic portal vein

the hepatic portal vein dumps its blood into the liver sinusoids for processing U hepatic
vein U inferior vena cava U right atrium

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c 246
 ARTERIAL BLOOD SUPPLY TO THE STRUCTURES OF THE PELVIC CAVITY

left ventricle U ascending aortaU aortic arch U thoracic aorta U abdominal aorta U common
iliac artery U internal iliac artery U various organs and structures

VENOUS RETURN FROM THE STRUCTURES OF THE PELVIC CAVITY

various organs and structures U internal iliac vein U common iliac vein U inferior vena
cava U right atrium

c 247