Give an Account of the Fetal Circulation and the Changes which Take Place at Birth.

What clinical problems can arise here?

The main difference between the circulation in an adult human and a fetus lies
in the fact that the lungs are not yet fully operational. Hence oxygenated blood,
originating from the mother’s heart, is provided through the umbilical vessels and
placenta into the right atrium through the inferior vena cava while deoxygenated
blood arrives at the right atrium through the superior vena cava. The oxygenated
blood is directed into the left atrium by the existence of an aperture between the right
and left atrium known as the forman ovale, which allows blood flow between these
chambers and thus removes pulmonary circulation of oxygenated blood from the right
ventricle. Further reinforcement comes from the ductus arteriosus, a special junction
between the aorta and pulmonary artery, which prevents blood flow to the lungs. The
majority of blood volume will pass from the left ventricle into the aorta to supply the
systemic circulation and internal organs. Some will flow into the umbilical arteries
through the internal iliac arteries in order to have waste products removed by the
mother’s circulation e.g. carbon dioxide.
During birth, the baby will inspire for the first time, which brings on a cascade
of structure-altering developments. Suddenly the resistance in the pulmonary
circulation plummets down and a greater volume of blood flows into the right
ventricle and less through the foramen ovale, so encouraging pulmonary circulation.
This pulmonary blood will travel into the pulmonary veins to the left atrium, at which
point it will bring about an increase in atrial pressure. The simultaneous increase in
left atrial pressure and decrease in right atrial pressure, as a result of the declined
pulmonary resistance, forces the migration of the septum primum against the septum
secundum hence shutting the formanen ovale and preventing left-right atrium flow.
This particular morphological arrangement is ultimately responsible for the concept of
the double circulation, dividing the heart into the pulmonary and systemic halves.
Approximately two days after birth, the connection between the aorta and pulmonary
artery, the ductus arteriosus, closes off allowing efficient pulmonary flow. Only the
ligamentum ateriosum, a ligament attaching the two adjacent vessels, remains.
In some cases, there can improper closure of the ductus arteriosus so affecting
the pulmonary circulation – patent ductus arteriosus. This congenital heart defect can
lead to cardiac arrhythmia and can ultimately give rise to congestive heart failure if
left untreated. To force it closed, one can administer drugs, which inhibit
prostaglandin synthesis. Either these lipid molecules’ synthesis can be hindered as in
this condition or conversely, prostaglandins can be directly applied to the baby to
prevent shutting, giving time for any abnormalities in the area to be rectified by
surgery.
Another common defect can occur from the improper fusion of the septum
primun and septum secundum. Sometimes the septum secundum is not large enough
to cover the septum primum resulting in an atrial septal defect. Although this can be
repaired using a relatively simple surgical procedure, the eventual ostium secundum
defect can permit the shunting of blood between the adjacent atria. In other cases, the
septim primum does not correctly fuse with the endocardial cushions causing an
ostium primum defect. A child suffering from this condition will be enduring both an
atrial and ventricular septal defect. In the worst cases, the defect can be so significant
that gradual fusion of two separate cavities can lead to the ventricles becoming a
single chambers. This is known as a triocular heart.
Give an account of the blood supply to the GI tract. What principles are illustrated
 here? What are the reasons behind the structure of it?

The GI tract consists of a sequence of digestive organs, which account for the
eventual absorption of nutrients and excretion of waste products. This begins with the
stomach, which is richly supplied by a group of arteries. These are the left and right
gastric arteries, the left and right gastro-epiploic arteries and the short gastric arteries.
Outflow of blood occurs in the corresponding veins, which subsequently drain into
the portal system.
Next the bolus of food passes into the duodenum, a ten-inch long curvature of
the large intestine wrapping around the head of the pancreas. In this space between
the pancreas and the duodenum lie two arteries, which account for their blood supply;
these are the inferior pacreaticoduodenal and the superior pacreaticoduodenal
originating from the gastroduodenal artery and the first branch of the superior
mesenteric artery respectively.
The intestine can be classed into three separate sections, each one being
delivered blood from a different source. The foregut, which includes the stomach and
duodenum up until the bile duct entry, is supplied by a branching out of the aorta,
known as the coeliac axis, at the verterbral level T12. The middle of the
duodenumuntil the distal transverse colon comprises the midgut. This portion’s blood
supply is provided by five tributaries of the superior mesenteric artery, which project
from the aorta at L1. The inferior pancreaticoduodenal artery accounts for the first
fragment in the mid-duodenum while the jejunal and ileal branches account for the
jejunum and the majority of the small intestine. The ileocolic artery supplies the
terminal ileum, the caecum and the initial sector of the ascending colon as well as an
appendicular outlet to the appendix. The rest of the ascending colon is supplied by the
right colic artery while the transverse colon is supplied by the middle colic artery.
The inferior mesenteric artery is responsible for the three branches, which
govern the blood flow of the hindgut. It extends from the aorta at L3. The left colic
artery supplies the descending colon, the sigmoid branches the sigmoid, and the
superior rectal artery the rectum.
Perhaps most distinctive about the structure of the small and large intestine is
its morphological arrangement to provide a huge surface area for optimal digestion
and absorption. The small intestine can be up to 33 feet long and the large intestine is
roughly 5 feet in an average male. In addition, the contorted shape of the gut and the
massive number of finger-like projections internally, help to further the already
significant surface area of the intestine. Similarly, in order to generate a maximal rate
of absorption, a rich blood supply must exist as well as the surface area upon which
the vessels can act. The arterial supply in the GI tract epitomizes this. The numerous
branches and anastomoses, which arise from the great arteries such as the aorta and
superior and inferior mesenteric arteries, bestow a substantial and even distribution of
blood among the gut providing a consistent transporter of assimilated nutrients. Every
individual segment of the GI tract is exploited with vessels to extract as much as
possible from the substance currently being digested.

Describe the portal circulation. Describe how alcohol intake is both affected by and
 affects the portal circulation.

There are two portal systems in the human body, one associated with the
draining of blood from vessels interspersed among the GI tract and the other involved
with the circulation of the pituitary gland. The former collects blood from various
areas of the tract and drains them into the liver to be processed prior to returning to
the heart. The majority of the GI tract, stretching from the lower section of the
esophagus to the upper part of the anal canal including the spleen, pancreas, and the
gall bladder takes part in the portal venous, which subsequently drains into the liver.
The portal venous system is extremely important in the detoxification of
chemicals during digestion preventing any detrimental effects on the physiology of
the body. Formed by the merging of the superior mesenteric vein and the splenic vein,
it initially separates into two discrete branches before passing into the liver – the left
and right branch. The blood contained in the portal vein has a much-decreased partial
pressure of oxygen and perfusion relative to in other organs. This arises from the fact
that the liver welcomes both oxygenated and deoxygenated blood into its system.
The portal vein branches out into several tributaries when it enters the liver,
these being the left and right gastric veins, the superior mesenteric vein and the
splenic vein, which the inferior mesenteric vein drains into. These individual branches
of the portal vein are dispersed among sinusoids in the liver, the spaces between
collections of hepatocytes. These sinusoids must also be presented with a blood
supply to survive and this comes from different branches originating from the hepatic
artery. Having provided the necessary requirements to the hepatocytes, the blood then
accumulates into a series of veins and ultimately the hepatic vein and inferior vena
cava to return to the heart.
The digestion of alcohol involves a mechanism known as first pass effect.
After absorption in the small intestine, the chemical is transported through the portal
vein to the liver where it is processed before proceeding into the myocardial
bloodstream. This sequence of events occurs with drug metabolism as well. The
enzyme alcohol dehydrogenase converts the active ethanol ingredient into
acetaldehyde as well as breaking down glyceraldehydes into glycerol.
Cirrhosis is caused by a prolonged intake of too much alcohol. Areas of
hepatocyte cell death are deposited with fibrotic scar tissue and regenerative nodules.
This irreversible scarring of the liver causes oppression on certain blood vessels in or
neighboring the organ thus impeding blood flow. The result is portal hypertension –
increased blood pressure in the portal venous system. Generally this particular
condition results from increased resistance in the portal vein forcing alternate paths of
flow. Ultimately this can cause a number of pathological complications including
rupturing of the anastomoses of the portal venous system, esophageal varices (vessels
in the stomach and esophagus become enlarged and may burst as a result of collateral
portal blood flow), and ascites (an accumulation of fluid in the peritoneal cavity from
leaks in the vessels).