2. Introduction to Vascular Systems Flashcards by J L

Vascular Systems

̈____ carry blood at relatively higher pressures ____ from the heart
̈Large arteries ramify or ____ into smaller ones

̈____ carry blood ____ the heart at relatively lower pressures
̈Small veins become ____ of larger ones

____ are very small vessels distributed through the tissues of the body which bring blood into close contact
with the cells of the tissues and connect arteries to veins

arteries
away
branch

veins
toward
tributaries

capillaries

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The Cardiovascular System
The cardiovascular system consists of the heart and all blood vessels forming two pump-driven, closed vascular loops

The systemic circulation pumps blood through the following series of vessels:
Left ventricle > Aorta > Arteries > Arterioles
> Capillaries > Venules > Veins > ____

The pulmonary circulation pumps blood through the following series of vessels:
Right ventricle
> Pulmonary trunk
> Pulmonary arteries
> Alveolar capillary plexus of lungs
> Pulmonary veins > \_\_\_\_
(\_\_\_\_)

right atrium
left atrium
lower pressure

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The lumen
of each artery
is surrounded by three distinct layers of tissue

____
Loose connective tissue

____
Smooth muscle and
elastic tissue PROPORTIONS VARY

____
Endothelium plus its supporting connective tissue

tunica adventitia
tunica media
tunica intima

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ELASTIC (conducting) ARTERIES
• Distend and recoil with the sudden thrust of blood
from the heart, helping to move the blood with no initiation of energy by the vessel.
• Elastic tissue is most common in the large arteries near the heart (e.g. ____ and ____) where pressure is the greatest.
• While ____ cushions the sudden rise of pressure induced by ventricular contraction or ____, ____ smooths what would otherwise be a sudden drop in pressure as ventricular pressure falls to zero in ____.

aorta
pulmonary trunk
elastic expansion
systole
elastic recoil
diastole

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MUSCULAR (distributing) ARTERIES
• More peripheral vessels feature less elastic tissue and more ____ in the tunica media
• The caliber of such vessels is controlled by ____ (contraction) and ____ (relaxation) of vascular smooth muscle in response to physiologic need
• The ____ - comprised almost entirely of smooth muscle - are the most important governors of ____ to blood flow

Vasoconstriction/vasodilation is under control of the ____ of the ANS as well as various ____

smooth muscles
vasoconstriction
vasodilation
arterioles
peripheral resistance

sympathetic division
circulating hormones

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Vasculopathy I

• Atherosclerosis
Deposition and eventual calcification of ____ or ____ in the ____ of elastic vessels produces abnormal fluctuations in pressure with each cardiac cycle
• Plaques in turn predispose the vessels to ____ (blood clot) formation and occlusion (____)
• Turbulent flow occurring where large arteries ____, or where vessels make sharp ____, may amplify the local impact of atherosclerosis and lead to…

• Aneurysm
Weakening of all three ____ resulting from ____, ____ or ____ may lead to a bulging of the wall and widening of the arterial lumen to form a balloon-like dilation

fatty plaques
atheromas
thrombus
stenosis
branch
bends

tunicae
atherosclerosis
syphilis
congential disorders

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Rupture of ____ or ____ aneurysms may be life- threatening!

saccular

fusiform

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Anastomosis and Collateral Circulation
• The survival of tissues and organs distal to arterial occlusions depends upon the adequacy of the ____ to those tissues.
• Collateral circulation is dependent upon the presence of ____, or ____ between branches given off at more proximal levels of the arterial system and branches arising more distally.
• Anastomoses between multiple branches of an artery provide numerous potential detours for blood flow in case the “usual” pathway is obstructed.
• But… ____ arteries lack peripheral anastomoses with neighboring arteries; occlusion of such vessels may lead to tissue ____
Examples include ____, ____ and ____ arteries

collateral circulation
anastomoses
free communications
true terminal (end) arteries
necrosis
cerebral
retinal renal

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VEINS
• Veins are more abundant than arteries; many arteries
are accompanied by multiple ____.
– As a result, 80% of blood volume occupies the veins at any one
time. (20% found within the ____)
• Venules consist of an ____ and ____ only; while most larger veins feature varying degrees of ____ smooth muscle, (though veins, as a rule, do not ____ and do not spurt when severed)
• ____ have extremely thin walls, limited to epithelium; support is provided by stronger connective tissue (i.e. ____ in the cranial cavity)

venae comitante
arteries
intima
adventitia
longitudinal
pulsate
venous sinuses
dura mater

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VEINS
• Venous return toward the right side of the heart is facilitated by two major factors:
– Respiratory-related changes in thoracic pressure (specifically decreases in ____ and ____ pressures)
– The massaging action of ____ on deep veins, particularly in the extremities
• ____, infoldings of the intima, are arranged to allow free movement of blood toward the heart but prevent or impede passage of blood in the reverse direction

right atrial
thoracic vena cava
skeletal muscles
valves

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VASCULOPATHY II

While venous return from the head and neck is eased by gravity thanks to our orthograde posture, drainage of the body and extremities is more challenging…
Chronic Venous Insufficiency (CVI) –
impaired venous return, often causing lower ____, ____, and ____ changes.

____ (inflammation of a vein) or ____ (DVT’s) may lead to CVI as the result of venous obstruction, usually through venous damage and valvular incompetence
____ – as when decreased contraction of muscles surrounding deep veins (e.g. due to immobility) decreases forward venous flow

Prolonged venous hypertension causes tissue ____, inflammation, and ____, leading to symptoms such as aching, ____, pain, tiredness, and ____

extremity discomfort
edema
skin

phlebitis
deep vein thrombosis
venous hypertension

edema
hypoxia
cramps
parasthesias

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Increased pressure in deep veins may be transmitted to superficial veins if valves in ____, which connect both deep and superficial veins, are ineffective…
• ____ veins are dilated, superficial veins, usually found in the lower extremities
• Typically asymptomatic, they may cause a sense of fullness, pressure, and either ____ or ____ in the legs.
• They may also result from either ____ in the absence of surrounding skeletal muscle in the superficial veins themselves, or from primary dilation of the vein wall due to ____

perforating veins
varicose veins
pain
hypesthesia
primary venous valvular insufficiency with reflux
structural weakness

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Additional circulatory systems I

Portal systems
•Occur when a capillary bed drains into another capillary bed through veins, without first going through the ____. Both ____ and the ____ that connect them are considered part of the portal venous system

heart
capillary beds
vessels

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Hepatic
portal system
receiving blood
draining from the
\_\_\_\_

abdominal gut

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Hypophyseal
portal system
between the
\_\_\_\_
and the
\_\_\_\_

hypothalmus

anterior pituitary

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Additional circulatory systems II

Lymphatic System
•Arises from a network of highly ____ capillaries arising blindly in tissues
•With muscle contraction, fine filaments anchoring vessels to surrounding CT transfer tensional forces to endothelial cells, opening spaces between cells allowing proteins and large particles present in the interstitial fluid to enter the ____.
• Conveys its contents via ____ and a network of nodes and ducts into the ____ system in the ____

permeable
lymphatic capillaries
vasa lymphatica
venous
deep neck

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Superficial, deep or organ-specific lymphatic capillaries are the ____…

…draining to ____
and ultimately to a series of ____

initial lymphatics
collectors
lymphatic trunks

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Lymphatic Circulation II

…in fact the lymphatic circulation of a 3/4 of the body will be directed here to the root of the neck.
On the LEFT side will be where the ____ will introduce into the venous system lymph and metabolic products derived from the entire ____ and ____ of the body.

The upper right quadrant will be drained by ____. This drains into the venous system at the neck area as well.

thoracic duct
lower half
upper left quadrant

right lymphatic duct

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The thorax contains two
____
and a midline partition called the
____

pulmonary cavities

mediastinum

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A fibrous pericardial sac containing the heart and the roots of the great vessels lies in the
____

middle mediastinum

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STERNOCOSTAL surface of the heart
RIGHT BORDER:
\_\_\_\_
INFERIOR BORDER:
\_\_\_\_, \_\_\_\_, \_\_\_\_
LEFT BORDER:
\_\_\_\_, auricle of \_\_\_\_

right atrium

right atrium
right ventricle
left ventricle

left ventricle
left atrium

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Deoxygenated blood enters the right atrium from three sources:

____
(receives venous drainage form the head, neck, and the upper extremities)

____
(receives venous drainage from all body parts that lies below the diaphragm)

____ (thin large vessel that lies on the surface of
the heart that return most of the deoxygenated blood that was utilized by the myocardium

superior vena cava
inferior vena cava
coronary sinus

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CARDIOPULMONARY CIRCULATION

The ____ ejects the blood through the ____ which gives rise to the ____ and ____, whose further branching reflects the functional segmentation of each lung

right ventricle
pulmonary trunk
left
right pulmonary arteries

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Pulmonary
arterioles
are continuous with
a \_\_\_\_
in intimate contact with the \_\_\_\_, the terminal elements of the respiratory tree within each lung, which is in turn drained
by tributaries of the
\_\_\_\_

capillary network
alveoli
pulmonary veins

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____ | provide an oxygenated blood supply to the parenchymal tissues of each lung, ramifying along the bronchial tree

bronchial arteries

85% of the blood the bronchial arteries deliver to the lungs leaves those organs with the ____ blood in the ____

newly oxygenated | pulmonary veins

Paired ____ return blood from each lung to’ the ____, the most ____ located of the chambers of the heart

pulmonary veins left atrium posteriorly

Blood returning from the lungs is collected by and funneled through the ____ to the ____, which has by far the largest and thickest- walled of the four chambers... … The blood is in turn ejected under high pressure from the ventricle into the ____

left atrium left ventricle thoracic aorta

The plane of the sternal angle divides the ____ into three separate portions: ASCENDING AORTA (immediately above the ____ rising up into the superior mediastinum) AORTIC ARCH (lies in the ____ itself) DESCENDING AORTA (in the ____)

thoracic aorta left ventricle superior mediastinum posterior thorax

The aortic arch arches over the left main ____ and left ____

bronchus | pulmonary artery

Three large vessels usually arise from the aortic arch in the ____ ____ (directed towards the upper limb and head) ____ (rise from the heck and provide blood to the left side) ____ (passes thru the anterior and middle scalene to reach the upper extremities)

superior mediastinum brachiocephalic trunk common carotid artery left subclavian artery

Superior to the plane of the sternal angle... Neurovascular and visceral structures in the ____ transition to the root of the neck... ...by coursing through the ____

superior mediastinum | superior thoracic aperture

The Brachiocephalic Trunk (____ artery) | in turn gives rise to the ____ and ____

innominate right subclavian common carotid arteries

Common carotid and subclavian arteries rise through the superior thoracic aperture The Common Carotid bifurcates into its Internal and External branches at the level of the ____ After giving rise to the ____, ____ and ____ arteries, the Subclavian will provide blood to the ____ and ____

thyrohyoid interval ``` thyrocervical vertebral internal thoracic deep neck upper extremity ```

A variable number of visceral branches arise from the underside of the ____ and the anterior aspect of the ____: ____ provide an oxygenated blood supply to the parenchymal tissues of the lung, ramifying along the bronchial tree Esophageal Arteries supply the mediastinal portion of the ____

aortic arch descending thoracic aorta bronchial arteries esophagus

Nine pairs of ____ arise from the posterior aspect of the Descending Thoracic Aorta The first and second posterior intercostal arteries normally arise as indirect branches of the ____

posterior intercostal arteries | subclavian

____ lie in the costal groove along the inferior border of the ribs, accompanied by Ventral rami of thoracic spinal nerves ____ as elements of the ____

intercostal arteries T1-11 intercostal neurovascular bundles

Upper Anterior Intercostal arteries arise from the ____, a branch of the ____

internal thoracic | subclavian

The Internal Thoracic Artery is also known as the ____

Internal mammary artery

Anterior and Posterior Intercostal arteries anastomose laterally, forming an important path of collateral supply for ____, pelvis and ____ in case of ____ obstruction

abdomen lower limb aortic

The Internal Thoracic Arteries terminate inferiorly as the ____ and ____ arteries

musculophrenic | superior epigastric

The epigastric vessels are part of an important collateral pathway for the distribution of arterial blood to the lower extremities in case of obstruction of the ____ Subclavian > Internal Thoracic > Superior Epigastric > ____ > ____ > ____ Pelvic and abdominal viscera may also receive this collateral supply given the absence of ____ in the arterial system

``` descending aorta inferior epigastric external iliac femoral valves ```

Musculophrenic arteries supply the ____... ... and give rise to the remaining ____ arteries

diaphragm | anterior intercostal

The descending aorta passes thru the ____ of the diaphragm at the ____ level

aortic hiatus | T12

The Abdominal | Aorta descends along the posterior abdominal wall from ____ to its terminal bifurcation at the ____ level

T12 | L4

Branches of the abdominal aorta arise and distribute in three planes 1. ____ arise from the anterior aspect and supply the GI tract and digestive glands 2. ____ branches arise from the lateral aspects and supply primary retroperitoneal viscera (kidneys, adernal glands and gonades) 3. ____ branches arise posteriorly and supply diaphragm and posterior abdominal wall

unpaired branches paired visceral paired parietal

Three unpaired arteries arising from the anterior aspect of the abdominal aorta supply the GI tract Branches of these vessels are transmitted to GI viscera and digestive glands through suspensory peritoneal structures called ____ These vessels supply organs derived from the three abdominal divisions of the ____ gut

mesenteries | embryonic

Celiac, Superior Mesenteric and Inferior Mesenteric arteries arise consistently in relation to the ____ spine Celiac: ____ Superior mesenteric: ____ Inferior mesenteric: ____

lumbar L1 L1 L3

Celiac artery supplies derivatives of the embryonic foregut: - ____ - Stomach - ____ - Gall bladder - ____ - (Spleen) - ____

abdominal esophagus liver pancreas proximal duodenum

``` Superior mesenteric supplies derivatives of embryonic midgut: - ____ - Pancreas - ____ - Cecum - ____ - proximal 2/3 Transverse colon ```

distal duodenum jejunum and illeum ascending colon

Inferior mesenteric supplies derivatives of embryonic hindgut: - ____ - Descending colon - ____ - Rectum

distal 1/3 transverse colon | sigmoid

``` Anastomoses exist between the three arteries supplying the abdominal gut 1. Around the ____ and the ____ 2. Around the ____ flexure ``` - Between the ____ and ____ via the pancreaticoduodenal arteries - Between the ____ and ____ arteries (middle and left colic arteries; Riolan and Drummond anastomoses, see F)

``` duodenum pancreatic head left colic (splenic) ``` celiac trunk superior mesenteric artery superior inferior mesenteric

RENAL ARTERIES Provide blood to ____, ____ and ____

kidneys adrenals ureters

Despite differences in the position of the two kidneys, both renal arteries arise from the ____ at the upper ____ level Segmentation and repeated division of each renal artery occurs until the ____ to the glomeruli are reached

aorta L2 afferent arteries

Inferior phrenic arteries Lumbar arteries ____ - the caudal proongation mammalian aorta

median sacral artery

A transverse plane tangent to the high points of the iliac crests intersects the lumbar spine at the L4 level and marks the bifurcation of the ____ into Left and right ____

abdominal aorta | common iliac arteries

Presents as pulsating enlargement or tender mass on physical examination • Symptoms may include prolonged pain in back, abdomen, or groin but ... Superior to the bifurcation is a common site of ____

abdominal aortic aneurysm

Venous blood from the head, neck and upper extremities drains into the ____ Venous blood from abdominopelvic viscera and the lower extremities drains into the ____

superior vena cava | inferior vena cava

Veins of the anterolateral thoracic and abdominal walls drain into the ____

caval system

The ____ drains up to the right atrium through an opening (____) in the central tendon of the diaphragm, with venous return against gravity promoted on ____

IVC caval foramen inspiration

The Azygos System • A network of valveless veins draining the posterior thoracic and abdominal walls, as well as mediastinal viscera including the ____ and ____ • Drains superiorly through the ____ into the ____ • Anastomoses inferiorly with the ____ and renal veins • The system provides a collateral pathway of venous return to the right atrium in case of ____

``` esophagus primary bronchi arch of the azygos superior vena cava inferior vena cava caval obstruction ```

Obstruction of either VC, we have a ____ where blood can return Superiorly lies the ____ The INFERIOR VENA CAVA anastomoses with the AZYGOS SYSTEM along the ____

collateral arch of azygos posterior abdominal wall

Azygos and Hemiazygos are formed at the confluence of the ____ and ____ So the azygos system offers a collateral path of venous return to the ____ in case of obstruction of the ____

subcostal ascending lumbar veins right atrium inferior vena cava