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AP2 > AP2 Exam 2 > Flashcards

AP2 Exam 2 Flashcards

1
Q

Blood composition:

A

40% blood cells (solid portion); RBC, WBC, PLTs

60% plasma (fluid portion): electrolytes (maintains osmolarity ~300mOsm/L) and proteins (albumins, globulins, fibrinogens)

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2
Q

Structure of arteries and veins (picture)

A
  • Tunica externa aka adventitia: connective tissue, nervi vasorum, and vasa vasorum
  • Tunica media: smooth muscle is innervated by SNS only
    • arteries: external elastic lamina
  • Tunica interna aka intima:
    • arteries: internal elastic lamina
    • veins: valves (more in lower limbs than upper) present
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3
Q

Tunics: Arteries vs. Veins (table)

A

Tunica interna/intima

Tunica media

Tunica externa/adventitia

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4
Q

The endothelium of the tunica interna/intima produces the following:

A
  • Endothelin: vasoconstrictor
  • Nitric oxide: vasodilator
  • Prostacyclin: vasodilator; type of prostaglandin
  • Thromboxane: vasoconstrictor
  • tPA: promotes fibrinolysis
  • vWF: promotes PLT aggregation

Additionally, the endothelium proliferates to form new cells during repair (angiogenesis)

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5
Q

Two types of arteries:

A

gradual transition from elastic to muscular (no clear demarcating line)

elastic (aka conducting arteries): highest % elastic fibers in tunica media; found closest to heart (aorta thru common carotid and iliacs; pressure reservoir [potential energy of the stretch])

muscular (aka distributing arteries): more muscle in tunica media (still some elastic recoil however relies on musculature to push blood fwd)= more vasodilation/constriction= adjust rate of flow; axillary, brachial, femorals

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6
Q

Anastomoses should only occur between ______ vessels.

A

like

*collateral circulation: results when blockage or flow slows in small vessels

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7
Q

Neovascularization:

A

vasculogenesis: occurs mostly in embryonic development; hemangioblasts proliferate

angiogenesis: new vessels from pre-existing vessels (new cap. from post cap. venules); triggered by hypoxia or damage

arteriogenesis: remodeling of existing vasculature>leads to collateral circulation; triggered by exercise or ischemic vascular disease

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8
Q

De novo means:

A

from the new

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9
Q

Arteriole structure:

A

aka resistance vessels

Tunica externa: very thin

Tunica media: 1-2 layers of smooth muscle; sympathetic vascular tone

Tunica intima: thin layer

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10
Q

Arterioles:

A

aka resistance vessels: resistance is due to blood components rubbing against the vessel wall

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11
Q

Metarteriole:

A
  • short vessels that connect arterioles to the capillary networks
  • structural characteristics of both an arteriole and capillary:
  • arteriole-metarteriole junction: normal tunica media layer allowing for vasodilation/constriction
  • metarteriole-capillary junction: single circumferential smooth muscle cells that can acts as a sphincter (precapillary sphincter)
    • thoroughfare channel: when precapillary sphincters are all closed, blood flows from arteriole>metarteriole>thoroughfare channel>venule
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12
Q

Capillaries:

A

aka exchange vessels; extensive number of cap. increase SA>rapid exchange of materials

exchange of nutrients and waste products can only occur at capillary post AND capillary venule level

very small: blood cells must slow down= buys time for exchange

capillary bed: arise from a single metarteriole

vasomotion: periodic relaxation/constriction of precap. sphincters (ensures blood flow at rest)

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13
Q

Types of capillaries:

A
  • all cap. consists only of single endothelial layer and basement membrane (no tunica interna/externa)
  • continuous:
    • most common
    • endothelium is continuous with small intercellular clefts (exchange of smaller molecules)
    • CNS, lungs, muscle, skin
  • fenestrated:
    • many fenestrations (larger particles) and clefts
    • kidneys, endocrine glands, villi of small intestine, choroid plexus, ciliary process of the eyes
  • sinusoid:
    • least common
    • incomplete or absent basement membranes
    • unusually, very large fenestrations and intercellular clefts
    • may contain specialized cells (e.g. kupffer cells)
    • liver, marrow, spleen, lymph nodes (lymph fluid), endocrine glands
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14
Q

Capillary portal systems:

A

blood passes from one capillary network into another capillary network

e.g. hypophyseal and hepatic portal systems (first pass)

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15
Q

Postcapillary venules:

A

allow for diapedesis (WBCs moving into tissues) due to porous nature

only other site of metabolic exchange

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16
Q

Muscular venules:

A

1-2 layers of smoother muscle

no metabolic exchange

most distensible elements of entire vascular system (reservoir for blood prn)

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17
Q

The thin walls of both ______ and ______ venules make them the most distensible elements of the entire vascular system.

A

postcapillary and muscular

serve as reservoirs of large amounts of blood prn

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18
Q

Veins have high capacitance: explain

A

capacity to distend to store high volume of blood

*lack internal and external elastic laminae= very inelastic

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19
Q

Most venous walls are ______ layers of smooth muscle with ______ amount of elastic and collagen fibers

A

thin

small

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20
Q

Low blood pressure in the veins allows blood to flow backwards (to a point): when?

A

during ventricular diastole

to a point: valves>cusps project into the lumen with the cup portion aiming toward the heart

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21
Q

Vascular sinus

A

vein with thin endothelial wall

no smooth muscle

dense connective tissue replaces tunica media and externa (provides support)

examples include: coronary sinus

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22
Q

Why do our veins appear blue?

A

venous blood is deep dark red but their thin walls and tissue of the skin absorbs red light wavelengths

this allows blue light to pass through the surface where we see them as blue

23
Q

Superficial veins form small connections with deep veins via:

A

perforating veins

superficial veins lie in the SC layer

deep veins travel between muscles

24
Q

Upper vs Lower limbs (veins)

A
  • Upper:
    • superficial larger than deep
    • some superficial dump directly into vena cava (bypass deep veins)
  • Lower:
    • deep larger than superficial
    • serve as the principle return pathway to heart
    • one-way valves in perforating vessels allow blood to pass from superficial to deep veins, but prevent reverse flow
25
Q

Varicose veins

A
  • leaky venous valves cause veins to become dilated and twisted (varicose)
    • blood pooling creates pressure that distends vein= fluid leaks into surrounding tissue
    • may cause vein and tissue to become inflamed and tender
  • valvular defect can occur from congenital, mechanical issues, or aging
  • Treatment includes: elastic stockings, sclerotherapy, laser, and stripping (removal)
  • most common in: superficial veins of lower limbs (valves fail between deep and superficial veins), anal canal (hemorrhoids), esophagus (varices)
26
Q

Substances enter and leave capillaries by three basic mechanisms:

A
  • Diffusion: movement down concentration gradient (slow)
    • O2 and CO2 diffusion
    • Brain:
      • most areas have continuous capillaries (prevents crossing BBB)
      • certain parts lack BBB (hypothalamus, pineal gland)
  • Transcytosis: small quantity of material crosses capillary walls (very slow)
    • via both endo or exocytosis
    • larger, lipid insoluble molecules (Ab’s such as IgG, insulin)
  • Bulk flow: passive process by which large amount of fluid moves into and out of capillaries rapidly
    • pressure driven
27
Q

Bulk flow (pressure driven)

A
  • Filtration: from blood to interstitial
    • pressure driven by blood hydrostatic pressure (BHP) and interstitial fluid osmotic pressure (IFOP)
    • BHP+IFOP
  • Reabsorption: from interstitial to blood
    • pressure driven by blood colloid osmotic pressure (albumin)
    • BCOP+IFHP (interstitial fluid hydrostatic pressure; near 0mmHg unless pathology)
  • Net filtration pressure (NFP)
    • measured on the arterial AND venous end of the capillary (2 separate measurements)
    • difference between the filtration (positive NFP=net filtration) and reabsorption (negative NFP=net reabsorption)
    • NFP=(BHP+IFOP)-(BCOP+IFHP)
    • Starling’s law of the capillaries: volume filtered is near volume reabsorbed
28
Q

Lymphatic drainage (picture):

A
  • Right lymphatic duct empties into blood at the junction of the right internal jugular vein and the right subclavian vein; drains:
    • right side of head and neck
    • portion of right thorax
    • right arm
  • Thoracic duct (left) empties into blood at the junction of the left internal jugular vein and left subclavian vein; drains:
    • left side of head and neck
    • left side of thorax
    • left arm
    • lower portion of the body
29
Q

Tissues without lymphatic drainage:

A
  • superficial skin
  • CNS: uses CSF instead
  • Endomysium
  • Bones
30
Q

Virchow’s node

A

left supraclavicular lymph node is highly suspicious for metastatic cancer from abdomen, pelvis, or left side thorax (these areas of the body drain into the left thoracic duct)

Virchow’s node, a left supraclavicular lymph node, was first described by Virchow as a sign of metastatic malignancy mainly from gastric cancer. The term “Troisier’s sign” describes an enlarged palpable hard left supraclavicular node following Troisier’s work, which is now sometimes used interchangeably with Virchow’s node.

31
Q

Compliance

A

aka distensibility

greater compliance minimizes increased resistance (and BP)

arteries allow for higher pressure changes

veins allow for more volume changes

32
Q

Elasticity

A

ability of vessel wall to stretch and recoil

arteries have more elastic fibers (internal and external elastic lamina)

33
Q

Hydrostatic pressure

A

“intravascular pressure”

pressure generated by the blood on the vessel walls

34
Q

Radial pressure

A

the pressure exerted across the walls of the vessels

the difference between the intravascular pressure and the extravascular pressure

35
Q

Flow

A

units of volume per (unit of time)

e.g. mL/min

Q= (pressure difference)/resistance

36
Q

Velocity

A

units of distance per (unit of time)

e.g. cm/min

37
Q

Cross sectional area

A

units of [total surface area] of like vessels

the given area the blood flows through

38
Q

Cross sectional area is ______ proportional to velocity of flow.

A

inversely

velocity of flow is slowest in capillaries

velocity of flow is fastest in large vessels

39
Q

v = F/A relationships

A

v: velocity

F: flow

A: surface area

40
Q

There must be a ______ between pressure 1 (initial pressure) and pressure 2 (terminal pressure) for there to be any flow.

A

difference

41
Q

What helps aid venous return to the heart?

A

pressure generated by left ventricular systole

extravascular pressure

skeletal muscles (fights gravity)

respiratory pump (fights gravity)

42
Q

Poiseuille’s Equation

Q = 𝝅Pr4/8nl relationships

A

Q: volumetric flow

P: ΔP

r: radius of vessel
n: viscosity
l: length of vessel

43
Q

Increased volume flow results in ______ velocity.

A

decreased

think finger over the end of the water hose

44
Q

Respiratory “pump”

A

During inhalation, contraction of the diaphragm (moves downward)

abdominal veins are compressed pushing greater volume of blood toward the heart

During exhalation, valves prevent backflow out of the thorax

45
Q

What fights venous return to the heart?

A

increased right sided heart pressure

tricuspid valve failure>increased RA pressure>blood backs up

gravity (countered by the skeletal and resp. “pumps”)

46
Q

Intrinsic control of blood pressure and flow:

A
  • autoregulation: most tissues, blood flow is adjusted by the metabolic activity
  • myogenic: when arterial BP changes, the arterioles can adjust to keep a relatively constant flow regardless of systemic pressure
  • endothelium mediated:
    • prostacyclin: dilates smooth muscle (not sure what triggers release however could be shear force); also prevents PLT adherence to endothelium
    • NO: dilates smooth muscle (released when stimulated by Ach, shear stress, other vasodilating substances)
    • endothelin: constricts smooth muscle (triggered by various hormones; thought to be involved in pathology such as atherosclerosis)
47
Q

Extrinsic control of blood pressure and flow:

A
  • primary function is to regulate arterial BP by altering SVR
  • several interconnected negative feedback systems
    • HR, SV, SVR, blood volume
    • some are rapid control (orthostatic)
    • others provide long term control
  • Cardiovascular center: regulates HR, contractility, and vessel diameter
    • located in medulla
    • composed of:
      • cardio-stimulatory center
      • cardio-inhibitory
      • vasomotor consists of:
        • vasodilator/constrictor center
    • sensory input from: proprioceptors, baroreceptors, chemoreceptors
    • output:
      • sympathetic:
        • cardiac accelerator nerves
        • vascular tone
      • parasympathetic via vagal nerves
  • Higher brain centers provide sensory input to CV center
    • cortex, limbic system, hypothalamus
  • neural regulation of BP
    • baroreceptor and chemoreceptor reflexes>these work quickly
48
Q

Chemoreceptor

A
  • Chemoreceptor reflex
    • carotid and aortic bodies
    • detect changes in blood concentration of O2 (hypoxia), CO2 (hypercapnic), and H+ (acidosis)
    • CV center increases sympathetic stimulation to arterioles and veins causing vasoconstriction (increased BP)
49
Q

Baroreceptor

A
  • carotid sinus reflex
    • Carotid sinus: outpouching of R/L internal carotid arteries; just above the branching
    • CNIX (sensory portion)
  • aortic reflex
    • ascending and arch of aorta
    • CNX sensory portion
50
Q

Neurohumoral regulation works ______ vs. baro/chemoreceptors which work ______.

A

slowly

quickly

51
Q

Epinephrine

A

increased HR: beta 1

vasoconstriction: arteries and veins (alphas)
vasodilation: skeletal muscle and liver tissues (beta 2)

can serve a neurotransmitter or hormone

secreted from adrenal medulla from fight or flight only

52
Q

Norepinephrine

A

increased HR: beta 1

vasoconstriction: arteries and veins (alphas)

continuously released in low levels= vascular tone

made mostly in neurons and released as overflow

small amounts made in adrenal medulla from fight or flight

53
Q

Blood pressure:

A

progressively drops as you get further away from LV

normal pulse pressure: 40-60

normal MAP: 70-100

measurement: bare arm, pump 30mmHg (usually) above normal SBP for PT

54
Q

CVP waveforme

A

“a” waves will disappear in A fib

large “a” wave: pulm. HTN, tricuspid valve stenosis

large “v” wave in tricuspid regurgitation

AP2 (4 decks)

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