Circulatory and Lymphatic Systems

Question 1

The Blood Vessels

The cardiovascular system is a complex, but has some basic principles.

All the vessels have ___ layers.

The ____ side generally has ____ walls with more ____ muscle.

The ____ side has ___ more ____ walls.

Thicker walls of most of the arterial vessels allow maintenance of ___ ___ in the vessels.

Venous vessels because the blood is under ____ pressure are ___ in ____ size than corresponding arteries.

Venous vessels rely chiefly on the___ ____ to aid in return of blood to the heart.

Answer 1

The Blood Vessels The cardiovascular system is a complex, but has some basic principles. All the vessels have 3 layers. The arterial side generally has thicker walls with more smooth muscle. The venous side has thinner more compressible walls. Thicker walls of most of the arterial vessels allow maintenance of blood pressure in the vessels. Venous vessels because the blood is under lower pressure are larger in lumen size than corresponding arteries. Venous vessels rely chiefly on the surrounding muscles to aid in return of blood to the heart.

Question 2

The Vascular System We will go from the heart, out the arterial system, through the capillary bed and back up the venous return. Compare and contrast the thickness of the three layers (tunica) as we do this comparison. Also recognize the components of the three layers.

Answer 2

We will go from the heart, out the arterial system, through the capillary bed and back up the venous return. Compare and contrast the thickness of the three layers (tunica) as we do this comparison. Also recognize the components of the three layers.

Question 3

On to the Vascular System General Structure of Blood vessels

Three Layers

Answer 3

General Structure of Blood vessels Three Layers Tunica Adventitia (Outside) Tunica Media (Middle) Tunica Intima (Inside)

Question 4

The largest of the arterial vessels is the ____ ____-____

Answer 4

The largest of the arterial vessels is the Elastic Artery - Aorta

Question 5

Elastic artery Note layer thickness!! In the syllabus you have this compared with a large vein, just for immediate recognition of differences

Answer 5

Elastic artery Note layer thickness!! In the syllabus you have this compared with a large vein, just for immediate recognition of differences

Question 6

Thickest layer is the ____, containing ____ muscle cells and ____ tissue.

Adventitia is fairly ____l as it contains ___s and ___ ___ and:

Tunica Intima is fairly ___, ___ to ___, but does sit on an underlying ___ layer

Answer 6

Thickest layer is the media, containing smooth muscle cells and elastic tissue. Adventitia is fairly substantial as it contains nerves and Vasa Vasorum and: Tunica Intima is fairly thin, squamous to cuboidal, but does sit on an underlying fibrous layer

Question 7

With the large elastic arteries there is an added internal element that allows these vessels to ____ as a ‘pulse’ of blood from the heart passes through. This is the___ ___ ___

A large vein also has one, but it is much ___ and not as ____.

The Large Elastic Artery also has an____ elastic lamina which again, isn’t as ___ and as visible as the internal.

Answer 7

With the large elastic arteries there is an added internal element that allows these vessels to open as a ‘pulse’ of blood from the heart passes through. This is the INTERNAL ELASTIC LAMINA. A large vein also has one, but it is much thinner and not as visible. The Large Elastic Artery also has an external elastic lamina which again, isn’t as thick and as visible as the internal.

Question 8

On to stage 2

Large (Muscular) Arteries gradually lose the copious ____ fibers and rely more on ____ muscle in the media to sustain their ____ , to remain ___, and to accept the boluses of blood

Answer 8

Large (Muscular) Arteries gradually lose the copious elastic fibers and rely more on smooth muscle in the media to sustain their shape, to remain open, and to accept the boluses of blood

Question 9

Large Vein Large Muscular Artery

Note that layers (tunicae) retain their ‘____ ’ and that only ___ ___ is seen on the right – ___ gone

Answer 9

Large Vein Large Muscular Artery Note that layers (tunicae) retain their ‘ratio’ and that only Smooth muscle is seen on the right – elastic gone

Question 10

Note tunica dimensions of A muscular artery versus a Medium sized vein

Answer 10

Note tunica dimensions of A muscular artery versus a Medium sized vein

Question 11

Stage 3

Muscular arteries lose their layers of smooth muscle (goes from ___ layers to___ layers) and at this stage they become ____

So, exam question…Which vessel has 2-4 layers of smooth muscle, etc, etc

At this point, for comparison, a medium to small vein has only ___ of ___ muscle and ____ tissue associated with it.

That gives us a clue….. Arterioles, with more substance, tend to retain their ___ shape, while small veins tend to become ___

Answer 11

Muscular arteries lose their layers of smooth muscle (goes from 5 – 30 layers to 2 - 4 layers) and at this stage they become ARTERIOLES So, exam question…Which vessel has 2-4 layers of smooth muscle, etc, etc At this point, for comparison, a medium to small vein has only wisps of smooth muscle and connective tissue associated with it. That gives us a clue….. Arterioles, with more substance, tend to retain their round shape, while small veins tend to become squashed.

Question 12

Note – ___ concentric layers of ___ muscle in arteriole

And___profile

___ ___ vein with Large ___

Answer 12

Note – Two concentric layers of Smooth muscle in arteriole And round profile Squashed, thin vein with Large adventitia

Question 13

OK onwards and downwards We have now passed through large elastic arteries to large muscular arteries, to smaller vessels with 2-4 layers of smooth muscle, the arterioles.

Next in line are capillaries, which ___ almost all their associated smooth muscle (maybe retain a ___ or two), but are basically a ___ cell in which the ___ surrounds a ___.

Answer 13

We have now passed through large elastic arteries to large muscular arteries, to smaller vessels with 2-4 layers of smooth muscle, the arterioles. Next in line are capillaries, which lose almost all their associated smooth muscle (maybe retain a cell or two), but are basically a single cell in which the cytoplasm surrounds a hole.

Question 14

There are 3 types of capillaries,

Continuous (___ holes in the epithelium)

Fenestrated (There ___ holes in the epithelium)

Sinusoidal (___, up to ___ microns wide) with ___ holes in the epithelium

Now think of where you’d actually want each particular type.

Continuous in areas where no___ or ___ of substances into the blood is desired - – such as ___, ___ glands, etc

Fenestrated where there is the need for ___ things to enter and/or Leave the blood, BUT with ___ limitations….e.g ____ enter the circulation in endocrine tissue

Sinusoids, where it is necessary for ___e products, even ___ to Travel and exit or enter…………….___, where ___ __ ___And ___s move through the epithelium

Answer 14

There are 3 types of capillaries, Continuous (NO holes in the epithelium) Fenestrated (There ARE holes in the epithelium) Sinusoidal (Large, up to 30 microns wide) with big holes in the epithelium Now think of where you’d actually want each particular type. Continuous in areas where no leakage or uptake of substances into the blood is desired - – such as muscle, exocrine glands, etc Fenestrated where there is the need for certain things to enter and/or Leave the blood, BUT with size limitations….e.g hormones enter the circulation in endocrine tissue Sinusoids, where it is necessary for large products, even cells to Travel and exit or enter……………..liver, where red blood cells And macrophages move through the epithelium

Question 15

First One, simple cell Around a lumen No holes in Basal Lamina CONTINUOUS

Answer 15

First One, simple cell Around a lumen No holes in Basal Lamina CONTINUOUS

Question 16

Fenestrated

To get a little more control over what products pass through the capillary lining, fenestrated capillaries either ___ or ___ have, a ___.

Those in ___and ___ tissue tend to have diaphragms to allow the transport of products __ ___ than the synthesized hormone e.g. thyroxine, but where ___ products or cells are required to receive passage, the diaphragms are___. This is the case in the ____, where protein(s) often passes out of the glomerulus into the filtrate.

Answer 16

To get a little more control over what products pass through the capillary lining, fenestrated capillaries either HAVE, or DON’T have, a diaphragm. Those in endocrine and GI tissue tend to have diaphragms to allow the transport of products no larger than the synthesized hormone e.g. thyroxine, but where larger products or cells are required to receive passage, the diaphragms are missing. This is the case in the kidney, where protein(s) often passes out of the glomerulus into the filtrate.

Question 17

Finally The biggest of the capillaries, best seen in the Liver, are sinusoids

These large (30 micron wide) capillaries house macrophages (Kupfer Cells), and allow the transit of blood, proteins and other large products.

In fact, red blood cells and macrophages often Push through into the underlying tissue (Space of Disse, Ito and Pit Cells).

So the holes in these capillaries are HUGE

Answer 17

The biggest of the capillaries, best seen in the Liver, are sinusoids These large (30 micron wide) capillaries house macrophages (Kupfer Cells), and allow the transit of blood, proteins and other large products. In fact, red blood cells and macrophages often Push through into the underlying tissue (Space of Disse, Ito and Pit Cells). So the holes in these capillaries are HUGE

Question 18

Now we go back up the venous return BUT FIRST…… In tissues there are _____ _____.

These occur where blood empties directly into ___ from ____, but can be controlled under certain conditions.

For example, in the skin when it is cold, we want the blood to stay away from the surface to conserve heat.

Here we need to direct the blood inwards and this is done by a ‘____’ of the vessels, with the help of smooth muscle ___ and Special cells called ____ that also are found ‘attached’ to capillaries

Answer 18

Now we go back up the venous return BUT FIRST…… In tissues there are arteriovenous anastomoses. These occur where blood empties directly into venules from arterioles, but can be controlled under certain conditions. For example, in the skin when it is cold, we want the blood to stay away from the surface to conserve heat. Here we need to direct the blood inwards and this is done by a ‘contraction’ of the vessels, with the help of smooth muscle sphincters and Special cells called pericytes that also are found ‘attached’ to capillaries

Question 19

These anastomoses Incorporate vessels Known as___ Shown here as M

C= capillary

These vessels have an ____ Cell layer Covered by cells called ____.

They have ____ abilities and Communicate with the ____

Answer 19

These anastomoses Incorporate vessels Known as Metarterioles Shown here as M C= capillary These vessels have an Epithelial Cell layer Covered by cells called pericytes. They have Contractile abilities and Communicate with the epithelium

Question 20

So, at this point where Metarterioles connect the arterial system to the venous system, sometimes directly bypassing the capillaries, the pericytes and smooth muscle sphincters, formed by the remaining ___ muscle cells surrounding the arterioles and Metarterioles, direct blood directly___ fom the capillary bed.

Answer 20

So, at this point where Metarterioles connect the arterial system to the venous system, sometimes directly bypassing the capillaries, the pericytes and smooth muscle sphincters, formed by the remaining smooth muscle cells surrounding the arterioles and Metarterioles, direct blood directly away from the capillary bed.

Question 21

Just a quick trip back up to the heart-

So far we’ve gone from Elastic arteries, to large muscular arteries to arterioles, to Metarterioles, to capillaries……. And now we go on to venules.

Very ___ walled, usually not ___ in appearance, with almost No associated ___ (squamous to ox cuboidal), ______ Smooth muscle cells, and ___ of connective tissue, vessels, etc.

___ intima, ___ media, ___ adventitia

Answer 21

Just a quick trip back up to the heart- So far we’ve gone from Elastic arteries, to large muscular arteries to arterioles, to Metarterioles, to capillaries……. And now we go on to venules. Very thin walled, usually not round in appearance, with almost No associated epithelium (squamous to ox cuboidal), one of two Smooth muscle cells, and lost of connective tissue, vessels, etc. Thin intima, thin media, substantial adventitia

Question 22

Here’s a larger vein.

Note that it still has a thin ___ wall, though more ___, something of ___ appearing with a few __ ___ cells, and a fairly ___adventitia Oh yeh, it has a___

Answer 22

Here’s a larger vein. Note that it still has a thin inner wall, though more cells, something of media appearing with a few smooth muscle cells, and a fairly thick adventitia Oh yeh, it has a valve

Question 23

As we move back up towards the heart, veins tend to accumulate ____ smooth muscle so that___ of the vessel is reduced.

(Eventually they have a number of large,___ ___ ___ .)

Answer 23

As we move back up towards the heart, veins tend to accumulate more smooth muscle so that collapse of the vessel is reduced. (Eventually they have a number of large, longitudinal muscle bundles.)

Question 24

NOW, what we have to understand, that in a LARGE VEIN, these muscle bundles are in the ___ , whereas the circles of smooth muscle are in the ___ of a Large and/or Muscular Artery

So, the layers, tunicae, still maintain that overall, general pattern for The vessels, that being

Vein/Artery

___flat intima/__ flat intima, often with __ ___ connective tissue

__ ___ media/___ muscle media

Very___ adventitia/ ___, often ___ with ___, ____

Answer 24

NOW, what we have to understand, that in a LARGE VEIN, these muscle bundles are in the Adventitia, whereas the circles of smooth muscle are in the media of a Large and/or Muscular Artery So, the layers, tunicae, still maintain that overall, general pattern for The vessels, that being Vein Artery Thin flat intima Thin flat intima, often with sub-intimal connective tissue Connective tissue media Thick, muscle intima Very wide adventitia Wispy, often indistinct With vessels, nerves, etc adventitia

Question 25

So here’s the general comparison

VEINS vs ARTERIES

___ Wall/____Wall

___ Lumen/___ ___ lumen

__ ___ lamina/__ ___ elastic lamina

___ Valves/___ valves

___ Adventitia / ____ Adventitia

___ Media/ ___ Media

Answer 25

VEINS vs ARTERIES Thinner Wall Thick Wall Larger Lumen Smaller, round lumen Ill-defined lamina Well defined elastic lamina Possess Valves No valves Wide Adventitia Narrow Adventitia Narrower Media Wide Media

Question 26

Lymphatic System The lymphatic system consists of ___, ___ and ___.

It transports a fluid called ____.

Lymph distributes ____ cells and other factors throughout the body.

It also interacts with the ___ circulatory system to ___ fluid from ___ and tissues.

The lymphatic system contains immune cells called ____

Answer 26

The lymphatic system consists of organs, ducts, and nodes. It transports a fluid called lymph. Lymph distributes immune cells and other factors throughout the body. It also interacts with the blood circulatory system to drain fluid from cells and tissues. It also interacts with the blood circulatory system to drain fluid from cells and tissues. The lymphatic system contains immune cells called lymphocytes.

Question 27

What is Lymph?

It is a ___ fluid in which are supended various cells.

___ and ___ are missing and ____ are very few in number.

The ___ is similar to that of blood.

Like blood, lymph can ___; however, it does so very ___ forming a ___ clot.

During digestion, the lymphatics of the intestines become ___ filled with ___known as ___. These are stored by the ___ ___

Answer 27

It is a clear fluid in which are supended various cells. RBCs and platelets are missing and granulocytes are very few in number. The plasma is similar to that of blood. Like blood, lymph can coagulate; however, it does so very slowly forming a clear clot. During digestion, the lymphatics of the intestines become lipid filled with chylomicrons known as chyle. These are stored by the lymphatic organs.

Question 28

Functions

The lymphatic system has multiple interrelated functions:

is responsible for the removal of __ ___ from___

it a___ and ____s __ __ and ___ as ___ from the___ system

transports___ blood cells to and from the l___ ___ into the ___s

The lymph transports __ ___ cells, such as dendritic cells, to the l___ __ where an immune response is stimulated.

Answer 28

The lymphatic system has multiple interrelated functions: is responsible for the removal of interstitial fluid from tissues it absorbs and transports fatty acids and fats as chyle from the digestive system transports white blood cells to and from the lymph nodes into the bones The lymph transports antigen-presenting cells, such as dendritic cells, to the lymph nodes where an immune response is stimulated.

Question 29

Lymphatic Circulation

Unlike the cardiovascular system, the lymphatic system is not ___ and has no ___ ___

Lymph transport, therefore, is ___ and ___

Despite low pressure, lymph movement occurs due to ____, ___s, and ____ during contraction of adjacent ___ muscle and arterial pulsation.

Lymph that enters the lymph vessels from the interstitial space usually does not flow ____ along the vessels because of the presence of ___s.

If excessive hydrostatic____ e develops within the lymph vessels, though, some fluid can leak back into the interstitial space and contribute to formation of ____

Answer 29

Unlike the cardiovascular system, the lymphatic system is not closed and has no central pump. Lymph transport, therefore, is slow and sporadic. Despite low pressure, lymph movement occurs due to peristalsis, valves, and compression during contraction of adjacent skeletal muscle and arterial pulsation. Lymph that enters the lymph vessels from the interstitial space usually does not flow backwards along the vessels because of the presence of valves. If excessive hydrostatic pressure develops within the lymph vessels, though, some fluid can leak back into the interstitial space and contribute to formation of edema.

Question 30

The lymphatics converge to form two large trunks, the ___ ___ and the ___ __ ___, that empty into the ____ ____.

They empty into the left and right ___ ____.

Lymph passes through lymph ____, where it is ___, old and damaged cells are removed, etc.

Answer 30

The lymphatics converge to form two large trunks, the THORACIC DUCT and the RIGHT LYMPHATIC DUCT, that empty into the venous return. They empty into the left and right subclavian veins. Lymph passes through lymph NODES, where it is cleaned, old and damaged cells are removed, etc.

Question 31

The Lymphatics

These originate as ____ end vessels, ___ endothelium and ____ basal lamina.

They have ___(as do veins), but contain ___ staining, ___ ___ lymphocytes (as opposed to RBC’s which are found in venules, with which lymphatics are often confused)

Answer 31

These originate as closed end vessels, thin endothelium and incomplete basal lamina. They have VALVES (as do veins), but contain dark staining, non-concave lymphocytes (as opposed to RBC’s which are found in venules, with which lymphatics are often confused)

Question 32

So the comparisons are -

LYMPHATIC /VEIN

Valves /Valves

___ thin /Thin, but more____

Carries lymphocytes/ Carries RBC’s

__ ___ system/ ____ system

Unidirectional lymph flow due to ___ ___,___ and __ ___ ___/ Unidirectional flow due to ___ ___, ____, __ and ___

Answer 32

LYMPHATIC VEIN Valves Valves Very thin Thin, but more substantial Carries lymphocytes Carries RBC’s Blind-ended system Circulating system Unidirectional lymph flow Unidirectional flow due to interstitial pressures, due to blood pressure, Valves and skeletal muscle anastomoses, Contraction sphincters and valves

Question 33

One last bit————- In the___, after a fatty meal, the ____ portion of the ___ will contain a ___, ___ fluid. This is known as a ___, and is part of the lymphatics

Answer 33

One last bit————- In the intestine, after a fatty meal, the Central portion of the villi will contain a milky, thick fluid. This is known as a LACTEAL, and is part of the lymphatics

Question 34

Lymph Nodes CSGLT

(1) capsule, (2) subcapsular sinus, (3) germinal centers, (4) lymphoid nodule, (5) trabeculae.

Answer 34

(1) capsule, (2) subcapsular sinus, (3) germinal centers, (4) lymphoid nodule, (5) trabeculae.

Question 35

Lymphatic System

1: ____ Submental
2: ____Sub Mandibular
3: ____Supraclavicular
4: ____S___Cervical
l5: ___ Retroauricular and _____

6: ___ ___ Retro

7: ___ Buccal
8: ___ Parotid
9: ____ and ____ Jugular

Answer 35

1: Submental2: Submandibular3: Supraclavicular4: Retropharyngeal5: Buccal6: Superficial cervical7: Jugular8: Parotid9: Retroauricular & occipital

Question 36

Lymph Nodes Lymph Nodes are very important in cancer staging!!! Oral Cavity Staging

T = ___ ___(Tis –T4b)

N =__ ___ Involvement (N0-N3)

M = ____ (M0-M1)

T1N0M0 = ___ lymph Node involvement

T1N1M0 = Lymph Node involvement

(T1 = Tumor less ____ in size)

Answer 36

Lymph Nodes are very important in cancer staging!!! Oral Cavity Staging T = Tumor size (Tis –T4b) N = Lymph Node Involvement (N0-N3) M = Metastices (M0-M1) T1N0M0 = No lymph Node involvement T1N1M0 = Lymph Node involvement (T1 = Tumor less 2 cm in size)