1. Blood Vessels

2. Intracellular Fluid (ICF): Fluid located within the cell; cytosol
Extracellular Fluid (ECF): Fluid outside of body cells; plasma and interstitial fluid
Interstitial Fluid (IF): The portion of extracellular fluid that fills the microscopic spaces between the cells of tissues; tissue fluid

4. Bulk Flow
Filtration and reabsorption of fluids due to pressure (osmotic/hydrostatic) differences
Balance of pressures = net filtration pressure (NFP)
Starling's Law of the Capillaries - movement of fluid between plasma and the interstitial fluid is in a state of near equilibrium at the arterial and venous ends of a capillary

6. Blood hydrostatic pressure (BHP)= pressure of blood acting against the capillary walls forcing fluids out of capillaries
Interstitial fluid hydrostatic pressure (IFHP) = pressure acting outside the capillaries pushing fluid in
Blood colloid osmotic pressure (BCOP)= pressure as a result of moving fluid into capillaries due to attraction to non diffusible solutes (i.e. plasma proteins)

7. Edema - filtration exceeds reabsorption resulting in increased interstitial fluid volume; causes include:
Increased blood hydrostatic pressure in capillaries (cardiac failure, blood clots)
Decreased concentration of plasma proteins (burns, malnutrition, kidney dis.)
Increased permeability of capillaries
Increased extracellular fluid volume
Blockage of lymphatic vessels (radical mastectomy)
Edema is not detectable in tissues until IF is increased 30% above normal

8. Blood flows from high pressure (arterial)
to low pressure (venous).
Arteries-arterioles-capillaries-venules-veins
Pressure: aorta: mmHg
arteries:
arterioles: 60-80
capillaries: 20-40
venules: 10-20
veins: 5-10
vena cava: 0-5

10. NFP = (BHP+IFOP) - (BCOP+IFHP)
Arterial end:
NFP=(35+1)-(26+0)=(36)-(26)=10 mmHg
Venous end:
NFP=(16+1)-(26+0)=(17)-(26)= -9 mmHg

11. Definition of Terms
Resistance =the opposition to flow and is a measure of the amount of friction blood encounters as it passes through vessels.
Blood viscosity
Total blood vessel length
Blood vessel diameter .

12. Blood Pressure =the force per unit area exerted on a vessel wall by the blood contained within it (expressed in mm Hg).
Arterial blood pressure
Systolic pressure
Diastolic pressure
Pulse pressure
Mean arteriole pressure
Capillary blood pressure
Venous blood pressure

14. Venous Blood Pressure
Muscular pump
Respiratory pump

15. Factors affecting Blood Pressure
Cardiac Output
Increased CO = increased BP
Decreased CO = decreased BP
Peripheral Resistance
Increased vasoconstriction = increased BP
Increased vasodilation = decreased BP
Blood Volume
Increased blood volume = increased BP
Decreased blood volume = decreased BP

16. Maintaining BP (Short-term: neural)
Vasomotor center
Baroreceptors
Chemoreceptors
Hypothalamus and cerebral cortex

17. Peripheral chemoreceptors

18. Maintaining BP (Short-term: chemical)
Adrenal medulla hormone (Adrenalin)
Atrial natriuretic peptide (ANP)
Antidiuretic hormone (ADH)
Angiotensin II
Nitric oxide
Alcohol
Endothelin

19. Maintaining BP (Long-term)
Renal Regulation
High blood pressure due to increased blood volume causes decreased reabsorption in kidneys resulting in a decrease in blood volume and a lowering of blood pressure.
Renin-angiotensin II mechanism=when artery blood pressure drops, renin triggers angiotensin II production which causes vasoconstriction and increased blood pressure

20. Blood flow =the volume of blood flowing through a vessel, an organ, or the entire circulation in a given period

21. Blood pressure:
Heart pumps blood through vessels. Blood flow is under pressure due to resistance in the system
F= P R
F= blood flow
P= pressure
R= resistance
Blood flow is directly proportional to changes in blood pressure.
Blood flow is inversely proportional to peripheral resistance.

22. Systolic: Ventricles ejecting blood into the aorta
Diastole:: ventricles relaxing, pressure drops in aorta
Difference between the two is called pulse pressure.
What is the pulse pressure on a normal BP of 120/80?
40mm/Hg

23. Pulse pressure is increased in conditions like arteriosclerosis.
Total peripheral resistance is controlled by arterioles. BP is controlled by arterioles.

24. Arteries and veins
1- Tunica intima: inside layer of the vessel.
in veins= valves
2- Tunica media: smooth muscle is thicker in arteries and thinner in veins. Can dilate and constrict.
- vasoconstriction and vasodilation
3- Tunica adventitia: outer layer. Thicker in veins

28. Capillaries:
Extensions of the inner layer of the arteriole: endothelium (simple squamous)
Continuous: skin, muscles and blood brain barrier
Fenestrated: openings called pores that permeable to fluid and small solutes.
Found in small intestine (absorption), endocrine glands (hormone release) and kidneys (filtration of blood)
Sinusoids: liver, bone marrow and spleen
Very leaky.

30. Capillary Transport Mechanisms

31. Pulse Points

32. Vascular anatomy:
Arterial:
Major branches off of aorta:
Aortic sinus (ascending): right and left coronary artery
Arch of aorta:
1- Brachiocephalic trunk which bifurcates into right subclavian a. and the right common carotid a.
2- Left common carotid a.
3- Left subclavian a.

34. Descending aorta:
Thoracic aorta lies anterior to the vertebral column and above the diaphragm
Branches are: pericardial a.
esophageal a.
posterior intercostal a.
Abdominal aorta lies below the diaphragm.
Branches are: celiac a.
- left gastric a.
- hepatic a.
- splenic a. (tortuous)

36. Phrenic a.: diaphragm
Superior mesenteric a.:
jejunum, ileum, cecum, ascending colon and transverse colon.
Inferior mesenteric a.:
descending, sigmoid colon and rectum
Renal and suprarenal a.:
supplies blood to the paired kidneys and adrenal glands

37. Gonadal a.:
Male: spermatic a. that descend through the inguinal canal to supply blood to the testes.
Female: ovarian a.
Middle sacral a.: long slender a. descending anterior to the lumbar vertebra and sacrum to supply blood to sacrum and coccyx.

39. Abdominal aorta will bifurcate into left and right common iliac arteries.
These further divide into:
- internal iliac a.
- external iliac a.
Internal iliac a.:
iliolumbar a.: ilium and back muscles
superior and inferior gluteal a.: buttocks
internal pudendal a.: external genitalia
middle rectal a.: rectum

41. External iliac a.:
- main blood supply to lower limb
- Between the pubis symphysis and the ASIS it becomes the femoral a.
Femoral a.:
- superficial circumflex iliac a.: groin
- deep femoral a.: muscles of thigh and hip joint
- deep geniculate a.: distal end of thigh
Popliteal a.: knee joint
- Will bifurcate into anterior and posterior tibial a.

42. Posterior a. branches into fibular a. (largest branch)
Ant. tibial a. becomes dorsalis pedis a. (pedal pulse)

44. Arm, head and neck.
Subclavian a.:
- vertebral a.: through transverse
foramina into brain through foramen magnum.
- becomes single basilar a. along the ventral aspect of the brainstem
- basilar a. divides into two post. cerebral a.
- becomes part of the Circle of Willis at base of brain

46. - thyrocervical a.: thyroid and parathyroid glands pharynx and trachea.
Common carotid a.: branch into internal and external carotid a.
External carotid a.:
- superior thyroid a.
- lingual a.
- facial a.
- occipital a.

48. Internal carotid a.:
Ophthalmic a.
Post. communicating a. (circle of Willis)
Terminate in the anterior and middle cerebral arteries. These vessels supply blood to the motor, sensory and speech cortices of the brain.

51. Arm:
Subclavian a. give rise to axillary a.
- humoral circumflex a.
Axillary becomes brachial a. (BP)
- deep brachial a. supplies triceps
At the elbow the brachial a. divides into ulnar and radial a. (pulse).

54. Major Veins Superior vena cava braciocephalic
external/internal jugular
vertebral
subclavian
axillary
cephalic

55. brachial
basilic
median cubital
ulnar
Radial
inferior vena cava
splenic hepatic
renal
superior mesenteric
inferior mesenteric

56. common iliac
external/internal iliac
femoral
great saphenous
popliteal
anterior/posterior
tibial
fibular
dorsal digital

59. Clinical corner
Aneurysm - a balloon-like outpocketing of an artery wall that places the artery at risk for rupture
Microangiopathic lesion - an abnormal thickening of a capillary basement membrane due to the deposit of glycoproteins
Phlebitis - inflammation of a vein accompanied by painful throbbing and redness of the skin
Hypotension (low BP) and hypertension (high BP)
Angiogenesis - formation of new blood vessels
Claudication - pain and lameness or limping caused by defective circulation of the blood in vessels of the limbs (Intermittant)
Occlusion - the closure or obstruction of the lumen of a structure such as a blood vessel
Hypovolemic shock - large-scale blood loss followed by "thready" pulse
White coat hypertension!!!