1. 1 maria immaculata iwo, sf itb

2. 2 Blood vessels are of three types: –arteries, –capillaries, and –Veins These vessels function to: 1. Transport blood and its contents 2. Carry out exchange of gases in the pulmonary capillaries and exchange of gases plus nutrients for waste at the systemic capillaries 3. Regulate blood pressure; 4. direct blood flow to those systemic tissues that most require it at the moment.

3. 3 JANTUNG Arteri besar Arteri sedang Arteri kecil Arteriol Capillary beds Venula (vena terkecil) Vena sedang Vena besar Vena cava: Superior - inferior Jaringan (Cairan interstisial) Darah didistribusi ke seluruh tubuh melalui pembuluh darah Vena  pembuluh aferent  Membawa darah kembali ke jantung Arteri  pembuluh eferent  Membawa darah ke luar dari jantung Sistem limfatik Vena kecil aorta

4. 4 Heart Big Artery Mdium Arteri Small Arteri Arteriol Capillary beds Venules (smallest vein) Medium Vein Big Vein Cava vein Superior & inferior tissue (interstitial fluids) Blood vessel circulates the blood to whole body Vein  afferent vessel  bring blood return to the heart Artery  efferent vessel  take blood away from heart Lymphatics System

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6. 6 Lapisan/dinding pembuluh darah Tunika intima –Dinding dalam, –lapisan tipis tdd endothelium dan sedikit jar. ikat longgar, –sel-selnya berdekatan  membentuk permukaan licin  mengurangi friksi ketika darah melewati lumen pembuluh maria immaculata iwo, sf itb

7. 7 Tunika media: – Lap. tengah, paling tebal, – tdd otot polos dan jar. elastik. –dikontrol oleh saraf simpatikus  diameter pembuluh: Konstriksi  tek darah naik, Dilatasi  tek. darah turun Tunika eksterna: – Lap. paling luar, tdd jar. ikat fibrous, –fungsi mensupport/melindungi pembuluh maria immaculata iwo, sf itb

8. 8 ARTERY VEIN

9. 9 BLOOD VESSELS

10. 10 FEATURETYPICAL ARTERYTYPICAL VEIN General appearance in sectional view Usually round, with relatively thick wall Usually flattened or collapses, with relatively thin wall Tunica intima: - Endothelium - Internal elastic membrane Usulally rippled, due to vessel constriction Present Often smooth Absent Tunica media External elastic membrane Thick, dominated by smooth muscle cells and elastic fiber Present Thin, dominated by smooth muscle cells and collagen fibers Absent Tunica externaCollagen and elastic fibers Collagen and elastic fibers and smooth muscle cells

11. 11 ARTERIES Arteries carry blood under great pressure, and theirare adapted to handle that pressure  Their relatively thick muscular walls make arteries elastic and contractile Elasticity permits passive changes in vessel diameter in response to changes in blood pressure. The contractility of the arterial walls enables them to change in diameter actively, primarily under the control of the sympathetic division of the autonomic nervous system. When stimulated, arterial smooth muscles contract, thereby constricting the artery- a process called vasoconstriction. Relaxation of these smooth muscle increases the diameter of the lumen – a process called vasodilation.

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13. 13 Wall of an artery consists of 3 distinct layers of tunics:  Tunica intima –Composed of simple, squamous epithelium called endothelium. –Rests on a connective tissue membrane that is rich in elastic and collagenous fibers.  Tunica media –Makes up the bulk of the arterial wall. –Includes smooth muscle fibers, which encircle the tube, and a thick layer of elastic connective tissue.  Tunica adventitia –Is relatively thin. –Consists chiefly of connective tissue with irregularly arranged elastic and collagenous fibers. This layer attaches the artery to the surrounding tissues. –Also contains minute vessels (vasa vasorum  vessels of vessels) that give rise to capillaries and provide blood to the more external cells of the artery wall.

14. 14  Smooth muscles in the walls of arteries and arterioles are innervated by the sympathetic branches of the autonomic nervous system. Maria Immaculata Iwo, sf itb

15. 15 arteries Vasoconstiction and vasodilation affect : 1. The after-load on the heart 2. Peripheral blood pressure, and 3. Capillary blood flow. Contractility is also important during the vascular phase of hemostasis, when the contraction of damaged vessel wall helps reduce bleeding. maria immaculata iwo, sf itb

16. 16 arteries In traveling from the heart to peripheral capillaries, blood passes through –Elastic arteries  Conducting arteries –Muscular Arteries  Medium-sized arteries or distribution arteries –Arterioles (See Fig 21-2) maria immaculata iwo, sf itb

17. 17 Elastic arteries Elastic arteries, or conducting arteries, are large vessels with diameters up to 2.5 cm (1 in.) These vessels transport large volumes of blood away from the heart. The walls of elastic arteries (see Figure 21-2.) are extremely resilient because the tunica media contains a high density of elastic fibers and relatively few smooth muscle cells. As a result, elastic arteries can tolerate the pressure changes that occur during the cardiac cycle. maria immaculata iwo, sf itb

18. 18 During ventricular systole, pressures rise rapidly and the elastic arteries expand. During ventricular diastole, blood pressure within the arterial system falls and the elastic fibers recoil to their original dimensions. –The elasticity of the arterial system dampens the pressure peaks and valleys that accompany the heartbeat. By the time, blood reaches the arterioles, the pressure oscillations have disappeared, and blood flow is continuous. Elastic arteries

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20. 20 Muscular Arteries Muscular arteries, also known as medium-sized arteries or distribution arteries, distribute blood to the body's skeletal muscles and internal organs. Most of the vessels of the arterial system are muscular arteries. – These arteries are characterized by a thick tunica media that contains more smooth muscle cells than does the tunica media of elastic arteries (see Figures 21-1 and 21-2.). A typical muscular artery has a lumen diameter of approximately 0.4 cm (0.16 in.), but some have diameters as small as 0.5 mm.

21. 21 Muscular Arteries Superficial muscular arteries are important as pressure points - places in the body where muscular arteries can be forced against deeper bones to reduce blood flow and control severe bleeding. Maria Immaculata Iwo, sf itb  The external carotid arteries of the neck, the brachial arteries of the arms, the mesenteric arteries of the abdomen, and the femoral arteries of the thighs. are examples of muscular arteries

22. 22 Arterioles Arterioles, with an internal diameter of 30 μm or less,  smaller than muscular arteries. Arterioles have a poorly defined tunica externa, tunica media in the larger arterioles consists of one or two layers of smooth muscle cells  The tunica media of the smallest arterioles contains scattered smooth muscle cells Maria Immaculata Iwo, sf itb

23. 23 CAPILLARIES Capillaries are the only blood vessels whose wall permit exchange between the blood and the surrounding interstitial fluids. Because capillary walls are thin, diffusion distances are small,  In addition, blood flows through capillaries relatively slowly, gave sufficient time for the diffusion or active transport of materials across the capillary walls.  the histological structure of capillaries permits a two-way exchange of substance between blood and interstitial fluid. so exchange can occur quickly maria immaculata iwo, sf itb

24. 24 CAPILLARIES A typical capillary consists of an endothelial tube, a delicate basal lamina; neither a tunica media nor a tunica externa is present The average diameter of a capillary is about 8 μm, very close to that of a red blood cell. There are two major types of capillary: –Continuous capillaries –fenestrated capillaries.

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26. 26 Continuous Capillaries  Are named because the cytoplasm of the endothelial cells is continuous when viewed in cross- section through a microscope.  Cytoplasm appears as an uninterrupted ring, except for the endothelial junction. maria immaculata iwo, sf itb

27. 27 Continuous Capillaries  Most regions of the body are supplied by continuous capillaries. Continuous capillaries are located in all tissues except epithelia and cartilage. Continuous capillaries permit the diffusion of water, small solutes, and lipid-soluble materials into the surrounding interstitial fluid, but prevent the loss of blood cells and plasma proteins. In addition, –some exchange may occur between blood and interstitial fluid by bulk transport the movement of vesicles that form through endocytosis at the inner endothelial surface. maria immaculata iwo, sf itb

28. 28 Continuous Capillaries In specialized continuous capillaries throughout most of the central nervous system and in the thymus, the endothelial cells are bound together by tight junctions. –These capillaries have very restricted permeability characteristics  one example-the capillaries responsible for the blood-brain barrier maria immaculata iwo, sf itb

29. 29 Fenestrated Capillaries  Differ from continuous capillaries cells have numerous pores or fenestrations where the cytoplasm is very thin or absent.  Found in kidneys, villi of the small intestine, chorroid plexus of the ventricles of the brain, and endocrine glands. Fenestrated capillaries (fenestra, window) are capillaries that contain "windows," or pores, that penetrate the endothelial lining (Figure 2l-4b).

30. 30 Fenestrated Capillaries The pores permit the rapid exchange of water and solutes as large as small peptides between plasma and interstitial fluid. Examples of fenestrated capillaries include: the choroid plexus of the brain and the blood vessels in a variety of endocrine organs, such as the hypothalamus and the pituitary, pineal, and thyroid glands.  Fenestrated capillaries are also located along absorptive areas of the intestinal tract and at filtration sites in the kidneys. Both the number of pores and their permeability characteristics may vary from one region of the capillary to another. maria immaculata iwo, sf itb

31. 31 Sinusoids Sinusoids or Discontinuous Capillaries  Are wider than capillaries and more tortuous  Contain spaces between endothelial cells instead of having the usual endothelial lining.  Basal lamina is incomplete or missing.  In addition, sinusoids contain specialized lining cells that are adapted to the function of the tissue.  In the liver, sinusoids contain phagocytic cells called stellate reticuloendothelial (Kupffer) cells.

32. 32 Sinusoids  Sinusoids occur in the liver, bone marrow, spleen, and many endocrine organs, including the pituitary, parathyroid, and adrenal glands, and bone marrow.  At liver sinusoids, plasma proteins secreted by liver cells enter the bloodstream.  Along sinusoids of the liver, spleen, and bone marrow; phagocytic cells monitor the passing blood, engulfing damaged red blood cells, pathogens, and cellular debris. maria immaculata iwo, sf itb

33. 33 Sinusoids Sinusoids resemble fenestrated capillaries that are flattened and irregularly shaped.  In contrast to fenestrated capillaries, sinusoids commonly have gaps between adjacent endothelial cells, and the basal lamina thinner or absent.  As a result, sinusoids permit the free exchange of water and solutes as large as plasma proteins between blood and interstitial fluid. Blood moves through sinusoids relatively slowly; maximizing the time available for exchange across the sinusoidal walls. maria immaculata iwo, sf itb

34. 34 Capillary Beds Capillaries do not function as individual units but as part of an interconnected network called a capillary bed, or capillary plexus (Figure 21-5-). A single arteriole generally gives rise to dozens of capillaries that empty into several venules  the smallest vessels of the venous system. The entrance to each capillary is guarded by a band of smooth muscle called a precapillary sphincter. –Contraction of the muscle cells narrows the diameter of the capillary, thereby reducing the flow of blood. –Relaxation of the sphincter dilates the opening, allowing blood to enter the capillary faster. maria immaculata iwo, sf itb

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36. 36 Figure 12.11 Anatomy of a capillary bed.

37. 37 Figure 12.11 Anatomy of a capillary bed. A capillary bed forms a maze of capillary vessels that lies between an arteriole and a venule. When sphincter muscles are relaxed, the capillary bed is open, and blood flows through the capillaries. When sphincter muscles are contracted, blood flows through a shunt that carries blood directly from an arteriole to a venule. –As blood passes through a capillary in the tissues, it gives up its oxygen (O2). Therefore, blood goes from being O2-rich in the arteriole (red color) to being O2- poor in the vein (blue color).

38. 38 The cycling of contraction and relaxation of smooth muscles that changes blood flow through capillary beds is called vasomotion. Vasomotion is controlled locally by changes in the concentrations of chemicals and dissolved gases in the interstitial fluids. For example, –when dissolved oxygen concentrations decline within a tissue, the capillary sphincters relax, so blood flow to the area increases. –This process, an example of capillary autoregulation, will be the focus of a later section. maria immaculata iwo, sf itb

39. 39 When you are at rest, –blood flows through roughly 25% of the vessels within a typical capillary bed in your body. –Your cardiovascular system does not contain enough blood to maintain adequate blood flow to all the capillaries in all the capillary beds in your body at the same time. –As a results, when many tissues become active, the blood flow through capillary beds must be coordinated. maria immaculata iwo, sf itb

40. 40 Veins Veins collect blood from all tissues and organs and return it to the heart. The walls of veins can be thinner than those of corresponding arteries because the blood pressure in veins is lower than that in arteries. Veins are classified on the basis of their size. Even though their walls are thinner, in general veins are larger in diameter than their corresponding arteries (Fig. 21-2, p.711) Veins which carry blood back to the heart, follow pathways roughly parallel to those of the arteries. Walls of veins are similar to those of arteries, in that they are composed of three distinct layers. –Middle layer is poorly developed. –As a result, veins have thinner walls that contain less smooth muscle and less elastic tissue than arteries.

41. 41 Veins Veins also function as blood reservoirs that can be drawn upon in time of need. –If a hemorrhage accompanied by drop in blood pressure occurs, the muscular walls of the veins are stimulated reflexively by the sympathetic nervous system. Veins constrict and help to raise the blood pressure. This mechanism ensures a nearly normal blood flow even if as much as 25% of the blood volume is lost. Maria Immaculata Iwo, sf itb

42. 42 Venous Valves  Many veins, particularly those in the arms and legs, have flaps or valves which project inward from the lining.  Valves are usually composed of two leaflets that close if the blood begins to back up in the veins.  Valves are open as long as the blood flow is toward the heart and closed if it is in the opposite direction.

43. 43 Venous Valves The arterial system is a high-pressure system. Almost all the force developed by the heart is required to push blood along the network of arteries and through miles of capillaries. Blood pressure in a peripheral venule is only about 10 percent of that in the ascending aorta, and pressures continue to fall along the venous system. The blood pressure in venules and medium-sized veins is so low that it cannot overcome the force of gravity. In the limbs, veins of this size contain valves, folds of the tunica intima that project from the vessel wall and point in the direction of blood flow. These valves, like those in the heart, permit blood flow in one direction only. Venous valves prevent the back flow of blood. See FIG.21-6 The Function of Valves in the Venous System

44. 44 Medium-Sized Veins  Medium-sized veins range from 2 to 9 mm in internal diameter, comparable in size to muscular arteries. In these veins, the tunica media is thin and contains relatively few smooth muscle cells. The thickest layer of a medium-sized vein is the tunica externa, which contains longitudinal bundles of elastic and collagen fibers. Maria Immaculata Iwo, sf itb

45. 45 Large Veins  Large veins include the superior and inferior venae cavae and their tributaries within the abdomino pelvic and thoracic cavities. All the tunica layers are present in all large veins. The slender tunica media is surrounded by a thick tunica externa composed of a mixture of elastic and collagen fibers. Maria Immaculata Iwo, sf itb

46. 46 Venules  Venules are the microscopic vessels that continue from the capillaries and merge to form veins.  Venules, which collect blood from capillary beds, are the smallest venous vessels. They vary widely in size and structure. An average venule has an internal diameter of roughly 20 μm. Venules smaller than 50 μm lack a tunica media, and the smallest venules resemble expanded capillaries. maria immaculata iwo, sf itb

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49. 49 Blood Capillaries Water and other small molecules can cross through the cells of a capillary wall or through tiny clefts that occur between the cells. Large molecules in plasma, such as the plasma proteins, are too large to pass through capillary walls. Three processes influence capillary exchange  blood pressure,  diffusion, and  osmotic pressure:

50. 50 Blood pressure, –which is created by the pumping of the heart, is the pressure of blood against a vessel’s (e.g., capillary) walls. Diffusion, –as you know, is simply the movement of substances from the area of higher concentration to the area of lower concentration.  Osmotic pressure - is a force caused by a difference in solute concentration on either side of a membrane.

51. 51 Capillary Pressures and capillary Exchange Capillary exchange plays such an important role in homeostasis. The most important processes that move materials across typical capillary walls are  diffusion  filtration  reabsorption maria immaculata iwo, sf itb

52. 52 Diffusion is the net movement of ions or molecules from an area where their concentration is higher to an area where their concentration is lower The difference between the high and low concentrations represents a concentration gradient, and diffusion tends to eliminate that gradient. Diffusion occurs most rapidly when: (1) the distances involved are small, (2) the concentration gradient is large, and (3) the ions or molecules involved are small. Diffusion maria immaculata iwo, sf itb

53. 53 1. Water, ions, and small organic molecules, such as glucose, amino acids, and urea, can usually enter or leave the bloodstream by diffusion between adjacent endothelial cells or through the pores of fenestrated capillaries. 2. Many ions, including sodium, potassium, calcium, and chloride, can diffuse across endothelial cells by passing through channels in cell membranes. 3. Large water-soluble compounds are unable to enter or leave the bloodstream except at fenestrated capillaries, such as those of the hypothalamus, the kidneys, many endocrine organs, and the intestinal tract. Different substances diffuse across capillary walls by different routes: maria immaculata iwo, sf itb

54. 54 4. Lipids, such as fatty acids and steroids, and lipid- soluble materials, including soluble gases such as oxygen and carbon dioxide, can cross capillary walls by diffusion through the endothelial cell membranes. 5. Plasma proteins are normally unable to cross the endothelial lining anywhere except in sinusoids, such as those of the liver, where plasma proteins enter the bloodstream. maria immaculata iwo, sf itb

55. 55 Filtration Filtration is the removal of solutes as a solution flows across a porous membrane; solutes too large to pass through the pores are filtered out of the solution. The driving force for filtration is hydrostatic pressure, which, as we saw earlier, pushes water from an area of higher pressure to an area of lower pressure. In capillary filtration, water and small solutes are forced across a capillary wall, leaving larger solutes and suspended proteins in the bloodstream (Fig 21-11). The solute molecules leaving the bloodstream are those small enough to pass between adjacent endothelial cells or through the pores in a fenestrated capillary Filtration occurs primarily the arterial end of a capillary, where CHP is highest.

56. 56 Reabsorption Reabsorption occurs as the result of osmosis. Osmosis is special term used to refer to the diffusion of water across a selectively permeable membrane separating two solutions differing solute concentrations. Water molecules tend to diffuse across a membrane toward the solution containing the higher solute concentration (see Fig. 3-16, p. 88) The osmotic pressure (OP) of a solution is an indication of the force of osmotic water movement in other words, pressure that must be applied to prevent osmotic movement across a membrane.

57. 57 The higher the solute concentration of a solution, the greater the solution's osmotic pressure. The osmotic pressure of the blood is also called Blood Colloid Osmotic Pressure (BCOP), because only the suspended proteins are able to cross the capillary walls. Clinicians often use the term Oncotic pressure (onkos, a swelling) when referring to the colloid osmotic pressure of body fluids. The two terms are equivalent. Osmotic water movement will continue until either solute concentrations are equalized or the movement is prevented by an opposing hydrostatic pressure. Remember that –hydrostatic pressure forces water out of a solution, –whereas osmotic pressure draws water into a solution.

58. 58 The Interplay between Filtration and Reabsorption The net hydrostatic pressure tends to push water and solutes out of capillaries into the interstitial fluid. The net hydrostatic pressure is the difference between: CHP and IHP CHP  The capillary hydrostatic pressure (CHP), which ranges from 35 mm Hg at the arterial end of a capillary to 18 mm Hg at the venous end, IHP  The hydrostatic pressure of the interstitial fluid (IHP). Maria Immaculata Iwo, sf itb

59. 59 Forces acting across Capillary walls. At the arterial end of the capillary, capillary hydrostatic pressure (CHP) is greater than blood colloid osmotic pressure (BCOP), so fluid moves out of the capillary (filtration). Near the venule, CHP is lower than BCOP, so fluid moves into the capillary (reabsorption). In this model, interstitial fluid colloid pressure (ICOP) and interstitial fluid hydrostatic pressure (IHP) are assumed to be 0 mmHg and so are not shown

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61. 61 Measurements of IHP have yielded very small values that differ from tissue to tissue - from +6 mm Hg in the brain to -6 mm Hg in subcutaneous tissues. A positive lHP opposes CHP and the tissue hydrostatic pressure must be overcome before fluid can move out of a capillary. A negative lHP assists CHP and additional fluid will be pulled out of the capillary. However, under normal circumstances the average lHP is 0 mm Hg, and we can assume that the net hydrostatic pressure is equal to CHP.

62. 62 The net filtration pressure (NFP) is the difference between the net hydrostatic pressure and the net osmotic pressure. In terms of the factors just listed, this means that net filtration = net hydrostatic - net colloid osmotic pressure pressure pressure NFP = (CHP - IHP) - (BCOP - ICOP) At the arterial end of a capillary, the net filtration pressure can be calculated as follows: NFP = (35 - 0) - (25 - 0) = 35 - 25 = 10 mm Hg  Because this value is positive, it indicates that fluid will tend to move out of the capillary into the interstitial fluid.

63. 63 At the venous end of the capillary, the net filtration pressure will be: NFP = (18 - 0) - (25 - 0) = 18 - 25 = -7 mm Hg The minus sign indicates that fluid tends to move into the capillary; that is, reabsorption is occurring. If the maximum filtration pressure at the arterial end of the capillary were equal to the maximum reabsorption pressure at the venous end, this transition point would lie midway along the length of the capillary. maria immaculata iwo, sf itb

64. 64 Under these circumstances, filtration would occur along the first half of the capillary, and an identical amount of reabsorption would occur along the second half. However, the maximum filtration pressure is higher than the maximum reabsorption pressure, so the transition point between filtration and reabsorption normally lies closer to the venous end of the capillary than to the arterial end. As a result, more filtration than reabsorption occurs along the capillary  Of the roughly, 24 Liters of fluid that moves out of the plasma and into the interstitial fluid each day, 20.4 Liters (85%) is reabsorbed.  The remainder (3.6 L) flows through the tissues and into lymphatic vessels, for eventual return to the venous system. maria immaculata iwo, sf itb

65. 65 This continuous movement of water out of the capillaries, through peripheral tissues, and then back to the bloodstream by way of the lymphatic system has four important functions: 1. It ensures that plasma and interstitial fluid, two major components of extracellular fluid, are in constant communication. 2. It accelerates the distribution of nutrients, hormones, and dissolved gases throughout tissues. 3. It assists in the transport of insoluble lipids and tissue proteins that cannot enter the bloodstream by crossing the capillary walls. 4. It has a flushing action that carries bacterial toxins and other chemical stimuli to lymphoid tissues and organs responsible for providing immunity to disease. maria immaculata iwo, sf itb

66. 66 Net pressure in Net pressure out Capillary exchange

67. 67 Capillary exchange At the arterial end of a capillary, blood pressure is higher than osmotic pressure; therefore, water tends to leave the bloodstream. In the midsection of a capillary, small molecules follow their concentration gradients: Oxygen and nutrients leave the capillary, while wastes, including carbon dioxide, enter the capillary. At the venous end of a capillary, osmotic pressure is higher than blood pressure; therefore, water tends to enter the bloodstream.

68. 68 In the midsection of a capillary, small molecules follow their concentration gradients: Oxygen and nutrients leave The capillary, while wastes, including carbon dioxide, enter the capillary. At the arterial end of a capillary, blood pressure is higher than osmotic pressure; therefore, water tends to leave the bloodstream. At the venous end of a capillary, osmotic pressure is higher than blood pressure; therefore, water tends to enter the bloodstream.

69. 69 Lymphatic vessel 3,6L 24 L/day Forces acting across Capillary walls. At the arterial end of the capillary, capillary hudrostatic pressure (CHP) is greater than blood colloid osmotic pressure (BCOP), so fluid moves out of the capillary (filtration). Near the venule, CHP is lower than BCOP, so fluid moves into the capillary (reabsorption). In this model, interstitial fluid colloid pressure (ICOP) and interstitial fluid hydrostatic pressure (IHP) are assumed to be 0 mmHg and so are not shown. Arteriole Venule

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71. 71 Capillary dynamics  If hemorrhaging occurs, both blood volume and blood pressure decline. This reduction in CHP lowers the NFP and increases the amount of reabsorption. The result is a reduction in the volume of interstitial fluid and an increase in the circulating plasma volume. This process known as a recall of fluids.  If dehydration occurs, the plasma volume decreases owing to water loss, and the concentration of plasma proteins increases. The increase in BCOP accelerates reabsorption and a recall of fluids that delays the onset and severity of clinical signs and symptoms.  If the CHP rises or the BCOP declines, fluid moves out the blood and builds up in peripheral tissues, a condittion called edema. maria immaculata iwo, sf itb

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