Anatomy of Circulatory System

Structure: Supply:

I. External Carotid Artery

1. Superior thyroid a.
a. Infrahyoid a.
b. Sternocleidomastoid a.
c. Superior laryngeal a.
d. Cricothyroid a.
2. Ascending pharyngeal a.
a. Pharyngeal a.
b. Inferior tympanic a.
c. Meningeal a.
3. Lingual a.
a. Suprahyoid branch
b. Dorsal lingual branches
c. Sublingual a.
4. Facial a.
a. Cervical group
i. Ascending palatine a.
ii. Tonsillar a.
iii. Glandular branches
iv. Submental a.
b. Facial group
i. Inferior labial a.
ii. Superior labial a.
iii. Lateral nasal branch
5. Occipital a.
a. Sternocleidomastoid branches
b. Mastoid branch
c. Stylomastoid a.
d. Auricular branch
e. Muscular branches
f. Descending branches
i. Superficial branch
ii. Deep branch
g. Meningeal branches
h. Occipital branches
6. Posterior auricular a.
a. Stylomastoid a.
b. Auricular branch
c. Occipital branch
7. Superficial temporal a.
a. Transverse facial a.
b. Anterior auricular branches
c. Zygomatico-orbital a.
d. Middle temporal a.
e. Frontal (anterior) branch
f. Parietal (posterior) branch
8. Maxillary
a. First part
i. Deep auricular a.
ii. Anterior tympanic a.

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 iii. Middle meningeal a.
1. ganglionic branches
2. petrosal branch
3. superior tympanic a.
4. temporal branches
5. anastomotic branch with the lacrimal a.
iv. Accessory meningeal branch
v. Inferior alveolar (dental) a.
b. Second part
i. Deep temporal branches
1. pterygoid branches
2. masseteric a.
ii. Buccal a.
c. Third part
i. Posterior superior alveolar (dental) a.
ii. Infraorbital a.
iii. Greater palatine a.
iv. Pharyngeal branch
v. Artery of the pterygoid canal
vi. Sphenopalatine a.

II. Internal Carotid Artery

1. Cervical part
2. Petrous part
a. Caroticotympanic
b. Pterygoid
3. Cavernous part
a. Cavernous
b. Hypophysial
c. Meningeal
4. Cerebral part
a. Opthalmic
b. Anterior cerebral
c. Middle cerebral
d. Posterior communicating
e. Anterior choroid

III. Subclavian Arteries

1. Vertebral a.
a. Cervical branches
i. Spinal br.
ii. Muscular br.
b. Cranial branches
i. Meningeal br.
ii. Post. Spinal a.
iii. Ant. Spinal a.
iv. Post. Inf. Cerebellar a.
v. Medullary a.
c. Basilar a.
i. Pontine br.
ii. Labyrinthine br.
iii. Ant. Inf. Cerebellar a.
iv. Superior cerebellar a.
v. Posterior cerebral a.
2. Internal thoracic (mammary) a.
a. Pericardiacophrenic a.

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 b. Mediastinal a.
c. Pericardial br.
d. Sternal br.
e. Ant. Intercostal br.
f. Musculophrenic a.
g. Superior epigastric a.
3. Thyrocervical
a. Inf. Thyroid a.
b. Suprascapular a.
c. Superficial cervical a.
4. Costocervical
a. Superior intercostal a.
b. Deep cervical a.
5. Dorsal scapular

IV. Axillary Artery

1. First part
a. Superior thoracic a.
2. Second part
a. Thoraco-acromial a.
b. Lateral thoracic a.
3. Third part
a. Subscapular a.
b. Anterior circumflex humeral a.
c. Posterior circumflex humeral a.

V. Brachial Artery
1. Arteria profunda brachii
2. Nutrient a.
3. Muscular a.
4. Superior ulnar collateral a.
5. Inferior ulnar collateral a.
6. Ulnar a.
a. Anterior ulnar recurrent a.
b. Posterior ulnar recurrent a.
c. Common interosseous a.
d. Anterior interosseous a.
e. Posterior interosseous a.
f. Muscular branches
g. Palmar carpal branches
h. Dorsal carpal branches
i. Deep palmar branch
j. Superficial palmar arch
i. 3 Common palmar digital arteries
7. Radial a.
a. Radial recurrent
b. Muscular branches
c. Palmar carpal branch
d. Superficial palmar branch
e. Dorsal carpal branch
f. First dorsal metacarpal a.
g. Arteria princeps pollicis
h. Arteria radialis indicis
i. Deep palmar arch
i. Palmar metacarpal
ii. Reforating

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 iii. recurrent

Arteries of the Abdominal Aorta

Ventral
I. Coeliac Trunk
a. Left gastric a.
b. Hepatic a.
i. Right gastric a
ii. Gastroduodenal a.
iii. Right gastro-epigloic a.
iv. Superior pancreaticoduodenal a.
v. Cystic a.
vi. Terminal, intrahepatic br.
c. Splenic a.
i. Pancreatic br. Stomach and Esophagus
ii. Short gastric a. Liver
iii. Posterior gastric a.
iv. Left gastro-epiploic a.
v. Terminal splenic br.
II. Superior Mesenteric Artery
a. Inferior pancreaticoduodenal a
b. Jejunal and ileal br.
c. Ileocolic a.
d. Right colic a.
e. Middle colic a.
III. Inferior Mesenteric Artery
a. Left colic a.
b. Sigmoid (inf. L colic) a
c. Superior rectal artery
d.

Dorsal
I. Lumbar
II. Medial Sacral

Lateral
I. Inferior phrenic
II. Middle suprarenal
III. Renal
IV. Testicular or Ovarian

Terminal
I. Common Iliac A.
a. Right common iliac a.
b. Left common iliac a.
II. Anterior trunk of the Internal Iliac A.
a. Superior vesical a.
b. Inferior vesical a.
c. Middle rectal a.
d. Uterine a.
e. Vaginal a.
f. Obturator a.
g. Internal Pudendal a.
i. Muscular brnaches
ii. Inferior rectal a.
iii. Perineal a.

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 iv. Artery of the bulb of the penis
v. Urethral a.
vi. Deep artery of the penis
vii. Dorsal artery of the penis
viii. Inferior gluteal a.

III. Posterior trunk of the Internal Iliac A.

a. Iliolumbar a.
b. Lateral sacral a.
c. Superior gluteal a.

IV. External Iliac Arteries

a. Inferior epigastric a.

Arteries of the Lower Limbs

1. Femoral Artery
a. Superficial epigastric a.
b. Superficial circumflex iliac a.
c. Superficial external pudendal a.
d. Deep external pudendal a.
e. Muscular branches
2. Arteria profunda femoris
a. Lateral circumflex femoral a.
b. Medial circumflex femoral a.
c. Perforating a.
d. Muscular branches
e. Descending genicular a.
3. Popliteal artery
a. Cutaneous branches
b. Superior muscular branches
c. Sural a.
d. Superior genicular a.
e. Middle genicular a.
f. Inferior genicular a.
4. Anterior Tibial Artery
a. Posterior tibial recurrent a.
b. Anterior tibial recurrent a.
c. Muscular branches
d. Anterior medial malleolar a.
e. Anterior lateral malleolar a.
f. Arteries around the ankle joint
g. Dorsal artery of the foot
i. Tarsal a.
ii. Arcuate a.
5. Posterior Tibial Artery
a. Circumflex fibular a.
b. Peroneal a.
c. Nutrient a.
d. Muscular branches
e. Communicating branch
f. Medial malleolar branches
g. Calcanean branches
h. Medial plantar a.
i. Lateral plantar a.
6. Plantar arch
a. Perforating branches

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 b. Plantar metatarsal branches

Guyton Chapter 14:

Systemic Circulation “Greater or Peripheral circulation” – supplies blood to the whole body
Pulmonary circulation – supplies to the lungs

Arteries
 transport blood under high pressure
 strong vascular walls
 blood flows at high velocities
Arterioles
 control conduits through which blood is released into the capillaries
 strong muscular walls
 capability of vastly altering blood flow in each tissue bed
Capillaries
 site of exchange of fluid, nutrients, electrolytes, hormones and other substances between
the blood and the interstitial fluid
 thin walled and have numerous minute CAPILLARY PORES – permeable to water and
other small molecules
Venules
 collect blood from capillaries
 coalesce into larger veins
Veins
 conduits for transport of blood back into the heart
 reservoir of excess blood
 low pressure
 thin walled
 muscular enough to contract and expand thereby acting as a major reservoir of excess
blood

Circulatory Structure Cross Sectional Area (cm2) Blood in %

Systemic Circulation 84
Heart and Lungs 16
Aorta 2.5 Heart (7%)
Small Arteries 20 13
Arterioles 40 7
Capillaries 2500 7
Venules 250 64
Small Veins 80 64
Venae Cava 8 64

 Velocity of Blood is inversely proportional to vascular cross-sectional area

 33 cm/s in aorta

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  0.3 mm/s in capillaries
 THUS remains in the capillaries for 1 – 3 s for exchange
Pressures

 Mean Aortic Pressure = 100 mm Hg

 Systolic Pressure = 120 mm Hg
 Diastolic Pressure = 80 mm Hg
 Arterial Pressure = Between 120 – 80 mm Hg
 Mean Pressure (@ ® Atrium) = 0 mm Hg
 Systemic Capillaries Pressure = 35 mm Hg (arterial end)
 Systemic Capillaries Pressure = 10 mm Hg (venous end)
 Vascular Beds = 17 mm Hg

 Pulmonary Artery Systolic Pressure (at the aorta) = 25 mm Hg

 Pulmonary Artery Diastolic Pressure = 8 mm Hg
 Mean Pulmonary Arterial Pressure = 16 mm Hg
 Mean Pulmonary Capillary Pressure = 7 mm Hg


Basic Theories of Circulation

1. The Rate of blood flow to each tissue of the body is almost always precisely
controlled in relation to the tissue need.
 20-30 at resting level
 Microvessels monitor tissue needs such as availability of oxygen, and other nutrients and
accumulation of carbon dioxide and other tissue waste products
 Act directly on local blood vessels – dilating or constricting to control blood flow at a
level required by tissue
 CNS provide additional help
2. Cardiac Output is controlled by the sum of all local tissue flow.
 blood returns into the heart by way of the veins
 heart acts as an automaton, responding to the demands of the tissues
 nerve signals may also help heart respond to pump required amounts of blood
3. Arterial pressure is controlled independently of either local blood flow control or
cardiac output control.
 Nervous signals:
a. increase pumping force of heart
b. increase contraction in large veins to produce more blood in the circulation
c. generalized constriction of more arterioles such that more blood accumulates in
large arteries to increase arterial pressure
 Kidneys – hours and days – secrete pressure controlling hormones and regulating blood
volume

Determinants of Blood Flow

1. Pressure Difference

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  Pressure Gradient – blood between 2 ends of a vessel
 Force that pushes the blood along the vessel
2. Vascular Resistance (Ohm’s Law)
F = ∆P or F = P1 – P2
R R

* The difference in the pressure between 2 ends and NOT the Absolute Pressure
determines flow

Blood Flow
 quantity of blood that passes a given point of circulation over a period of time
 mL / min OR L/min
 NORMAL CARDIAC OUTPUT = 5000 mL / min or 5 L / min
1. Electromagnetic Flowmeters – electrical voltage proportional to the rate of blood flow
generated between to electrodes measures
2. Ultrasonic Doppler Flowmeter – portion of the sound reflected by RBCs in flowing blood
to crystals transmitting a lower frequency as RBCs move further away in the flow
(Doppler Effect)
Laminar Flow
 steady rate through a long smooth blood vessel as it flows in streamlines
 central portion stays in the center of the vessel
Turbulent Flow
 blood flowing in all directions in the vessel
 continuously mixing
 when the rate of blood flow becomes too great when it passes by an obstruction in a
vessel or a sharp turn or when it passes over a rough surface
 forms Eddy current – whorls
 blood flows with greater resistance because eddy currents add to overall friction
 increases in direct proportion to the velocity of blood flow, diameter of blood vessel and
density of blood
Reynolds Number (Re)
Re = V . d . p
n
where V = velocity (cm /s)
d = diameter (cm2
p = density
n = viscosity (in poise)
 200- 400 and above causes turbulent flow
 2000 and above will cause turbulent flow in smooth blood vessel
 Normal: 200-400 in large arteries

Blood Pressure
 force exerted by blood against any unit of blood against a unit area of the vessel wall

Resistance
 impediment to blood flow

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PERIPHERAL RESITANCE UNIT (PRU) = Net pressure difference / Cardiac output (100 mL/s)
Total Peripheral Resistance = 1 PRU
 constriction can raise to 4 PRU
 dilation can decrease to 0.2 PRU
 Total Vascular Pulmonary resistance – 0.14 PRU

Conductance
 measure of blood flow through a vessel given a pressure difference
 mL / s or mL / mm Hg
C= 1
Resistance
 slight changes in vessel diameter cause tremendous changes in the vessels ability to
conduct blood when flow is streamlined
C = Diameter 4

Poiseuille’s Law
 blood that is near the wall of a vessel flows extremely slowly compared to more rapid
flow in the middle of the vessel
 by integrating velocities of all concentric rings of flowing blood and multiplying them by
the areas of the rings:
F= π∆Pr4
8nl
Where: F = rate of blood flow
∆P = pressure difference between 2 ends of the vessel
r = radius of the vessel
l = length of the vessel
n = viscosity of blood

Rate of blood flow is directly proportional to fourth power of radius

 2/3 of total systemic resistance to blood flow is arterial resistance in the small arterioles
with internal diameters of 4 – 25 micrometers
 There is a 4 fold increase in vessel diameter can increase flow to as much as 256-fold
 Small change in arterioles’ diameter responding to nervous signals or local chemical
signals can either turn off almost completely or vastly increase blood flow

Total Peripheral Vascular Resistance

Series: R = R1 + R2 + R3 + R4 …
 sum of all resistances in arteries and veins, capillaries, arterioles and venules
Parallel: 1=1 1 1 1
R R 1 + R 2 + R3 + R 4
 permits tissue to regulate its own blood flow to a great extent independent of other tissue
 total resistance is far less than the resistance in a single blood vessel
 determined by the pressure gradient and its own resistance and not the resistance of other
parallel blood vessels

Total Conductance C = C1 + C2 + C3 + C4

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Hematocrit
 affects blood viscosity
 where blood is 3X the viscosity of water
 large number of RBCs in large hematocrit increase frictional drag against adjacent cells
and walls of blood vessels
 Average for Men = 42
 Average for Women = 38
 Polycythemia = 60-70

Guyton Chapter 15:

Vascular Distensibility
 increased blood flow not only because of increased pressure but also because of decresed
resistance leads to 2x
 allows arteries to accommodate the pulsatile output of the heart to average out the
pressure pulsations
 provides smooth and continuous flow of blood through very small blood vessels of
tissues
Vascular Distensibility = increase in Volume (mL)
Increase in Pressure X Orig. Volume (mmHg.mL)
 arteries on the average are 8X less distensible than veins
 pulmonary vein’s distensibility same as systemic circulation
 pulmonary arteries’ distensibility 6X as those in systemic

Vascular Compliance = Increase in Volume

Increase in Pressure
= Distensibility X Volume
 Systemic vein 24X distensible as its corresponding artery
 Volume Pressure Curve – relationship of pressure to volume in a vessel
 Systemic Venous System = 2000-3500 mL with a change in Pressure = 3-5 mm Hg

Effects of Sympathetic Stimulation and Inhibition

 increase in vascular smooth muscle tone caused by sympathetic stimulation increases
pressure at each volume of the arteries or veins
 sympathetic inhibition decreases the pressure at each volume
 valuable means for diminishing the dimensions of one segment in the circulation thus
transferring blood to other segments
 sympathetic control of vascular capacitance is also important to hemorrhage
 sympathetic tone enhancement especially to the veins reduces the vessel size enough for
circulation to continue in an almost normal level even as much as 25 % of blood has been
lost
delayed compliance – vessel exposed to increase in volume first exhibits a large increase in
pressure but progressively delayed stretching of smooth muscle in the vessel walls that allows
the pressures to return back to normal toward a period of minutes to hours

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Arterial Pressure Pulsations
Systolic Pressure = 120 mm Hg
Diastolic Pressure = 80 mm Hg
Pulse Pressure = (Difference between systolic and diastolic) = 40 mm Hg

FACTORS
1. Stroke Volume Output
2. Compliance (Total Distensibility of the Arterial Tree)
3. Character of ejection of blood
 the greater the stroke volume output, the greater the amount of blood that must be
accommodated in the arterial tree with each heartbeat
 the greater the pressure rise and fall during systole and diastole causing a greater pulse
pressure
 in old age pulse pressure may rise to 2X normal

ABNORMAL PULSE PRESSURES

1. Aortic Stenosis – diameter of the aortic valve opening is reduce significantly, the arterial
pressure pulse is decreases significantly because of diminished blood flow outward
through the stenotic valve
2. Patent Ductus Arteriosus – ½ or more of the blood pumped by the aorta by the left
ventricle immediately flows back into the pulmonary artery and lung blood vessels thus
causing diastolic pressure to fall in the next heartbeat
3. Aortic regurgitation – aortic valve is absent or does not close completely such that blood
pumped out of the aorta flows back into the ventricle resulting to fall of aortic pressure
between heartbeats

Transmission of Pulse Pressure = 3-5 m/s

Large arterial branches = 7-10m/s
Small arteries = 15-33 m/s
 the greater the compliance of each vascular segment, the slower the velocity which
explains the slow transmission in the aorta and the much faster transmission in the
smaller and much less compliant distal arteries
 aortic velocity is 15X pulse pressure velocity
 intensity of pulsation becomes progressively less in smaller arteries and arterioles and
especially in capillaries
 aortic pulsations are extremely large or the arterioles are greatly dilated can pulsations be
observed in the capillaries
DAMPING – progressive diminution of the pulsations in the periphery
1. resistance of blood movement in the vessels
2. compliance of the vessels
 resistance damps the pulsations because the more compliant the vessel, the greater the
quantity the blood required at the pulse wave front to cause an increase in pressure
 the degree of damping is almost directly proportional to the product of resistance X
compliance

AUSCULATORY METHOD

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KOROTKOFF SOUNDS - when the cuff pressure is great enough to close the artery during part
of the arterial pressure cycle then sounds are heard
 caused mainly by blood jetting through the partially occluded vessel
 jet causes turbulence in the vessel beyond the cuff and sets up vibrations heard

Veins and their functions

Veins
 capable of constricting and enlarging and therefore storing either small or large quantities
of blood and making this blood available when it is required to remain in the circulation
VENOUS PUMP
 even help to regulate cardiac output
CENTRAL VENOUS PRESSURE - pressure in the raight atrium
 right atrial pressure is regulated by a balance between
1. the ability of the heart to pump blood out of the right atrium and ventricle into the lungs
2. the tendency for blood to flow from peripheral veins to the right atrium
 when right atrial pressure decreases, weakness of the heart can elevate right atrial
pressure
 rapid inflow of blood elevates right atrial pressure
 increased venous return
1. increased blood volume
2. increased large vessel tone throughout the body with resultant increased peripheral
venous pressures
3. dilatation of arterioles which decreases peripheral resistance and allows rapid flow of
blood from the arteries to the veins
Normal ® Atrial Pressure = 0 mm Hg
Increase in ® Atrial Pressure = 20-30 mm Hg (abnormal conditions)
1. serious heart failure
2. massive transfusion which generally increases total blood volume and causes excess
quantities to attempt to flow into the heart from peripheral circulation
Lower Limit = -3 - -5 mm Hg
 pressure in the chest cavity
 when the heart pumps with exceptional vigor or when blood flow into the heart from the
peripheral vessels is greatly depressed such as in a sever hemorrhage
VENOUS RESISTANCE AND PERIPHERAL VENOUS PRESSURE
 large veins have little resistance to blood flow when they are distended that the resistance
is almost 0 or of no importance
 large veins do usually offer some resistance to blood flow
 +4-+6 mmHg than arterial pressure
 ® atrial pressure rises above normal value making blood back up into the veins especially
at +4-+6 mm Hg
 This causes a corresponding rise in peripheral venous pressure in limbs
 Sign of cardiac failure
 Intra-abdominal Pressure = +6 mm Hg
 Max rise in intra-abdominal pressure = 15-+30 mm Hg
 Result of pregnancy, large tumors or excessive fluid (ASCITES) in the abdominal cavity
 Femoral pressure must at least be equal to return blood at +20 mm Hg

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  Gravitational Pressure = rises 1 mm Hg of each 13.6 mm distance below the surface
 Pressure results from weight of water or Hydrostatic pressure
 Also occurs in vascular system due to weight of blood
 Standing still pressure in the feet = +90 mm Hg
 due to the gravitational weight of the blood in the veins between the heart and the feet
 Arm Pressure = +6 mm Hg
 Due to compression of the subclavian vein as it passes over the rib
 Gravitational pressure down the length of the arm is determined by the distance below the
level of this rib
 Gravitational Difference between the rib and the hand = +29 mm Hg
 This is added to the +6 mm Hg caused by the compression of the ribs
 Total Pressure of Veins in the Hand = +35 mm Hg
 Neck veins in upright position is collapsed = 0 mm Hg
 Sagital sinus (Brain Pressure) = -10 mm Hg
 Due to the hydrostatic suction in the skull

Venous Pump
 valves cause the pressure in the veins of the feet NOT to remain at + 90 mm Hg always
 every time a person moves, muscle tightens and contracts that it compresses the veins
adjacent to the muscles
 this squeezes the blood out of the veins to flow towards the heart
 Walking Adult Pressure in the legs = +20 mm Hg
 Venous pressure in the lower legs increase to full +90 mm Hg in 30 s
 This causes capillary leaking from circulation to tissue space
VARICOSED VEINS
 incompetent or destroyed valves
 stretched by excessive venous pressure lasting for weeks to months
 increased in diameter of the vessels that the leaflets no longer completely close  failure
of the venous pump
 bulbous protrusions of veins beneath the entire leg (lower leg)
 venous and capillary pressures become so high that leakage occurs and edema sets in the
leg
 prevents adequate diffusion of nutrient material from the capillaries to the muscles and
skin cells causing pain

Reservoir Structures
 veins can accommodate up to 20%
 nervous signals from carotid sinus and other pressure sensitive areas of the vessels
 sympathetic nerves  constrict pumping blood out

STRUCTURE ACCOMODATION (mL)

Spleen 100 – several hundred mL
Large abdominal veins 300
Venous plexus beneath the skin Several hundred mL
Heart 50 – 100
Lungs 100-200

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Spleenic pulp 50 (concentrated RBCs) H = 1-2%

Guyton Ch 16: Microcirculation, Lymphatic System: Capillary Fluid Exchange, Interstitial

Fluid
 The most purposeful function of circulation occurs in the microcirculation: transport of
nutrients in the tissues and removal of cellular excreta

STUCTURE OF MICROCIRCULATION AND CAPILLARY SYSTEM

Artery – branches 6-8 times
Arterioles – internal dia. <20m; highly muscular; dia. Change mayfold; branches 2-5x
Metarterioles – terminal arterioles; midway between arterioles and capillaries; smooth muscle
fibers encircle vessel at intermittent points
Capillaries – (large) preferential channels; (small) true capillaries.
Venules – larger than arterioles; weaker muscular coat; pressures much less than arterioles

 Blood enters through arteriole and leaves through venule

Precapillary sphincter – a smooth muscle fiber that usually encircles the capillary at the point
where each true capillary originates from the metarteriole; opens and closes entrance of capillary

Metarterioles and the precapillary sphincters are in close contact with the tissues they serve;
local conditions can cause direct effects on vessels controlling local blood flow.

Structure of Capillary Wall

 composed of unicellular layer of endothelial cells
 surrounded by basement membrane on the outside
 total thickness of wall: ~0.5m
 internal diameter: 4-9 m

“Pores” in the Capillary Membrane

 2 minute passageways that connect the interior of capillary with the exterior:

intercellular cleft
 thin slit that lies between adjacent endothelial cells
 interrupted periodically by short ridges of protein attachments holding endothelial cells
together
 each ridge broken after short distance
 fluid percolate freely through the cleft
 uniform spacing width: 6-7 nm
 located only at edges of endothelial cells
 water molecules, water-soluble ions and small solutes

plasmalemmal vesicles
 form at one surface of the cell
 by imbibing small packets of plasma or ECF
 can move slowly through endothelial cell

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  (theory) can coalesce to form vesicular channels all the way through the endothelial cell
 of little importance according to experiments in lab animals

 Special Types of “Pores” Occur in the Capillaries of Certain Organs

 to meet the peculiar needs of the organs
examples:
brain: junctions between the capillary endothelial cells are mainly “tight” junction that allow
only extremely small molecules (eg. H2O, O2, CO2) to pass into or out of the brain tissues
liver: clefts between endothelial cells are wide open, so that almost all dissolved substances of
the plasma, including the plasma proteins, can pass from the blood into the liver tissues
intestinal membranes: midway between those of the muscles and those of the liver
glomerular tufts of the kidney: numerous small windows called fenestrae penetrate all the way
through the middle of the endothelial cells, so that tremendous amounts of very small molecular
and ionic substances can filter through the glomeruli without having to pass through the clefts
between the endothelial cells.

FLOW OF BLOOD IN THE CAPILLARIES – VASOMOTION

Vasomotion – blood does not flow continuous ly through the capillaries; intermittent flow every
few seconds; through metarterioles and precapillary sphincters

Regulation of Vasomotion
Oxygen in the tissues –most important factor to affect the degree of opening and closing of
metarterioles and precapillary sphincters

 O2 usage = intermittent blood flow occurs more often, lasts much longer

Average function of capillary system

Average rate of blood flow through each capillary bed
Average capillary pressure w/in capillaries
Average rate of transfer of substances between blood in capillaries and surrounding ISF

EXCHANGE OF NUTRIENTS AND OTHER SUBSTANCES BETWEEN BLOOD AND

INTERSTITIAL FLUID

Diffusion through the capillary membrane

= most important means by which substances are transferred between plasma and ISF
= due to thermal motion of H2O and dissolved particles

 lipid-soluble substances can diffuse directly through the cell membranes of the capillary
endothelium
 water-soluble, non-lipid-soluble substances diffuse only through intercellular “pores” in
the capillary membrane
 intercellular clefts
 water of plasma is exchanged 80x before plasma goes the entire distance through
capillary

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  effect of molecular size on passage through pores: permeability of the capillary pores for
different substances varies according to their molecular diameters
 effect of concentration difference on net rate of diffusion through the capillary
membrane: proportional to the concentration difference between 2 sides of the
membrane.

INTERSITIUM AND INTERSTITIAL FLUID

Interstitium – spaces between cells; 1/6 of body
Interstitial fluid – fluid that fills interstitium

Structure of Interstitium
2 major types of solid structure
collagen fiber bundles
proteoglycan filaments

Collagen fiber bundles – extend long distances into the interstitium; extremely strong; provide
most of the tensional strength of tissues
Proteoglycan filaments – extremely thin, coiled molecules; 98% hyaluronic acid, 2% protein;
“brush pile”

“Gel” in the interstitium

derived from filtration and diffusion from capillaries
contains most of the fluid of ISF
contains almost the same constituents as plasma except lower concentration of proteins
mainly in the minute spaces among the proteoglycan filaments
tissue gel
diffusion in gel occurs 95% to 99% more rapidly than in free fluid

“Free” Fluid in the Interstitium

rivulets of “free” liquid
small free fluid vesicles
<1% in normal tissues
edema = expand up to 50% of edema fluid

PROTEINS IN THE PLASMA AND INTERSTITIAL FLUID ARE ESPECIALLY

IMPORTANT IN CONTROLLING PLASMA AND INTERSTITIAL FLUID VOLUMES

Pressure in capillaries  force fluid through capillary pores and into interstitial spaces

Colloid osmotic pressure  osmotic pressure caused by plasma proteins; fluid from interstitial
spaces to blood; prevents significant loss of fluid volume from blood

Lymphatic system – returns to the circulation the small amounts of protein and fluid that leak
from the blood

Four Primary Forces that Determine Fluid Movement (aka Starling forces)

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the capillary pressure (Pc), which tends to force fluid outward through the capillary membrane
the interstitial fluid pressure (Pif), which tends to force fluid inward through the capillary
membrane when Pif is positve but outward if Pif is negative.
the plasma colloid osmotic pressure (p), which tend to cause osmosis of fluid inward through
the capillary membrane
the interstitial fluid colloid osmotic pressure (if), which tends to cause osmosis of fluid
outward through the capillary membrane

Capillary pressure
Estimate capillary pressure experiments:
direct micropipette cannulation of the capillaries = 25 mmHg
indirect functional measurement of the capillary pressure = 17 mmHg

Interstitial fluid pressure

Negative interstitial fluid pressure – values few mmHg < atmospheric pressure
Methods:
direct cannulation of the tissues with a micropipette = -2 mmHg
the measurement of the pressure from implanted perforated capsules = -6mm Hg @ loose
subcutaneous tissue; -2 mmHg at smaller capsules
the measurement of pressure from a cotton wick inserted into the tissue = -1 to –3 mmHg
Interstitial fluid pressure in tightly encased tissues
 normal ISF pressure is usually several mmHg negative with respect to the pressure that
surrounds each tissue
average value of –3 mmHg in loose subcutaneous tissue
 due to pumping of lymphatic system

Plasma Colloid Osmotic Pressure

 Proteins in the plasma cause colloid osmotic pressure
 Total osmotic pressure – osmotic pressure at the cell membrane
 Normal values for p
 28 mmHg
 19 mmHg due to molecular effects of dissolved proteins
 9 mmHg due to cations held in the plasma by proteins; Donnan effect
 different plasma proteins contributions
 albumin = 21.8 mmHg
 globulins = 6.0 mmHg
 fibrinogen = 0.2 mmHg
 albumin important in capillary fluid dynamics

Interstitial fluid colloid osmotic pressure

 protein in ISF slightly > protein in plasma
 amount of ISF 4x of plasma
 average [protein] = 3g/dl or 40% of plasma
 average if = 8 mmHg

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Exchange of Fluid Volume though the Capillary Membrane
 Average capillary pressure at the arterial ends: 15 to 25 mmHg > at the venous ends
 Fluid filters out the capillaries at arterial ends
 Fluid reabsorbed at venous ends back to capillaries

At the arterial end:

Forces tending to move fluid outward
 Capillary pressure
 Negative interstitial free fluid pressure
 Interstitial fluid colloid osmotic pressure
Forces tending the move fluid inward
 Plasma colloid osmotic pressure
Summation of forces
 More outward forces than inward
 Net outward force

At the venous end:

Forces tending to move fluid inward
 Plasma colloid osmotic pressure
Forces tending the move fluid outward
 Capillary pressure
 Negative interstitial free fluid pressure
 Interstitial fluid colloid osmotic pressure
Summation of forces
 More inward forces than outward
 Net inward force

Starling Equilibrium for Capillary Exchange

 fluid in at arterial end = fluid out at venous end
 excess flows to lymphatic vessels
 net filtration = 2mL/min
 filtration coefficient – expression for each mmHg imbalance

LYMPAHTIC SYSTEM
 An accessory route by which fluid can flow from the interstitial spaces into the blood
 Exceptions: superficial portions of the skin, CNS, endomysium of muscles, bones
 pre-lymphatic
 Lymph from the lower part of the body  thoracic duct left internal jugular vein and
subclavian vein
 Lymph from left side of the head, left arm and parts of the chest  thoracic duct
 Lymph from right side of neck and head, right arm and parts of the right thorax  right
lymphatic duct juncture of the right subclavian vein and internal jugular vein

Terminal Lymphatic Capillaries and Their Permeability

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  The fluid that returns to the circulation by way fo the lymphatics is extremely important
because substances of high molecular weight, such as proteins, cannot be absorbed from
the tissues in any other way; can enter lymphatic capillaries umimpeded

Special structure of lymphatic capillaries

 Endothelial cells of lymphatic capillaries attached by anchoring filaments to the
surrounding connective tissue
 At junctions of adjacent endothelial cell: overlap of endothelial cells, free to flap inward
(a minute valve to interior of capillary)
 Lymphatics have valves at the very tips of the terminal lymphatic capillaries up to larger
vessels to emptying point in blood circulation

Formation of Lymph
 lymph derived from ISF that flows into lymphatics
 protein concentration of ISF
 most tissues : 2 g/dl
 liver : 6 g/dl
 intestine: 3 to 4 g/dl
 2/3 of all lymph from liver and intestines
 3 to 5 g/dl @ thoracic duct
 lymphatic system, one of the major routes for absorption of nutrients from GI tract
 responsible for the absorption of fats
 bacteria can enter lymph  filtered and destroyed

Rate of Lymph Flow

 total estimated lymph flow: 120mL/hr = 2-3L/day
 any factor that increases ISF pressure normally also increases lymph flow if the lymph
vessels are functioning normally
factors include:
1. elevated capillary pressure
2. decreased plasma colloid osmotic pressure
3. increased ISF colloid osmotic pressure
4. increased permeability of capillaries
5. maximum lymph flow rate @higher pressures than 0 mmHg
6. lymphatic pump increases lymph flow; generate up to 50-100 mmHg
7. pumping caused by external intermittent compression of the lymphatics
8. lymphatic capillary pump

Factors that determine lymph flow

ISF pressure
activity of the lymphatic pump

“ the rate of lymph flow is determined by the product of ISF pressure times the activity of the
lymphatic pump”

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Role of the Lymphatic System in Controlling Interstitial Fluid Protein Concentration, Interstitial
Fluid Volume, and Interstitial Fluid Pressure
 lymphatic system an “overflow mechanism” to return to the circulation excess proteins
and excess fluid volume from the tissue spaces
 plays a central role in controlling:
1. ISF protein concentration
2. ISF volume
3. ISF pressure
 Once the ISF protein concentration reaches a certain level and causes
comparable increase in ISF volume and ISF pressure, the return of protein and fluid by
way of the lymphatic system becomes great enough to balance exactly the rate of leakage
of these from the blood capillaries
 Reach a steady state

Significance of Negative Interstitial Fluid Pressure as a Means for Holding the Body Tissues
Together
 At places where connective tissues are very weak or absent, where tissues slide past each
other, the tissues are held together by negative ISF pressure, a partial vacuum. When the
tissues lose their negative pressure, fluid accumulates in the spaces and the condition
known as edema occurs.

Neural Regulation of Blood Pressure

BARORECEPTORS – pressure sensitive receptors in Aorta, ICA and other large arteries in the
neck and chest
Carotid Sinus Reflex – regulate BP in the brain
Carotid Sinus – small widenings in right and left ICAs just above point where they branch from
common carotid arteries
 propagate through Glossopharyngeal CN IX
 initiates aortic reflex through Vagus CN X
CHEMORECEPTORS – detect changes in oxygen, carbon dioxide and hydrogen levels in the
blood

Hormonal Regulation
Factor influence Hormone Effect on BP
Cardiac Output – increased Norepinephrine Increase
heart rate and contractility Epinephrine
Systemic Vascular Resistance
Vasoconstriction Angiotensin II Increase
Vasopressin
Norepinephrine
Epinephrine
Vasodilation Atrial natriuretic peptide Decrease
Epinephrine
Nitric Oxide
Blood Volume
Increase Aldosterone Increase

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 Antidiuretic Hormone
Decrease Atrial natriuretic peptide Decrease

Autoregulation
1. Physical Changes
 smooth muscle exhibit MYOGENIC RESPONSE – more forceful contraction when it is
stretched and relaxed
 example: when blood flow in arterioles decreases  more relax  dilated  increases
blood flow
1. Vasoconstriction and dilation
 WBC, platelets, smooth muscle fibers and endothelial cells secrete chemicals that alter
blood-vessel diameter
 Includes potassium, hydrogen, lactic acid ATP and nitric oxide
 Tissue trauma  kinins and histamines
 Walls in systemic dilate in response to low oxygen levels
 Walls in pulmonary circulation constrict in response to low oxygen levels

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