blood vessel trans97

8/8/2019 Blood Vessel Trans97

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GROSS ANATOMY 1: Blood Vascular System and Lymphatic System

Dr. Flordeliza De Jesus

Tine, Glyn, Yba, Char, Gellie, Isabel, Marra, Roberoza, rellyB

Circulatory System

Functions:

Carries blood and lymph

Transport of materials:

Gases, particularly oxygen are being transported fromthe lungs to the cells. and carbon dioxide is transportedfrom the cells to the lungs

Transport of nutrients to the cells (glucose)

Transport of other waste materials from cells (ammonia,urea)

Transport of hormones

Contains cells which are component of the immune system

Helps in the stabilization of pH and ionic concentration ofbody fluids

Maintenance of body temperature

Regulates blood pressure

Direct blood flow to tissues: blood vessels direct blood tothe tissues when there is increase blood flow

Organs of the Circulatory System

Cardiovascular organs

Heart and blood vessels

Lymphatic organs

Lymph node, spleen, bone marrow, lymph vessels

carry blood AWAY from the heart whether the blood isdeoxygenated or oxygenated

Classification of Arteries according to size and function

1. Conducting arteries large arteries that arise from theheart

Characterized by prominent elastic fibers of thewalls of the tunica media (AORTA)

Recoil when stretched, preventing blood pressureto fall rapidly

2. Distributing Arteries arteries that reach individualorgans and branching into them

Aka as the muscular arteries

Tunica media contains thick layer of smooth muscle

RENAL ARTERY, ULNAR AND RADIALARTERIES

3. Resistance Arteries main source of peripheralresistance

Example: ARTERIOLES4. End Arteries

Anastomosis joining of branches of arteries, either from sameor different trunkAnatomical end arteries found in brain, retina, internal ear,liver, kidney, appendix

Do not anastomose with branches of arteries supplying theadjacent areas.

Functional end arteries are vessels whose terminal branchesdo anastomose with those adjacent arteries, but, the caliber ofthe anastomosis is insufficient to keep the tissue alive should oneof the arteries is occluded.

Coronary vessels in children (as one grows older, theanastomosis develops to some extend which can

temporarily support the heart when a vessel is occluded)Terminal Branches when an artery divides into two equalsizes.Example: maxillary artery and superficial temporal artery-terminal branches of external carotid artery

Carry blood towards the heart

Aka the compliant vessels where majority of the bloodresides (60-70%)

Some of the veins have flaps/ valves (except SVC)

Large veins which terminate in the heart: Superior Vena

Cava and Inferior Vena CavaTributaries smaller veins that unite to form a larger vein

A division of a main portion of a blood vesselExample: cephalic vein drains/terminates into axillaryvein

Joining of tributaries with one another formsVENOUS PLEXUSRemember: Veins do not branch, they receive tributaries

Collateral circulation

Alternative blood channel which dilates when the needarises.

accessory or secondary circulation which maintainscirculation in small anastomosing vessels when the mainartery is obstructed

Significance: knowledge of existence and position of suchchannels may be of vital importance should it necessary totie off a large artery that has been damaged by trauma ordisease.

Comparison of Blood Vessel

Artery Vein

Location Deep Superficial

Thickness Thicker Thinner

Color Whitish pink Dark

Thickest part Tunica media Tunicaadventitia/

externa

Character ofblood

Oxygenated

Except:pulmonary

trunk

Partiallydeoxygenated

Except:

Pulmonaryvein

Flow of blood AWAY fromheart

Towards theheart

When injured Blood spurtsfreely

Blood flowsfreely/ floods

over

Lumen Patent, circular Collapsed

Presence ofclotted blood

Absent Present

Systemic Circulation - transport of blood from the heart todifferent parts of the body and then back to the heart

Main trunks:Aorta carries blood away from the heart (from the left side ofthe heart, circulates, ending to right side)Superior vena Cava- blood back to the heart

Inferior Vena Cava- blood back to the heart

Pulmonary Circulation circulation of deoxygenated blood fromthe RV to the pulmonary trunk branches then pulmonaryarteries (Right and Left), oxygenated to the lungs, then to thepulmonary vein and back to the left atrium

Portal Circulation transport of blood from capillaries of one ormore organs to the capillaries of another organ

exemplified by the hepatic portal circulation

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Blood Vessel Generalities

Peripheral Circulation

ARTERIES

VEINS


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the blood supplied to spleen, pancreas, stomach, andintestines is not carried directly to the heart, they flow to thePORTAL vein

the portal vein divides like an artery into hepatic sinusoidswhich are intimately connected to hepatocytes (Liver)

Microcirculation involves capillaries as exchange vessels

blood will flow to the venules then venules will drain to largerveins

Pulse tactile arterial palpation and counting of the heart beat

Areas where pulse can be palpated:

Region Artery

Temporal (temple) Superficial temporalartery

Over the body ofmandible

Facial artery

Cervical Common carotid artery

Antecubital Brachial artery

Carpal Radial artery

Inguinal Femoral artery

Popliteal Popliteal artery

Behind the medialmalleolus

Posterior tibial artery

Dorsum of foot Dorsalis pedis artery

1. Superior Thyroid Artery curves downward to the upper pole of thyroid gkand

accompanied by external laryngeal nerve, supplies thecricothyroid muscle

2. Ascending pharyngeal artery

Supplies the pharyngeal wall3. Lingual artery

Supplies the tongue4. Facial artery

Supply the tonsi, submandibular salivary gland, musclesand skin of the face

5. Occipital artery

Supplies the back of the scalp6. Posterior auricular Artery

Supplies the auricle and the scalp7. Superficial temporal artery

Accompanied by auriculotemporal nerve, supplies thescalp

8. Maxillary artery

Supplies the upper and lower jaws, muscles ofmastication, nose, palate, meninges of the skull

1. Ophthalmic artery

Gives off the central artery of the retina, enters the opticnerve and runs forward to enter the eyeball.

Central artery is the only blood supply to the retina2. Posterior communicating artery

Runs backward to k=join posterior cerebral artery3. Anterior Cerebral Artery

Supply the medial and superolateral surfaces of thecerebral hemispheres

4. Middle Cerebral Artery

Supplies entire lateral surface of the cerebral hemisphereEXCEPT

Narrow strip of the superolateral margin

Occipital pole

Inferolateral surface of the hemisphere and all motor

area of the cerebral cortex (except leg area)5. Circle of Willis

Formed by anastomoses between branches of two internalcarotid arteries and two vertebral arteries

Anterior communicating, posterior cerebral and basilar(junction of two vertebral arteries) contribute to the circle

Cortical and cerebral branches supply the brain

1st part - extends from the origin of the subclavian artery to themedial border of the scalenus anterior muscle.Gives off:

Vertebral artery

Thyrocervical trunko Terminal branches:

Inferior thyroid artery

Superficial cervical artery

Suprascapular artery

Internal thoracic arteryo Divides into superior epigastric and musculophrenic

arteriesBranches:

Vertebral arteryo Ascends in the neck through the foramina in the

transverse processes of the upper six cervicalvertebrae

Basilar arteryo Gives off branches to the pons, cerebellum, internal

earo Divides into two posterior cerebral arteries

Posterior cerebral arteryo Cortical branches supply inferolateral surfaces of the

temporal lobe and the visual cortex on the lateral andmedial surfaces of the occipital lobe

2nd part branch : costocervical trunk

3rd part extends from lateral border of scalenus anterior muscle,across the posterior triangle of the neck to the lateral border ofthe 1st rib, where it becomes the axillary artery

- NO BRANCHES- Superficial cervical arteries and suprascapular

arteries arise from here

Branches in the neck: spinal and muscular arteriesBranches in the skull: meningeal, anterior and posterior spinal,posterior inferior cerebellar, medullary arteries

1. Venous sinuses

Superior and inferior sagittal sinuses

Straight sinus Transverse sinus

Sigmoid sinus

Occipital sinus

Cavernous sinus

Superior and inferior petrosal sinus2. Diploic veins3. Emissary veins

1. Facial Vein

Formed at the medial angle of the eye by union ofsupraorbital and supratrochlear veins

Joined by anterior division of retromandibular vein Drains into internal jugular vein

2. Superficial temporal vein

Formed on the side of the scalp

Enters parotid salivary gland, where it joins the maxillaryvein to form the retromandibular vein

3. Maxillary vein

Formed in the infratemporal fossa from the pterygoidvenous plexus

Joins superficial temporal vein to form theretromandibular vein

4. Retromandibular vein

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Branches of the Internal Carotid Artery

Branches of Subclavian Artery

Veins of Face and Neck

Veins of Brain

Blood Vessel of the Head and Neck

Branches of the External Carotid Artery


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Formed by the union of superficial temporal andmaxillary veins

Divides into anterior branch joins the facial vein,posterior branch joins the posterior auricular vein toform the external jugular vein

5. External jugular vein

Drains into subclavian vein behind the middle of theclavicle

Formed behind the angle of the jaw by the union ofposterior auricular vein with posterior division of

retromandibular vein Tributaries

Posterior external jugular vein from back of theskull

Transverse cervical vein from the skin and fasciaover posterior triangle

Suprascapular vein from back of the scapula

Anterior jugular vein6. Anterior jugular vein

Joins the external jugular vein deep to thesternocleidomastoid muscle

7. Internal jugular vein

Receives blood from the brain, face and neck

Continuation of the sigmoid sinus and leaves skullthrough jugular foramen

Ends by joining subclavian vein behind the medial endof clavicle to form brachiocephalic vein

Closely related to deep cervical lymph nodes

Superior bulb dilatation on upper end

Inferior bulb at lower end, above this is bicuspid valveTributaries:

Inferior petrosal sinus

Facial vein

Pharyngeal veins

Lingual vein

Superior thyroid vein

Middle thyroid vein8. Subclavian Vein

Continuation of axillary vein at outer border of 1

st

rib Joins internal jugular vein to form brachiocephalic vein

Receives external jugular vein

Receives thoracic duct on left side and lymphatic ducton right side

1. Thoracic Aorta

Distal continuation of the arch of aorta

Commences at the level of T4 vertebra

Ends at the level of aortic hiatus of the diaphragm in front of

the body of T12 vertebra

Branches of the Thoracic aorta

o Parietal branch

Supplies the posterior wall of thorax and diaphragm

Supplies the 3rd 11th Posterior Intercostal arteries

1st and 2nd intercostal arteries are supplied by

Subclavian artery

Supplies the Superior Phrenic and Subcostal arteries

Visceral branch

Pericardial artery

Esophageal artery

Supplies the middle third of the

esophagus

Bronchial artery

one right, two left

Supplies the trachea, bronchi and lungs

Mediastinal artery*

Supplies the lymph nodes in the posterior

mediastinum

*mam sort of mentioned the mediastinal artery but she saidshe wont include it

2. Subclavian artery

Branches that supply the thorax

Internal mammary artery / Thoracic artery

Gives rise to the anterior intercostal artery to the

upper 6 intercostal space

Gives rise to Superior Epigastric and

Musculophrenic artery at the 6th intercostal space

Musculophrenic gives rise to the 7th and 11th

anterior intercostal space

Costocervical artery

Gives off the upper 2 posterior intercostals

arteries

3.Axillary Artery

begins at the lateral border of the first rib as a continuation

of the subclavian and ends at the lower border of the teres

major muscle, where it continues as the brachial artery

Throughout its course, the artery is closely related to the

cords of the brachial plexus and their branches and is

enclosed with them in a connective tissue sheath called

the axillary sheath

Branches of the Axillary Artery

From the first part:

The highest thoracic artery is small and runs along the

upper border of the pectoralis minor.

From the second part:

The thoracoacromial artery immediately divides into

terminal branches.

The lateral thoracic artery runs along the lower border of

the pectoralis minor(Fig. 9-17).

From the third part:

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Blood vessels of the Thorax

ARTERIES
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The subscapular artery runs along the lower border of

the subscapularis muscle.

The anterior and posterior circumflex humeral

arteries wind around the front and the back of the

surgical neck of the humerus, respectively (Fig. 9-17

).

Arteries that supply the external surface of the anteriorthoracic wall

1. Posterior Intercostal Artery

At the level of 11th thoracic

2. Anterior Intercostal Artery

1st to 6th Internal Thoracic Artery

7th to 9th Musculophrenic Artery

3. Internal Thoracic Artery / Internal Mammary Artery

Superior Epigastric Artery

Musculophrenic Artery

4. Subcostal Artery

Supplies the anterolateral abdominal wall

Azygos vein

Begins in the abdomen

Enters thorax through the aortic hiatus of diaphragm

Drains the right side of posterior thoracic wall from 11th to

5th intercostal space

Receives the superior intercostal vein

Terminates at superior vena cava

Tributaries:

Posterior intercostal vein

Hemiazygos vein

Accessory hemiazygos vein

Bronchial vein

Esophageal vein

Hemiazygos vein

Begins at the abdomen

Arises from the junction of the left subcostal

vein and the ascending lumbar vein

Enters thorax behind the left crus of diaphragm

Drains the left side of posterior thoracic wall

from the 11th to the 7th intercostal space

Thoracoepigastric Vein

Connects the Superficial Epigastric vein with

Lateral Thoracic Vein

Connects Femoral vein with Axillary vein

Anterolateral abdominal wall

superior part: supplied by branches from themusculophrenic artery, a terminal branch of the internalthoracic artery;

inferior part: supplied by the medially placed superficialepigastric artery and the laterally placed superficialcircumflex iliac artery, both branches of the femoralartery

At a deeper level:

Superior epigastric (internal mammary) Artery

Superior part of the wall

terminal branch of the internal thoracic artery

enters the upper part of the rectus sheath betweenthe sternal and costal origins of the diaphragm

descends behind the rectus muscle, supplying theupper central part of the anterior abdominal wall, andanastomoses with the inferior epigastric artery

Deep Vein

follow the arteries of the same name and draininto the internal thoracic and external iliac veins

Inferior epigastric (external iliac)

Artery

Supplies the inferior part of the wall branch of the external iliac artery just above the

inguinal ligament

runs upward and medially along the medial sideof the deep inguinal ring

pierces the fascia transversalis to enter the rectussheath anterior to the arcuate line

ascends behind the rectus muscle, supplying thelower central part of the anterior abdominal wall,and anastomoses with the superior epigastricartery

Deep Vein


Intercostals vessels Artery

Supplies the lateral part of the wall (10th and

11th intercostals arteries)

lower two posterior intercostal arteries,branches of the descending thoracic aorta, andthe four lumbar arteries, branches of theabdominal aorta, pass forward between themuscle layers and supply the lateral part of theabdominal wall

Deep Vein

posterior intercostal veins drain into the azygosveins, and the lumbar veins drain into theinferior vena cava

Subcostal Artery

Supplies the lateral part of the wall

Deep circumflex iliac

Artery

supplies the inferior part of the wall

branch of the external iliac artery just above theinguinal ligament

runs upward and laterally toward the

anterosuperior iliac spine and then continuesalong the iliac crest

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23 August 2010

Blood vessels of the Abdomen

VEINS OF THORAX

ANTERIOR ABDOMINAL WALL
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supplies the lower lateral part of the abdominalwall

Deep Vein


*lateral thoracic vein connects with the tributaries ofsuperior epigastric veins and forms the thoracoepigastricvein* Veins of similar names follow the arteries and areresponsible for venous drainage.

Abdominal aorta and branches

Inferior vena cava and tributaries

Commencement of azygos and hemiazygos vein

ABDOMINAL AORTA

begins at the aortic hiatus of the diaphragm as a midlinestructure at approximately the lower level of vertebra TXII

passes downward on the anterior surface of the bodies ofvertebrae LI to LIV, ending just to the left of midline at thelower level of vertebra LIV

divides into the right and left common iliac arteries

this bifurcation can be visualized on the anterior abdominalwall as a point approximately 2.5 cm below the umbilicusor even with a line extending between the highest points ofthe iliac crest

As the abdominal aorta passes through the posteriorabdominal region, the prevertebral plexus of nerves andganglia covers its anterior surface

It is related to numerous other structures:

Anterior: (as it descends) pancreas and splenic vein,the left renal vein, and the inferior part of theduodenum;

several lumbar veins cross it posteriorly as

they pass to the inferior vena cava

Right side: cisterna chyli, thoracic duct,

azygos vein, right crus of the diaphragm, andthe inferior vena cava;

Left side: left crus of the diaphragm

Branches can be classified as:

posterior branches/parietal branches supplying thediaphragm or body wall;

visceral branches supplying organs;

terminal branches.

Parietal branchesPaired

Inferior phrenic arteries

Lumbar arteries (4 pairs)

Unpaired Median sacral artery

Visceral branchesPaired

Middle suprarenal arteries

Renal arteries

Gonadal (testicular or ovarian) arteriesUnpaired

Celiac trunk

Superior mesenteric artery

Inferior mesenteric artery

Table 4-3. Branches of the abdominal

aorta

Artery Branch OriginParts

supplied

Celiac trunk Visceral(unpaired)

Immediately inferior tothe aortic hiatus of thediaphragm

Abdominalforegut

Superiormesentericartery

Visceral(unpaired)

Immediately inferior tothe celiac trunk

Abdominalmidgut

Inferiormesenteric

Visceral(unpaired)

Inferior to the renalarteries

Abdominalhindgut

artery

Middlesuprarenalarteries

Visceral(paired)

Immediately superiorto the renal arteries

Suprarenalglands

Renal arteries Visceral(paired)

Immediately inferior tothe superior mesenteric artery

Kidneys

Gonadal(Testicular orovarian)

arteries

Visceral(paired)

Inferior to the renalarteries

Testes in maleand ovaries infemale

Inferiorphrenicarteries

Parietal(paired)

Immediately inferior tothe aortic hiatus

Diaphragm

Lumbararteries

Parietal(paired)

Usually four pairs Posterior abdominal walland spinalcord

Median sacralarteries

Parietal(unpaired)

Just superior to theaortic bifurcation, passinferiorly acrosslumbar vertebrae,sacrum, and coccyx

Common iliac

arteries

Terminal Bifurcation usually

occurs at the level ofLIV vertebra

INFERIOR VENA CAVAFormation:

formed when the two common iliac veins come together atthe level of vertebra LV just to the right of midline

ascends through the posterior abdominal region anterior tothe vertebral column immediately to the right of theabdominal aorta

continues in a superior direction, and leaves the abdomen bypiercing the central tendon of the diaphragm at the level ofvertebra TVIII.

During its course, the anterior surface of the inferior vena cava is

crossed by the right common iliac artery, the root of themesentery, the right testicular or ovarian artery, the inferior partof the duodenum, the head of the pancreas, the superior part ofthe duodenum, the bile duct, the portal vein, and the liver, whichoverlaps and on occasion completely surrounds the vena cava

Tributaries:

common iliac veins;

lumbar veins

Not all of the lumbar veins drain directly intothe inferior vena cava

fifth lumbar vein generally drains into theiliolumbar vein, a tributary of the common iliacvein

third and fourth lumbar veins usually drain intothe inferior vena cava

first and second lumbar veins may empty intothe ascending lumbar veins

ascending lumbar veins are long,anastomosing venous channels that connect theexternal iliac, iliolumbar, and lumbar veins withthe azygos and hemiazygos veins of the thorax.

If the inferior vena cava becomes blocked theascending lumbar veins become importantcollateral channels between the lower and upperparts of the body.

right testicular or ovarian vein;

renal veins;

right suprarenal vein; inferior phrenic veins;

hepatic veins.* There are no tributaries from the abdominal part of thegastrointestinal tract, the spleen, the pancreas, or the gallbladderbecause veins from these structures are components of theportal venous system, which first passes through the liver.

Organs/Regions Drained by the Inferior Vena Cava

Tributaries Organ/Regions Drained

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POSTERIOR ABDOMINAL WALL


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Hepatic vein Liver

Suprarenal vein Adrenal glands

Renal vein Kidney

Gonadal vein Ovaries/Testes

Inferior phrenicvein

Diaphragm

Lumbar veins Lumbar portion of the abdomen

Internal Iliac vein Muscles of the pelvic region

External iliac vein Legs

Median sacral vein Pelvis

Relations of the Inferior Vena Cava

Posterior to the abdominal cavity

Lateral to abdominal aorta

Medial to right lung

Runs along side of the vertebral column on its right side

Enters the right atrium at the lower right, back side of the

heart.

PORTAL VEIN

2.5 in (5cm) long

begins at the level of L2 and is formed by the union of the

superior mesenteric and splenic veins

lies anterior to the inferior vena cava and posterior to the

neck of the pancreas

surrounded by the hepatic nerve plexus and accompanied

by many lymph vessels and some lymph nodes

ascends to the right, behind the first part of the duodenum,

and enters the lesser omentum

it runs upward in front of the opening into the lesser sac to

the porta hepatitis, where it divides into right and terminal

branches

Enters the liver and breaks up into sinusoids, from which

blood passes into the hepatic veins that join the inferior

vena cava

Organs Drained by the Portal Vein

GIT, spleen pancreas and gallbladder (these are

elaborated under the tributaries of the portal vein)

Drains blood from the abdominal part of thegastrointestinal tract from the lower third of the

esophagus to half way down the anal canal

Also drains from the spleen pancreas and gallbladder

Enters the liver and breaks up into sinusoids, from which

blood passes into the hepatic veins that join the inferior

vena cava

Tributaries of the Portal Vein

Splenic vein: This vein leaves the hilum of the spleen and

passes to the right in the splenicorenal ligament. It unites with thesuperior mesenteric vein behind the neck of the pancreas to formthe portal vein. It receives the short gastric, left gastroepiploic,inferior mesenteric, and pancreatic veins.

Inferior mesenteric vein: This vein ascends on the posterior

abdominal wall and joins the splenic vein behind the body of the

pancreas. It receives the superior rectal veins, the sigmoid veins,

and the left colic vein.

Superior mesenteric vein: This vein ascends in the root of the

mesentery of the small intestine. It passes in front of the third part

of the duodenum and joins the splenic vein behind the neck of

the pancreas. It receives the jejunal, ileal, ileocolic, right colic,

middle colic, inferior pancreaticoduodenal, and rightgastroepiploic veins.

Left gastric vein: This vein drains the left portion of the lesser

curvature of the stomach and the distal part of the esophagus. It

opens directly into the portal vein.

Right gastric vein: This vein drains the right portion of the lesser

curvature of the stomach and drains directly into the portal vein.

Cystic veins: These veins either drain the gallbladder directlyinto the liver or join the portal vein.

Porto-Caval Anastomosis

is a specific type ofanastomosisthat occurs between the veins

ofportal circulation and those ofsystemic circulation

normal conditions: the portal venous blood traverses the liverand drains into the inferior vena cava of the systemic venouscirculation by way of the hepatic veins this is the direct route

if the direct route is blocked: other smaller communicationsexist between the portal and systemic systems play a role inblood supply

Areas of porto-caval anastomoses:

At the lower third of the esophagus, the esophageal branchesof the left gastric vein (portal tributary) anastomose with theesophageal veins draining the middle third of the esophagusinto the azygos veins (systemic tributary).

Halfway down the anal canal, the superior rectal veins (portal

tributary) draining the upper half of the anal canal anastomosewith the middle and inferior rectal veins (systemic tributaries),which are tributaries of the internal iliac and internal pudendal

veins, respectively.

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The paraumbilical veins connect the left branch of the portal

vein with the superficial veins of the anteriorabdominal wall(systemic tributaries).

The veins of the ascending colon, descending colon,

duodenum, pancreas, and liver (portal tributary) anastomosewith the renal, lumbar, and phrenic veins(systemic tributaries).

Importance of Portal-Caval Anastomosis

Portal hypertension is a common clinical condition; it is the

hypertension in the portal vein and its tributaries

It causes the blood being forced down alternate channels by

the increased resistance to flow through the portal system

Enlargement of the portalsystemic connections is frequently

accompanied by congestive enlargement of the spleen

Portacaval shunts for the treatment of portal hypertension

may involve the anastomosis of the portal vein, because it lieswithin the lesser omentum, to the anterior wall of the inferiorvena cava behind the entrance into the lesser sac. The splenicvein may be anastomosed to the left renal vein after removingthe spleen.

named differently as they pass to different regionsSubclavian Axilllary Brachial Radial and ulnar

Palmar arches Digital arteries

Landmarks:

o Between the subclavian and axillary artery - Lower

border of the first rib

o Between the axillary and brachial artery - Lower border

of the teres major

o Between the brachial and radial/ulnar arteries -Neck of

radius

Axillary Arteryo Begins at the lateral border of the first rib as a

continuation of the subclavian artery

o Ends at the lower border of the teres major muscle,where it continues as the brachial artery

o Closely related to the cords of the brachial plexus and

their branches and is enclosed with them in aconnective tissue sheath called the axillary sheath.

The pectoralis minor muscle crosses in front of the axillary arteryand divides it into three parts:

o First Part - extends from the lateral border of the first rib

to the upper border of the pectoralis minor.Relations:

o Anterior: pectoralis major and the skin

o Posterior: long thoracic nerve (nerve to the

serratus anterior)

o Lateral: three cords of the brachial plexus

o Medial: axillary vein

o Second Part - lies behind the pectoralis minor muscle.

Relations:

o Anterior: pectoralis minor, pectoralis major, and

skin

o Posterior: posterior cord of the brachial plexus,

the subscapularis muscle, and the shoulderjoint

o Lateral: lateral cord of the brachial plexus

o Medial: The medial cord of the brachial plexus

and the axillary vein

o Third Part - extends from the lower border of

the pectoralis minor to the lower border of the teresmajor.

Relations:

o Anterior: pectoralis major for a short distance;

lower down the artery it is crossed by themedial root of the median nerve

o Posterior: subscapularis, latissimus dorsi, and

teres major. The axillary and radial nerves alsolie behind the artery

o Lateral: coracobrachialis, biceps, and humerus.

The lateral root of the median and themusculocutaneous nerves also lie on thelateral side

o Medially: ulnar nerve, axillary vein, and medial

cutaneous nerve of the arm

Branches of the Axillary ArteryFrom the first part:

o The highest thoracic artery is small and runs along the

upper border of the pectoralis minor.

From the second part:o The thoracoacromial artery immediately divides into

terminal branches.

o The lateral thoracic artery runs along the lower border

of the pectoralis minor

From the third part:

o The subscapular artery runs along the lower border of

the subscapularis muscle.

o The anterior and posterior circumflex humeral

arteries wind around the front and the back of thesurgical neck of the humerus, respectively.

Scapular Arterial Anastomosiso The extreme mobility of the shoulder joint may result in

kinking of the axillary artery and a temporary occlusionof its lumen.

o To compensate for this, an important arterial

anastomosis exists between the branches of thesubclavian artery and the axillary artery, thusensuring that an adequate blood flow takes place intothe upper limb irrespective of the position of the arm.

o Branches from the Subclavian Artery

o The suprascapular artery, which is distributed

to the supraspinous and infraspinous fossae ofthe scapula

o The superficial cervical artery, which gives

off a deep branch that runs down the medialborder of the scapula

o Branches from the Axillary Artery

o The subscapular artery and its circumflex

scapular branch supply the subscapular andinfraspinous fossae of the scapula,respectively.

o The anterior circumflex humeral artery

o The posterior circumflex humeral artery

Both the circumflex arteries form ananastomosing circle around the

surgical neck of the humerus

Brachial Arteryo Begins at the lower border of

the teres major muscle as a continuation of the axillaryarteryo Provides the main arterial

supply to the armo Terminates opposite the

neck of the radius by dividing into the radial and ulnararteries

o Branches:

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Blood vessels of the Upper Extremities

ARTERIES OF THE UPPER EXTREMITY


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o Muscular branches to the anterior compartment

of the upper arm

o The nutrient artery to the humerus

o The profunda artery arises near the beginning

of the brachial artery and follows the radialnerve into the spiral groove of the humerus.

o The superior ulnar collateral artery arises

near the middle of the upper arm and followsthe ulnar nerve.

o The inferior ulnar collateral artery arises

near the termination of the artery and takespart in the anastomosis around the elbow joint.

Ulnar Arteryo Enters the hand anterior to the flexor retinaculum on the

lateral side of the ulnar nerve and the pisiform boneo Gives off a deep branch and then continues into the

palm as the superficial palmar arch

o Superficial palmar arch

o Direct continuation of the ulnar artery

o On entering the palm, it curves laterally behind

the palmar aponeurosis and in front of the longflexor tendons

o Completed on the lateral side by one of the

branches of the radial arteryo Curve of the arch lies across the palm, level

with the distal border of the fully extendedthumb

o Fourdigital arteries arise from the convexity of the arch

and pass to the fingers.

o The deep branch of the ulnar artery arises in front of

the flexor retinaculum, passes between the abductordigiti minimi and the flexor digiti minimi, andjoins theradial artery to complete the deep palmar arch.

Radial Arteryo Leaves the dorsum of the hand by turning forward

between the proximal ends of the first and secondmetacarpal bones and the two heads of the first dorsalinterosseous muscle.

o On entering the palm, it curves medially between the

oblique and transverse heads of the adductor pollicisand continues as the deep palmar arch.

o Deep palmar arch

o Direct continuation of the radial artery

o Curves medially beneath the long flexor

tendons and in front of the metacarpal bonesand the interosseous muscles

o The arch is completed on the medial side by

the deep branch of the ulnar artery.

o The curve of the arch lies at a level with theproximal border of the extended thumb.

o Sends branches superiorly, which take part in

the anastomosis around the wrist joint, andinferiorly, tojoin the digital branches of thesuperficial palmar arch.

o Branches:

o arteria radialis indicis - supplies the lateral side

of the index finger

o arteria princeps pollicis - divides into two and

supplies the lateral and medial sides of thethumb

o Deep veinso Venae comitantes of radial and ulnar arteries

o Venae comitantes of brachial artery unites

with the basilic veino Axillary vein

o Subclavian vein found in the root of the neck

o Superficial veins

o Cephalic vein

o Ascends in the superficial fascia on

the lateral side of the biceps and, on

reaching the infraclavicular fossa,drains into the axillary vein

o Basilic vein

o Ascends in the superficial fascia on

the medial side of the bicepso Halfway up the arm, it pierces the

deep fascia and at the lower border ofthe teres major joins the venaecomitantes of the brachial artery toform the axillary vein.

o

Median cubital veino Communication between the cephalic and

basilic veinso Located in the cubital fossa

o separated from the underlying brachial

artery by the bicipital aponeurosis.

Axillary Vein

o Formed at the lower border of the teres major muscle

by the union of the venae comitantes of the brachialartery and the basilica vein.

o Runs upward on the medial side of the axillary artery

and ends at the lateral border of the first rib bybecoming the subclavian vein

o Receives tributaries, which correspond to the branches

of the axillary artery, and the cephalic vein.

Femoral Artery

Begins behind the inguinal ligament where it lies midwaybetween the ASIS & the symphysis pubis.

Descends through the femoral triangle & the adductor canal.

Branches of the Femoral artery

Superior Circumflex Iliac Artery

Superficial Epigastric Artery

Deep External Pudendal Artery

Superficial External Pudendal Artery

Profunda Femoris

Superior Circumflex Iliac Artery

Arises below the inguinal ligament& runs laterally towards theASIS.

Superficial Epigastric Artery

Arises below the inguinal ligament & runs upward to theabdominal wall as far as the umbilicus.

Deep External Pudendal Artery

Arises below the inguinal ligament& run medially to supply theskin of the scrotum.

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Blood vessels of the Lower Extremities

Arteries of the Palm

ARTERIES OF THE LOWER EXTREMITY

VEINS OF THE UPPER EXTREMITY


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Superficial External Pudendal Artery

Profunda Femoris Artery

Large branch that emerges from the femoral artery below theinguinal ligament.

Supplies structures in the anterior, medial & posterior fascialcompartments of the thigh.

Branches of the Profunda Femoris Artery

Medial & lateral femoral circumflex arteries.

Three (3) perforating arteries

4th perforating artery

Terminal portion of the profunda artery

Descending Genicular Artery

Arises in the adductor canal

Trochanteric anastomosis provides the main blood supply tothe head of the femur via the:

Superior Gluteal Artery

Inferior Gluteal Artery

Medial Femoral Circumflex Artery

Lateral Femoral Circumflex Artery

Popletial Artery

Extends up to the level of the popliteus muscle where it dividesinto anterior & posterior tibial arteries.

Branches of the Popletial Artery

Muscular branches

Articular branches- knee joint

Terminal branches- anterior & posterior tibial arteries

Anterior Tibial Artery

Arises at the bifurcation of the popliteal artery in the poplitealfossa.

Becomes the dorsalis pedis at the ankle joint.

Branches of the Anterior Tibial Artery

Muscular branches

Anastomotic branches

Dorsalis Pedis

Continuation of the Anterior Tibial Artery in front of the ankle

joint midway between the malleoli.

Bounded by the tendon of the extensor digitorum longus on thelateral side & the tendon of the extensor hallucis longus on itsmedial side.

Branches of the Dorsalis Pedis Artery

Lateral Tarsal Artery - supplies the dorsum of the foot

Arcuate Artery gives off branches to the toes

First Dorsal Metatarsal Artery supplies both sides of thebig toe.

Posterior Tibial Artery

Arises at the bifurcation of the Popliteal Artery in the poplitiealfossa.

Terminates behind the medial malleolus by dividing into medial& lateral plantar arteries.

Branches of the Tibial Artery

Peroneal artery

Medial plantar artery

Lateral plantar artery

Peroneal Artery

gives off muscular branches, a nutrient artery to the fibula and

anastomotic branches around the ankle joint.

Medial Plantar Artery

Smaller of the terminal branches of the posterior tibial artery.

Lateral Plantar Artery

Larger of the terminal branches of the posterior tibial artery.

Ends by curving medially to form the plantar arch

anastomosing with the dorsalis pedis artery.

SUPERFICIAL VEINS

Dorsal Venous network

Lies at the dorsum of the foot

Drained at the medial side by the great saphenous vein & on

the lateral side by the small saphenous vein

Great Saphenous Vein

Arises from the medial side of the foot & ascends in front of themedial malleolus

Ascends and passes behind the knee & curves forward aroundthe medial side of the thigh.

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VEINS OF THE LOWER EXTREMITY


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Passes through the saphenous opening in the deep fascia &joins the femoral below & lateral to the pubic tubercle.

Tributaries of the Great Saphenous Vein

Superficial circumflex iliac vein

Superficial epigastric vein

Superficial external pudendal vein

DEEP VEINS

Venae Comitantes

Unite at the poplitieal fossa to form the popliteal vein

Popliteal Vein

Formed by the union of the venae comitantes of the anterior &the posterior tibial arteries.

Receives the tributaries including the small saphenous vein.

Femoral Vein

Continuation of the popliteal vein

Ascends through the adductor canal of the femoral triangle

Becomes continuous with the external iliac vein.

Receives the greater saphenous vein & veins that correspondto the branches of the femoral artery.

Lymph

Remnants of the secretions reabsorbed by the capillaries

Tissue fluid collected by lymphatic vessels from interstitialtissues

Lymphatic Vessels

Tubes that assist the CV system in the removal of tissue fluidfrom the interstitial tissues of the body

Begin blindly from the interstitial tissues Return the fluid to the blood

Have beaded appearance due to the presence of numerousvalves

lymph capillaries lymph vessels lymph trunks ducts

Main Lymphatic Ducts

1. Right Lymphatic DuctDrains the following regions:

Right side of the head and neck

Right upper extremityRight side of the thorax

Terminate at the angle of junction between the rightinternal jugular vein and right subclavian vein or at thebeginning of the right brachiocephalic vein

2. Thoracic Duct

Begins below in the abdomen as a dilated sac, thecisterna chyli

Ascends through aortic opening in the diaphragm, reachesthe esophagus at the level of lower border of T4, entersthe root of the neck, then turns downward and enters thebeginning of the left brachiocephalic vein

Drains the following regions:

Left side of the head and neck

Left upper extremity

Left side of the thorax

Abdominal cavity (except upper border of liver) Pelvic cavity

Lower extremities

At the root of the neck, receives the left jugular trunk, left

subclavian trunk and left bronchomediastinal trunk.

Organ Location Function

Thymus Within themediastinum, behindthe manubrium

Important site ofimmunity in a child;houses lymphocytes;changesundifferentiated

lymphocytes into Tlymphocytes

LymphNodes

In clusters or chainsalong the paths oflarger lymphaticvessels

Sites of lymphocyteproduction; house Tlymphocytes andB lymphocytes that areresponsible forimmunity;phagocytes filterforeign particles andcellular debris fromlymph

Spleen In upper left portionof abdominal cavity,beneath thediaphragm andsuspended from thestomach

Serves as bloodreservoir; phagocytesfilter foreign particles,cellular debris, andworn erythrocytes fromthe blood; houseslymphocytes

Tonsils In a ring at thejunction of the oralcavity and pharynx

Protect againstinvasion of foreignsubstances that areingested or inhaled

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23 August 2010

Lymphatic System

LYMPHATIC CIRCULATION

LYMPHATIC ORGANS

Paningit! :P

The most fundamental principle of Medicine is Love.

PARACELSUS (1493-1541)

The Great Art of Surgery


11/11

Tine Glyn Yba Char Gellie Isabel Marra Roberoza rellyB

We all need to be fit! Our bodies must be able to sustain 4 yearsof medical school! Knowing your number is the first step. What is

your BMI??? No need to calculate, just check the chart above.

Are you exercising properly? How high is your heart rate duringexercise??? At ~20 mins of aerobic exercise we start to lose/burnmore fats + improves endurance see chart above to knowapproximately how much heart rate you need to achieve to get to

your aerobic zone.

Sensya na medyo lame ang mga paningit. Yan kasi laman nglaptop ko. Babawi na lang kami next trans :P Mark GRDumlao! Fridays after class lang ang dota schedule! hehe

Nawalan po ako ng cellphone. I am currently using a new SIM.

My new number: SUN +639339315494 /rellyB

Please give us your comments/suggestions.

In behalf of the anatomy trans group. Good luck!

Tine, Glyn, Yba, Char, Gellie, Isabel, Marra, Roberoza

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