let's continue with our arteries and go then to the vertebral arteries so why vertebral if we have our heart with our a sending let's do it in red while we got it a sending aorta coming out into the subclavian here after the arch or brachiocephalic and then our supply subclavian the first branch coming off here is what party common carotid right so that's common carotid so you go one beyond the common carotid on the subclavian and you'll come to the vertebral so our second one is our vertebral it has an unusual pathway as it goes up the neck to the brain it will go through let's put in this will be our skulls or and our destination is this big frame and here what do we call it foramen magnum good foramen magnum and then we have the cervical vertebra one two three four five six seven do I put an eighth one no all right and their transfers processes remember the transverse processes on the vertebra little ones up here these are transfers processes so here we have these vertebral arteries coming off and they will go through foramen in the transverse processes as they go up to the foramen magnum now who can tell me why we have that kind of adaptation these would be vertebral arteries these were all our cervical vertebra rather an interesting arrangement just twist your head like this like you do all day long why do you think those vessels are within those processes it must be advantageous I'll leave that to your imagination and sometime you'll tell me all right let's continue on then with the subclavian the subclavian then we'll come around and as it comes to the axilla it's going to change its name to the axillary artery as it goes down to the arm what are you going to call it there the brachial artery and how many have had the blood pressure taken got some hands so that's this where you take your blood pressure on the brachial artery and just about a centimeter below the elbow the brachial artery branches into the radial and ulnar arteries so this will be about one centimeter below elbow and we'll have then which is going to be on the outside and which on the medial side which is on the lateral side radial artery owner and then the hand will have the palm our arch and the digital's palmar arch and digital's in the fingers so that gives roughly where do we take our pulse we take it distal where yes so x equals area take pulse distal radial you take it with your thumb or with your fingers with your fingers of course so let's now follow the descending aorta let's start at the top of a page because I want to go clear down to the leg if possible so we have our arch and then we have the descending aorta and we know where the diaphragm is now as long as our heart is there because we know the pericardium will attach to the diaphragm we start putting things together now as we get more systems so this will give us the thoracic aorta here and inferior to the diaphragm we'll have the abdominal aorta part of the descending aorta and within the thoracic we have the esophageal artery coming off we have the intercostals and we have the bronchioles so this will be esophageal you know how the soffits is passing through this area we had it in the mediastinum and then we have the intercostals get all the muscles between the costal cartilages and ribs and then we have the bronchial arteries going where Cardon lung sure so now we come down to the abdominal aorta and at the abdominal aorta we have many vessels coming off some are paired and some are not paired so you have room for them over there well we'll put them here we have these are the abdominal we'll have first the unpaired which will be the celiac celiac and the celiac will be supplying blood to your liver very rich in blood to your stomach to your spleen also rich in blood to pancreas as examples so many of your abdominal organs so the celiac will be the first to come off here then the second coming off its unpaired will be the superior mesenteric superior mesentery so it will supply the small intestine and part of the large intestine large intestine we call the colon and so we'll have a colon form sort of a picture frame around your abdominal wall you have an a sending transfers descending colon so if we put in our colon like this is it's a sending then it goes across the abdominal cavity then it goes down then it comes over so I can get to the rectum so the part that the superior mesenteric up to half of the transverse colon this will be supplied by superior mesentery and we'll put our superior mesentery in here and our next one is the inferior mesenteric what to use inferior mesentery and it will supply the rest of the intestine and the rectum rest of large intestine and rectum so this if you're going to be an abdominal surgeon like we had speaking to us the other day if they have to take out part of a colon because of cancer whether they take out part of the transverse ER we had an automobile accident reported and they had crushed the whole transfers so they had seat belt going across there right so they had to sew the a sending to the descending they have to know the blood supply when they're cutting these out so number three we're going to put it down a little further leave space here so these are your unpaired arteries off the abdominal now we have the paired arteries the first paired will be the renal arteries to the kidney so let's make it four will be the renal arteries as a name applies renal is kidney so we know where they're going and the vascular surgeon will be alluding to these when he comes so be sure that you keep these orders in place he'll be talking about the renal is how they use them for landmarks so here's my real coming off here and my next one will be the go Natalie arteries goon Adil arteries we have the ovarian arteries going to the ovaries and the testicular arteries going to the testes and so whether it's male or female we just call it go nate'll here it will be coming they'll be coming off as paired arteries a little longer five four go nate'll so you can see if this is going to the testes that go down it's going to be long the testicular artery to go all the way to the testes versus just to the pelvic cavity if it's the ovarian artery so that gives us the branches off of our abdominal aorta you'll see some pictures in 131a where they'll have an aneurysm of the abdominal aorta usually occurs below the renals and normally a one-inch a Horta will be swollen to 5 inches and they can see it when you lie down it pulses out here phenomenal what this artery can take and then be mended so at l4 the abdominal aorta divides into a common iliacs into the two common iliac this is a common iliac so you can feel where l4 is roughly there's going to be right about there so you transfer that around to see where you're getting the division of your abdominal aorta and the common iliac will go into an internal iliac and an external iliac this is internal iliac and it will be going to the pelvic organs and the external iliac external iliac will go in to become the femoral artery becomes femoral artery what landmark do you think it becomes the femoral artery what do you have coming from here to here at this region of the groin the inguinal ligament so we've learned that femoral arteries on the inferior part of the inguinal ligament so from here on this is going to be femoral artery now the femoral artery will go down the thigh and at the posterior aspect of the knee it's going down by posterior knee it will be called a popliteal popliteal artery you don't popliteal means not going to help you any it means ham well if they're calling these hamstrings they call the artery down their popliteal I didn't name and I'm just telling you why it gets such funny names then we go on down let's post here your knee and then we're going to divide into an anterior tibial and a posterior tibial anterior tibial posterior tibial on the other side and so forth and you'll get your types of arches they're similar but not identical and on down to your toes but I think why I want to be sure that you know the anterior tibial how many have ever had surgery where you're out for quite some time one two if they want to be sure that the feet are getting blood supply after a long prolonged hours and hours of surgery they take the pulse on the distal anterior tibial to be certain circulation as adequate after surgery you remember them doing that no all right so that gives you a bird's eye feel of your arteries obviously there many many many more than we have time to give in this class so let's turn to veins then and veins are not quite as regularly arranged as arteries nor are their coats as regular banes have three coats to and we could say how they differ from arteries we're not going to go into all of them one very thinner they have a larger lumen and what's another characteristic of veins that you don't find in arteries they have valves I mean you've got this blood coming up from your legs so in the extremities the veins have valves have you ever tried to see your valves put your hands down see they really have to be down it's kind of hard when you're sitting on the floor but if you're sitting there and then see if they swell in my body I've got huge veins in my hand so I can push out the blood and then let it come back in again it stopped by the bank by the valve but you don't have such large veins I'm sure but they're good for something the students often come to office hours and they want to see it closed see those veins because you can see the valve is way up here I pushed out the blood there's no blood in that valve I don't know what you can see but then it all comes back again right but it lets you know in the extremities you have valves so blood in veins is pushed along by contraction of our skeletal muscles that's why we get up and walk after sitting in a plane for a long time the legs begin to swell so the skeletal muscles of the leg they help propel blood in veins why you exercise you want to keep strong healthy muscles and strong healthy veins so where does all of the blood from the lower extremities and lower trunk collect to get into the heart inferior vena cavas sure where it is all the blood from the head and the upper extremities collect to get into the heart superior vena cave a simple little thing that you want to review every now and then to keep these in mind they she's asking about the valves in the extremities they look like semilunar valves I've only seen them with two flaps the ones I'll show you today for in the slides will just have two flaps one on each side all right no it's good question no you don't want all the baggage that you have in the heart for a valve you want a simple one that's going to go against the wall when the blood goes up and when it tries to come back it flaps back out so what we want to look at now are the arrangements for getting blood out of the brain so in the brain Venus Bloods going to go into veins nothing unusual but then it's going to go into venous sinuses something new venous sinuses and from venous sinuses it's going to leave the brain and go into the internal jugular vein outside the skull so what we want to discuss now is to introduce you to these important structures what are venous sinuses there are channels for venous blood in folds of dura dura mater folds I put four black of a better term dura mater what is dura mater what does it mean what's dura hard what's mater mother hard mother we could tell little stories about that because we have the Pia mater and what's the Pia mater gentle mother is talking with little kids once and they said where's the mad mother you know where they were coming from that day so dura mater is sort of like a bathing cap I mean we've all seen bathing caps that hug the scalp when you go swimming you could just take off the scalp and the hair and put one of those on the brain you've got this cap of thick connective tissue but it has many variations to so it's a thick CT covering over brain so how do we put venous sinuses into this let's take what we call a coronal section of the head coronal section is cutting straight across this way so this will be a coronal section of the head and we'll put a brain in it in its simplest form so we'll have our dura mater there are other membranes I'm not going to put those in I'm just going to give you the dura mater so one layer of the dura mater is adherent to the inside of the skull sprain the sequel's dura mater and they're actually two layers of dura mater here but when we get to the midline they separate these two are closely adherent and here is where we have formed a venous sinus it's between the layers of dura right coming across the top of your head part of this dura will come come down between the hemispheres here later we'll put in the other membranes we're just doing the dura and this sinus that we've developed here with venous blood flowing between the dura is the superior longitudinal sinus so let's take now a midsagittal cut right down the center of the head and we'll have our superior sagittal suture line titude '''l sinus running up here and it's fold of dura and then we had the dura that was coming down here so we have to put this coming down here it's coming down let's see how we want it like this so all of this is dura between the hemispheres what's it look like look like a sickle that they use to cut the hey have your handle here at sharp magic it's called a Faulks which is sickle folks sorry if al X cerebri and that's just the dura mater here this is the falx cerebri here in this veal crosses and this is it in this manner what do we see in the free edge here we see the inferior longitudinal sinus blood flow is going in this direction please this is my inferior longitudinal sinus all blood in the brain will be running into these sinuses eventually when you study it carefully you see what veins are leading into these inferior longitudinal sinus so we're flowing back and we're not going to give all of these but we'll put in here the straight sinus which will be connecting my superior with my inferior this is the straight sinus never heard of these before ever thought this is going on inside your skulls now we have what's called the tenth of the cerebellum separating the cerebral hemispheres is a layer of dura separating the cerebellum so we're going to put in this tentorium cerebelli here you have to imagine that the cerebellum is underneath just to give it its appropriate name here this is called the tentorium it's dura between cerebrum and cerebellum 10 Torr iam a very useful landmark cerebellum very simple and when these two sinuses here run together are straight and our superior I'm doing this simply it's actually more complex but I'm doing it simply along the edge of the skull where the tentorium comes we have what's called a Transpo transfer sinus it's going to come out as a transverse sinus transverse sign is all hitting blood from the brain you saw the picture of all the blood that was getting into the brain and now it's going to come up here and make an S shape sigmoid sinus sigmoid sinus and this finally will go out through the jugular foramen jugular foramen jugular means neck jugular foramen and become the internal jugular vein that's going to go down to your superior vena cava internal jugular then so you can see how all this blood you can picture in your own head it's coming around sideways and then down and coming out and see when you get a concussion and you get a subdural hematoma no two of my friends have just died from sub turtle hematomas because they're elderly and they fell so keep your bodies healthy so when you fall you can I see you sitting up straight now anyhow very serious things can happen but you'll learn all that when your clinical neurology but this gives you how the blood leaves the brain and goes back into circulation there's one other sinus that I think you should know because it's an important one I'm just going to put it in in here like this because it's right on each side of the pituitary so I'm going to put an X there because I can't draw much in there this is called the cavernous sinus cavernous sinus their folds of dura on each side of the sella turcica cavernous sinus so they'll be fold of dura lateral to sella turcica so you know where we are now terribly important area but for now we'll just put it there so at least you've heard of it where the cavernous sinus is so it gives you an idea of the complexity of the blood supply leaving the brain going into these venous sinuses so now let's just take a little bit by looking at veins and extremities where we've shown you already that they have valves and we going to take a few veins here so veins of extremities so let's just take upper the median cubital vein who knows the median cubital vein where is your median cubital thing it's right here in the anterior aspect of your elbow it's the one that you use if you're going to give blood they withdraw blood from the median cubicle this is anterior elbow withdraw blood and you get infusion of blood there right have you ever had to have either blood or saline or anything inject it into your body now put it in the median so infuse blood here all right just a few veins in the lower extremity some lower extremity let's just take two examples let's take a deep femoral so you can imagine where it's going to be you've seen the femoral artery in the thigh this is going to be the deep vein in the thigh and it can be subject to a condition called phlebitis how many have ever heard of phlebitis nobody phlebitis is inflammation of the vein so you can picture a veins wall because you know it has the three coats just like the artery but they're not as well formed we'll show a picture in a moment and in phlebitis with the inflammation of the vein clots are formed for the leg gets painful when did they frequently see phlebitis after surgery and then you're immobile for weeks or so don't move phlebitis can occur they can go in and tie off the deep femoral vein and you have to set up all new what we call collateral circulation terribly painful if we have a deep vein we have superficial vein the superficial vein of the lower extremity super official thing lower extremity anybody know the name of it it's the thank you longus vein in your body the saphenous vein saphenous never heard of it it's the longest vein in body it's coming from the medial aspect of the arch of your foot can't read that very well sorry medial aren't Oh foot where is it going to empty into the femoral vein where is your femoral vein on the surface Oh femoral triangle right hmm said federal triangle 20 times if I said it once all right so it's going to enter ferrule vein that femoral triangle remember femoral triangle navel and a de L what did our V stand for vein right review review review because this when you go into the field it's essential so what did they use the saphenous vein for today anybody know anybody who's had bypass surgery yeah lots of us professor wait care had bypass surgery went down cut out a piece of his saphenous vein use that to replace his carotid artery his coronary artery something to think about saphenous vein used for bypass surgery are we finished no I'll do this because I want you to appreciate this because somebody in bioengineering right now is trying to use stem cells to grow endothelial cells and smooth muscle cells to make artificial arteries because you're putting a vein or an artery let's look at a vein slides please see if you would like a vein being supplemented for your arteries [Applause] here we are with the arteries we've just discussed we have our internal common carotid that our external internal carotid well they won't show the subclavian coming off here I mean the vertebral but we'll just take this one this is the subclavian coming down to the axillary around the armpit the axilla the break he'll then switch branching into radial ulnar palmar arch and digital's and then we had the arteries from the descending aorta they don't show the branches of the thoracic here but they have a celiac and they show the this would be the superior mesenteric arenal the good Adil's the inferior mesenteric coming down to the common iliac the internal iliac the external iliac could become femorals popliteal down to posterior tibial anterior tibial down to arches and digital's next one next one please now these are just cross-sections with a scanning am to see blood vessels beautiful clear blood vessels next one next one please this is an outside of a scanning am and this is a peri site it's thought that parasites pick up things that are leaking from blood vessels the next slide will be a unique one that you won't find anywhere in the next slide this is a blood vessel in an alzheimer individual these are the multiplication of parasites which tell us about leaky blood vessels in Alzheimer's as my husband's work at UCLA and he showed this decades ago and he told me yesterday this has become fashionable now that leaky blood vessels may play a big role in but you can see these parasites in the next one and then this is our descending aorta it will be giving off the intercostals it will show everything now we see the diaphragm coming down to the abdominal aorta with our celiac and our mesenteric our renals coming off here in the next one now this is an artery you've seen this what kind of artery elastic or muscular muscular bye good for you your internal elastic membrane your muscle and your connective tissue next one what's that large lumen thin wall it's a vein would you like the vein substituting for an artery you would if your coronaries block today's world but hopefully that someday we'll have replaced arteries rather than using the saphenous vein in the next one and this is a vein it's a larger one it's a smooth muscle connective tissue next one now this is a vein with valves you asked about valves these are endothelial flaps of connective tissue and they're sort of like pockets on a coat if I worn a coat today you know you have your pocket when you're want to go down my hands are too dirty to put them in my pockets but the flap goes out when it blood goes by the pocket goes sideways you can see how that would work so we have two flaps here in a vein next one and this just shows the veins they look pretty rich but you could see how they're coming up for you have the popliteal vein here's your long saphenous coming up from down here all the way up to your femoral here you have your external iliac vein internally as we said pretty much they follow the arteries but here you'll have your inferior vena cava here having superior vena cava and the next one shows next one please here's the saphenous vein see how big it is when you get varicose veins it frequently swells tremendously but they feel they could get rid of this because there's so many other veins to take blood from the foot so that they'll take a piece of vein but you never take a piece of an artery in the next one and here it is coming all the way up into our femoral triangle here at the superior aspect of the thigh in the next one and these then are the traverses for the venous blood in the skull we'd have a superior longitudinal sinus the inferior longitudinal sinus the straight sinus the transfers sinus II they've taken out the tentorium cerebelli here it's on the ridge then it will curve around in the sigmoid sinus and go out through the jugular foramen just one more I think next one this shows the transverse sinus as I showed you with a coronal section they call it either superior sagittal or superior longitudinal but we'll learn more when we talk about cerebral spinal fluid coming back into this sinus all right you