back with blood vessels and the blood to the liver the liver is extremely rich in blood vessels it will get oxygenated blood through the hepatic artery so first we have the hepatic artery and it will be giving the O2 blood does anybody know where the hepatic artery comes from no good guess but not right that's all right now from the Celiac do you remember the Celiac not too well where is the Celiac coming from the abdominal aorta good for you now the second blood supply coming into the liver is your hepatic portal vein hepatic portal vein and it will be bringing in nutrients from the stomach and small intestine so we'll learn what it does with these when we study the liver itself but I just wanted to give you the liver's blood vessels because it is so rich anybody know anybody who's had an accident and torn open the liver yes tremendous hemorrhagic situation occurs after that all right now let's um look at some of the disorders is the blood vessels we've talked about aneurisms let's just look at one for a moment said an aneurism is a weakening and a swelling of a vessel wall weakening swelling a vessel wall so we're just going to take an aneurysm of the aortic Arch so we'll have our normal Arch something like this if this is our ascending aorta coming out of the heart giving rise to our aortic art and if we have an aneurysm then it will look something like this with a swelling so this will be my aneurysm so we want to replace it so we have to tie off the input the output and remove the aneurysm and replace it with a Dacron sleeve we'll just put it up here here's my Dacron sleeve so replace with dakron sleeve and they always give heprin an anticoagulant after they put in a replacement because we may have an un smooth surface as the blood's going through and we may get clots so you administer heprin to prevent clotting now another disorder with the vascular system will be hypertension hypertension which as you know is high blood pressure reportedly one out of five adults in America have hypertension so what is normal blood pressure 120 over 80 what does that stand for 120 is the forest of systolic pressure force of systolic pressure with ventricular contraction and the 80 then represents the force of dis olic relaxation as it's filling force of disol relaxation while filling because we said that's what dist was so then what is the threshold that lets us know we're in trouble with our blood pressure so the threshold for high blood pressure is 140 over 90 that's the threshold for high or hypertension so it's important that we learn how to reduce high blood pressure all sorts of meditations that we can learn our taii our yoga now one other varicose veins for another disorder vericose veins is the swelling of veins in the lower extremity the swelling of superficial veins swelling of superficial [Music] veins in lower extremities called varicose veins what causes them obesity you get all this fat up here and there no muscles Contracting to keep those veins getting rid of the blood so the veins swell so obesity pregnancy think we mentioned this already that pregnancy can put pressure on the inferior vena preventing all the blood coming from the lower extremities so the veins swell and also hereditary maybe your mom or dad has vericose veins then you have to be alert that you might as well how about age age isn't a factor if one's healthy because to help those veins you have to have good skeletal muscle in your extremities right so if you if somebody in your family has varicus veins then you keep your legs go on the treadmills do all these good things aha anyhow you can work to prevent them in most cases but this gives you some examples of problems with veins so we're going now to our lymphatic system how many thought about your lymphatic system this morning how many have ever thought about their lymphatic system it's like everything else you pay no attention to it till something goes wrong so let's go to our lymphatic system so what does it consist of lymphatic tissue and lymphatic vessels and what lymph so what are our lymphatic tissues we have the spleen lymph nodes lymph nodes we've talked about a mass of lymphatic tissue that was sitting on our great vessels what did we call it thymus we'll see in a moment where our tonsils are have you've heard of your tonsils and so-called pyes patches ever heard of Pyers patches never knew you had them I'll show you a slide of them be surprised how many there are so Pyers after Mr Pyers or Dr Pyers who first found them PES patches so these are all examples of lymphatic tissue so let's take them one by one see why we need them all why take the spleen to begin with no I tried at The Rotary Club one day too a big audience as big as this and asked how many knew what their spleen did one hand went up how many had had a spleen removed same hand has anybody in this class had a spleen removed no I've had it the same thing happen in this class I'll have one student who knows about the spleen and strictly you don't care about it till it goes wrong then get it removed so spleen it's the largest mass of lymphatic tissue in your body so we'll start and give it that largest mass of lymphatic tissue in body how big is it then it's 5 in by 3 in by 2 in what does that tell you same as your heart right so you don't forget the size of your spleen or talking to little kid size of your fist makes it more tangible or big kids if you want now where is the Spain it's in the upper left abdominal quadrant what do we mean by that location let's put in our diaphragm our abdominal walls our ingal ligaments and our umbilicus so this represents our abdominal wall now we just make it into quadrants you'll find those going into surgery you talk about this all the time so we've got the upper this is my upper left abdominal quadrant where are you going to tell somebody the appendix is lower right sure right down here but it immediately helps you define area with regarding underlying organs so here we're going to have put in our spleen but we're going to use the stomach coming through the esophagus here and we have what it's called the fundus of the stomach it Curves in this way and then the stomach comes over onto the left side so I first have put in my stomach and the swelling here sorry is the fundus and the explain will sit between the diaphragm and the fundus so it caps the fundus here so you could quickly tell anybody explain this right here so in yellow is our spleen now why do you have a spleen what does it do for you it's designed as we'll see in a moment to filter blood how long did we say your rbcs last 120 days so it destroys old rbcs and it's the largest mass of lymphatic tissue in the body so it's producing lymphocytes so how is it built then to carry out these functions it has a connective tissue capsule is our CT capsule made of collagenous and elastic fibers collagenous and elastic fibers it's covered by a layer of parium which we'll talk about when we get to the abdominal cavity lay of ponum which is a cirrus membrane of mesothelial cells a Cirus membrane of mesothelial cells then to give it internal support it has tabula made of collagenous fibers that divide it off these represent tabula they're collagenous fibers just giving the internal support as well as a reticulum a reticulum means a network of reticular fibers and we can just crudely sort of put in our Network CU see we've got to be filtering blood here blood's got to be able to go through so equal a reticulum many organs have reticulums which is a network of reticular fibers much thinner than collagenous and on those reticular fibers sit macro phases so to destroy pathogens that may be coming in hundreds of them just illustrating a few macrofagos destroy pathogens and we're bringing in arterial blood spleenic artery spleenic vein so it can filter through this reticulum but on on the reticulum we have what it's called the white pulp and the red pulp white pulp just so when you're getting an exam and you see white pulp you know immediately it's spleen and it's not a lymph node for example red pulp and the white pulp consists of a central artery surrounded by masses of lymphoid just a characteristic feature of the splain central artery and lymphocytes so we'll see the white pulp up here in the cortex of the kidney of the it looks like a kidney of the Spain so if you're asked to point that out in your slide in lab you go out here for it so there's an example of what's called White pulp the majority of the spleen is red pulp and it consists of just blood sinuses with lymphocytes so all of this will have blood with lymphocytes no specific structure but it gives you the basic fundamentals of how blood can come in be filtered and go out through the spleenic vein now in contrast we have let's just be sure I've covered everything on the spleen because it is important no that's fine lymph nodes lymph nodes again are oval bodies but it's much smaller small oval bodies they can be anywhere from 1 millimet to several CM put it something that you're familiar with one millimeters can be the head of a pin and several sonometers lima beans does anybody eat lima beans few why don't you like lima beans I could tell you stories about liab beans but I won't but just giving you an example perhaps you don't even know how big they are but I was putting liab beans in here as an example for size and where do we find lymph nodes they're usually in groups I'll give you just a few location in groups let's give you the cervical because most of you probably know those cervical lymph nodes obviously they're going to be in the neck they're going to be on the medial border of your sternal cleidomastoid so now you know your sternal clyto mastoid palpate it go to your med medal border you're not there there you are do you feel lymph nodes there probably if you don't you're healthy anybody feel big ones you know when doctor feels your lymph nodes when you've got an infection in your throat right you don't get sore throats all right so this will be on the medial border of the sternal just another way for you to R view your muscles Sterno clo mastoid then we have the axillary group lymph nodes so you know where they are by the name why do I give those these are in the AEL or armpit if you prefer because it's important that women know their axillary lymph nodes well because with breast cancer the breast cancer cells will travel from the breast cancer in the lymph nodes and the first ones it's going to encounter are the axillary lymph nodes so we use the term metastasize that breast cancer cells metastasize they mobilize and go to the um axillary lymph noes metas size to axillary lymph nose so women are always told to palpate their own breasts to look for nodules but you palpate your axillary lymph nodes as well because when they do a mastectomy remove the breast they have to take out where the cancer has traveled you'll find that cancer travels all over the brain gets lung cancer we've had brains in lab were just filled with lung cancer metastasized from lungs gets in the lymphatics goes to the brain when you get into the fields you'll find how important it is to know your lymphatic system what's draining what so when you get abnormal enlargements let's just take one more the inguinal lymph nodes you remember studying the inguinal lymph nodes do you remember having n a b e l what did L stand for lymph nodes so you know exactly where they are you know where your ingon ligament is you come medially and there you could palpate has anybody had an infection in your foot and get swelling in the ininal region nobody nobody go barefoot when you were little and get stung by an ant really anybody grew up in Southern California we always had swollen in olymp noes because little kids with barefoot no all right times have changed nobody eats Li of beans and nobody got an antin modern population all right the ininal lymph nodes you know where they are and you're never going to forget Naval to remember the relationships here so that gives us our location of lymph nodes so now let's see what their function is and then we'll look at their structure so we've looked at Lo at function well lymph nodes will filter lym what did the sple do pardon filtered blood a big difference between the two we need these two filtering system systems the lymph nodes will produce lymphocytes and will produce plasma cells which we've had so these are main functions there are others of our lymph nodes so let's see how they're designed in contrast to the spleen spleen was filtering blood we have to filter lymph we have make them big just so you could see them these oval lymph node we're again going to have a connective tissue capsule we're going to have some tracula but what is different here is the arrangement of the vessels coming in and going out in the large curvature here we're going to have afferent lymph vessels these are afferent lymph vessels and we'll have eant lymph vessels e for exit e and again we'll have a reticulum because we're going to be filtering lymph and we'll see an arrangement of lymphatic nodules where a lymphocytes are being developed in these compartments you'll have lots of them so the lymphocytes then will come in and go out through the lymph vessels and we'll have a constant source of lymphocytes being produced no Central artery Now what is lymph H what do you think lymph is lymph is a tissue fluid so it's mostly water just like blood consists of water proteins sugars and other things and in some cases fat so the lymph vessels have to convey lymph convey lymph and at the blood capillary level certain amount of protein goes out into the tissues at the blood capillary level protein out to tissues and then it's essential that protein comes back to blood to blood vessels if you get excess protein and it's not able to get back into the bloodstream what happens death so it's a terribly important relationship here that blood vessels and lymph vessels play with each other they have to be permeable these lymph vessels to get the protein back into the bloodstream now the fat for some reason I don't know whether you've been taught this in your classes why fat is so different in its absorption ion to get from the intestine into the Venus system it has its own pathway and the fat is going to be absorbed in the intestine a whole different pathway it's absorbed in small intestine in lymph capillaries called Lacs lymph capillaries which are called Lacs Lacs collect in lymph vessels and go into what's called a sisterna Kylie sisterna Kylie ever heard of a sister and a Kylie what's a sistern it's a reservoir a reservoir sorry Reservoir and Kylie will be the white fat thank you and so we've already absorbed our fat into its own channels and from the sister a Kylie the lymph with the fat will go all the way up to the base of the neck see I've got here's my diaphragm and I'll have my stomach here coming around into my small intestine and the fats being absorbed in the sister of Kylie will be we'll just put it in here crudely from it will come the thoracic duct which will go along the thoracic aorta this is a thoracic duct taking the lymph up to the junction of the internal jugular with the subclavian vein so this is my internal my left internal jugular and my left subclavian and the fat will be distributed into the Venus system here is that an interesting pathway study the evolution of that why is that essential to show you the importance of lymph how much lymph is produced in a day here's your lymph the thoracic duct carries 1,000 milliliters in 24 hours it's a busy system here thoracic duct carries th000 CC's lymph for 24 hours all right we didn't quite finish our lymphatic but let's look at slides if you want to study fat absorption you put in radioactive fat you can collect it that's what we did as graduate students so you can get rates of absorption first slide please this is just to show the underside of the liver to see how vascular it is just filled with blood vessels what's this what's that no it's gallbladder right those in 131 had a whole lecture on how to take out gallbladders in the next one and this now will be the spleen here's the capsule here the tabul and it's a little hard to see Central arteries soe the next one this is reticulum reticulum you can see how blood could flow freely through it these are reticular fibers very different from collagenous and they'll have macrofagos on them to clean the the lymph in the next one here it's some very good welldefined Central arteries in white pulp of the spleen you will not see anything like this in other lymphatic tissues only the spleen in the next one and this is red pulp there's just blood flowing in the Venus sinuses with a reticulum in blue in the next one and this is a thymus gland we didn't get to the thymus it's clear to see because it has these so-called Hassel bodies which are degenerating epithelial cells has anybody in any class ever learned what Hassel bodies do I checked again this morning we still don't know but they're there next one and this will be the tonsil we'll have tonsil next time it's got stratified squamous epithelium because the mouth is the oral cavity is stratified squamous none others it doesn't filter it just produces lymphocytes next one these are py patches look at all those they're in your ilium the lower part of your small intestine what in the world are they doing there lots of them you might take a section like that and you say oh cancer of the lymphatics but that's not true this is normal amount of lymphatic tissue in your lower uh small intestine next one and then this will show what we were referring here your inguin lymph nodes down here in the grin and then you have aortic ones here's your sister a Kylie sometimes spelled with an i and sometimes with a Y coming up to the thoracic duct which will come into your uh subclavian coming up and your internal jugular coming down here would be the breast here would be the axillary lymph nodes and we have a right lymphatic trunk that we'll have to cover next time here your cervical lymph node but you see it's an independent system all of its own and yet closely aligned to the blood vascular system all right