Transcript for:
Blood Vessels Lab Lecture (Entire Lecture)

okay so so this lecture is gonna be consistent of the blood vessels lecture which will talk mostly about arteries but we will discuss arteries veins and capillaries we will also talk about not just the anatomy of the blood vessel but the locations that certain blood vessels as well as the histology now just I want to start off with the first thing I would like to say is let me just make sure I'm sure in the right screen all right is the first slide that you take a look at here now this lecture the blood vessels lab lecture is what I did is I condensed my cardiovascular to lecture which is really what this is and I took out the slides that are pertinent to the ones to the physiology stuff which we won't be tested on in here for the lab so what I did is I condensed it in the first slide kind of talks about a list unlike the heart there is no heart list you gotta know most of the heart anatomy of course anyway but I did make a list for their arteries at least the majority of the arteries that we got to know if you look here and then there are some veins that we have to know they're down here you could take a look at so we'll be discussing these throughout this lecture so another thing I want stocke talking about in this lecture is when we look at an artery vein or capillary all them are lined by simple squamous epithelial cells they're called endothelial cells so remember we took a look at this slide in previously and this is a longitudinal section of a capillary and is showing you two endothelial cells which are simple squamous epithelial cells now the entire wall which in this slide you can't catch that but the entire wall is lined by simple squamous epithelial cells not just in capillaries we see them in all blood vessels so you take a look at this slide here then which is the next one shows you that all the blood vessels from a large vein to a small size vein which is a venule or large artery like your aorta or your being a cable which is a larvae being - or a Horta to the arteriole which is a smallest artery all those are lined by simple squamous and dhothi léo cells including the capillary walls us don't forget that the heart itself remembered that inferior vena cava and aorta are continuous with the chambers of the heart all the chambers of the heart all for them both atriums and both ventricles the walls are lined by endothelial cells there is called the endocardium here is called the endothelium so again you should appreciate that another thing that you can see from this picture is that certain veins have valves right arteries will not have valves capillaries do not have valves and those valves are only present in large veins and medium-sized veins of the upper and lower extremities venules do not have one-way valves and the inferior or superior vena cava which are your largest veins do not have one-way valves arteries no one-way valves and capillaries have none as well and we'll talk about these one-way valves and the purpose of them remember they're only found in the veins large veins of the upper lower extremities not including the vena cavas and not including the venules and we'll discuss them a little further later so just going back to the endothelial cells remember these are simple squamous epithelial cells align all blood vessel walls from the capillaries to the order to the vena cava including the the inner chambers of the heart now they do have some function I left this slide in here just so you could appreciate it I'm not gonna ask you this for laboratory purposes but you could see that they're really important to help with vasodilation and constriction they help passing gases and nutrients into the tissues especially at the capillary level they allow white blood cells to migrate in and out of the circulation inhibit coagulation help with angiogenesis formation and blood vessels you have so many roles these endothelial cells so it's important to preserve them and you don't want to damage them I mean for example diabetes atherosclerosis hypertension all that which is not listed here hypertension DM means I diabetes mellitus destroy the endothelial cells in a chronic condition like that and that's not a good thing because then you need to have proper working healthy endothelial cells for things to work now appreciate that once blood gets pumped out of the left ventricle and it sends it into the aorta you know blood venture ventually travels from aorta to the arteries to the arterioles which are your small as arteries and then it goes into the capillaries now it's in the capillaries which are the smallest blood vessels in the body remember the capillaries is where the gas exchange and nutrients is occurring right so into the tissues of the organs of the brain deliver the kidneys so and we even have capillaries in the skin of course so the capillaries are everywhere remember capillaries are the smallest blood vessels they're all aligned by endothelial cells and a base membrane and we'll take a look at that little further as we come along eventually the deoxygenated blood gets sent to the venules which are the small veins the veins to the vena cava remember the vena Cambridge the largest vein the superior inferior vena cava and always remember that we said that these one-way valves that we see are only present in veins large and medium-sized veins of the upper and lower extremities now if we take a look at this slide it shows your cross-section of an artery ravine now both of them whether it's an artery or vein will have three walls or three three layers or I should say the Tunica intima the tunica media and then tunica adventitia now the tunica adventitia sometimes they also called the Tunica externa but either name is fine so the Tunica intima is an inner layer of their blood vessel walls and that's where you find the simple squamous epithelial cells called the endothelial cells here they say endothelium because they're referring to the simple squamous epithelial cells aligned the blood vessel walls along the Tunica intima remember in the heart it was called endocardium where you find endothelial cells here is called endothelium where you find the simple squamous endothelial cells of the Tunica intima of all blood vessel walls if you look at tunica media then this is all smooth muscle I remember smooth muscle is important for in blood vessel walls especially in arteries which we think of because it helps with blood pressure right raise a constriction in race to the dilation helps with the blood pressure control tunica adventitia is all connective tissue this anchors of blood vessels or in their location this slide tells you that Tunica intima and dhothi Liem tunica media ankles endothelial cells tunica media split muscle think of remembered in this case it's only going to be sympathetic nervous system that causes vasoconstriction or vasodilation there's also gases that those endothelial cells like nitric oxide that they secrete out that help with the vasodilation as well but always remember that here the tunica media is all smooth muscle Tunica externa he remembers also something called adventitia is basically just connective tissue that anchors of blood vessels into their location and the vas which I don't really stress the best of a storm that's blood vessels that supply the walls of the arteries and veins as you can see over here in this picture so always remember that whether it's an artery or vein it will have a tourniquet intimate media Tunica externa also called adventitia right now if we take a look now here this vein is showing you a little valve remember not all veins have valves right and another thing I want you to appreciate is that if you look at capillaries they don't have three layers the Tunica intima media external all they have is an endothelial cells lined by a basilar membrane that's another distinction between capillaries and all the other blood vessels all the other blood vessels have a Tunica intima media externa burst capillaries are only lined by endothelial cells which of course all other blood vessels are but in this case is that's it there is no smooth muscle there's basically just a base remembering I mean there's no there's no connective tissues like the externa as well just that basement membrane which has some connective tissue in it but again it's really thin layer it's allowing gases and nutrients to get into the tissues in Oregon so it makes sense you want just endothelial cells to be present so here's a picture of a huge artery and there's a nice-sized vein here now I appreciate that the arteries we can easily recognize them because they're round they keep their structure and you can see it has a Tunica intima the inner lie the border of the artery wall there's a tunica media and there's a tunica adventitia in the vein unlike now remember the vein also has these three layers it has the Tunica intima but if you look the tunica media is really small now some veins could appear that tunica media is large which is true but the veins won't have a round structure like the arteries do another the tunica adventitia right and here's a piece of a valve there's a piece of a valve there as well there's some adipose tissue as you can see surrounding these arteries and veins in between all those adipose there's some nerve fibers but again we're only focusing on the otter in vain JIT definitely be able to distinguish who is an artery who's a vein this is part of a better slide also appreciate that most of the veins are wobbly right so they don't maintain their structure some of them look a little oval but they won't be round perfectly round like this and give you see if I show you a perfectly round blood vessel that has to be an artery again it will have a huge tunica media and will be almost perfectly round like that whereas veins could be wobbly too oval-shaped smaller tunica media and not all then will have a valve but yes it will have the three layers just like the artery here's another artery in vein this is a small sized artery you can see right Tunica intima media adventitia I know this is an artery because it's round huge tunica media I know this is a vein because it's oval wobbly shaped small tunica media right it still has the three layers open I can distinguish both of them you should definitely be able to distinguish an odd or universe the vein now just to show you what it will look like in a cadaver if you look at this line I'm going to back away who are dissect the superficial layers these are small veins right so this is the external jugular vein if you look it's really wobbly and collapsed right that's a small vein look a large drain now this is the internal jugular vein now this vein will drain blood from the head in the brain you can see it's really wobbly and collapse of course there's no blood in here but you can see that the structure of the vein even after death doesn't maintains or does not maintain a round structure first if you look at an artery for example the common carotid artery which is artery which we'll be talking about soon it's a that's the one you take a pulse in the neck it has a round structure right so if you look you can see the arteries here have round structures so even after death arteries maintain their round structure that's again there's two reasons for that one if we go back to the lecture it's because they have a huge tunica media and another one is because they have abundant elastic connective tissue which we'll show you in a histology slide coming up this is what an a capillary will look like right so you can see a really thin wall super thin and it just has one endothelial cell lining the wall here but all of them are lined by that and you can appreciate that the blood vessels are coursing through which are the riether sites in a very nice ordered formation right so you could tell how small this blood vessel is because the red blood cells the erythrocytes are passing in a nice ordered formation they call it a reuleaux formation again you should easily be able to identify and this is a capillary because of the fact of the red blood cells or erythrocytes lining up in that form another way you could see a capillary is this is the longitudinal section of the capillary but if you look here this is the capillaries as well right there and you can see that it's small enough for just one erythrocytes the erythrocytes right there right and this is the capillary and you can see how small they are so again they're meant for erythrocytes to pass in a nice order formation singular order formation sometimes you can see there looks a little obstructed there but again this is normal flow of red blood cells passing through capillaries again you should be able to distinguish that another thing I want to show you so if you look here's another nice picture this is a cross-section of an artery and you could tell this is the Tunica intima and it shows you the endothelial cells with the nucleoli nning the wall shows you the tunica media all this layer here and it shows you the externa which is in slayer out there which is full of connective tissue now remember what causes arteries to mainly what causes arteries in regards to vasoconstriction and vasodilation is the tunica media is this huge wall of muscle which is smooth muscle and you can identify it smooth muscle because it's non striated this looks spindle-shaped no no dark bands like in cardiac and you can easily distinguish this is smooth muscle you should definitely be a dent affiant muscle for me as well as whether it's an artery whether it's coming from an artery or by just showing you smooth muscle by itself which I have and there's some external which is connective tissue out here now again it's the the tunica media the smooth muscle which is mainly responsible because there's other things that are in play but the smooth muscle is what mainly causes the veins of restriction or vasodilation regulating blood flow through the arteries now appreciate you know I'm not gonna ask you some tests but again at least for lab purposes always remember that when you vizac restrict an artery you're narrowing the diameter of the blood vessel wall that should increase the pressure passing through the artery right so you increase the pressure blood pressure if you Veysel dilate you increase the diameter not decrease you increase the diameter of the blood vessel wall and that's a blood pressure will fall right just make sense in terms of that that's where they're showing you here right if you've aged up restrict a blood vessel by decreasing the dam and or the the lumen of the hole the blood will go much faster right so there'll be a higher pressure think of it like if you put a finger on a hose and the water is coming out and you put your finger to cover it not partially the water that comes out from that partial hole because you reduce the diameter it's gonna come out shooting fast right with higher pressure so it makes sense if you do that so go on just to go over again to reiterate some of the things that I said how would you remember a order in your largest artery vena cavas large vein veins large veins and medium veins are the upper lower extremities are the ones with the one-way valves always remember whether it's a vein or an artery it's always gonna have a Tunica intima media adventitia and always remember that where the capillaries where the gas exchange occurs and nutrients is happening this is where into the tissues and organs this is where you only find endothelial cells with a basement membrane there is no Tunica intima there's no tunica media there's no tunica adventitia so again we could appreciate so in this slide we've seen before this is a different slide to show you if you look here this is oops I know that one this one and just make sure I'm sharing the right screen cuz sometimes I don't share right so again this we could easily see this an artery right huge tunica media nicely around we could easily see the vein but here like you see it has a thick tunica media as well right so this is probably a large size vein because of the fact that I see it huge tunica media and the fact that it's all voice it's not perfectly round shaped and I showed you again how that you could see in the cadaver what it looks like so this is one with blood in it passing through and you can see this is a small artery because because he has a small tunica media there showing you the endothelial cells look at the smooth muscle cells forming the tunica media and this is a venule which is the smaller size veins right so remember that after capillaries comes venules and and you could see maybe one or maybe one or two layers of smooth muscle forming tunica media a really small wall and you could always appreciate the endothelial cells really nicely and I always remembered you could see the erythrocytes and white blood cells coursing through at least in these slides you could something like this doesn't show you that this one's not so great in terms of histology I don't like the way this show the smooth muscle color and everything but anyway I want to show this one I'll show really good one in terms of something like that or something like this of course or even something like that but here anyway you can appreciate the Tunica intima media adventitia and the endothelial cells a little bit this is a small artery again this was nice to show you the endothelial cells lining the artery wall and you can see it's probably a medium-sized artery because of the layers of smooth muscles that are make up the tunica media this is an arterial which is the smallest size order remember after so it goes a order arteries or arterioles and then capillaries so for materials it goes right into capillaries so you can imagine these are small just like the venules maybe one or two layers of smooth muscle to make up the attune akin to mill and you can appreciate the endothelial cells lining that wall as well this is a venule again you can appreciate the same Anatomy never saw before some artery arterioles and venules here as well and then we seen that slide some mice most of my slides are like repetitive so let me talk about the artery again so we said why does arteries maintain so again just to go back and show you this why why if we look at a vein the largest vein in the neck called internal jugular it's wobbly and collapsed after death and then if you look at an artery which is in the internal carotid artery you neck the major artery in your neck it's round and has a round hard structure again there's gonna be two reasons for that one we already talked about is a huge Tunica intima sorry the tunica media which is all this tunic but meet the middle wall made of a smooth muscle so that's why if arteries one of the reasons arteries have a huge new comedians to maintain their structure and to help with the resilience of pounding blood pressure throughout the years of your life right so you got to have a resilient walls another thing that helps with keeping their structure in the resilience of arteries compared to veins is these two layers so this one this slide here stunts not it's not stained for it but this slide is stained for it so we know this is an artery because again huge tunica media and it's kind of round although we don't have to see the whole structure but this slide is stained specifically for two layers of abundant elastic connective tissue something called an internal elastic lamina something called the external elastic lamina now the external elastic lamina has more abundant elastic connective tissue in it but both of these walls the excuse me both these layers of internal elastic lamina and extraordinary elastic lamina consistent with the huge tunica media is what allows arteries to maintain their structure and their resilience throughout lifetime now again appreciate that this slide here is stained for the internal and external elastic lamina this one is not right still an artery is round huge to the media will have the data like those two layers of elastic connective tissue but it's not stained for unlike in that one this one is also stained for it but I rather show you stuff like that because you can appreciate it's coming from the artery but you can see right this is showing you the tunic the endothelial cells where you find the Tunica intima right underneath the Tunica intima where you find endothelial cells there you see the tunic internal elastic lamina so it's basically underneath the endothelial cells and it's the smooth muscles which make up the tunica media and then comes an external elastic lamina again this is a lower magnification which is something I would show you simple more like there's two you could easily tell this is an artery there's a Tunica intima under a lot where you will find endothelial cells underneath the Tunica intima you find an internal elastic lamina and smooth muscle and then you find the external elastic lamina and then you find the Tunica externa slash adventitia so this just shows you that in arteries this is a representation of the layers of what you would find again internally in the walls the lumen surrounding the wall the lumen of the artery you will find endothelial cells which are really important then underneath that that will be the internal elastic lamina remember number one is really the the Tunica intima right number one is where you find the Tunica intima but here they're showing you that within the Tunica intima you find endothelial cells is number one and underneath that in number two you find it internal elastic lamina which they're showing you in this picture right here it's a little black squiggly lines around the really dark ones this layer the external one is much thicker so but before they get that you can see that three is smooth muscle four is the external elastic lamina and then five is the adventitia which is the connective tissue so all arteries have this so it's important to know and why they have it this just shows you a little bit about the type of cells that are found there but we kind of already know this sort of extent of course it will have nerve endings fibroblasts in the collagen making collagen on within the Tunica externa so that's and there's some adipose tissue there too as you can see all right so shift our focus to veins a little bit about veins so we kind of said already that veins have some veins have these one-way valves remember they still have the Tunica intima media adventitia your lima endothelial cells small smaller tunica media which we did discuss but why do they have these one-way valves at least in the veins of the of the upper and lower extremities of the larger medium beings of the arms and legs right this is where we find these one-way valves and why don't they have them well these are 1.we valves because blood is going in one direction so blood and veins goes anterograde meaning forward and these one-way valves prevent it from going retrograde backwards right so you want blood to going forwards now just to explain this don't have a picture here no let me go back to another I'll come back to 42 I like this one so if you look here we kind of already know let me before we're going I need to explain why we have these roaming valves and how blood goes to veins but before we do that let me refresh your memory how blood moves through arteries right so what pushes the blood for an aorta to the capillaries remember this is oxygenated arterial blood what pushes that blood from the aorta to the capillaries well the answer is your systolic blood pressure right your blood pressure your systolic blood pressure which is coming from the left ventricle left ventricular systole it's the driving force of blood being pushed from the aorta all the way to the capillaries and your brains in your toes right that's why if you're extremely hypotensive and your blood pressure drops you couldn't syncope right you pass out because there's no oxygen going to your brain so it makes sense that you want to have a stable blood pressure because I'm not I'm not going to get oxygen nutrients to my vital organs right and again having you want a normal blood pressure because then if you have too much of it that causes arteriosclerosis and hardening and then you can have aneurysms and strokes you want to maintain a normal blood pressure of course but it is your systolic blood pressure which drives blood from the aorta to the capillaries what drives blood from the eventually the deoxygenated blood from the venules to the main to the vena cava well when it comes to the arms and legs the venules that are restricting the veins of the upper lower extremities or the medium large veins they have with these one-way valves so let me go back to the slide of 42 and again the and medium veins or the upper lower extremities have these wall valves so that blood is being shunted towards the inferior and superior vena Kiba so this is just showing you these little one-way valves you can see here I'm not gonna attack the valve but just I showed you a picture of it you can see what it looks like it shows you a venule who kind of looked at that so let me explain why what happens so what pushes blood from the up veins of the upper lower extremities towards the vena cavas so it's not your blood pressure all right it has to do with your skeletal muscle contraction so when you're moving around and your muscles and your skeletal muscles contract if it pushes the blood through these one-way valves towards the vena cavas right that's why it's important not only to have this one with valves but you have to move around right so you're sitting around and not doing anything your blood is pooling and that predisposes you to get blood clots right so you got the way your venous blood gets shunted back towards the vena cavas is because of skeletal muscle contraction when the skeletal muscles contract it squeezes the venous blood through the veins through these one-way valves towards the vena cavas so skeletal muscle contraction with the help of these one-way valves of the upper lower extremities is what pushes venous blood towards the vena cavas now the vena cava does not have this one.we valve and that's why I left this slide in here just to explain that to you and I go over this in my lecture as well but again I like to talk to this lab because it'll gives you an understanding that it's your skeletal muscles with the help of the one-way valves that pushes the blood and the upper lower extremity is the venous blood towards the vena cavas but once it gets into the vena cavas the superior and inferior vena cava they refer to it as a respiratory pump because it's the breathing in and out and the movement of your internal abdominal organs but mainly the pressure within your thoracic cavity that is pushing the venous blood from the inferior superior vena cava into your right atrium and so remember it really has nothing to do with your blood pressure and it really has nothing to do with call to muscle contraction once you get into the the veins and then once you get into the vena cavae skeletal muscle contraction with one-way valves is occurring in the upper lower extremities to push that blood towards the vena cavas once you get to the vena cavas it is the respiratory pump meaning the increase and decrease in thoracic and abdominal pressure which pushes the blood from the vena cavas into the right atrium so this picture here they're kind of showing you that you know she's moving up and down and she's pushing the blood right she's exercising that's why it's important to exercise right not only because exercise builds bones and muscle mass bone density and muscle mass but also because it helps with your circulation your brain needs it your it's great for your venous circulation is good for your lymphatic circulation now I did include this pathology stuff here I'm not gonna ask you technology again but this shows you some varicose veins now some people are more predisposed to get varicose veins this is showing you these are superficial veins that have been that are that are not working appropriately right but usually a lot of people get this from standing too long but some people are just bought prone to get them than others this is so what's happening here so varicose veins what happens that when if you're standing for long periods of time you're not moving around and what happens to blood pools in the veins and when the blood pools in the veins it stretches the one-way valves it distorts them and once the one-way valves get distorted it doesn't go back to normal and what happens is that the blood pools and that can predispose you through class right so we don't the way you get clots well could be that possible ways you get constable and when blood doesn't when blood pools also called stasis or pooling of blood if the blood doesn't flow adequately or there's a lot of turbulence those are just some reasons to get to have predispositions to develop blood clots so that's why you know a lot of people will get blood clots in the lower extremities in the veins because of the pooling of the blood and not only that remember if you mess with the vows and distort them they don't go back to their original shape and that's what's happening here right you can see these valves have been distorted soul and blood but when you contract your skeletal muscle the blood is regurgitating retrograde rites going backwards and staying in the pool veins of the lower extremities which mainly happens in the lower extremities again because of gravity not so much in the upper extremities but you can appreciate that the vowels have been distorted so again that's what they're showing you here same thing and again this is just some factors to predispose you to get blood clots in mobility again that's because you're pulling blood smoking inflammations prior surgeries injuries hormones obesity there's many other things this is just some factors so what happens so what happens is that if you if your blood core if your blood is pooling chronically and then it coagulates that becomes a thrombus now a thrombus is a stationary clock and if a piece of that thrombus comes off it becomes an embolus right now normally when we think of a clot a thrombus we think of a coagulated blood clot which is true most people think of muqaddas coagulate it's the farmers a thrombus could also be a plaque right a piece of plaque like a flute score addict plaque is in a wall of an artery the inner lining of it comes to be a mat you know piece of bacteria so or growth or bacterias that came off and could cause a throwing act as a thrombus and it comes off and come becomes an embolus so if a piece of that plaque a piece of the bacteria or a piece of this blood clot comes off and starts traveling and becomes an embolus if it happens in the lower extremities at least in this case with coagulated blood you end up getting deep vein thrombosis now just to appreciate this is superficial so you could correct this cosmetically but if this is happening superficially imagine to the large veins which is really what's worrisome of the lower extremities that you can not correct because that's large veins and it's deep inside the legs this is just very cosmetic and superficial veins it's the large veins and your lower extremities going to play a major role in pushing the blood towards the vena cavas and they're the ones playing the major role when you end up getting a deep vein thrombosis right DVT now DVDs are life-threatening because if that piece of thrombus comes off and becomes an embolus where is it going to go well if you know your Anatomy you know that these veins will empty their blood into the inferior vena cava right and so here they're showing your thrombus and then a piece comes out and becomes an embolus if that travels where's it gonna go well it's gonna go towards the inferior vena cava and then it's gonna go and travel up the inferior vena cava and then towards the right atrium right atrium goes into the right ventricle by tricuspid has mitral and where's gonna go pulmonary trunk and usually get stuck within pulmonary trunk pulmonary arteries you end up with a pulmonary embolism and this is extremely life-threatening because you can get massive clots imagine getting massive clots blocking the blood the deoxygenated blood from getting into the lungs that means you're not going to get no oxygen and this is completely life-threatening as you can see sometimes very fatal these huge pots that develop in the pulmonary trunk called a saddle embolus remember you don't need to know any of the pathology but I just do this in here so you can ppreciate it what it looks like there's huge clots going into the left and right pulmonary arteries you could see left and right pulmonary arteries and huge clots going right into the lungs same thing here you can see alright so we kind of ended of that portion of the lecture now we're going to get into the more anatomy and stick to anatomy of the major arteries and some beans so what we'll do is I'm going to start with the arteries in the heart of the hoja to refresh your memory if we take a look at the heart I will start where they order but remember this is ascending there is your arch there's your descending as soon as a wraps posteriorly so as soon as that wrap so that soon is that this is descending and then this is thoracic e order some people refer to the whole thing is descending but remember this is arch that little piece is descending and then anything posteriorly is called thoracic you order you call it for me thoracic only that piece right here is decently a little curve right there again you can see that here a sending arch descending now the way you could see that thoracic aorta just to show you before I continue is right here right so you can see this is thoracic aorta we're looking at the posterior mediastinum in the thoracic cavity and that's where you find the trachea bronchi South fergus is posterior to the trachea bronchi and to the left of the esophagus is the thoracic aorta always remember that in human anatomy the esophagus in the order are the two most posterior structures the thoracic cavity wall there adjacent to the vertebral bodies and they're always in the orientation left to right in terms left is a thoracic aorta and the right will be always the esophagus again those two are being the most posterior structures your thoracic cavity wall again tagging purposes this will be arch because they see branches coming off I can't see a setting or descending but I do see thoracic somehow I will show you differently excuse me another thing I want to talk about is the left to right coronary arteries which we kind of talked about in the harbor just refresh your memory here's your right coronary artery there's the left coronary order coming out there underneath the pulmonary trunk I remember the left my coronary arteries are the first branches of the order so remember the first branches of the order are the left coronary arteries that feed oxygen to the myocardium of the heart three branches of the arch are not the first branches of the arch of the order and remember it's your left and right coronary arteries so remember that so if we have this as a sending and this is our CH we're going to be talking about the three branches off the arch brachycephalic the left common carotid and the left subclavian again there's three branches off the arch break the cephalic sometimes they call artery or trunk left common carotid excuse me unless of Clayton so if we take a look at those by the way this is another picture of your thoracic aorta that's arch Ave order there's thoracic you order so this just shows you that branches right so here's 8 sending a order arch how do I know this is arch well I see three branches a little bit one two three this is the pulmonary trunk there's a all three branches left brachiocephalic left kumquat a list of Cleveland and three branches were seen right there and same three branches we see here right here we see a order arch there's descending order the little piece right there there's thoracic going down so this is if this is the arch because I see one two three branches there's your brachiocephalic artery there's your left common carotid there's your left subclavian you could even see the trachea behind it same thing here right shows you three branches here's a sending arch descending in one two three the three branches were talking about so let's first talk about the brachycephalic and that one that branch is going to go towards the little right side of the neck and the right upper extremity so we see that here here's your brachycephalic so this is the first branch break your cephalic off the arch going this way you see right here on this all this I get here you can take it there so we've seen that here so appreciate that the first branch of the arch is the right common carotid that's what we see here so there's a break it's a phallic right there's a right common carotid that's the first branch going up the right and left common carotid do the same thing it bifurcate at the neck meaning they divide into two into internal and external carotid now I appreciate that the breaker cephalic is going to give you two branches the right common carotid and the right vertebral but you're not going to be able to see the right vertebral in the model because it doesn't show you that don't show you break-in cephalic shows you right common carotid but does does not show you the right vertebral the right vertebral artery which is the second branch of the break is phallic and we don't do all the branches but there's some that we do talk about you can see here here's your right vertebral going up the cervical vertebra and remember the left and right vertebral arteries which we'll discuss further feed oxygen to post your party brain eventually the break has cephalic ends and becomes so it ends and becomes the right subclavian so you can see this is right subclavian right there and the right subclavian and short-lived because as soon as it passes the clavicle it becomes an axillary artery so let's take a look at that here so here's the break of Alec first branch off to arch there's your right common carotid coming off of it cannot see right vertebral we ignore that for now so you can see it here and you can see the brain is phallic turns into the right subclavian which you can catch right there so that little piece right there is your right subclavian this is brachycephalic brachiocephalic when I come and carotid and right about there I could call this right subclavian once it passes the clavicle this is your clavicle right here you left the right clavicle once it passes a clavicle your subclavian turns into X Larry for that it's unique model of the upper extremity so this torso model is probably one of the best models we have or at least that I have with my powerpoints to show you the anatomy of the three branch results the arch to neck major arteries common carotid and it shows you the subclavian right before the clavicle shows you the lesser clavia the right subclavian sorry and the lips of cleave you which haven't talked about now before we continue talking about three results to arch I want you to appreciate again that look the upper extremity right so now left and right upper extremity are kind of similar in terms of the anatomy of course but it's just where the words of the subclavian originate from the right subclavian which goes into the right upper extremity originates from the brachiocephalic so it's a it's a continuation of the brigade's fallow so as a breaker stuff I like goes up it branches to the right common carotid right vertebral and it becomes the right subclavian so that's where the right subclavian comes from passes the clavicle comes axillary axillary turns into brachial and then brachial divides into two major branches called a radial radial artery and the own order always remember radius thumb your radial bone will be by your thumb and your radial artery will be by your thumb right your wrist ulnar pinky and any anatomical rotation of your anatomical position then again palms facing forward thumbs facing laterally that means your order will be on the lateral side and your own order would be on the medial side let's take a look at this what it looks like in the model so this is upper extremity model this is the clavicle right there so that right there you're catching the end of the subclavian which I will not touch the clay in here and then you can see this will be the axillary this one right there and then excellent ends right about here and between here and here you can see this is brachial so between here and here axillary brachio and that the brachial divides into two this is your radio over here and you can catch her right there you can't you hear and you can catch it there this is your ulna this one here and you can catch your it it kind of disappears behind the muscles but again you can catch radial here radial they're all no they're all no their axillary break he'll whether it's left to right upper extremity it doesn't change so here they're shown you right so remember so Clavin passes the clavicle becomes axillary excellent the brachial brachial turns into radial ulnar make sure you able to identify these blood vessels this is showing you the bicep from the medial view you can see here's this is brachial cannot see axillary there's the radial and there's all no going our way this model shows you that the radial and ulnar bifurcate a little further down but you can still see that would amuse this woman this one's a little complicated again I will show you a whole model like that or something easily identify some point that you can easily tell who is one radial on the right this harder here here is your own radio so now we finish with the upper extremities let's go back to the three branches off the arch and continue our way up to the head and the left upper extremity to complete that so we talked about the branch of the brachiocephalic first branch off the arch and what happens to it now let's discuss the second branch off the arch now the second branch off the arch is the left common carotid remember the left common carotid comes off the second branch off the arch of the order versus the right common carotid is the first French off the brachiocephalic which you can see here you know here second branch off the arch of the order is the left common carotid and it goes up the neck this way it does exactly what the right comic order does it bifurcates in the neck so once the left or right go up the neck whether it's left right it bifurcates into internal/external and I showed you this before or it leans a little bit here's your comma karate which the right common carotid is coming off the break it's of phallic and then you can see there's external carotid and there's your oops there's your internal carotid right here which is going into the brain high in the brain external stays outside to feed the facial structures the muscles the tissues and stuff like that the battery for the computer cuz it's running out all right let me go back to the so we talked about the second branch off the arch which is your left common carotid again it does exactly what the right does here we see it right there so look here's a breaking cephalic there's your right common carotid can't see right material but you can see it turns into the right subclavian there's a left common carotid second branch off the arch now let's talk about the third branch of the arch so the third brain the arch is the left subclavian right so this is your left subclavian you can see it nicely in this model because some model doesn't show it to you so you can see one two three here's your third branch old arch again the left's are claiming you can also see these three branches from the heart model alright so the left subclavian is gonna go up the left side of the neck towards the left side of the neck but it's gonna deviate towards the left upper extremity so the left's are claiming you can catch it in two places you can catch you here where it comes off the arch as a third branch or you can catch it right before the clavicle so you can tag it here it's a little hard to see in this view but you can see it here and you can see it here so always remember the left wiser claim is originating four different places right the right subclavian which you can see here is coming from the brachycephalic turns into the right subclavian the left acclaiming comes from the third branch of the arch which you can catch it in two places here and right before the clavicle so here to show you that here's a left subclavian going towards the left upper extremity there is an artery that comes off of it which I'm not going to hold you responsible for and that artery is they call it the Ella VA the left vertebral artery so remember the right vertebral artery comes off the second branch of the brachial cephalic the left vertebral artery is actually coming off you can see it right here the left subclavian but none of the models will ever show you where they come off those vertebral but definitely no be able to identify the vertebral and where they go to that's more important which we'll be discussing so just to go back to you some more models here this one's nice one it shows you ascending arch descending nicely shows you off the arch or the three break-ins phallic left common carotid little avian shows you the first branch out to break this phallic where I come across it all right this is your left common carotid here again we these are the ones we're talking about so what you think this one is the one in pink well I know this is the arch why because I see one two three branches coming off of it see a little bit of descending right there this is your fibrous pericardium with the pericardium being attached underneath that was left behind see the trachea bronchi but sticking to cardiovascular this is your arch this is your break as a phallic we can't see where the right common carotid comes off of it or returns of the subclavian hasn't been dissected further you can see all this is brachial cephalic you can see the one in pink is your left common carotid you only catching a little bit of the less of claiming again none of this up here has been dissected thoroughly so what happens when that left the right common carotid go up the neck again this is your left common carotid so here's your right common carotid and there's your left common carotid those are the major blood vessels that you feed oxygen to your net and your brain and your head again when you take a pulse in the neck you'll you're basically trying to stick hold your fingers on the common carotid artery now the left and right common carotid go off the neck I'll show you this one better so here's your left common carotid going up and then somewhere up here above the larynx a little bit this is your larynx right there's your trachea but somewhere about here you can see it bifurcates into two it's going to turn into internal external so internal is going to feed the brain and die an external stays outside of the skull and feed your soft tissues your muscles and stuff like that you can see here it goes right there's your right common carotid calling up the neck and then there's internal excuse me internal external how do you know whose internal external always remember some models and some cadavers will show you where their internal is thicker and larger that's true so the internal is going to be the thicker one and the larger one external is a little thinner another way you recognize both of them sometimes with models and I'll show you that for example here they're kind of gonna show you that I always remember the one next posterior going towards the back is your internal and this one the most anterior one is your external again some models or in the cadavers you can easily see it though right you can see the internals much thicker and posterior external thinner well come back to those in the second this model is good shows you nicely the subclavian right there's your right subclavian there's your lips of cleaving there's your lips of cleaving left common carotid can't see right common carotid nicely at all this muscles in the way you can see a sending arch can't and can't see descending that's as much as I could see so you can test yourself from here right here you can see a sending arch can't see descending though I can stick to this they were going over I appreciate that 21 and 20 the 21 is your superior vena cava you can't see inferior because it comes from down here and don't forget 26 is your opponent Trump what are they pointing out here that would be your descending aorta right because that's a sagging orange descending this one shows you nicely go three of them so let's talk about the brain the blood vessels in the brain and show you the anatomy and I'll show you a quick video on that too so if you take a look at this from here we talked about before that that there is a left and right vertebral artery right so let me show you that again this should show the picture before there's a lifetime I'm 40 bro what happens at the left or a vertebral it's going to go through the transverse foramen of the transverse process of the cervical vertebra you only find that are we in all seven cervical vertebra now I'm not going to ask you the bones is that's a skeletal system you should appreciate that these arteries pass only through the seventh cervical vertebra and then eventually with the spinal cord going through the way through with the spinal cord through the foramen magnum so one thing once they go in through the foramen magnum you can see there's your left or right vertebral along with the spinal cord and then they join to form the basilar artery there's a basal artery and then there's there's a lot of other branches that come off of this stuff but we're only sticking to the basics now once the left vertebral joined to find the basal er the basal er will then join something called the circle Willis sometimes called cerebral arterial Circle Circle of Willis and within a circle Willis that's when you find the left and right internal carotid remember those the internal carotid is coming is this one right the larger one is the bifurcation of the common carotid whose external internal the left and right internal will go on through the skull and is gonna feed the eye most about 80% of the brain so the internal the left-to-right internal carotids are more important than your vertebral but the vertebral is also important because they feed the posterior part of the brain and they meet at the base of the brain an area called the Circle of Willis also called cerebral arterial Circle that's where you find the major branches of the internal carotid the left and a right so let me show you a video and we'll come back to this stuff blood flows to the brain through the internal carotid vertebral and basilar artery the terminal branches of the internal carotid arteries are the anterior and middle cerebral arteries they supply blood to 80% of the cerebrum the vertebral arteries enter the cranial cavity through the foramen magnum they unite to form a single basilar artery on the ventral aspect of the brainstem the terminal branches of the basilar artery the posterior cerebral arteries supply the occipital and temporal lobes of the cerebrum at the base of the brain branches of the internal carotid and basilar arteries form an anastomosis or an end-to-end communication between vessels this is called the cerebral arterial circle also known as the Circle of Willis the Circle of Willis provides alternate routes for blood to reach the brain blood is drained from the brain through small veins that it will come back to that part so let me go back to the lecture and show you this so again here it's a little blurry here but here's your right common carotid and they're highlighting the internal carotid again it's most posterior the external is over here but you can see this is the internal goes in towards through the skull through the into the brain this model we can see there's your icon this is your left common carotid and then it bifurcates into two you can appreciate that there's your internal there's your external here it shows that you is posterior where's internal posterior and external anterior and it also showed you nine of all models but at least in this model are showing you that the posterior one which is your inter is much larger this one doesn't really show you that but does show you internal external again and here you can see because the most the most posterior one is the internal carotid is your external carotid in all this is your common Quran and that's one you take a pulse room same thing there this is another good one right so here we're looking if you look at the ear we're looking at the left side of cadaver and you can see here's your right left common carotid sorry there's a left common carotid and then it bifurcates into - there's your internal carotid there's your external card you can see the size difference internal external same thing here common carotid this one looks like it's the left and then you can see internal you can look at a huge that is compared to internal sorry internal compared to external carotid so we said that just like the video said that once these left are my vertebral arteries come in with spinal cord and they basically are on the brainstem they joined to form the basilar artery the basal artery has branches as you can see as well and I worried about them but then it joins the circle Willis where it's also called a cerebral arterial circle and that's where you find the left to right internal carotid there's more right there right there now in the model or I would say in the cadaver picture you're not gonna see a huge artery you only see a little cut of a stem of a stump a little artery that was cut always remember your internal carotid is just like a video said feed your eyes in about 80% of your brain so these left internal carotid are extremely important they're the world major blood supply to you oxygen and nutrients your brain bursts of a team roles also play a role in the posterior part of the brain but they meet with the bases at the base of the brain so it brings oxygen from different directions they're referred to as the nasty Moses here's the left or it's not label the bay's ler circle Willis and you can see you there's your left and right internal carotid now you can see that there's way more branches that come off right I'm not gonna ask you those aside from the ones I just mentioned that's running vertebral basal er circle will is left and right internal carotid make sure you know that same thing here left right vertebral Easler there's just final core moving this right vertebral there's your brainstem so there's a left right vertebral phase alert so Aiko Willis left to right internal carotid it's that little stump and that little stump that was left same thing here left our materials baesler's Circle Willis and right there's your left common carotid and right there's your right common carotid again it's been cut ignore this one this one is just showing you a slot a branch buff the internal carotid we're not worried about the branches of the internal carotid testing purposes it's the middle cerebral artery that they're showing you hearings you can see it's this artery but we're not worried about those branches I'm just briefly going to discuss atherosclerosis I'm actually this is my lecture as well appreciate what is atherosclerosis remember this is plaque deposits in the walls of an a that's a flow sporadic plaques that are the positive and the walls of arteries now normally atherosclerosis begins early on in adolescence especially if you have a bad die and you don't eat healthy throughout life but usually plaque deposits occur early on in adolescence and then eventually as they build up throughout the years and your diet doesn't change you don't exercise you know you're gonna get a stroke or heart attack which are the two major kills when it comes to pass those coasts now when we talk about art ethylic erotic plats of the heart and we think of plaque deposits it can occur in the Wolves inside the wall of an artery or it could occur in the lumen on the surface where the endothelial cells are at now in the small arteries like the ones in certain parts of the brain and especially in the common carotid excuse me in the coronary arteries of the heart plaques deposit occurs inside the wall like this so here's the Tunica intima this is tunica media adventitia you can see the smooth muscle and plaque deposits start occurring inside the wall like this - it's very common and that's not good because what happens that if you get plaque deposits of cholesterol you know white blood cells are going to go there these called macrophages and it cause even more information being a scar tissue formation and then you get a calcification and that hardens and weakens the walls of the artery that could lead to rupture if you tear that Tunica intima right away you're gonna get a huge massive clot you're gonna include that artery so you don't want to tear any interlining or blood vessel wall because it would cause that especially in your in your coronary arteries by the way what causes plaque deposits well it you know when it comes to your diet it's really cholesterol ready from plant I miss you cholesterol from animal products a dairy meats chicken you know you know beef all that has cholesterol even milk and cheese of course all that is coming from that any animal products will give you high cholesterol so if you limit animal products and you stick to plant-based class rolls of plant-based foods and proteins that's gonna make you live longer and prevent effluence parodic plaques and actually could reverse it if you maintain a right diet like the Mediterranean diet and proper exercise you can actually reverse path loss for plaques but it requires a big lifestyle change you got to maintain your diet and maintain exercise some people are more predisposed to build up cholesterol levels because of genetic influences but environment plays a major role in terms of your lifestyle smoking - alright so this just shows you ok none of this is on the test this is just educational purposes but again this is the coronary artery showed you look there's fatty plaque deposits being built inside the excuse me within the wall and then wypall cells are coming in causing plants to get hard and they get calcified you can scar tissue formation and that causes more inflammation and what happens at this coat Oleum without if it doesn't burst the inner lining of the wool lottery that could cause a total occlusion but if it bursts like we see here it tears you got to get total occlusion from a clot because blood will start coagulate and this is what leads to Mario Cardinal infarctions and the heart heart attacks and strokes especially in the brain and here's the coronary artery and you can see it's totally occluded the huge clot most likely because this happened you're building plaque deposits calcified scar tissue formed and then it bursts and now you have a huge clot which we can see something like that total occlusion right you get total occlusion whether it's from a clot or because of the plant that's so big that's not good you know gotta get oxygen to the myocardium and the heart doesn't regenerate and you get a get a myocardial infarct now another way you can build plaques just so you could have a good at understanding of this is enlarged arteries like large arteries tend to build plaques on the lumen on the surface of the wall so it's not in the muscle right so here we're seeing it more inside the muscle within the walls inside the wall burst this is within the inner lining of the wall the lumen and usually these are plaque deposits remember now plaque deposits that build up like this usually occur in large arteries and usually it happens in for example in the common carotid arteries of the neck and then and then usually when you get to elderly years some you know again this this is a considerate of thrombus by the way right if it's a stationary remember clot doesn't have to be a coagulated blood and like we saw in DVT deep vein thrombosis before that was coagulated blood this is actually huge plaques that became a promise and now are considered a thrombus because if a piece of that plaque comes off it becomes an embolus just like a blood clot it would as well but in this case the embolus is not a blood clot it's actually a piece of the plaque and if that piece of that plaque comes off as an embolus it's gonna travel guess where up the internal carotid and into the brain causes a stroke so that's why a lot of elderly patients majority of them get strokes because of plaque deposits that come off the major arteries especially the common carotid in the neck so not good to play in the neck with elderly patients because if you move around the comic Rd to Mike you could dislodge one of the thrombus plaques which could turn into embolus so again a lot of this happens in big arteries like the common carotid and just to show you here's a huge clot because he has coagulated again you know this could caught just the plaque alone forming obstruction coke or blood to also coagulate so you don't have to wait for a dislodgement of plaque formation to form an arm or an embolus just because you have this thrombus full of plaque that itself could cause blood to coagulate so I mean you're in trouble if you have stuff like this right you can see here's the coagulated blood causing total obstruction of the internal carotid huge massive infarction again your brain your heart don't regenerate to the to the extent for example like your liver very little regeneration so you know if you lose it that's it most to certain extent especially depending on the area of the brain that gets affected now it's just more educational things I showed you this is karate and to our entire to directa me where they remove portions of the plaque you can see now here they opened up the common carotid and look at the plaque this is a thrombus this is a platform this so this piece of this could come off and become an embolus or you could develop coagulated blood just because you had this causing obstruction in turbulence of blood flow so this kind of be removed look all this plaque in the wall and on the surface all right so we're almost done now I won't do any more pathology I think it's a little bit at the end but let me discuss now let's continue with the thoracic aorta so I already showed you where the thoracic e order is just to go back three this is thoracic aorta I thought there we go so again tagging purpose thoracic aorta toward thoracic aorta so this is what it looks like we're here it's passing through the thorax now appreciate that it does have branches the bronchioles fgo mediastinal and pericardial tickles the pericardial sac pericardium but we don't see any of those so you're not responsible for all you got to be responsible for just thoracic your order but I appreciate the are branches we just don't see them eventually a thoracic aorta is gonna pass through the diaphragm and become the abdominal in order that one you got to be able to identify two as the entire abdominal aorta and you got to be able to identify the branches which we're gonna go now just just so you have an idea this is your diaphragm we're looking at in free review there are only three things that penetrate the diaphragm your vena cava your aorta and your esophagus those are the three things and the penetrate the diaphragm going from thoracic into abdominal so if we take a look at these branches so this is your abdominal aorta right this is the diaphragm so now we're looking at the abdominal aorta from here to here or from here to here because then bifurcates into two so all this is a family order has branches the celiac superior mesenteric adrenals renals for metals inferior mesenteric so this one shows you that where they are at but I'm just going to highlight it here because you can see you better so if this is the dom Lyoto all this and what is this abdominal aorta but then I cut a guy say well what is this branch right here well the first branch does three branches coming down the middle one two three one two three the first branch down the middle of the abdominal aorta is your celiac this is the cilia Carter that gives oxygen delivers plane stomach pancreas you don't need to know the organs it goes to I just care that you know the artery and tell me the name of my tank the second branch down the middle is your superior mesenteric artery small intestines that feed on fish with small intestines the third branch down the middle we see a right there that's your inferior mesenteric that feeds oxygen to your large intestines and nutrients and then there's gonna be a renal artery going to the left or right so there's only one super silly act one superior mesenteric one for your mesenteric and then there's a left and right renal go and touch the kidneys which Jukka see so the renals and granado's are going to the testes and ovaries so they see an artery right here going down this way little one looks like a little red spaghetti little thin in a little artery so this one is your right go nate'll there's your left go needle now let's take a look at it in cadaver so the pink is your abdominal aorta there's three branches down the middle one two three number one silly act number two superior mesenteric number three inferior mesenteric here's your renal artery there's two of them here's your gonna know the left there's Ranko nettle and then is another artery called the adrenal artery and that one is hard to see I won't tag I will not tag that one because the most part holes is a hard to see but there's an adrenal gland here and here on top and it's part of the endocrine system learn more about it in the endocrine lecture but it does have its own blood supply from the abdominal aorta but it's really hard to see the artery penetrating it so I leave that out for tagging purposes but there is an adrenal artery as well and those are your branches here you can see a different view here you can see this all this is abdominal aorta they're just silly act superior mesenteric inferior mesenteric own atlatl Reno Reno mmm that's if they're that view this is a cadaver I'd rather show your model for tagging purposes something like this so don't stress the abdominal aorta cadaver review because there are some cadavers I will show you but I tell you which ones are important you could always ask me here that here you're seeing go Nano go nano and inferior mesenteric and that's all they're showing you coming off the abdominal aorta and then it bifurcates right it turns into to about l4 l5 so once the abdominal order finishes it bifurcates into two and you can see that the left excuse me you can see the abdominal aorta and you can see the inferior vena caper right next to it on the right always keep that in mind too you can see the inferior vena cava right here I always remember the abdominal aorta in the inferior vena cava always in this orientation family orders for the left inferior vena cavas towards the right and they are the most two posterior structures on your vertebral column so they're adjacent or basically touching it so always remember domina order bifurcates about l4 l5 and you can see it here but l4 l5 disc area it bifurcates into two we're in bifurcates into two that's called your left and right common iliac artery there so there's your common iliac I'm Lilia coming earlier and that's what we see here so here's your right common iliac and between here and here is your left common iliac and I know to stop here because then it bifurcates again internal iliac and external iliac groups that's internal iliac external earlier so there's your common iliac internal iliac and there's your external internal iliac feet oxygen into the pelvic structures so this is your abdominal cavity down here is your pelvic cavity that contains some GI organs reproductive and urinary and enter our iliac we'll go into the pelvic cavity to feed some pelvic organs external iliac is larger and you can see it goes this way comes out towards and this is the groin to inguinal region I'm not going to ask you that region but I just care you know the lottery this is your external iliac and right about here becomes a femoral artery which goes into your lower extremity so again order bifurcates about 405 turns into the common iliac over here we're looking a left comment earlier then it bifurcates again internal earlier and then this is external iliac and right about here at the groin you in gonna region becomes a femoral so if i tagged this artery right there that's femoral artery where did that come from it's a continuation of the external iliac and that's what to show you here and look at they're telling you that so external iliac becomes common femoral artery sometimes a cord it's also poor known as common femoral but most people just say femoral artery so again here show common iliac turns into internal iliac externally an external becomes the femoral and then femoral feeds oxygen to the lower extremity now there are other arteries associated here just stick to the ones that we're talking about because you can see that they could get a little overwhelming with more arteries that are not on the list that we talked about at the beginning of the lecture so what happens that femoral is going to go down into the lower extremity and it's gonna feed it just it's going to become the popliteal artery and the posterior part of the knee so you can mean the femoral artery is a great artery to to take a pulse from you also do a lot of procedures from the femoral artery but remember the family will become the popliteal in the post your part of the need the post a part of the knee you could also feel a pulse there your sticky famers deep really deep into the post your part of the knee it's called a popliteal area that's where you find a popliteal artery which remember it's a continuation of the femoral and then the popliteal is going to give you two arteries that we worry about that are on your list anterior tibial and the posterior tibial artery so but we'll get to that in a second so this model shows you this is the abdominal pelvic cavity up here so it has portion of it there's your common iliac so bifurcate about 12 for l5 you're I'm telling your order that's your common iliac it's not labeled here so how many I left internal iliac sorry external iliac and then right there I've become femoral this one's labeled for femoral but again this is common iliac internal iliac external iliac and external becomes femoral same thing here a little harder to see from this view but this is common iliac inter alia external iliac femoral so as it goes into the groin lower extremity femoral from here down now remember we'll go eventually behind me and become the popliteal so we're looking at the poster part of the knee the muscles have been removed that leaves portions of the lower extremity muscles here to show you the arteries so this is your popliteal artery which is a continuation in the femoral you can see it better here so see it right about here this is all femoral and you can see it here too little blower to feed attention this is the femoral artery coming down now femoral it's going to give you two branches the anterior tibial artery which goes entirely and that gives you an artery on top of your foot called the dorsalis pedis artery so remember the anterior tibial artery it's a branch of the popliteal and the anterior tibial goes anteriorly and then gives you a branch called the dorsalis pedis artery on the dorsal aspect on top of your foot another good Poulsen tape the other branch of the popliteal is the posterior tibial artery we don't discuss the perineal but the posterior tibial artery is another artery that runs posteriorly and wraps around the medial malleolus of the of the of the tibia so wraps around it and you could get a good pulse if you stick your fingers behind the medial malleolus that is the pulse of the post field tibial artery and then that runs into the lower extremity of regards to the foot so look at the anterior artery you would see a lower extremity model and muscles have been removed the extensor is some extensors to show you the artery running anteriorly you can see here running down and then there's a branch of it right on top of the foot this is called the dorsal aspect of the foot a plantar is the bottom dorsal is a top in regards to the foot in the dorsal aspect you find an artery called the dorsalis pedis artery right on top right there so if I point to the foot and you see an artery and point to it there Salle's pedis artery remember the one running on the medial side of the ankle on the medial matter that malleolus in the tibia that ones is the posterior tibial artery that mean you can also see in the models especially I don't have a good one in the pictures but in most of the lab models you can see here you could try to show you the same thing right so here's a pup this is a not-so-great Anatomy wise but it still shows you a really simplistic model to show you that what we're trying to talk about here's a popliteal remember here's femoral going down becomes popliteal behind a knee and then you have anterior tibial and you're dorsalis pedis artery right there and there's your Dorse posterior tibial artery as a wraps around the media malleolus goes in the lower aspect of the foot all right so in regards to the veins so we said make sure you know your superior inferior vena cava and let me talk about a vein or at least a venous sinus that we have to know so your brain drains deoxygenated blood into dural venous sinuses and these dural venous sinuses collect the oxygen they blend the brain eventually they send it down through the internal jugular of your neck I'm going to show you this now the dural venous sinuses is a bunch of them all I care as you know just one of them it's called a superior sagittal sinus you should know it because that's where CSF gets recycled you should have learned about it but you can see it easily in the model and some kendamas so just to show you what it looks like so let me show you the video of what is the dural venous sinuses you can have an idea of what happens with venous blood which were shown before and let's watch this again at least halfway through it blood is drained from the brain through small veins that empty into venous channels called dural venous sinuses blood in the superior sagittal sinus passes to the confluence of sinuses blood in the inferior sagittal sinus and the great cerebral vein which unites to form the straight sinus also passed to the confluence of sinuses from here blood courses through the right and left transfers and sigmoid sinuses the sigmoid sinuses and at the jugular foramen ah at the base of the skull where they are continuous with the internal jugular veins you're gonna know two things out of here the internal jugular veins the drain to deoxygenated blood down the neck coming from the head from the brain itself coming from the dural venous sinuses and you got to know the superior sagittal sinus which is one of the dural venous sinuses let's take a look what I'm talking about so this is your superior sagittal sinus it's one of the dural venous sinuses that collects deoxygenated blood in the brain so you gotta be I recognize it you can see here this is a midsagittal head model it shows you the blue line is the oxygen in your blood and it runs right under the sagittal suture and it's called the superior sagittal sinus now again there's many other Sciences of cusine here and all these sinuses eventually drain deoxygenated blood found the internal jugular vein so this is the internal jugular vein coming down the major vein that drains deoxygenated blood from the brain so we could see the internal jugular vein right here so you can see it coming down this all this is internal jugular just call it internal jugular when you gotta know you can easily see it in the neck there's a remembers more superficial right because I showed you before in the dissection of the neck you initially see the internal jugular and then deeper then you would see the common carotid so here's internal jugular as well coming down there's another there's a right internal jugular left internal jugular you common carotid safety here thirty one and thirty one is your internal jugular 31 to Israel right common carotid sorry yeah right and then what number is that I can't see that's just and this is your left common carotid and of course don't forget superior vena cava and don't forget inferior vena cava now most of the other veins which I leave out correspond with the same name of the arteries but make sure you know the ones I'm talking about and then the last thing we're going to worry about is the liver although the liver is discuss in the GI lecture we've got to know the blood vessels I go in and out of the liver just for identification purposes so there's something called the hepatic portal system so let me explain this real quick you don't need to know about the hepatic portal system but I explain it so you can understand why these blood vessels going into the liver and exiting deliver so normally there's a venous blood system called the hepatic portal system so the venous blood that comes out of the GI tract intestines the small intestine large intestine the stomach majority the GI organs the venous blood gets sent through the hepatic portal system and gets sent to an acht or vein called the hepatic portal vein so when I take a look at the liver model the liver unlike all other organs normally when we think of an Oregon we have an artery going in and a vein going out in this case the liver has an artery going in and a vein going it so the artery normally we know when the artery brings in oxygen nutrients to an Oregon that's true we also have an oxygen a hepatic artery which brings oxygen nutrients liver that's how oxygen gets delivered mainly through the hepatic artery or alter the paddock order but there's a vein going into the liver right next to it which is larger so if I tagged that that's a hepatic artery if I tagged the larger one sometimes pinkish sometimes purplish in color it's larger than the artery and it's called the hepatic portal vein this is a pata portal vein brings in deoxygenated blood which is rich in nutrients after a meal especially after eating something into the liver so it drains all the deoxygenated blood from the GI tract including the small intestines where all the nutrients get absorbed and all the nutrients the majority of them get in to the liver because they have had a portal vein now your liver is a major organ that does a lot of things over 300 in the school finding functions for the liver the liver basically is the first organ to process all your nutrients and then it distributed throughout the body so it processes things and store it stores things and detoxifies things again I'm not going to get into the liver anatomy aside from the blood vessels or its functions because that's part of the GRE lecture but again tagging purposes I I just care about the blood vessels hepatic artery hepatic portal vein now let me show you video about the hepatic portal vein so you have a better understanding of it remember I don't care about the branches all i care is that you understand at least have an understanding of where it's coming from the blood from that padded portal vein it's coming from that padded portal system although I'm not going to ask you about that padded portal system in the lab I care about just a padded portal vein had a portal cyst is a series of veins that transports blood from abdominal organs directly to deliver this gives delivered first access to substances absorbed from the digestive tract these organs include the lower esophagus stomach small intestine large intestine spleen pancreas and gallbladder the hepatic portal vein is the largest vessel of the hepatic portal system again in this vein is the same vein that we're seeing it right here right there it is formed by the union of the splenic and superior mesenteric mains the splenic vein drains the spleen pancreas and portions of the large intestine the superior mesenteric vein drains the majority of the small and portions of the large intestine blood from the lower esophagus portions of the stomach and the gallbladder drains directly into the hepatic portal vein after entering the liver the hepatic portal vein branches numerous times to enemas channels called hepatic sinusoids now the rest of this liver in here regards to this stuff this is part of the GI lecture but just appreciate once the blood leaves the liver it's gonna leave through the left and right hepatic veins you know those you could see in the model as well so we gotta appreciate and they go right into the inferior vena Keeper so let's just take a look linor cells lining the sinusoids detoxifying metabolic wastes synthesize and secrete bile and plasma proteins as well as synthesize and store glycogen after filtering through the sinusoids blood collects in central veins throughout the liver thousands of central veins unite to form hepatic veins now there's a left and a right hand paddock vein that come out of the liver and they penetrate into the inferior vena cava you usually can the models could see the left and right hepatic veins that's where the blood exits the liver through the left to right hepatic veins and it goes right into the interview the hepatic veins exit the liver and immediately join the inferior vena cava so here in the liver models you also see the inferior vena cava because it's associated with it because what is being shunted from the hepatic portal system through the liver into the into the inferior vena cava through the hepatic veins so the way you can see a hepatic veins you see it this is from a superior view here's one there's another one back there and your other one here those are called your left and right hepatic veins it's left here and those on the right over there although it's not labeled or pictured there's the left and right hepatic veins you can see it right there coming out of the loop and it goes right into the inferior vena cava again most liver models will have an inferior vena cava model or attached to it because the left and right hepatic veins penetrate into the inferior vena cava so this model is a different view showing you the hepatic artery charge of the hepatic portal vein and ensure just intervening camera but it does not show you this view to show you the left where I had pata greens come out of it now to much pressure in the hepatic portal system that venous system that we talked about if there's a blood note the blood can't go through the liver into the inferior vena camera and there's pressure within the system this is what gives you a site ease that usually is caused by liver failure for whatever reason cancer cirrhosis or rights as a right-sided heart failure of this too much pressure backward flow of pressure into the inferior vena cava thy got to be drained remember that's too much fluid within the peritoneal cavity which is a serious memory and then that's it for the Anatomy you don't need to know the pathology but let me just go over quickly just what is the dissection and what is an aneurysm so you can see the dissections in the aortic dissection is usually lethal it's a tear and chest pain that radiates into the back I mean this is extremely painful unequal bull pulse and blood pressures between the upper extremities and it's acute onset so basically this happens quickly and it's lethal so and there's many types of Yoric dissections and usually it's by depending on locations but what is in aortic dissection so basically what happens that there's a tear normally if it's a small blood vessel and there's a tear you get occlusion of an artery but this is an aorta your aorta is your largest blood vessel or in terms of your largest artery so if you get a tear blood starts actually accumulating inside of that little tear forming a like hole forming a basically a false lumen right so that's what it basically is it's a false lumen because if you look this is your lumen the whole normal hole when blood flows but it by tearing it formed the false lumen and you get coagulated blood accumulating in there and the reason this is so lethal quickly that could kill you right away and you can see right there's that false lumen so normally blood is flowing through and because there's a tear though it's accumulating inside that dissected wall and you start causing total occlusion that's what happens you can see look there's a false lumen and there's blood accumulating in there coagulating and it's come from and it's totally occluding or a order and you can see that here for example right so this is a cross section of the aorta and this is the lumen or blood is flowing through but look what happens because there was a tear blood is accumulating inside of the wall and as it accumulates it coagulates and then totally obstruction so imagine if you totally obstruct your order that is your major artery that feeds oxygen and nutrients to everywhere you will die as soon as that occlude that's it so how do we prevent the order dissection sometimes they could be a genetic predisposition to some connective tissue disorders but the majority of time it's from smoking plaque deposits of Athos carotid plaque deposits or your diet lack of exercise smoking is a big one too but yeah if you weaken the walls of the aorta you're more prone to get this and how do you weak in the walls well hypertension plaque deposits you know smoking all those things weakens the walls just to show you what it will look like here again this is the false lumen it shows you that it's different types and you can say look at this is a normal x-ray right you can see this is the normal hard x-ray you can see trachea and the bronchi the air in it but this is normal this is the heart and this is part of the aortic arch because all summer in theory says this is the aortic arch right there and this is another normal x-ray so you can see a article arch right there like the arch now this is nobody who has an aortic dissection so look at that this is like an S shape they call it it looks like a boot the heart looks like a boot it was more boot-shaped you can see this is a total a ordered dissection you can see it here too look at that all that ballooning outward the wall is actually ballooning outward kind of similar to aneurysms and you can see that CT right this is a tear in the aortic arch little blood is the white because it's contrast you can see a tear within the wall because you tear right there in the wall this is the thoracic aorta and that's somewhere somewhere in the heart I don't know I think it was like the arch or symptom and this is thoracic aorta you can see the care coming all the way down again these are really usually very lethal within a matter of minutes you can't correct that once I mean once it occludes and that's it now on the other hand aneurysms you could catch beforehand and you can prevent if you watch them because if they get to certain X is these aneurysms are these guys can burst and you'll bleed to death so these guys if they burst basically you'll bleed internally and you'll die within seconds as well but if there's but as aneurysms grow you could watch them over time and if they get large enough then you would have to put stents again here you know there's many reasons there could be some genetic predispositions atherosclerosis you know even getting infections which on things could cause a cigarette smoke to so shows this all plaque deposits so we can the wolf preventing causing aneurysms to form most items in the brain occur at the Circle Willis but you can get huge aneurysms in your order anywhere and again you can show you the different types of aneurysms so you can see and again this is a normal x-ray and this is somebody with huge aneurysms look how huge they are the ballooning outward this is the heart that's part of probably the abdominal the thoracic aorta bullying and ballooning out that's crazy it's huge so again that's normal that's abnormal here's another abnormal one look at that ballooning outward it's probably aneurysm somewhere of the order of Archer and resending Ziller and here's another one a little smaller one lateral view look at that huge that's supposed to be there this is the heart but this is abnormal and again this is a this is what it would look like this looks like an abdominal aortic aneurysm look how huge is ballooning again if it's a certain over a certain size you're gonna have to put a stent all right so they do is they open it up and they put a stent because they don't it's gonna burst and you'll bleed to death and you can see some hand your resume that I'm bursting you see coagulated blood in there because he platform ations all that yellow stuff this is somebody who's had basically stents put in too and they've totally removed hearts portions here this is abdominal aorta there's your common iliac and all the common iliac and the internal looks like I've been removed and put and they've been put stents because if they didn't do that it was gonna burst alright and that's this lecture thank you