Anatomy 1352 Ross College this is unit four the third and final part definitely the shortest and also significantly easier than part two so we're going to start out here doing circulation talking about some uh number of the vessels and we'll cover the unique things uh hepatic portal system as well as fetal circulation and we'll go from there don't worry about getting these figures the majority of them are in your lab manual now these two little ones here for taking um pulse not in the lab manual but all the arteries depicted on them are in the lab manual images so quick way for checking circulation check the pulse some of you looking at me right now and going yeah no kidding well not always the easiest because not all everybody here works in the medical field yet so um that pulse is felt by the expansion and relaxing of the arteries um with the increase in systolic pressure that's what creates that feel you have the closer you are to the heart um the stronger the pulse the further from the heart the less stretching the less expansion the weaker the pulse pulse should be the same as heart rate it is possible for it to be different but you have to have some really screwed up circumstances to be there so let's stick with the normal common places to take them well a patient's wrist is really easy you do it at the radial artery it's on the uh radial side or the lateral side of the wrist it's close to the surface you could do the olner artery on the medial side but it's deeper in the tissue isue and it's much harder to feel so do the radial you can go up you can get the brachial artery you can actually do it at the elbow that's where you're normally listening for your common blood pressure um if it's a very weak pulse you can go up to the head take it at the coted artery on the neck now the coted artery is deeper so it's not always the easiest to feel but it's there and you can do it you can get it on the facial artery very easy by placing your hand in her proper location you'll do that in nursing classes not here you can also get it at the temporal artery personally I find the temporal artery easier to do than the facial but that's me you may feel differently you can get the femoral artery in the thigh popal artery in the knee and you can even get in the foot the dorsal Pettis artery so um dorsal um backside um or actually it's not on the back I don't know why the the dorsal surface of the foot is the top of the foot and then that artery There is close to the surface and easy to feel well why would you use these other locations well if you got a patient in chest surgery and they've got IVs in both arms you're not going at the arms you're going down at the feet where you're out of everybody's way if a patient has very weak pulse you might be using one of the ones closer to the heart brachial or in the neck and head so it's easier to feel uh if a patient has had an injury on an arm it very often inappropriate and you don't get a good read there so you've got a lot of areas you can work so know know some of these common ones and of course most common radial artery so now thinking about uh circulatory routes remember we have two sets of circulation we have pulmonary circulation leave the heart go to the lungs come back to the heart then there's systemic circulation leave the heart go around to the entire body then come back to the heart so two sets of circulation for completely different purposes so pulmonary leaves the right side of the heart right ventricle to the lungs and then back to the left atrial what's the purpose of pulmonary circulation take oxygen poor blood to the lungs get rid of CO2 get oxygen into the blood reoxygenate the blood and then return that oxygen-rich blood to the heart systemic circulation leaves the left side leaves through the left ventricle pumps out to the whole body um so to the uh brain the heart muscle kidneys digestive liver lungs bronchial we'll get we'll do the extra weirdness in the lungs when we do the respiratory system um and then back to the uh right atrium now the purpose of systemic is to deliver oxygen to the tissue and carry away the CO2 waste now be careful because blood does go through the lungs twice pulmonary goes to the Alvi where gas exchange occurs to get oxygen in the other part of the lungs systemic that goes to the muscle and the connective tissue to deliver oxygen to those areas for right now don't worry about the bronchial part of systemic um we'll cover that in respiratory But realize lungs different parts of the lungs are in each of the systems so now this diagram here shows us many of your arteries uh a lot of the biggies are labeled here um some of the ones you need to know are on the left subclavian brachial radial femoral pidal tibial for a lot of the body at least they named the arteries and the veins uh pretty logical subclavian under the clavicle okay brachial arm radial radial bone forearm FAL it's in the thigh femur poal we know that's the knee so those are at the knee tibial it's in the leg by the tibia there's more than one tibial uh so for a lot of them simply being able to translate the words know the word meanings you know the arteries and vein meanings meaning you know which artery goes to the um kidneys renal what artery goes to the liver hepatic what arteries go to the diaphragm frenic easy peasy things kind of go out the window when you get to the head so we'll do head separately uh going down here into the trunk of the body uh we've got all our chunks of the aorta frenic has also pointed out now the aorta does get confusing because it's so big and so important there are four regions to the aorta the little short going up part we call the ascending aorta then there's the it rolls over it curls over the aortic Arch so you guys all know the aortic Arch then you have the very long descending aorta now the descending aort going down we split into two halves if it's in the chest we call it thoracic aorta if you want to call the thoracic descending aorta great you're only helping clarify and then there's the abdominal aorta a continuation of the thoracic aorta simply below the diaphragm into the abdominal cavity and then you have many arteries branching off of the aorta now if you said if you were ever asked what artery takes oxygen-rich blood to the kidney uh aorta is the wrong answer aorta is the trunk what actually goes to the kidney is the renal artery so always be specific when you're doing things now the um thoracic aorta or sorry abdominal aorta ends where it splits into left and right iliac remember ilum the large upper part of the hip bone iliac arteries they're at the hip now the iliac splits into the internal and external um so external is the bigger one that goes down into the thigh region internal is smaller that feeds the tissues around the hip so now most of these arteries are left and right where they Branch off of the aorta but there's there are exceptions one of those exceptions that I won't ask you about is one it runs down midline at the sacrum and it splits off right where the iliacs branch off now a quick clue whenever you hear common for something know it's going to split into internal and external so but as far as I'm concerned the iliac arteries are in the hip I'm not going to really worry about internal external and and then we have the um femoral ones in the whoops femoral in the thigh so again these are some more of the ones you need to know by the way your study guide has all the ones you're responsible for which are clearly not everything on the list going down to the thigh or are well part of the thigh and part of the abdomen mesenteric renal iliac iliac is hip renal kidney MZ enteric e n t er entro that means intestines the mesenteric arteries are going to the intestines there's multiple mesenteric arteries by the way so going into veins again many of them are named for their location many of them are very very straightforward there are a few weird ones though so subclavian axillary it's in the armpit cuboidal it's in the wrist radial femoral tibial easy pz now in Venice return system sometimes there are redundancies in other words there may be ways for blood to get out of an area by two different routes that later come back together you see that in multiple places especially in the arms and legs now some of those redundant veins you have to give them different names just to help kind of keep everything straight um one of those in the leg is the sainis the sainis runs down the inner thigh and it's very close to the surface because it is redundant and blood you can take part of the saphenous vein out and anything that would go into the saffin now returns VI a different route the sainis is very important because that's usually the donor tissue for cardiac bypass um so very important now you might be saying well wait a minute don't veins have valves and aren't veins thinner walls yes they are and yes they have valves but the saffin vein is a larger diameter a little more heavyduty than some veins and compared to the cardiac arteries the coronary arteries um it is bigger and you don't have to worry about it now but because it does have valves when you do those transplants you got to make sure it's turned the right way so the blood can go through the valve properly so things to note all right again some of the ones you need to know the ones you have to know are not everything just what's in the study guide uh um some additional ones brachio calic well that's where the ones from The Head jugulars and the ones from the arm subclavian they come together bracho arm seph head the brachio calic comes from the arm and head brachio calics left and right come together to form your Superior vnea the venne cavas go into the right atrium now we also have frenic veins we also have an inferior vnea but there's a weird one in the chest there's lots of small arteries that go into the rib cage area go into the rib muscle uh muscle and ribs all of those veins don't go to the vnea all of those veins coming out of the rib cage the uh chest wall they all come together into a single vein called the ayus so the ayus is draining the chest wall the ayus then returns to the superior vnea so it's kind of an oddball in there now there are some weirdly named veins there is one called the sealc vein well you'd say well seph isn't that head sadly no the calic vein is actually in the arm and then there's the basilic vein the basill also in the arm because there are some redundant veins there's also our brachial veins in the arm U we've got some weird we got some weird names kind of like the uh safis down in the leg we got some weirdly named veins in the arm uh calic and basill are some of the common ones you see so if they're on the list know them if they're not on the list I ain't going to ask about it down in the uh lower region of the body renal veins return blood from the kidneys to the inferior vnea the iliac veins are taking blood from the hips and the leg region returning it to the inferior vnea sacral vein draining part of the hip area the sacrum area returning it to the um inferior vnea in that route so common ones there now the head is where things go out the window everything in the head has a weird name sorry we can't really do much about it so let's start with the veins though because they're easier now the main veins draining the head are the jugular veins there's an internal coming from the brain region there's an external coming from the head outside the skull region they come together to form the uh jugular or could be called common jugular most people just call it jugular I'm not going to differentiate jugular is a jugular there is a second set of veins leaving the inside of the skull that only drain from a small region of the head those run down along the vertebral column they're the cleverly named vertebral veins now if you've ever seen the um uh cervical vertebrae up close you realize there's actually holes or framan through the transverse processes the vertebral veins and the vertebral arteries actually pass through those little framen so uh if we were in lab that would be something we'd be pointing out in detail now going up to the blood supply you have the cored arteries taking most of the blood to the head splits into external internal external kateed surf surface tissue outside the skull and face internal cored dips into the cranial cavity most of the blood going to the brain there's also these small vertebral arteries we already mentioned them that also enter into the skull and Supply some of the blood to the brain now the brain has some really cool stuff to it the two ver arteries actually merge together into a very short one called the basill artery now the billar artery and the left and right cids all come into a circular artery called The Circle of Willis it surrounds the hypothalamus it's collateral circulation many arteries then Branch off the circle of w Willis and dist distribute brain uh blood to the middle part of the brain so it's a collateral circulation area some of the other arteries to the brain split off of the uh basill the vertebral or directly off the internal CDs so know that Circle of Willis it's important and the billar is labeled out there too so just some interesting ones um ptic portal is another one now we talk about frequently the liver being involved in digestion and it is however the liver produces exactly zero digestive enzymes the liver contributes nothing and I emphasize nothing to digestion that occurs in the intestines or stomach the only thing entering the intestines from the liver is um bile and bile salts we'll de those in digestive the liver's main role in digestion is processing of nutrients after they're absorbed into the bloodstream so in the abdominal region blood flow around the intestines and liver is different than everywhere else you have what we call our portal system here our hepatic portal hepatic being liver just like the previous portal system we did back in um endocrine you have arteries going to capillaries capillaries go to a portal vein portal vein goes somewhere else and then a second set of capillaries well in hepatic portal that hepatic portal vein goes from the intestines to the liver so so what you have are the first set of capillaries at the intestines picking up lots of nutrients coming together to form the portal vein the portal vein goes immediately to the liver delivering those nutrients directly to the liver for processing at the liver you have the second set of capillaries in our portal system here so now the second set of capillaries is in inside of the liver itself and then this is for pulling out extra sugars fats amino acids anything else that's in the blood that need doesn't need to continue to the rest of the body because you know at digestion you're absorbing a lot of nutrients there's more in the blood than needs to be there so the liver deals with some of that um some of it goes back into circulation immediately some of it goes into storage later return to circulation when low we'll deal with that in digestive though so here we have our diagramming of hepatic portal so the mesenteric and colic arteries took plenty of blood to the intestines where you have the first uh where you have all the first capillaries they come back together into medium veins which go to the hepatic portal vein hepatic portal vein oxygen poror blood nutrient Rich going to the liver second set of capillaries in the liver blood exits the liver by the hepatic veins returning to circulation by way of the vnea now you might be saying well wait a minute that's oxygen poor blood where is the liver getting oxygen there's also a hepatic artery delivering oxygen rich blood to the liver so two sources of blood flow into the liver hepatic artery hepatic portal vein know the differences all that blood in going to the liver all of it leaves by the hepatic vein so very important to know and then there's fetal circulation fetal circulation is well unique remember developing fetus developing baby in in uterus lungs are not working at this point there's no air to breathe so how is baby getting oxygen while in the uterus baby is getting oxygen from mother through the placenta oxygen exchange occurs at the placenta don't tell me the umbilical vein because the umbilical vein just carries oxygen-rich blood back into to Baby oxygen exchange the source of oxygen for baby is the placenta period no other way about it so we have multiple bypasses so very little blood goes through the lungs during fetal development at least through pulmonary circulation we have a extra branch of systemic circul that is functioning during fetal development we have umbilical arteries that actually come from the iliac arteries um you don't need to know the iliac part of that umbilical arteries leave through the umbilicus the belly button they go to the placenta at the placenta they get rid of carbon dioxide and pick up oxygen that very oxygen-rich blood returns through through the umbilical vein now the umbilical vein mixes with the hepatic vein and into the vnea so the oxygen-rich blood first goes to the liver and then it gets mixed with the oxygen por blood in the vinaa what well then you've got a sort of middle if oxygen rich is red and oxygen poor is blue this is more like purple blood somewhere in between Queen no it's not literally purple it's just the blending of red and blue in our pictures so that Medium amount of oxygen blood then returns to the heart goes through the heart through the bypasses and right back out to systemic circulation now if you're saying well wait a minute that fetal blood doesn't have full oxygen true but baby's not very big and baby has very low blood pressure baby makes up for that with a much more rapid fetal heart rate so pump the blood faster for every minute you still end up delivering the same amount of oxygen to the tissues it's just the blood's going quicker that's all it is no big deals it works beautifully and has for quite a long time so oxygen low o medium to low oxygen blood goes to the placenta through umbilical arteries arteries going away from the heart because comes off the um iliacs which come off the aorta oxygen exchange gas exchange at the placenta and then oxygen rich blood returns through the umbilical vein baby does not get oxygen from the umbilical vein baby gets oxygen from the placenta period That's where gas exchange is so people love to give me the wrong answer for this question all the time so that's why I'm emphasizing it now that umbilical vein it dumps into part of it goes to the liver part of it goes straight to the inferior vnea and then back to the heart uh there's a ductus Venice which takes some of that blood to the liver but I'm not concerned with that I won't ask you now blood enters back to the right atrium goes to the right ventricle from the right ventricle it's going to go out to the um pulmonary trunk pulmonary arteries to the lungs but through through pulmonary circulation but there's no Oxygen coming into baby's blood at pulmonary so a lot of that blood goes through what we call the bypasses so during fetal development there is a hole between the right and left atrium that hole is called the fan oal so some of the blood in the right atrium goes straight to the left atrium and does not go to the right ventricle that's bypass number one on the second slide here there's a second bypass called the ductus arteriosis so during fetal development there's a connection between the pulmonary trunk right here and the aorta so some of the blood that goes into the pulmonary trunk goes through the ductus arteriosis and straight into the aorta so some blood went right directly from right atrium left atrium only part of the blood went to the right ventricle what goes to the right ventricle less blood total starts to enter pulmonary circulation and some of that go straight into the aorta so a very small amount of blood actually goes through pulmonary circulation during fetal development you do have to know the fan oval and the ductus arteriosis will ask you about those so now then that blood then is then going out to systemic circulation and we've already said before the umbilical arteries Branch off of systemic go to the placenta so now those lungs they're actually collapsed there's high pressure at the lungs because they're collapsed very little blood wants to go through the lungs it goes to wherever there's less pressure which means most of the blood that reaches the right side of the heart goes through those two bypasses and then straight out into systemic circulation so that way have that now if you want to draw it out this crazy big picture has your bypasses so um it's got the placent it's got systemic Circ aorta systemic circulation vnea no big deals it's got the umbilical arteries the placenta the umbilical veins uh returning to the vnea and the liver won't to ask you this a little bit here now right atrium normal right ventricle pulmonary arteries lungs pulmonary veins left atrium here is your fan oval bypass right atrium to left atrium from pulmonary trunk your other bypass ductus AR iosis straight to aorta these two bypasses make it so very little blood runs through pulmonary circulation so that is your fetal circulation this is in utero circulation so then what happens at Birth how do we adjust and switch to neonatal circulation um there are are two major changes well three major changes at the heart and lungs first thing you startle baby and like everyone else being startled they usually take a deep inhale inflates the lungs you get very dramatic drop in pressure at the lungs so now blood wants to go through pulmonary circulation in addition the ductus arteriosis will collapse in a matter of minutes and begin to seal off so that in a few months it's nothing more than a little chunk of connective tissue So within minutes of birth you close the first bypass now more blood has to go through pulmonary and the pressure drops so Blood also wants to go through pulmonary now that fro Val that will begin to close actually before birth it's still mostly open at Birth but the frino Val then closes over the next several months now the pressure at each each Atrium is approximately equal so that there's not much mixing of blood because blood wants to go through pulmonary circulation yeah there's a little mixing for the first few months but it's overcome by the fact that baby has a very high heart uh heart rate so and that fro Val again closes over several months sometimes it closes slower and the doctor says well let's keep a look and see here and they keep checking on it as long as it's progressing leave it go it's only you have to intervene when it stops progressing remains open up until second or third year of life and then it is open heart surgery to mechanically close that hole so now the other thing that changes well those are our three changes at the um lungs and heart pressure drops in the lungs Blood starts flowing through the lungs ductus arteriosis collapses and seals almost immediately stops that bypass fonov Val be is closing within a few months closes that bypass those are the three important changes the other man-made change is to Simply clamp off the umbilical cord so blood is no longer going through the umbilical arteries and the umbilical vein so you clamp the cord um cut the cord either sew it closed we used to now we just cauterize it in Olden ancient times they literally tied it in a knot either way it worked so blood can no longer go to the placenta those are all your changes at neonatal circulation and I like to ask about these too so be prepared for them all right question six says know your arteries and veins in those slides 45 uh 49 to 55 um also what's in the study guide other questions and then couple of things to talk about uh syncopes and aneurysms sin cope is a fancy word for um fainting uh loss of consciousness uh not caused by head trauma this is usually caused by stress related can be caused by um medical drug induction whether recreational or prescribed is irrelevant um could be caused by orthostatic hypotension the drop in blood pressure orthostatic when you stand up um so any sudden drop in blood pressure can cause a fainting spell or sincope now an aneurysm most people have slightly wrong an aneurysm is a weakened part of an artery where it's thin and stretches that is an aneurysm a ruptured aneurism is when that aneurism itself tears open most people like to blend that all together in one term an aneurysm does not mean you're bleeding profusely internally an aneurysm means you have a weak artery that's bulging stretched out and is at high risk of tearing open a ruptured aneurysm that's when it has torn open causes of this atherosclerosis is the most common cause in older patients trauma can cause an aneurysm developmental or congenital defects can cause aneurysms and hey syphilis can cause aneurysms yay syphilis so ones to think about these are really important things to know about though now some of these slid sets have some how different systems interact I'm not going to go over this this is just reminding you of things you should already know uh you read them to yourself and that then brings to a close uh unit four this is the end of part three the end of unit four thank you very much