The Circulatory System

1
 The Circulatory System:-

• Transports fluids throughout the body

• It consists of the cardiovascular and lymphatic systems
– The heart, blood and blood vessels form the blood transportation network,
the cardiovascular system.
– Extracellular tissue fluid /lymph/, lymphoid tissue, lymphatic vessels and other
lymphatic structures form the lymphatic systems
– the cardiovascular system consists of;
 Heart – pumps or pushes blood through body
 Blood – body defense, carries nutrients, O2 & waste products to and from cells
 Blood Vessels - routes through which blood travels
– the lymphatic system, consists of
• lymph vessels
• lymphatic organs
• Lymph fluid 2
Functions of the circulatory system:

Distribute nutritional elements –digested nutrients

Transport respiratory elements – oxygen & carbon dioxide

Remove waste materials, such as urea
Prevent excessive bleeding by forming meshwork of platelets
Prevent infection from microorganisms.
Regulate body temperature

3
 Blood
• Blood is a fluid connective tissue which contains
 Cells (RBC, WBC, Platelets)
 liquid ground substance called plasma
 dissolved protein fibers, such as fibrinogen ....

• About four times more viscous than water.

• The scientific study of blood is known as hematology.
• The process of formation of blood cells in the bone marrow is
called hematopoiesis
• The sites where hematopoiesis occurs are known as
hematopoietic tissues or organs which are bone marrow.
• Cells responsible to do the function of hematopoiesis are known
as hematopoietic stem cells.

4
 Components of blood

Whole blood has two distinct components

Formed elements: consists of the blood cells
Liquid plasma: clear yellow fluid in which the blood cells and
many other substances are suspended.
 Formed elements
o Erythrocytes/RBC
o Leukocytes/WBC
o Thrombocytes/ platelets

 Leukocytes/WBC
 Granulocytes From left to right:
 Aganulocytes  Red blood cell (erythrocyte);
 Neutrophils Platelet (thrombocytes)
 Monocytes
 Basophils White blood cell (leukocyte).
 Lymphocytes
 Eosinophils
 T lymphocytes
 B lymphocytes 5
 NK cells
 Red Blood cells (erythrocytes)
• are produced in the red marrow of bones.
• are biconcave, disc-shaped that provides large area for O2 exchange.
 Lack nucleus, i.e. have no nucleus
 Transports oxygen and carbon dioxide, and is responsible for the
characteristic bright red color of arterial blood.
 function exclusively within the vascular system.
 Contain red pigmented molecule called hemoglobin.
 quite flexible, allows to adapt to the small diameters of capillaries

6
 White blood cells or Leukocytes
 Constitute an important part of the immune systems of the body.
 There are five types of leucocytes, divided into two main groups based
on their shape and cytoplasmic granules.
 Granulocytes or granular leukocytes
 Neutrophils
 Eosinophils
 Basophils
Agranulocytes or
agranular or mononuclear
leukocytes
 Lymphocytes
 Monocytes

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 Platelets/thrombocytes

• Irregular, membrane-enclosed cellular fragments

– about 2 micrometers in diameter (less than ¼ of size of erythrocyte).
• Continually produced in the red bone marrow as megakaryocytes.
• Megakaryocytes are giant cells that break down and produces a few
thousand of platelets.
• Platelets are important during trauma to a blood vessel; causes the
blood to coagulate, or clot.

8
 THE HEART
Size -Approximately one’s own fist
Location - in the central region of thoracic cavity in the mediastinum, the area between the
lungs. About two-thirds of it lies to the left of the median plane

9
 Pericardium
 The pericardium is a double walled fibro-serous sac that
enclose the heart and root of its greater vessels
 The conical pericardial sac is located
 In the middle mediastinum
 posterior to the body of sternum and 2nd to 6th costal
cartilages
 anterior to T5 to T8 vertebrae

 Pericardium serves as;

 Fibrous sac that protects and anchors heart
 Restricts heart movements
 Prevents the heart from overfilling with blood.

10
Covering of heart -pericardium

11
 The Pericardial sac consists of two parts:
 Fibrous Pericardium
strong external layer
composed of tough dense fibrous tissue
attached to both the sternum and the diaphragm
 Serous Pericardium
 the internal double layered sac
 composed of a transparent membrane
 has two layers:
o Parietal Pericardium is fused to the internal surface of the fibrous
pericardium
o Visceral Pericardium is reflected to the heart and forms Epicardium

The potential space between the parietal and visceral layers of serous
pericardium is called Pericardial cavity and contains thin film of serous fluid that
enables the heart move freely and beat in a frictionless environment.
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 The Heart
• It is a hollow, conical muscular organ
• Located in the middle mediastinum between the lungs, behind body
of sternum and above the diaphragm
• placed obliquely and about 1/3rd of it situated on the right and 2/3rd on
the left of median plane.
• It has the following features:
 Base
 Apex
 Surfaces - three
 Grooves - three
 Borders - four
 Wall - three layers
 Chambers - four
 Major valves - four 13
1. Base of the heart
 the posterior, most fixed part
 Formed by mainly left atrium with
the 4 pulmonary veins.
The visceral pericardium is continuous
with the parietal pericardium at this
point and forms the oblique
pericardial sinus
2. Apex of the heart
 the most moveable part
 Located in the left 5th intercostal
space 9cm from mid-sternal line.
 Formed by tip of left ventricle
14
3. Surfaces of the heart: 3 surfaces
 Anterior (sternocostal) surface: faces to sternum & costal
cartilages
 it contains anterior part of atrioventricular groove and anterior
interventricular groove.
 Left (pulmonary) surface: lies in the cardiac notch of the left lung
 presents left part of atrioventricular groove
 Inferior (diaphragmatic) surface: flat surface directed down ward & backward
 presents Posterior interventricular groove
 Rest on the diaphragm

15
16
4. Grooves/sulci of heart
 are shallow depressions on surfaces of heart
 Externally three important grooves demarcate junctions of
chambers of heart.
A. Interatrial groove – demarcates the right & left atrium
not well visible and hidden by Aorta & pulmonary trunk
B. Atrioventricular groove – demarcates the two atria above &
the two ventricles below, has anterior and posterior parts.
Anterior part: lodges right coronary artery & small cardiac vein
 Posterior part: lodges coronary sinus & anastomosis of right & left
coronary artery
C. Interventricular groove - Demarcates the right & left ventricles. It has
anterior and posterior part.
 Anterior part: lodges branch of left coronary artery & great cardiac
vein
 Posterior part: contains posterior Interventricular branch of right
coronary artery & middle cardiac vein. 17
 5. Boarders: four boarders

A. Right boarder
 extend from opening of superior vena cava to inferior vena cava
 Formed by right atrium
 separates sternocostal surface from base of heart
B. Inferior boarder
 sharp boarder; separates sternocostal from diaphragmatic surface
 Extends from opening of inferior vena cava to the apex

C. Left boarder
 Ill defined boarder separating sternocostal from left surface
 Formed by left auricle & left ventricle
 Extends from left auricle to apex of the heart

D. Superior boarder
 the upper boarder where the great vessels enter & leave the heart
 Formed by the right & left auricles
18
Boarders

Superior boarder

Lt.
Rt. boarder

bo
ard
er
Inferior boarde
r 19
 6. Wall of the Heart
– contain 3 distinct layers:
 Epicardium: thin, external membrane around
the heart
• thin, outer wall derived from visceral serous
pericardium
• In old ages this layer becomes thicker and more
fatty
 Myocardium: middle layer of heart wall
 composed of cardiac muscle tissue.
 thickest of the three heart wall layers
 much thicker in the ventricles than in the
atria.
 responsible for the ability of the heart to
contract for pumping blood.
 Endocardium: a thin, innermost layer of heart
and covers external surfaces of valves. 20
 7. Chambers of the heart
Interior of heart has 4 chambers separated by
septum
 Two upper chambers = atria
 Two lower chambers = ventricles

 2 receiving chambers
 Right atrium
 Left atrium

2 pumping chambers
 Right ventricle
 Left ventricle

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 Right atrium
– forms the right border of the heart
– It receives blood from
• Superior vena cava
• Inferior vena cava and
• Coronary sinus; venous blood from heart walls
– Interatrial septum - is a thin partition between right and left atria.
– Internally has fossa ovalis.
– Interior is divided by crista terminalis into anterior & posterior parts
– Anterior rough part contain pectinate muscles and posterior smooth
part is where great vessels open.
– blood passes from the right atrium in to the right ventricle through a
valve called tricuspid valve, it consists of three leaflets of cusps

22
Right atrium /RA, reflected!

23
• Left atrium
forms most of the base of the heart
 Smooth posterior part
 Has 4 openings of pulmonary veins & one left
atrioventricular opening guarded with mitral valve
 Rough anterior part
 Has musculi pectinati (pectinate muscles) capable of
contraction
– receives blood from the lungs through four pulmonary vein (2
right & 2 left)
– Blood passes from the left atrium in to the left ventricle
through the bicuspid (mitral) valve which has two cusps.

24
The left atrium The right ventricle

25
• Right ventricle
– forms most anterior surface of the heart
– Receives deoxygenated venous blood from the right atrium.
– separated from the left ventricle by inter ventricular septum
 The interior consists of two parts; rough and smooth parts
 Rough or inflowing part – receives blood from RA
• lined with trabeculae carnae (contractile tissue)
 Some form papillary muscles arising from the anterior and
posterior walls as well as septal papillary muscles
 apex of these papillary muscles are attached to cusp of tricuspid
valve by the chordae tendinae (thread like tendinous cord)
 Smooth part
 portion of out flow continuous with pulmonary trunk
 The pulmonary orifies located at the apex of the infundibulum is
guarded by a valve which has three cusps. 26
• Left ventricle
– forms the apex of the heart
– Largest of the four heart chambers.
– The thicker, most muscular chamber
 Rough or inflowing part : lined with trabeculae carnae from which
papillary muscles arising from anterior and posterior walls.
 Has anterior & posterior papillary muscles where cusps of the mitral
(bicuspid) valve attached by cordae tendinae
– Requires thick walls in order to generate enough pressure to force the
oxygenated blood from the lungs into the aorta and then through the
entire systemic circuit.
– Pump blood to the body through aorta
– Blood passes through the aortic valve in to the largest artery of the
body, aorta.
• It is about 5 times thicker than the right, Because;
• The right pump blood to lungs (4/25 mm Hg) where as the left is to systemic
pressure (80/120 mm Hg) 27
 The left ventricle
• Smooth part: just below & continuous with the aortic orifice
 aortic orifice is at the beginning of ascending aorta guarded by aortic valve
which has three cusps.

28
 8. Valves of the Heart
A. Tricuspid Valve: Right AV valve
• Has 3 Cusps (flaps) anchored in Rt. Ventricle
by Chordae Tendinae
• Chordae Tendinae prevent eversion of cusps
into atrium
• Flow of blood pushes cusps to open
B. Bicuspid (mitral) valve:
 left AV valve
 Has 2 cusps anchored in left ventricle by
chordae tendinae
• Functions same as Rt. AV valve
 Tricuspid and bicuspid close together during
systole.

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Berhanu K. (MSc) 30
 The valves of the heart…..

C. Pulmonary Semilunar Valve

 B/n right ventricle and pulmonary
trunk
 Prevent back flow of blood from
pulmonary trunk
 Has 3 cusps,
D. Aortic semilunar valve
 B/n Left Ventricle and Aorta
 Prevent back flow of blood from
aorta
 made of 3 cusps;

superior view
31
 Cardiac skeleton
• A collection of dense,
fibrous connective tissue
in the form of four rings
• four rings of the cardiac
skeleton surround
 two atrioventricular orifices
 aortic orifice
 opening of pulmonary
trunks

• They are anulus fibrosus. The interconnecting areas include:

 Right fibrous trigone - b/n aortic ring and right atrioventricular rings
 Left fibrous trigone - b/n aortic ring and left atrioventricular rings
 Tendon of infundibulum - a small fibrous tissue connecting plumonary and
aortic rings ( it is not a part of the annulus connection)
Berhanu K. (MSc) 32
 Surface markings of valves
• The four valves are located posterior to the sternum on an oblique
line joining Lt. 3rd and Rt. 6th costal cartilags
• They line up:- Pulmonary, Aortic, Mitral, and Tricuspid
 Pulmonary valve … left 3rd costal cartilage
 Aortic valve …. left 3rd intercostal space
 Mitral valve … left 4th costal cartilage
 Tricuspid valve … right 4th intercostal space

 The closing of the valves can be heard

 Aortic valve …. over right 2nd intercostal space
 pulmonary valve …..over left 2nd intercostal space
 Tricuspid valve ….over left 5th intercostal space immediately lateral to
the sternum
 Mitral valve …. over the apex, 9cm from midsternum

Berhanu K. (MSc) 33
location of the heart valves and auscultation points

Berhanu K. (MSc) 34
 Pathway of Blood Through the Heart and Lungs

• Vena Cavae & coronary sinus 

Right atrium  tricuspid valve 
right ventricle  pulmonary
semilunar valve  pulmonary
arteries  lungs  pulmonary
veins  left atrium  bicuspid
valve  left ventricle  aortic
semilunar valve  aorta 
systemic circulation

35
 Conduction system of the heart
The heart has specialized
junctional ‟myocytes” concerned
for origin & propagation of heart
beat.
There by coordinate the
contractions of the four heart
chambers.
They are:
Sinoatrial node
Atrioventricular node
Atrioventricular bundle
Rt. and Lt. bundle branches
Purkinje fibers

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 Blood supply of Heart

• Heart is supplied by
two arteries; Right &
left coronary arteries
• arise from right and
left coronary sinuses
at the base of aorta.

• Terms referring to
vessels of the heart:
 Coronary refers to
arterial vessels
 Cardiac refers to
venous vessels Berhanu K. (MSc) 37
 The Cardiac Veins
• Accompany coronary arteries and their branches
• Lie superficial to the arteries in the sulci
• Most of the veins drain into the coronary sinus

 The coronary sinus

• derived from the sinus venosus
• It drains into the Rt. atrium by an
opening to left of the entrance of
the IVC
The venous blood of heart is
drained by
 Three major veins (great cardiac
vein, middle cardiac vein & small
cardiac vein) through the coronary
sinus (60%)
 Other small veins (40%)
Berhanu K. (MSc) 38
 Innervation of heart
1) Sympathetic - is via
• Cervical cardiac branches from the superior and middle cervical
ganglia ( C1-6 ) – sup. and middle cardiac nerves
• Cervicothoracic branches from the stellate (cervicothoracic)
ganglion (C7-T1)– inferior cardiac nerve
• Thoracic branches from ( T2-4 )
 They are cardioaccelerators & coronary dilator
 Afferents associated with sympathetic trunk, conduct pain
sensation from the heart.

2) Parasympathetic - is via Vagus

• Is cardioinhibitory & coronary constrictor
 Saving energy between periods of increased demand
 Afferents associated with vagus, sense alterations in blood
pressure and blood chemistry
Berhanu K. (MSc) 39
• Two circulatory routes:
– pulmonary circulation:
• right ventricle ----pulmonary artery---- lungs----
pulmonary vein----- left atrium
– systemic circulation:
• left ventricle ----- aorta-----body------ superior and
inferior vena cava------right atrium
• Coronary circulation is part of the systemic circulation
and supplies blood to the heart tissues via coronary
arteries and veins.

40
41
 Blood Vessels

– Classified by size and

histological organization
Arteries: Carry blood away from
heart
Arterioles: Are smallest branches of
arteries
Capillaries/exchange vessels : Are
smallest blood vessels
• Location of exchange between blood
and interstitial fluid
Venules: small veins that collect blood
from capillaries
42
 Structure of Blood Vessels
• blood vessels have many structural features in common and present
a similar plan of construction.
• Blood vessels are usually composed of the following layers, or
tunics;
1. Tunica intima: inner layer…... endothelium
2. Tunica media: middle layer…..smooth muscle
3. Tunica adventitia/ externa……connective tissue

Arteries vs Veins:
Media largest in arteries,
externa largest in veins
Lumen is smallest in arteries
Artery wall have more elastic and collagen fibers

Berhanu K. (MSc) 43
 Arterial blood vessels: classified based on their diameter into;
 larger (elastic) arteries; eg. Aorta, brachiocephalic trunk,
 muscular arteries: have medium size; eg. brachial, femoral arteries
 arterioles, = small size arteries; usually unnamed
• Arteries branch, or bifurcate, into smaller and smaller vessels (arterioles) until they
feed into the capillaries, where gas and nutrient exchange occurs.
– From the capillaries, veins return blood to the heart
• Arteries become progressively smaller as they divide and get farther from heart
• Veins become progressively larger as they merge and get closer to the heart
• Anastomosis: Site where two or more vessels merge to supply the same body region
– Arterial anastomoses: alternate route
– Veins form many anastomoses than arteries
• End arteries
– Arteries that do not form anastomoses
– Only one route E.g. renal artery, splenic artery
• Functional end arteries 44
 Venous blood vessel: are also three types.
 Venules, are small sized veins.
 Medium veins: eg. Femoral vein, brachial vein
 Large veins: eg. Vena cava, brachiocephalic veins.
• Systemic veins carry deoxygenated blood to the right atrium of the heart,
while pulmonary veins carry oxygenated blood to the left atrium of the
heart.
• Venules merge to form veins.
• Blood pressure in veins is too low to overcome the forces of gravity.
• To prevent blood from pooling in the limbs, most veins contain one-way
numerous valves to prevent blood backflow in the veins.
• As blood flows superiorly in the limbs, the valves close to prevent
backflow.
Many deep veins pass between skeletal muscle groups.
• As the skeletal muscles contract, veins are squeezed to help pump the
blood toward the heart.
• This process is called the skeletal muscle pump. 45
Capillaries
• Contain only tunica intima,
but this layer consists of a
basement membrane and
endothelium only.
• Allow gas and nutrient
exchange between the blood
and the body tissues to occur
rapidly.
• Smallest blood vessels,
connect arterioles to venules.
• Are called the functional units
of the cardiovascular system.
• A group of capillaries (10–
100) functions together and
forms a capillary bed.
Capillaries …

• The three basic kinds of capillaries

1. Continuous capillaries
• The most common type
2. Fenestrated capillaries
3. Sinusoids, or discontinuous capillaries

47
 Systemic Arteries
• The systemic arteries begin with the aorta,
the largest artery
• Aorta: has three main parts
– Ascending aorta
• ascends from the heart (left ventricle)
• The coronary arteries are the only branch
of the ascending aorta
• The right and left coronary arteries
supply blood to the heart wall.
– Aortic arch
– Three vessels arise from the aortic arch:
• brachiocephalic artery–supplies right
upper limbs and head regions
• left common carotid artery
• left subclavian artery
– Descending aorta; has thoracic and
abdominal portions.
48
• brachiocephalic artery
– bifurcates into:
• right common carotid
artery; supplies the right
side of head and neck
• subclavian artery; supplies
the right upper limb.
• The left common carotid and
the left subclavian arteries
branch directly from the aortic
arch.

49
Arteries of the neck and head

• Common carotid artery

– ascends upwards in both
sides of the neck lateral to
trachea
– Divides slightly below the
angle of the mandible into
• internal carotid artery;
goes directly to the brain
with out branching in the
neck and face.
• external carotid artery;
supply structures in the
neck and face.
50
 The external carotid artery

 branches are named according to the area or

structures they supply
1. Superior thyroid artery -to thyroid gland
2. Ascending pharyngeal artery –to pharynx
3. Lingual artery- to tongue
4. Facial artery – muscles and skin of face
5. Posterior auricular artery – auricle and scalp of
adjacent area
6. Occipital artery - to occipital region of head
7. Maxillary artery- to maxillary region of face
and meninges of brain.
8. Superficial temporal artery - to superficial
temporal region of head
51
The brain is supplied by four
arteries:
– paired internal carotid
arteries
– paired vertebral arteries
1. The internal carotid arteries
 in the cranial cavity it
divide into;
 the ophthalmic artery
– supplies the eye,
 the anterior and
middle cerebral
arteries
– they supply the
cerebrum.
52
2. The vertebral artery
– arises from the
subclavian artery
– ascends in the neck
through the transverse
foramen of cervical
vertebrae
– enters the cranial cavity
through the foramen
magnum.
– The right and left vertebral
arteries unite to form the
basilar artery which, leads to
the arterial circle (circle of
Willis).

53
 Arteries of the upper limbs
• Right subclavian a. arises from
brachiocephalic trunk and left
subclavian- from aortic arch.
• Subclavian artery has several
branches in the thorax but
becomes the axillary artery as it
passes in the axilla.
• Then it becomes the brachial
artery in the arm.
– Brachial artery is the site for
BP(blood pressure) measurement.
• The brachial artery bifurcates at
the cubital fossa into radial and
ulnar arteries.
54
 • The ulnar artery passes along the ulnar (medial) side of the arm to
the wrist where it forms the superficial palmar arch
• The radial artery passes along the radial side of the arm to the wrist
where it forms the deep palmar arch. It is the site of measuring
pulse in the anatomical snuff box.
• The superficial and deep palmar arches anastomose, and give rise to
the digital arteries which supply the thumb and fingers.
• Ulnar artery – supplies muscles on the ulnar side of the forearm.

55
 Thoracic portion of the
descending aorta
• It is a continuation of the aortic arch
• gives branches to the muscles and
organs of thoracic region;
– Pericardial artery – to
pericardium of heart,
– Esophageal arteries – to
esophagus
– superior phrenic arteries - to
diaphragm
– Mediastinal arteries – to
structures in mediastinum
– Posterior intercostal (IC) arteries-
to each the 3rd-12th IC spaces.
– Bronchial artery – systemic 56
circulation to the lungs.
 Abdominal portion of descending
aorta
– Abdominal aorta is the segment
between diaphragm and L4
– Has unpaired and paired branches
 Unpaired branches of abdominal
aorta
1. Celiac trunk
– short, thick branch, which divides
into three vessels:
• Splenic artery (to spleen,
pancreas, stomach)
• Left gastric artery ( to left side
stomach)
• Common hepatic artery (to
liver, gall bladder, 1st part of
duodenum) 57
2. Superior mesenteric artery
– to the small intestine (except 1st
part of duodenum), cecum,
appendix, transverse, and
ascending colons.
– Has Inferior pancreaticoduodenal,
jejuno-ileal, Right colic, Middle colic,
Ileocolic arterial branches.
3. Inferior mesenteric artery
– last unpaired branch just before
bifurcation into the common
iliac arteries.
• Supplies the descending and
sigmoid colons, upper part of
rectum.
• Has Left colic, Sigmoidal and
superior rectal arterial branches
58
The 3 Unpaired branches of abdominal aorta
supplying GIT

59
 Paired branches of Abdominal Aorta
• The paired (right and left) lateral
branches of the abdominal aorta
include
– Phrenic arteries - supply the
diaphragm
– Suprarenal arteries - supply the
adrenal (suprarenal) glands.
– Renal arteries - the largest in this
group, carry blood to the kidneys.
– Gonadal arteries (Ovarian in
women; testicular in men) -
supply the sex gonads.
– Four pairs of lumbar arteries -
extend into the musculature of
the abdominal wall
Terminal branches of Abdominal Aorta

• The abdominal aorta finally divides

into two common iliac arteries
• Both of these vessels extend into the
pelvis, where each one subdivides
into internal and external iliac artery
• The internal iliac arteries then send
branches to the pelvic organs,
including
– The urinary bladder, the rectum and
some reproductive organs
• Each external iliac artery continues
into the thigh as the femoral artery
supply the lower limb
 The internal iliac artery
– supply gluteal muscles and organs of the pelvic region

• branches of internal iliac artery

– Middle rectal – part of rectum and organs in the pelvis
– Superior, inferior, middle vescical arteries - urinary bladder
– Uterine and vaginal arteries - female reproductive organs
– Superior and inferior gluteal arteries - gluteal muscles.
– Obturator artery - upper medial thigh muscles
– Internal pudendal artery - perineum and external genitalia of male and female

62
 PELVIC ARTERIES
• the internal iliac artery takes blood to the pelvis.
• The internal iliac arteries divide into anterior and posterior trunks which
supply the gluteal region, pelvic organs and muscles, and the external
genitalia.
• In females the vesical arteries takes blood to the bladder, the uterine arteries
take blood to the uterus, the vaginal arteries feed the vagina, the rectal
arteries feed the rectum, and the sacral arteries go to the sacrum.
• The Internal pudendal artery takes blood to supply the pelvic floor, the labia
majora and minora and the clitoris.
• In males the internal iliac artery takes blood to the bladder, rectum, sacrum,
the prostate, and seminal vesicles on the inside.
• The pudendal artery takes blood to the scrotum, penis and external pelvic
floor.
• In both sexes the obturator artery takes blood from the internal iliac artery to
the medial thigh while the gluteal arteries take blood to the muscles posterior
64
 The external iliac artery
– external iliac arteries and its branches
supply the entire lower limb.
– passes out of pelvis beneath the
inguinal ligament to become the
femoral artery.
• Femoral artery
– passes through the femoral triangle
on the upper medial portion of the
thigh.
– At this point it is close to the surface,
hence serve for pulpation and
pressure measurement.
– the femoral artery, after giving several
branches in the thigh, becomes the
popliteal artery as it passes across the
posterior aspect of the knee. 65
66
 The popliteal artery
– give several branches to knee joint and divides into:

 Anterior tibial artery

– Supply anterior leg muscles and dorsum of feet.
– forms the plantar arch with the lateral plantar
artery of the posterior tibial artery.
– The dorsal pedal artery is the site from which
the most distal pulse is recorded to get
information about circulation.
 Posterior tibial artery
– gives off the large fibular artery which supplies
the peroneal muscles of the leg.
– At the back of ankle it bifurcates into the lateral
and medial plantar arteries.
– The lateral plantar artery forms the plantar arch
and gives off digital arteries to the digits of the 67
Common sites of pulse measurement

Berhanu K. (MSc) 68
 Venous drainage of the body
• Arteries are deep while veins are superficial & deep.
• Superficial veins are just beneath the skin and can be seen
easily.
• Superficial veins are clinically important as sites for
withdrawing blood or giving injections.
• Deep veins generally travel alongside arteries and usually
bear the same name.

69
 Veins Draining the neck and head
• External jugular vein ; paired
– from scalp, portions of face, superficial neck
region
– drain into the respective right and left
subclavian vein.
• Internal jugular vein
– from brain, meniges, deep regions of face
and neck
– larger and deeper than the external jugular
vein
– passes in carotid sheath with the common
carotid and vagus nerve beneath
sternocleidomastoid muscle
• subclavian vein and internal jugular unite to
form the brachiocephalic vein
• the two brachiocephalic veins merge to form the
superior vena cava, which empties into the right 70
Veins of the upper extremity
• Consists of superficial and deep venous drainage
 Deep veins
• accompany the arteries and bear their names

 radial vein and ulnar

vein
 both drain from deep
and superficial palmar
arches
 radial and ulnar veins
join in the cubital fossa
to form the brachial
vein, which continues up
on the medial side of the
arm.
Brachial vein -axillary →
subclavian + internal
jugular → brachiocephalic 71
 Superficial veins
• The larger are basilic and cephalic veins
 basilic vein
– drains blood from ulnar/medial side of
forearm
– merges with brachial vein near the head of
the humerus to form axillary vein
 cephalic vein
– drains superficial region of hand and
forearm on radial/lateral side
– joins axillary vein in the shoulder region
– median cubital vein ascends from the
cephalic vein to join basilic vein on radial
side.
 median cubital vein is a site of 72
 Veins of the thorax
 Superior vena cava
• receives blood from the right and left
brachiocephalic veins, which drain head,
neck, and upper limb as well as from
azygous veins.
• lacks valves which are characteristics of Azygous vein
most veins
 The azygous vein
• ascends along the dorsal abdominal and
thoracic walls on the right side of the
vertebral column.
• joins the superior vena cava at T4.
• Its tributaries are:
– ascending lumbar veins - drain from
lumbar and sacral regions
– intercostals veins- from intercostals
regions
– accessory hemiazygous and
hemiazygous veins– from left of the 73
 Veins of the Abdominal Region

• The inferior vena cava

– parallels the abdominal
aorta on the right as it
ascends through the
abdominal cavity.
– It penetrates the
diaphragm and empties
into the right atrium
– largest in diameter of all
vessels in the body

74
75
 veins in the abdomen ...
 right and left gonadal veins -from testes/ ovaries
 right & left suprarenal veins –from adrenal glands
 Inferior phrenic vein – from diaphragm
 Hepatic veins – from liver
 renal veins -from kidney
 4 paired lumbar veins

76
 Hepatic portal system
• In portal system, the veins that drain one group of capillaries
in the GIT delivers blood to another group of capillaries in the
liver.
• Capillaries in liver are drained by hepatic veins that carry
blood to inferior vena cava and then into the right atrium of
heart.
• two capillary beds in series:
• veins that drain blood from capillaries in the intestine,
pancreas, spleen, gallbladder into the capillaries in the
liver (liver sinusoids).
• right and left hepatic veins drain the liver into the
inferior vena cava

77
 Hepatic portal system cont…
• Hepatic portal vein – drains blood from digestive organs
• formed by union of superior mesenteric vein (from small
intestine) and splenic vein (from spleen)
• Splenic vein is formed by convergence of - inferior mesenteric
vein (from large intestine), pancreatic vein, left gastroepiploic
vein.
• The right gastroepiploic vein from stomach drains directly
into the superior mesenteric vein.
• Three other veins drain directly into the portal vein: left and
right gastric vein (from lesser curvature) and cystic vein (from
gall bladder).

78
79
 Veins of the lower extremity
• have a deep and a superficial group
 deep veins
• accompany the name of the corresponding arteries
• These include:
– posterior and anterior tibial veins
• originate in the foot and ascend upwards in front of the tibia to the
back of the knee where they merge to form the popliteal vein.
– Popliteal vein
• drains blood from the knee region and above the knee, it becomes the
femoral vein
– the femoral vein
• receives blood from the popliteal, deep femoral vein and the great
saphenous vein, then becomes the external iliac vein (as it passes under
the inguinal ligament).
– the external iliac vein
• merges with the internal iliac vein to form the common iliac vein
80
 The superficial veins
• Small saphenous vein:
– arises from the lateral side of
the foot, courses posteriorly
along the surface of the calf of
the leg and enters deep into
the popliteal vein behind the
knee.
• Great saphenous vein:
– longest vessel in the body,
originates at the arch of the
foot and ascends superiorly
along the medial aspect of the
leg and thigh before draining
81
into the femoral vein.
 Fetal circulation
• Circulatory system of a fetus, called fetal circulation, exists only
in the fetus.
• It differs from the postnatal (after birth) circulation because
the lungs, kidneys, and gastrointestinal organs do not begin to
function until birth.
• The fetus obtains O2 and nutrients from the maternal blood
and eliminates CO2 and other wastes into it.

• Exchange of materials between fetal and maternal circulations

occurs through placenta, which attaches to the umbilicus of
the fetus by the umbilical cord.

82
 Fetal Circulation cont…
• Oxygenated blood from the
placenta enters through the
umbilical vein
• Blood is shunted away from
the liver and directly
toward the inferior vena
cava through the ductus
venosus
• Oxygenated blood in the
ductus venosus mixes with
deoxygenated blood in the
inferior vena cava.
• Blood empties into the
right atrium 83
• Most of the blood is shunted
to the left atrium via the
foramen ovale
• Blood flows into the left
ventricle and out the aorta
• A small amount of blood
enters the right ventricle and
pulmonary trunk, but much
of this blood is shunted to the
aorta through ductus
arteriosus.
• Blood travels to the rest of
the body, and the
deoxygenated blood returns
to the placenta through
umbilical arteries.
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THANK YOU!

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