Physiology of Circulation. Dr. Hiwa Shafiq 16/12/2018

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1 Physiology of Circulation Dr. Hiwa Shafiq 16/12/2018

2 Overview of the circulation The function of the circulation is to: 1. transport nutrients to the body tissues 2. transport waste products away 3. conduct hormones from one part of the body to another 4. maintain an appropriate environment in all the tissue fluids of the body for optimal survival and function of the cells. The circulation is divided into the systemic circulation and the pulmonary circulation

3 Structure of large diameter artery

4 Parts of the circulation Arteries : under high pressure, blood flows at a high velocity Arterioles: last branches of the arterial system, strong muscular wall, capable to close completely or to dilate several fold in response to tissue needs. Capillaries: thin walled, have many pores, the site for exchange of substances between the blood and the interstitial fluid. Venules: collect blood, coalesce into progressively larger veins. Veins: transport blood from the venules back to the heart, major reservoir of extra blood.

5 Vascular Cast of Blood Vessels in Human Skeletal Muscle.

6 Volumes of blood (in percentage of total blood) in the different parts of the circulatory system.

7 Velocity of blood flow: Under resting conditions, the velocity of flow is about 33 cm/sec in the aorta but only 0.3 mm/sec in the capillaries. However, because the capillaries have a typical length of only 0.3 to 1 millimeter, the blood remains in the capillaries for only 1 to 3 seconds and all diffusion of nutrient food substances and electrolytes that occurs through the capillary walls must do so in this exceedingly short time.

8 Cardiac output is the quantity of blood pumped into the aorta each minute by the heart. Venous return is the quantity of blood flowing from the veins into the right atrium each minute.

9 Pressures in the various portions of the circulation The mean arterial pressure in the aorta is about 100 mm Hg. The arterial pressure in the aorta and the systemic blood vessels alternates between a systolic pressure level of 120 mm Hg and a diastolic pressure level of 80 mm Hg (Pulsatile pumping) The mean pressure falls progressively to about 0 mm Hg at the venae cavae where they empty into the right atrium.

10

11 The pressure in the systemic capillaries varies from as high as 35 mm Hg near the arteriolar ends to as low as 10 mm Hg near the venous ends, but the average functional capillary pressure is about 17 mm Hg, which is low enough that little plasma leaks but even though nutrients can diffuse easily through these same pores to the interstitium.

12 In the pulmonary arteries, the pressure is pulsatile, just as in the aorta, but the pressure level is far less: pulmonary artery systolic pressure averages about 25 mm Hg and diastolic pressure 8 mm Hg, with a mean pulmonary arterial pressure of only 14 mm Hg. The mean pulmonary capillary pressure averages only 7 mm Hg.

13 Basic principles of the circulatory system 1. The rate of blood flow to each tissue of the body is precisely controlled in relation to the tissue need. Availability of oxygen and other Nutrients, accumulation of carbon dioxide and other tissue waste products, nervous control of the circulation from the central nervous system all help in controlling tissue blood flow.

14 2. The cardiac output is controlled mainly by the sum of all the local tissue flows (rate of venous return). 3. The arterial pressure is controlled independently of either local blood flow control or cardiac output control.

15 If at any time the pressure falls significantly below the normal level, within seconds the nervous signals: increase the force of heart pumping, cause contraction of the large venous reservoirs cause generalized arteriolar constriction throughout the body so that more blood accumulates in the large arteries to increase the arterial pressure.

16 Right atrial pressure (Central Venous Pressure) The pressure in the right atrium is called the central venous pressure. It is regulated by: 1- The tendency for blood to flow from the peripheral veins into the right atrium 2- The ability of the heart to pump blood into the lungs. The normal right atrial pressure is about 0 mm Hg, which is equal to the atmospheric pressure around the body. It can increase to mm Hg in heart failure and massive blood transfusion. And It can decrease to -3 to -5 in hypovolaemia (e.g. sever hemorrhage). 16

17 Venous Valves and the Venous Pump Without valves in the veins, the gravitational pressure causes the venous pressure in the feet always to be about +90 mm Hg in a standing adult. But every time a person moves the legs or even tenses the leg muscles, a certain amount of venous blood is propelled toward the heart. This is called venous pump. it is efficient enough that during walking the venous pressure in the feet remains less than +20 mm Hg. Indeed, about 10-20% of blood volume will be lost if a person stands still for minutes. When the venous valves become incompetent varicose veins 17 (varicosity) will develop.

18 18

19 Microcirculation The peripheral circulation of the whole body has about 10 billion capillaries with a total surface area estimated to be 500 to 700 square meters. The capillary wall is composed of a unicellular layer of endothelial cells and is surrounded by a very thin basement membrane on the outside of the capillary. 19

20 In the capillary membrane there are pores (thin slit-like channels) with a diameter of 6-7 nanometer through which fluid can pass freely but it is smaller than albumin molecule to permit it. 20

21 Special types of pore in certain organs 1. In the brain, because of tight junctions, only extremely small molecules such as water, oxygen, and carbon dioxide can pass. 2. In the liver, the opposite is true. All dissolved substances of the plasma, including the plasma proteins, can pass from the blood into the liver tissues. 3. The pores of the gastrointestinal capillary membranes are midway (smaller than those of liver). 4. In the glomerular tufts of the kidney, there are fenestrae so that tremendous amounts of very small molecular and ionic substances (but not the large molecules of the plasma proteins) can filter through the glomeruli without passing through the clefts between the endothelial cells. 21

22 Vasomotion: intermittent contraction of metarterioles and precapillary sphincter Oxygen??

23 Diffusion through the capillary membrane The most important means by which substances are transferred between the plasma and the interstitial fluid is diffusion. Lipid-soluble substances (oxygen, carbon dioxide) can diffuse directly through the cell membranes of the capillary endothelium while water-soluble (water molecules, sodium ions, chloride ions, urea and glucose) can diffuse only through pores in the capillary membrane. 23

24 Diffusion of fluid molecules and dissolved substances between the capillary and interstitial fluid spaces

25 The Interstitium About one sixth of the total volume of the body consists of spaces between cells, which collectively are called the interstitium. The fluid in these spaces is the interstitial fluid. This fluid is derived by filtration and diffusion from the capillaries. 25

26 Forces that determine fluid movement through the capillary membrane (Starling forces) 1.The capillary pressure (Pc), which tends to force fluid outward through the capillary membrane. 2. The interstitial fluid pressure (Pif), which tends to force fluid inward through the capillary membrane when Pif is positive but outward when Pif is negative. 3. The capillary plasma colloid osmotic pressure (π p), which tends to cause osmosis of fluid inward through the capillary membrane. 4. The interstitial fluid colloid osmotic pressure (π if), which tends to cause osmosis of fluid outward through the capillary membrane. 26

27 27

28 . 28

29 If the sum of these forces, the net filtration pressure, is positive, there will be a net fluid filtration (outward movement) across the capillaries. If the sum of the Starling forces is negative, there will be a net fluid absorption from the interstitial spaces into the capillaries. NFP = Pc - Pif - πp + π if Under normal conditions the NFP is slightly positive (0.3 mmhg), resulting in a net filtration of fluid across the capillaries into the interstitial space in most organs. This slight excess of filtration (NFP) is the fluid that must be returned to the circulation through the lymphatics 29

30 Lymphatic system The lymphatic system represents an accessory route through which fluid can flow from the interstitial spaces into the blood (mainly proteins and large particulate matter) neither of which can be removed by absorption directly into the blood capillaries. The lymphatic system plays a central role in controlling: (1) the concentration of proteins in the interstitial fluids (2) the interstitial fluid volume (3) the interstitial fluid pressure. 30

31 Special structure of the lymphatic capillaries and a collecting lymphatic 31

32 FORMATION OF LYMPH Lymph is derived from interstitial fluid that flows into the lymphatics. Therefore, lymph has almost the same composition as the interstitial fluid. The protein concentration in the interstitial fluid of most tissues averages about 2 g/dl. Lymph formed in the liver has a protein concentration as high as 6 g/dl, and lymph formed in the intestines has a protein concentration as high as 3 to 4 g/dl. the thoracic duct lymph, which is a mixture of lymph from all areas of the body, usually has a protein concentration of 3 to 5 g/dl. 32

33 RATE OF LYMPH FLOW About 100 milliliters per hour of lymph flows through the thoracic duct of a resting human, and approximately another 20 milliliters flows into the circulation each hour through other channels, making a total estimated lymph flow of about 120 ml/hr or 2 to 3 liters per day 33

34 Local blood flow control Local blood flow to the tissues can be divided into two phases: (1) Acute control (2) Long-term control Acute control is achieved by rapid changes in local vasodilation or vasoconstriction of the arterioles, metarterioles, and precapillary sphincters, occurring within seconds to minutes to provide very rapid maintenance of appropriate local tissue blood flow. The rate of metabolism in a local tissue and oxygen availability both affect acute local blood flow through the release of vasodilator substances (adenosine, carbon dioxide, histamine, potassium ions, and hydrogen ions) 34

35 Long-term control means slow, controlled changes in flow over a period of days, weeks, or even months. It occurs when the long-term metabolic demands of a tissue change. The arterioles and capillaries usually increase both in number and size within a few weeks to match the needs of the tissue. Oxygen also plays a main role in long term control of blood flow. 35

36 Humoral factors that affect circulatory function A. Vasoconstrictor agents: 1. Norepinephrine and epinephrine. Norepinephrine is a very powerful vasoconstrictor while epinephrine is less. They are released by the sympathetic system stimulation either directly from the sympathetic nerve endings or indirectly from the adrenal medulla into the entire circulation. 2. Angiotensin II. It is a powerful arteriolar vasoconstrictor and plays a major role in maintaining systemic blood pressure. 36

37 3. Vasopressin: Vasopressin (antidiuretic hormone) is formed in the hypothalamus and transported downward to the posterior pituitary gland to be released into the circulation. It is even a more powerful vasoconstrictor hormone than the angiotensin. It also increase water reabsorption from the renal tubules back into the blood and therefore help control body fluid volume. That is why it is also called antidiuretic hormone. 4. Endothelin: it is a powerful vasoconstrictor in damaged blood vessels. 37

38 B. Vasodilator Agents 1. Bradykinin: It causes both powerful arteriolar dilation and increased capillary permeability and released in response to vascular damage, tissue inflammation. It also play a role in blood flow regulation of skin, salivary and G.I.T glands. 2. Histamine: it is derived from mast cells in the damaged tissues and from basophils in the blood. It is a powerful vasodilator and released in response to tissue damage and inflammation. 3. Nitric Oxide A Vasodilator lipophilic Gas Released from Healthy Endothelial Cells. 38

39 Nervous Regulation of the Circulation 39

40 The nervous system controls the circulation almost entirely through the autonomic nervous system. Especially important regulatory part is the sympathetic nervous system, while the parasympathetic system mainly regulates the heart function. 40

41 Effects of sympathetic system on circulation: 1. Arteries and arterioles: Increases resistance to flow (decreasing rate of blood flow) 2. Veins: Decreases blood volume in the veins and hence increasing venous return to the heart. 3. Heart: Increases both the rate and the force of cardiac contraction. The sympathetic vasoconstrictor effect is especially powerful in the kidneys, intestines, spleen, and skin but much less potent in skeletal muscle and the brain 41

42 Nervous System Control of Arterial Pressure (Blood pressure) When there is need to increase the blood pressure, three major sympathetic nervous changes occur simultaneously with parasympathetic nervous inhibition: Almost all arterioles of the systemic circulation are constricted. This greatly increases the total peripheral resistance, thereby increasing the arterial pressure. The veins are strongly constricted increasing venous return. The heart is directly stimulated by the sympathetic nervous system, further enhancing cardiac pumping. 42

43 Effect of parasympathetic system on circulation: 1. Heart: Decrease the heart rate and slightly decrease in cardiac contractility. 2. They have a major role in regulation of gastrointestinal functions. 43

44 Vasomotor center: This center is located in the medulla oblongata and lower pons. It transmits parasympathetic impulses through the vagus nerves to the heart and sympathetic impulses through the spinal cord and peripheral sympathetic nerves to virtually all arteries, arterioles, and veins of the body. Vasomotor tone: Is the state of partial constriction of the blood vessels caused by continuous slow firing of the sympathetic nerves from the vasoconstrictor area of the vasomotor center. 44

45 45

46 The rate of excitatory and inhibitory effects of the vasomotor center itself is regulated by the higher brain centers. The sympathetic nerves to skeletal muscle blood vessels carry sympathetic vasodilator fibers as well as constrictor fibers. 46

47 Emotional Fainting Vasovagal Syncope-Fainting Attack. This is a vasodilatory reaction occurs in people who experience intense emotional disturbances that cause fainting. The muscle vasodilator system becomes activated, and at the same time, the vagal (parasympathetic) cardioinhibitory center decreases the heart rate markedly. The arterial pressure falls rapidly, which reduces blood flow to the brain and causes the person to lose consciousness. 47

48 Finished files are the result of years of scientific study combined with the experience of many years.

49 Q/ Describe the forces that determine fluid movement across capillary membrane and tell the importance of positive net filtration pressure.

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