In the thoracic region there will still be anterior rami still coming off.

But they will not form any plexi.

Thoracic anterior rami are going to run between each rib and they will innervate muscles in the thoracic
wall. So they are not going to form plexi they are just going to stay on their own.

When we get to the lumbar region we get to our last two plexi those are the lumbar plexi and sacral
plexi.

Sometimes called Lumbar-sacral plexus

Lumbar plexus

L1-L4 anterior rami

Big nerves: femoral nerve and the obturator nerve

The femoral nerve is going to run into the anterior thigh and it innervates the quadriceps muscles

The obturator nerve is going to stay internal and crosses further down its going to innervate the
adductors

Sacral plexus

The biggest thing coming out of it is the Sciatic nerve

L4-S4

You will notice there is some cross over; so L4 anterior Rami is a part of both the Lumbar and the sacral
plexus and that’s why a lot of the time they get clumped together.

We said the purpose of a plexus is for a bunch of nerves to work together to innervate an area. The
Lumbar and sacral plexi are working together to supply the lower limb. Even the pelvis and gluteal
region. But then all the way down to the foot.

Sciatic nerve : innervates the Hamstrings and it’s going to cross behind the knee and it’s going to divide
into the

>TIBial NERVE NOT THE POSTERIOR TIBial NERVE (error in course notes)-innervates the posterior leg but
it also gives division to the anterior leg. Handles most of the foot. The intrinsic foot muscles.

>the COMMON (peroneal) FIBULAR nerve. (lateral side) therefore the lateral leg muscles (peroneal
muscles)

There isn’t a lot of stuff that’s medial you would count that in with the posterior.

AUTONOMIC NERVOUS SYSTEM

Within our sensory and motor components of the nervous system

We will have components that are somatic (means of the body) (conscious level sensory and motor
innervation)

Then we have our visceral or autonomic side (subconscious).

Focus today is the MOTOR subconscious called the autonomic Nervous System (ANS). Control of things
like heart rate, blood vessel dilation, opening of sweat glands, dilation pupils.

The autonomic nervous system can be divided into two sections the sympathetic and parasympathetic.

Sympathetic is the increase side: so if we need to increase the heart rate, BP increases, open our blood
vessels. (dilation)

Parasympathetic NS- is the rest and digest, HR decreases, BV’s can constrict.

The cell bodies of the ANS are located in the lateral horn –contains cell bodies of the ANS.

Posterior horn has sensory neurons

Anterior horn has motor cell bodies

We also have autonomic nerves that come directly off the brain; the rest come from the lateral horn in
the spinal cord.

The big difference between the somatic motor system and the autonomic motor system is when a
somatic motor neuron leaves the spinal cord (from the anterior horn)>a somatic motor neuron can just
go directly to the organ or wherever its going (called the effector) A SINGAL NEURON can do that often
does.

In the ANS the actual neuron that leaves the spinal cord CANNOT go directly to its destination. It has to
pass on the message at least once (basically synapse at an autonomic ganglion) to a second neuron and
that on goes to the effector.

The first neuron (the one that leaves the spinal cord is called the pre ganglionic neuron) preganglionic
tells you there is a ganglion coming, autonomic ganglions are all over the body ready to receive these
signals. Those autonomic ganglions have autonomic cell bodies in them waiting to get a message to take
to the destination

These ganglia are set up very similarly to the posterior root ganglia

The parasympathetic and sympathetic systems WILL NOT SHARE GANGLIA; we have Sympathetic ganglia
separate from parasympathetic ganglia.

Parasympathetic and sympathetic can come off the brain and spinal cord at difference levels so there is
no chance of interacting with each other.

Parasympathetic will come off the brain and the sacral region and that’s it! And they exit through the
anterior horn with the anterior rootlets the same way any nerve does.

The parasympathetic will come off very specific areas of the brain > remember we have 12 pairs of
cranial nerves. The ones that carry parasympathetic nerve fibers with them are CN 3 7 9 and 10

Also parasympathetic are coming off the sacral region. S2-S4

Sympathetics- come off the spinal cord only from T1 to L2 that it not where else in the spinal cord. Why
it stops at L2 is because the spinal cord proper is done at L2 there is no more lateral horn to exist.
PARASYMPATHETICS ARE NOT GOING TO TRAVEL TO BLOOD VESSELS or SWEAT GLANDS;

Ie if we have a sympathetic signal to the sweat gland to open it up. To turn it off all we do is turn off the
sympathetic signal; we don’t send a parasympathetic signal to shut it off.

Parasympathetic Nerves: are going to come from the brain or lateral horn; a parasympathetic neuron is
going to exit still through the anterior horn but instead of following the rootlets and roots and going to
the spinal nerve, as soon as a parasympathetic axon gets out of the spinal cord it’s just going to take off.

Catching a ride with arteries – when our para sym and symp neurons come out; they sometimes can
travel within an existing nerve (because nerves are just big tunnels) if its going to the right place but
often its not.

Specifically, on the parasym side if there isn’t a somatic nerve going to the right place; it’s going to wrap
itself around an artery that is going to the right place and that give it a little structure/protection to the
axon; if we harm a neuron it cannot fix itself. It may even hop from one artery to another artery until it
gets to its destination. BUT REMEMBER the para axon has to synapse before it gets to its destination
remember pre gang and post gang (that’s the one that goes to the destination). The autonomic ganglia
is where the synapse happens. In the parasympathetic NS the ganglia are location fairly close to the
destination. Ie. Lacrimal gland.

Sometimes you will see the term catching a ride with a somatic nerve; which usually means its just going
to travel in the tunnel with the other nerves.

Sympathetic pathway (more options)

Fight or flight

In addition to innervating all the organs like the parasympathetic did and things like the salivary glands;
the lacrimal glands. But the ONLY Sympathetics will also innervate the Blood vessels and the sweat
glands.

In the sympathetic NS there are two big chains of ganglia right next to the spinal cord; they are right on
the back wall of the rib cage, between where the Sympathetics are coming off between T1 and L2 which
is where the Sympathetics are coming off.

But they don’t always synapse here

The SympNS has two divisions the somatic and autonomic systems now the autonomic system must
synapse.

Ie the sympathetic neuron leaves the lateral horn>its exits through the anterior horn and it follows the
rootlet root spinal nerve route just like the somatic NS does but now we get to that chain of ganglia
called the sympathetic chain. And all those ganglia contain sympathetic neurons just waiting to get a
signal

So the pathway continues the pre ganglionic sympathetic neuron reaching that sympathetic chain
through the spinal nerve but it has to the get to that sypm chain before it can continue on. We have
these on ramps and off ramps that connect us from the spinal nerve to the sym chain. And they are
called white ramus(off ramp from the spinal nerve lead to the ganglia) and gray ramus)on ramp).
Get off a ganglia at the symp chain and synapse. Then we have some options

Take the gray ramus back to the spinal nerve

Leave from the symp ganglion and go elsewhere (this happens a lot in the thoracic and abdominal areas)

Start July 16 half of this class was finishing the NS and the start of the circulatory system the second
half.

Of the cranial nerves and spinal nerves that are exiting our system we will see

(non-stress response system) PARASYMP NEURONS IN FOUR OF THE CRAINAL NERVES 3 7 9 10 as well
as S2-S4 parasymp will decrease your HR when you are NOT stressed

(stress response system) SYPM NEURONS come of T1-L2 will increase your HR when you are stressed

For symp response is caused by any type of stress including mental and physical. Lachrymal gland can
cause tears happy or sad. Includes short term and long term stress (constant stress-symp response.

The symp NS will tell BV to constrict and sweat glands to open. Symp is just turned off to do the
reverse. Not involving the parasymp innervation.

When a parasymp signal coming from the brain or spinal cord (CNS). We will have our cell body in the
lateral horn but the axon still exits through the anterior horn. (note the slide in the SympNS the
autonomic NS side has the parasymp neurons)

As this axon that left eh anterior horn leaves the spinal cord it’s going to catch a ride with an artery for
example PARASYMP ALWAYS SYNAPSE and that parasymp ganglia will be waiting close to the
destination. There a post ganglionic neuron will go to the destination.

*Axons leaving through the anterior horn applied to symp and parasymp as well as somatic; the only
place where things can exit.

SYMPATHETIC SYNAPSES (note this is part of the SympNS but the Somatic NS branch)

The big differentiating factor between somatic and autonomic motor systems is IN THE SOMATIC
SYSTEM AND SINGAL NEURON can leave the anterior horn and travel all the way to the destination.
(effector organ)

Whereas on the autonomic side we have to have a synapse, pre gang (the neuron that leaves the spinal
cord) which synapses with a cell body in the ganglia of a second neuron call the post gang neuron that
goes to the destination.

That pre gang neuron synapses at the sympathetic chain before those white and gray ramuses.

HOW THE SYMPNS passes on its messages from the pre gang neuron to the post gang neuron
sometimes it does it the same way as the parasymp neurons>it leaves the anterior horn catches a ride
on an artery or another nerve and then synapses elsewhere.
But usually symp nerves are going to synapse in this structure called the sympathetic chain-which is two
strips of sympathetic ganglions on either side of the spinal cord. T1-L2 which is where all our symp spinal
nerves come off of the spinal cord.

SYPM PATHWAY most commonly when we get a symp signal coming off the spinal cord its going to
synapse in one of the ganglion on the symp chain.

 Pre gang symp neuron has its cell body in the lateral horn
 It exits the anterior horn
 Ant. Rootlets>Ant. Roots>Spinal nerve
 Hoop off through the off ramp called the white ramus so we can synapse
 Sometimes the synapse will happen right at the first ganglion if it does (its also goes to wherever
 It will then hops back on through the gray ramus now this cell body is inside the ganglion and its
axon goes to the gray ramus (on ramp back to the spinal nerve) and then it will follow the
spinal nerve to the destination.

SYMPATHETIC CHAIN (PARAVERTEBRAL GANGLIA) (22 pairs) note there are ganglia besides this
location that are called PREVERTEBRAL GANGLIA they are further away from the vertebral column.

PREVERTEBRAL GANGLIA (sympathetic) alternative location for a sympathetic synapse to happen.

 Usually by themselves
 Closer to a destination

>>>>>Why would a symp signal travel through one of the above routes and not the other. The answer is
it all has to do with

destination.

It matters where spinal nerves are going

The symp chain goes from T1-L2 which leaves a lot of the body uncovered

For instance, the anterior rami make the plexi; they cover all over your body. But if you look at the
anterior rami for the thorax they just wrap around the ribs staying superficial. So if we have to get a
sympathetic signal to the heart or lungs we can’t just follow a spinal nerve we have to do something
slightly different, the same goes for abdominal organs.

SYMPATHEITC PATHWAYS

1) DIRECT SPINAL NERVE EXIT TO A NEARBY EFFECTOR (white ramus>synapse right away gray
ramus and spinal nerve); what is meant by nearby by effector is the destination of the signal is
really close to where the sympathetic nerve comes off the spinal cord.
 Cell body of the sympathetic neuron in the lateral horn whose axon come out through
the anterior horn> rootlets> roots >spinal nerve>white ramus>SYNAPSE AT THE FIRST
GANGLION WE REACH>instead travel up or down to the level where our destination is
and synapse there> Where the post gang cell body (site of synapse) is going to carry our
signal through its axon to the gray ramus out through the spinal nerve. Then effector.
2) INDIRECT SPINAL NERVE EXIT TO THE VERVIAL/LOWER LUMBAR AND SACRAL REGIONS (travel
up or down the symp chain because we are not at the right level to exit)
 Cell body of the sympathetic neuron in the lateral horn whose axon come out through
the anterior horn> rootlets> roots >spinal nerve>white ramus>NOT GOING TO SYNAPSE
AT THE FIRST GANGLION WE REACH>instead travel up or down to the level where our
destination is and synapse there> Where the post gang cell body will carry our signal to
the gray ramus out through the spinal nerve.
 The only thing we have added to make it indirect is when the pre gang neuron is the
symp chain ganglion its going to travel up or down to a level where the destination is.
Remember the off ramp gray ramus comes before the spinal nerve in the post gang
neuron.
WHITE RAMI ONLY EXIST BETWEEN T1 AND L2 there are a few ganglia that a sort of
continuations into the neck of the sympathetic chain but there are NO WHITE RAMI
THERE- we don’t need off ramps for nerves that don’t exist for that level; T1-L2 have
sympathetic nerves coming off the spinal cord above that there are no sympathetic
nerves coming off the spinal cord so no off ramps are required.
 Sending signals to the lower and upper limbs when we are in the symp chain the pre
gang neuron will travel down to the level of some spinal nerve that is going to the knee
that would be the femoral or sciatic nerve; it will synapse at that level and then catch a
ride with those spinal nerves to the knee.

3) HEAD
 What if we have to take a sympathetic signal to somewhere in the head (ie lacrimal,
salivary glands, pupils of the eye); as we know the sympathetic chain is lining with
where the sympathetic spinal nerve exit so it stops at T1 how can we get signals in the
neck even rib 1?
 Usually Pre gang nerve exits fairly high T1-T3>Exits the normal way >takes the white
ramus to get to the sympathetic chain>then the signal will be taken all the way up the
symp chain to three ganglia above it called the CERVICAL GANGLIA –three additional
ganglia that are loosely attached to T1. They are found in the neck they are still
sympathetic ganglia and they are directly connected to the sympathetic chain. They are
going to allow a higher location to synapse if we need to send a signal higher. Superior
middle and inferior cervical ganglia similar to indirect pathway but difference is in the
fact we DON’T HAVE GRAY RAMUS that we can jump on. There are spinal nerves but we
can’t gray ramus it. (means we can’t hop onto the spinal nerve)
 Exit the spinal cord the normal way gets off on white ramus of T1 travel up one of the
cervical ganglia whichever one is at the desired level and synapse there>the new cell
body in that cervical ganglia (post gang) is going to hop off catch a ride with a blood
vessel the same way the parasympathetics do.
 4) THORACIC ORGANS
 We signal go to the thoracic organs; note we don’t have spinal nerves going into the
thorax *the thoracic anterior rami stay very much superficial in the thoracic wall.
 Typical beginning from the lateral horn >>>spinal nerve>white ramus (direct or indirect
through symp chain) usually its T4 or higher because that’s closer to the heart and lungs
for example>then the post gang neuron leaves the symp chain NO GRAY RAMUS off
ramp back to the spinal nerve. The post gang just leaves after synapsing at the symp
gang. That post gang neuron leaves the symp chain going to the organ of the thorax;
 USUALLY THEY POST GANG AXON GOING STRAIGHT TO THE THORAX ORGAN DOES
NOT NEED TO CATCH A RIDE because the THORAX ORGANS ARE PACKED SO TIGHTLY
THAT THERE IS NOT MUCH DISTANCE TO BE TRAVEL TO GET TO THE DESTINATION.
5) ABDOMIANL ORGANS (PREVERTEBRAL GANGLIA)-
 Symp neuron cell body in the lateral horn>typical exit>spinal nerve>white ramus travel
to appropriate level (indirect)usually L1-L2 right at the bottom of the symp chain>then
THE PRE GANG NEURON (NO SYNAPSES HAPPENED) is going to just leave the ganglion
and it’s going to travel to a prevertebral ganglion that is close to the destination.
USUALLY THE POST GANG NEURON CATCHES A RIDE there are three major abdominal
organ arteries which are
1) The celiac trunk, 2) the superior mesenteric artery (SMA), 3) inferior mesenteric
artery (IMA)

Sometimes we don’t have a sympathetic chain spinal nerve to go where we need it to go so we need to
do something else and this applies to 3 4 5 above.

SUMMARY of what you really need to know

Where in the brain or spinal cord the symp and parasymp exit

 Parasymp Cranial Nerves 3 7 9 10; sacrum S2-S4; rest responses>with the exception of
BV’s and sweat glands which only get symp
 Symp leave the spinal cord between T1-L2; causing stress response
 ANS (Symp and parasymp) we have to have a synapse; we must pass the signal from pre
gang neuron to post gang neuron before destination.
 Parasymp system that’s going to involve the axon leaving the…it exits the spinal cord
thru the anterior horn then catches a ride on an artery and goes to a ganglion near its
destination to synapse
 Symp we have 5 options that we discussed above
1) >>off a white ramus>synapse in a symp chain hope back on gray rami to spinal
nerve and leave
2) May travel up or down the symp chain before synapsing
3) When we are going to a destination where we don’t have spinal nerve options
which are HEAD THORAX AND ABDOMEN
 In the HEAD >hop off from the ganglion catch a ride on an artery
4) In the THORAX we are going to leave the symp chain and go directly to our
destination
 5) Abdomen the only one that we don’t have a symp chain cervical ganglia synapse;
keep in mind our synapse for the symp are further away in a prevertebral ganglion

END OF NERVOUS SYSTEM LECTURES

START OF CIRCULATORY SYSTEM

Major function of the circulatory system is TRANSPORT o2 co2 waste removal (usually the liver or the
kidney) nutrients and anything else that might be in the blood like drugs or toxins

Note if you would like to transport more of a particular substance through the Circ system to a particular
region we will dilate those blood vessels more and constrict blood vessels in an area where we don’t
need it as much. I.e. if we were running a tiger we do not care about digestion. In that instance we are
going to vasodilate the blood vessels around quads and hamstrings to run away. And vasoconstrict the
blood vessels around the abdominal organs.

(SYMP NS CONTROLLED) Why not vasodilate everything? NOT ENOUGH BLOOD FOR THAT; we have so
many blood vessels in the body that if we opened them up to full capacity the pressure would drop
dangerously low. (faint)

TEMPERATURE REGULATION –our core body temp has to stay fairly consistent if it raises to high or goes
too low the chemical processes in our body will not function.

If hot environment we want to take heat from the internal areas of our body and move it to the outside
surface of our body for the heat to be transferred to the outside environment.

 Vasodilate the BV’s that are really close to the skin so more blood goes
there and then the warms dissipates through the skin surface. (flushed skin)
 The opposite is true if it’s really cold BV’s near the skin constrict and we will
try and keep all that heat internally. That’s why when its cold outside your
skin looks paler

FLUID BALANCE-(reservoir for water) there is fluid in blood but also the cells and the interstitial fluid
between them. Specific amounts of fluid are required in these areas for proper function. Water
specifically is transferred to regulate fluid balance. Transfer occurs between cells and blood.

MEDIASTINUM (area)– is basically everything in the thorax that’s in between the two lungs

Superior Mediastinum-Sternal angle to Rib 1 anteriorly; fibrocartilage disc between T4-T5

Inferior Mediastinum- Sternal angle to fibrocartilage disc under T12

Anterior middle and posterior mediastinum>note the heart is in the middle mediastinum

PERICARDIUM (2-3)- is membranous layer that surrounds the heart that are an added layer of
protection located in the mediastinum

Outside to inside
 Outmost layer is called the (PARIETAL) FIBROUS PERICARDIUM (thicker layer)
 Next layer in is called the PARIETAL SEROUS PERICARDIUM (parietal layer of the serous
pericardium)
Often these two layers are considered one lay because they are stuck to one another.

 VISCERAL SEROUS PERICARDIUM –Is formed from the looping of the PARIETAL SEROUS
PERICARDIUM and runs back on itself over the heart making a double layer with a space in
between called the PARICARDIAL CAVITY
Serous means it secretes serous fluid – thick oily fluid>as the heart contracts and relaxes it’s
going to allow these layers to glide on each other. If this fluid where not there would be too
much friction damage and inflammation results.

 MYOCARDIUM-muscle in the walls of the heart

 Endocardium (simple squamous)–thin epithelial layer lines the inside in the chambers and also
going to follow the blood vessels as they leave the heart. There is a thin epi layer in the lumen of
blood vessels even outside the heart. That’s a continuation of the endocardium of the inner
chambers of the heart.

CORONARY SINUS-found in the right atrium under the FOSSA OVLALIS; the coronary sinus is
another vein that is bringing less oxygenated blood from the heart muscle itself.
FOSSA OLALIS – in right atrium and it’s a fetal remnant- means we had a structure in the fetus it
turns into some else when you are born. Used to be the foramen ovalis in the fetus. It used to
be an opening between your right and left atrium. The reason is when you are a fetus you are
not breathing air on your own which means you do not have to end blood to the lungs from the
right side of the heart so you skip that part. That’s why there is a hole and blood goes straight
from the right atrium to the right (left side??) ventricle. Some of it will still follow the usual
pathway. And then circulates. Because we have a separate circulation that goes to the mother
and that circulation will handle the o2 and nutrients and waste products.

PAPILLARY MUSLCES/CHORDEA TENIDINAE

–once there is enough blood in right atrium it will push the tricuspid valve open (no muscles
needed to push the valve open) and blood will fill the right ventricle once there is blood in the
right ventricle that is going to force the door (valve) closed. But when the right ventricle there is
a huge force>we can’t have the valve pushing into the right atrium because then the blood will
back flow there instead of going to the pulmonary artery. THE JOB OF THE PAPILLARY
MUSLCES/CHORDEA TENIDINAE IS TO HOLD THE VALVE CLOSED DURING VENTRILCE
CONTRACTION

JULY 23 CIRCULATORY SYSTEM

Follow a drop of blood through the heart example-easy

ASCENDING AORTA!! AORTIC AND PULMONARY SEMI LUNAR VALVES

AV VALVES ARE THE MIRTAL(BICUSP)
the right and left coronary arteries that come off of the aortic semilunar valves like in the pocket of
them above the valve, they come to the front of the heart one separates the rt atrium from the rt
ventricle that’s called the RT CORONARY ARTERY and it’s in the coronary sulcus and the other in hear
the left side and kind of goes down the interventricular septum, in fact it branches down to the called
the ANTERIOR INTERVENTRICULAR SEPTUM.

AURICLES: there are two that cover each rt and lt atria. They are extensions of the tissues of the heart
Fxns:

Cover the coronary arteries to some extent; added Protecting the coronary arteries. Covers the
CORONARY SULCUS (within which the right coronary artery lies) sulcus keeps the coronary arteries SAFE
fat keeps these safe too. The sulcus runs all the way to the back of the heart. It’s like a groove between
the atria and the ventricles. In the back its at the TOP part of the heart like a ring at the top. There are
also veins alongside them.

Allows more space to open up the atria to receive blood.

CORONARY SINUS is at the back of the heart below the left pulmonary veins (form the base of heart) this
vein is huge very notable and it opens into the right atria.

Other two main sulci:

That divide the ventricles

ANTERIOR INTERVENTRICULAR SULCUS –the coronary vessels in that sulcus are not in the course. Kind
of loops to the back and connects to the posterior interventricular artery??

POSTERIOR INTERVENTRICULAR SULCUS-that’s in the back near the IVC side of the heart. Between the
right and left ventricles in the back of the heart close to the vena cava’s

SELF EXCITABILITY in the heart which means a signal can be sent to the heart muscle to contract without
the NS being involved

SA node (sends signal to atria to contract)>AV node (bottom of atria) picks up that signal from the SA
node and its going to send the signal down to the ventricles so they can contract next)>AV bundle
(bundle of HIS); which is a continuations of specialized cardiac cells; this AV bundle is going to
divide>now we are moving into the divider of the two ventricles called the interventricular septum; that
division of the bundle of HIS into the interventricular septum is called the bundle branches there are two
here>then going down to the inferior ventricles are the Purkinje fibers the carrier of the message to all
the myocardium around the ventricles and the ventricles can contract at once.

Atrial contraction happens while the signal is still moving through all of the above. So the atria contract
they push the blood into all the ventricles, they push the valves close; then the ventricles have gotten a
signal then they contract too and send the blood out.

VAGUS NERVE send a parasymp signal all the time to SA node unless you are running from a tiger SA is
not always beating 100 bpm

I.e. tears are related to a sympathetic signal

STRUCTURE OF ARTERIES AND VEINS

ARTERIAL SIDE

Elastic large arteries are closer to the heart. They are more elastic because they accept a lot of blood
than further ones

Muscular arteries are the next biggest, they are farther away from the heart, not as elastic they branch
until they get smaller and turn into>>

>>arterioles which are the smallest arteries and we have these when we are getting close some cells
that we are going to drop off the blood.

From there we move into capillaries where exchange of stuff happens; a capillary will be right next to
cells o2 co2…. etc. diffusion. Glucose is bigger so because of that the capillaries have simple squamous
thin ass walls sometimes they have holes. Just basement membrane and endothelium

VENOUS SIDE

Smallest and closest to the capillaries are called venules

Medium sized vein

Large vein

BLOOD VESSEL WALL

Veins have thin walls compared to arteries and capillaries have the thinnest walls

THREE BASIC LAYERS

innermost vessel in either artery or vein is called the TUNICA INTIMA (it’s a layer of epithelial cells and
a layer of areolar connective tissue) and a basement membrane because epithelial cells have to have a
basement membrane. Its simple squamous layer

note capillaries have only tunica intima its not even a complete one its just simple squamous and a
basement membrane and that’s it! NO areolar connective tissue

TUNICA MEDIA this is the muscular layer <smooth muscle controlled by the autonomic NS> i.e. if we get
a sympathetic signal we get vasoconstriction vice versa; remember only symp innervation in Blood
vessels. Its way thicker in arteries cause that’s what controls BP.

TUNICA EXTERNA made up of areolar CT; this layer helps literally stick the BVs to nearby structures.
Much thicker in veins which adds more structural integrity to the veins themselves because the
muscular layer of veins is so thin.

Musculo-venous pump contracting them squeezes the veins and pushes the blood through. Diaphragm
and the pressure from its contracting. I think it was inhale causes blood flow into lungs. Called the
thoraco-abdominal pump.
MAJOR ARTERIES AND VEINS OF THE BODY

Right subclavian art>rt axillary art>rt brachial art

Ascending aorta>aortic arch which has three branches

1) Brachiocephalic artery (trunk-means artery) which divided into the right subclavian art (arm)
and right common carotid (neck)
2) Left common carotid art goes to the left side of the neck
3) Left subclavian art goes to the left arm

From the Brachiocephalic artery the right common carotid art will divide into the external and internal
carotid art which supplies the brain

On the left the common carotid comes directly off the aortic arch will divide into the external stays
outside the skull and internal carotid art which supplies the brain

External carotid art will split near the ear to give the maxillary art and the superficial temporal art

Branches of the subclavian art

The vertebral art is the only branch in this course; the cervical vertebrae have transverse Formina in the
transverse processes that house this artery. This goes up into the brain. The arteries in the brain have a
lot of repeat routes to make sure blood supply has an alternative path.

The subclavian art goes over Rib1> under the clavicle>becomes the axillary art after passing the clavicle
and rib 1>branches to a lateral thoracic art goes in front of the thorax/rib cage and supply stuff there>a
branch just inferior and medial as well as the lateral thoracic art branch called the subscapular art heads
back toward the scapula >after these two branches name is changed to brachial art its where the teres
major muscle inserts in the humerus; this art comes out from behind teres major this is the exact point
in which the name changed to brachial art. There is a branch that wraps to the back of the arm called
the deep brachial art and this wraps medial to lateral behind the humerus>the brachial art down
around the elbow its going to divide to give the radial art (lateral) and the ulnar art (medial)> the ulnar
art will go deep the flexor carpi ulnaris, the radial art stays superficial.>they will both spilt into
superficial and deep branches at the wrist/hand > the arteries join called anastomose to supply an area
with blood together why is it important because they cover areas that require blood when one art fails
to do so, so basically the art have each other’s backs. The hand is our first anastomose>the superficial
art of both radial and ulnar art will connect and make a loop (attach) and that makes the superficial
palmar arch; the exact same thing happens with the deep radial and ulnar art joining to make the Deep
palmar arch. Note the superficial palmar art is mainly supplied by the ulnar art and the deep palmar arch
is supplied by the radial art. >digital art going to the fingers and those are coming off the superficial
palmar arch
THROAX ARTERIES

Areas of the body that have organs will like visceral arteries and parietal branches.

After the ascending aorta going down is the descending thoracic aorta further down PASSING THROUGH
THE DIAPHRAGM ITS CALLED THE descending abdominal aorta

In the thorax:

Visceral branches of the aorta going to the organs the heart and the lungs

Parietal (going to the wall of the thorax) branches which go between the ribs called the intercostal
arteries

ABDOMINAL ARTERIES

Visceral branches of the aorta are going to all the organs

Parietal (going to the wall of the abdo) branches come off more posterior of the aorta and they go to
the abdo muscles and walls

Descending abdo aorta have three visceral branches from top to bottom

1) Celiac trunk above the stomach but under the diaphragm; the celiac trunk comes a few inches
below the diaphragm off the descending aorta
2) Superior mesenteric artery a few inches lower; its starts in the bottom moon crest of the
stomach like its in the top part not the bottom. And it goes underneath the stomach and it goes
to the right side more
3) Inferior mesenteric artery just above the bifurcation (L4) of the descending aorta goes to the
left side more
These supply blood to all the organs of the digestive tract such as the liver spleen stomach and
intestines to name a few.
>>>>the bifurcation (L4) of the descending aorta are called the RT AND LT COMMON ILIAC
ARTERIES

ARTERIES IN THE LOWER EXTREMEITES

Each common iliac artery is going to split again in the iliac fossa

The division will give us the external iliac artery (anterior) the one that goes down to the actual leg and
the internal iliac artery (posterior) gives off branches that supply the organs of the pelvis bladder
reproductive organs

external iliac artery (anterior) the one that goes down to the actual leg will pass under a ligament called
the inguinal ligament this runs from the anterior superior iliac spine (ASIS) to the pubic tubercle

once the external iliac artery passes the inguinal it’s called the Femoral artery almost right away there
will be a branch called the deep femoral artery -leds to the posterior thigh behind the femur.
The femoral artery is going to continue down the medial leg its going to pass through the adductor
Magnus muscle has a hole in it called the adductor hiatus at this point it’s going to change names again
to the popliteal artery runs behind the knee then there will be a muscle called the populous muscle in
the area of the knee that will be passed and the popliteal artery will split to give the anterior tibal and
posterior tibal arteries

> anterior tibal which will go through a little hole in the interosseous membrane between the tibia and
fibula from back to front and when it gets to the foot it changes names to the dorsalis pedis artery its
more lateral too.

> posterior tibal arteries on the back of leg branches first really fast/high in the leg called the fibular
artery and it goes more laterally on the back of the leg/side leg>going to the foot it splits to give two
arteries that will anastomose to supply the bottom of plantar part of the foot. It looks like the triangle
and they are called the lateral and medical plantar arteries. Runs deep to soleus

End of arteries

START OF VEINS

When writing the flow charts for veins they should be opposite of arteries because the blood flow for
veins goes in the opposite direction compared to arteries.

Deep veins of the upper extremities

In the hand

superficial and deep palmar venous arches>drain into the radial and ulnar veins>drain into brachial veins
axillary veins >subclavian veins

everything happens at the same points as the arteries

cutaneous veins – hold out the forearm and AC region; there are only two and they drain the blood on
the dorsal side of the hand everything we talked about above drained the palmer side of the hand

>same applies to the foot

Those two cutaneous veins are called the cephalic (lateral upper portion runs between the deltoid and
the pec major and then it will drain into the axillary vein just inferior to the clavicle) and basilic veins
(medial also drains the dorsal side of the hand again drains into the axillary vein)

Near the AC there is a down up connection between the cephalic and basilic vein called the median
cubital vein.

Veins of the head

All the venous sinuses around the brain are eventually draining into the internal jugular vein to go the
heart

External jugular vein stays very external just like the external carotid artery did; external jug vein runs
on the outside of the sternocleidomastoid muscle

internal jugular vein much deeper runs along the common carotid artery
External Jug vein drains into> subclavian vein>when the subclavian veins meet the internal jug vein
called the brachiocephalic vein

At the heart where the aorta is the veins are set up different than the arteries

brachiocephalic vein drains into the superior vena cava – it’s the bottom of the Y the right part of the Y
is the internal jug vein the left part of the Y is the subclavian vein they meet to make the
brachiocephalic vein drains into the superior vena cava

on the left side of the heart the veins are set up the same as above just add the word left to all of the,
and add one more branch coming off the left subclavian vein called the left EXTERNAL jug vein. Drains
into the subclavian and there is another one on the other side. Then the two brachiocephalic veins meet
and they become the superior vena cava

Veins in the lower limbs most of the veins called the deep veins are going to follow the arteries but then
again we will add some cutaneous veins just like the arm that drain the dorsal side of the foot

Starting from the foot

Anterior tibial vein drains the plantar foot some of the top and it goes to the back just like the arteries
path>fibular vein again more lateral and the posterior tibial veins >anterior and posterior tibial veins will
join > called the popliteal vein>passes the adductor hiatus in the adductor Magnus muscle just like the
artery does >becoming the femoral vein >passes under the inguinal ligament >becoming the external
iliac vein.

cutaneous veins-the great saphenous vein and the small saphenous vein > mostly they drain the dorsal
so the top of the foot

great saphenous vein-runs in front of the medial malleolus staying medial all the way up seems to
attach to the femoral vein yes it does drain into the femoral vein

small saphenous vein-more posterior its going to run behind the lateral malleolus and it drains into the
popliteal vein not the femoral so it drains lower in the leg.

Moving up- the femoral vein crosses under the inguinal lig and turns into the external iliac vein which
joins with the internal iliac vein (comes from the medial region of the pubis to make the common iliac
vein > the rt and lt common iliac veins join to form the inferior vena cava>the right atria of the heart

Other veins in the abdomen> parietal drainage are the same as the arteries but the visceral is similar but
with a different set up for the veins

Superior mesenteric vein >joins with the splenic vein and together they will join to form the hepatic
portal vein –goes into the liver

The inferior mesenteric vein will drain into the splenic vein.

hepatic portal vein>liver>hepatic veins >drain into the IVC.

In the thorax veins are parietal and visceral.

Parietal veins-the intercostal veins run alongside the arteries

Drainage in the venous system is different than arteries; the IVC and SCV region in between>the veins of
the parietal and visceral branches are going to drain into the azygos system the azygos vein is running
just right of the vertebral column it will drain into the superior vena cava a lot of the veins of the right of
the thorax are going to drain into azygos and then into SVC

On the left side there are other veins that work their way to azygos they are

The accessory hemiazygos vein most superior the hemiazygos below it and they will both go inferior to
join the azygos vein they all drain into the SVC

START OF RESP END OF CARDIO

nose and nasal cavity.

NASAL CAVITY-is split into two halves>there are bones in the middle the ethmoid and the vomer which
splits the nasal cavity in half that diving line is called the nasal septum

Note the resp system is nearly all covered in mucus membrane which means there are epi cells that
secrete mucus which make it sleek which is good but it also means there is some cilia on the membrane
is a lot of places. This benefits because they move things along and help in immune defense if you take a
big breath in and there is a bug its should get trapped by the cilia and the mucus via sneezing or
swallowing it. That bug can really damage the lungs

Nasal cavity – there are three pieces of bones that stick out in rounded shapes called concha they are
bony projections into the nasal cavity

So the nasal cavity has

 The superior nasal concha-very posterior and small compared to the others looks like there’s
nothing really there
 The middle nasal concha can see on skull kind of looks like its coming off the ethmoid bone
 The inferior nasal concha below the middle one a bit bigger looks like its coming off another
bone as well
 Vestibule

The superior and middle are part of the ethmoid bone

The inferior one is its own bone called the inferior nasal concha that’s the name of the bone

There are three on the left nasal side and another three on the right

Underneath there are tunnels formed by these conchae that are called meatuses

The superior meatus would be under the superior nasal concha

Same with the other two

Note all these structures are part of the Nasal cavity

Nasal concha/Meatus importance

>when air comes into the nasal cavity to trap the foreign substances we need all the all to touch a wall
because the walls have the mucus and the cilia. Heat and humidifies the air >running example of the
function of the conchae

In this system tucked up underneath each concha especially right up at the top of the nasal cavity there
lie the olfactory receptors – sense smells these are connected to sensory nerves and they will go up
through the ethmoid bone at the top nasal cavity, olfactory will connect to the first cranial nerve CN1

The pharynx three parts is for the digestive system and the resp system

 The nasopharynx which is behind the nasal cavity –there lies the opening auditory tube is a
connection of the nasopharynx and the ear; the reason we have it there is a tympanic
membrane and that will bock off the outer ear from the internal ear>in certain environments
pressure is different if it’s a big difference it can affect your hearing its opens this auditory tube
the default Is closed There are also tonsils here called the pharyngeal tonsils
Paranasal sinuses are holes in the bone in and around the face they are a continuation from the
nasopharynx and the nasal cavity which means they are directly connected to those areas and
just like those areas they are covered in mucus and cilia they are going to help with heating and
humidifying the air>some of the air goes here first then come back out and go down the pharynx
one of the more important function is making the skull less heavy and areas where there is no
need for skull bone our cervical vertebrae has enough weight from the brain and skull. Also
putting in some air in these spaces can decrease pressure inside the skull when we need it >
there times when you have a cold or cold area. The mucus membrane thicken they do this to be
protective to release more mucus and trap more bad guys and heat the air but it increases the
pressure and this can give you a headache so these sinuses give us a little extra space to put the
air and that may or may not help decrease the pressure.
Frontal
Ethmoidal
Sphenoidal
Maxillary
Mostly in the first two higher ones because air rises

 The oropharynx which is behind the oral cavity running from what seems to be the uvula off the
soft palate (MARKS THE TOP OF THE OROPHARYX) (made smooth muscles and mucus
membrane) this soft palate combined with the hard palate makes the roof of the mouth; to the
tip of the epiglottis. Oral cavity crossing into the oropharynx are the palatine tonsils get infected
most often.
 The Laryngopharynx which is behind the larynx

When we get to the bottom of the pharynx we have the option of going into the larynx going to the
lungs or keep going down to the esophagus
RESP START OF FULL HOUR LECTURE

The larynx from above has a hyoid bone which is a floating bone above the thyroid bone with houses the
Adams apple anteriorly called the laryngeal prominence

Main cartilage that makes up the larynx

Thyroid cartilage its open at the back its not a complete ring laryngeal prominence meets the two
halves of the thyroid cartilage anteriorly

The thyroid cartilage is attached to the hyoid bone by a ligament or membrane called the thyrohyoid
membrane

Inferior to the thyroid cart is the Cricoid cartilage (ring): even though there are no joints here the
cartilages are going to make joints and they are going to move by way of muscles that can move them.

The horns on the bottom of the thyroid cartilage are called the inferior horn of the cricoid cartilage is
connecting to the cricoid cartilage. Where these two connect is called the cricothyroid joint this is one
of the areas that can move; what this means is we are able to tilt the thyroid cartilage backwards and
forwards (flex and extends the thyroid cartilage)

Within the thyroid cartilage are the vocal ligaments form part of the vocal cords so when you say you
are moving the joints in your larynx they are going to be import for things like producing a higher or
lower pitched sound

Attached to the inside back of the ends of the thyroid cartilage by a ligament; sort of the stem of the leaf
like epiglottis (elastic cartilage) – it can raise and lower to open the entrance to the larynx

There are tiny cartilage that are not important called the cuneiform and corniculate cartilages (attached
to the arytenoid cartilages

Arytenoid cartilages are important they sit on top of the cricoid cartilage in the front shaped like
pyramids; there are two important parts on them

>the vocal process (she call its front)-where the vocal cords are to attach

>the muscular process (she calls it back) Its where the muscles attach to move the vocal cords

The vocal ligament goes from the vocal process to the thyroid cartilage below it is a membrane that goes
from the vocal ligament to the cricoid cartilage; its one structure see after draping the vocal ligaments
with this membrane its called the vocal folds or vocal cords. This membrane is of ligament design it
connects the coracoid cartilage to the vocal process and the inner surface of the thyroid cartilage. There
is one membrane on the right and left

The muscles that flex and extend the thyroid also rotate the arytenoid cartilage open is abducted and
closed is adducted (when swallowing food)

Glottis –space between the two vocal ligaments (if thicker that would produce a lower pitched sound)

Rotating the arytenoid cart only part way for example and by Tilting the cricoid thyroid you can increase
or decrease pitch
Trachea

Right below the cricoid; runs from eh larynx to the bifurcation externally occurs at the sternal angle 9the
disc between T4 and T5. Splits into two primary bronchi one going to the left lung and the other to the
right lung. The point where it splits is called the carina (occurs at the sternal angle)

Right primary bronchus is a lot more vertical pointing straight down therefore more porn to infection.

Right and left primary bronchi will divide to give branches of secondary bronchi which are just the first
braches off the primary bronchi’s.

The right primary bronchi will split into 3 secondary bronchi because the right lung has 3 lobes

The left primary bronchi will split into 2 secondary bronchi because the left lung has 2 lobes

These will continue to divide until you get bronchioles the smallest division > then these will end at
little sacs called alveoli – is the place where gas exchange will occur where pulmonary arteries and veins
will form capillary beds around each alveoli

Lungs

Covered in a double membrane 2 layers

Outer parietal pleura

Inner Visceral pleura

In between is a pleural cavity

Outer parietal pleura and Inner Visceral pleura don’t touch easily at the bottom of the lungs

Outer parietal pleura and Inner Visceral pleura are going to directly connect to each other at an area
called the ROOT of the LUNG this is where the arteries, veins and the bronchi will enter and leave the
lungs and its quite medial by the heart. At that point the parietal and visceral pleura meet each other
therefore they are continuing with each other. It’s like punching a soft balloon the balloon is these two
layers it basically one piece and the hand in the lung. ROOT of the LUNG surrounds the HILUM –which is
where all the stuff comes in and out of the lungs (the pulm art and veins and primary bronchi)

Start of Digestive system

A child under the age of 6 so between the age of 2-6 would have a full set of MILK TEETH or deciduous
teeth or baby teeth. So ten on the top and bottom. A typical adult has 32 teeth

The two sets of premolars behind the canine teeth are not seen in children

A total of six molars on one roof of the mouth the 3rd molar (called wisdom teeth) they don’t come out
until you 20’s
There are 3 pairs of salivary glands exocrine

1) Parotid duct pierces the cheek muscle called the buccinators to get into the oral cavity travels
outside the masseter muscle
2) Sublingual –numerous ducts that open in the floor of the mouth and are more lateral than the
submandibular ducts
3) Submandibular single duct just next to the Lingual frenulum –attaches your tongue to the floor
of the mouth one on either side

Lingual frenulum – made of mucus membrane attaches the tongue to the floor of the mouth

The tongue is covered in bumps called papillae and house the taste buds not all have them, also helps
crush the food into small pieces and move the food around.

Oral cavity - hard/soft palate, tongue, oropharynx>laryngopharynx>esophagus>stomach