VASCULAR SYSTEM

TWO INTERDEPENDENT SYSTEM

1.Pulmonary circulation
2.Systemic circulation
Vascular system composition:
• Arteries-
• Capillaries
• Arterioles and venules
• Lymphatic vessel
Composition of vascular system
 comparison
arteries veins
• Thick walled structure that • Walls o are thin and less
carries oxygenated blood muscular-allowing them to
distend that allows large
from the heart to the blood volume to remain in the
tissues veins under low pressure
• Some vein have valves (lower
extremity)-prevent blood from
seeping backward as it is
propelled toward the heart
• Competency of the valve
depends on the integrity of
the vein wall
 arterioles
• small arteries and arterioles have much less
elastic tissue
• Smooth muscles in the media controls the
diameter of the vessel by contracting and
relaxing. ( chemical, neuronal, hormonal
activity of the body)
• Arterioles (resistance vessels)- they offer
resistance to blood flow
 arterioles
• Regulate the volume and pressure in the
arterial system and the rate of blood flow to
the capillaries
 capillaries
• Walls lack smooth muscle and
adventitia
• Composed of single layer of
endothelial cells
• Thin-walled structure permits
rapid and efficient transport of
nutrients to the cells and
removal of metabolic waste
• Diameter is very small-
• Changes in the capillary
diameter –passive- influenced by
contractile changes in the blood
vessels that carry blood to and
from it.
capillaries
 Veins and venule
• Capillaries join to form a larger vessel known
as venules which joins to form veins
 Lymphatic vessel
• Are a complex network of thin-walled vessels
similar to the blood capillaries
• Collects lymphatic fluids from tissues and
organs and transports the fluid to the venous
circulation
• Two main structure:
1. Lymphatic duct
2. Thoracic duct
• Peripheral lymphatic vessel joins larger lymph
vessels and pass through regional lymph nodes
before entering the venous circulation
• Lymph nodes filter foreign particles
• Lymphatic vessels are permeable to large
molecules and provides the only means by
which interstitial protein can return to the
venous system
 Function of the vascular system
• Circulatory needs of tissue- vessels dilate and
constrict depending on the tissues metabolic
need
• Blood flow
-unidirectional blood flow cause by a pressure
difference that exist bet. The venous and arterial
system
-Arterial pressure= 100mmhg
-Venous pressure =40mmhg
• In long smooth blood vessel- blood flow is
laminar or streamlike- blood in the center of
the vessel moving slightly faster than the blood
near the vessel wall
• Laminar flow becomes turbulent when:
-blood flow rate increases
- Diameter of the vessel becomes greater than
normal
- Segments of the vessel are narrowed or
constricted.
• Turbulent blood flow- bruit
 Function of the vascular system
• Capillary filtration and reabsorption-
-fluid exchange in across capillary wall is
continuous( interstitial fluid)
-the equilibrium between hydrostatic forces and
osmotic forces of the blood and interstitium, as
well as capillary permeability, determines the
fluid movement across the capillary
• Hydrostatic pressure- is a driving
pressure that is generated by the
blood pressure
• Osmotic pressure is the pulling
force created by plasma proteins
• Arterial end of the
capillary- high hydrostatic
pressure-drive fluid out
of the capillary and into
the tissue spaces.
-osmotic pressure tends to
pull back the fluid into the
capillary but can’t overcome
the high hydrostatic
pressure
• venous end of the capillary- lower hydrostatic
pressure
-pulling back of fluid into the capillaries by
osmotic pressure
-osmotic forces predominates over the low
hydrostatic pressure
Reabsorption of fluid from the tissue space into
the capillary
• This process help maintains tissue fluid
volume, and removing tissue waste and debris
• Sometimes fluids filtered out greatly exceeds
the amount reabsorbed and carried away by
the lymphatic vessel- due:
✓ Damage to capillary walls-increase
permeability
✓ Obstruction of lymphatic drainage
✓ Elevation of venous pressure
✓ Decrease plasma protein osmotic force
Peripheral vascular regulating mechanism

• Sympathetic ( adrenergic) –innervates all blood

vessels except the capillary and precapillary
sphincter- vasoconstriction (norepinephrine)
• Hormonal substance-
-epinephrine-acts like the nor epinephrine
(vasoconstriction) but low dose cause
vasodilation in skeletal muscles, heart and brain
Angiotensin
• Reduce blood flow through peripheral blood
vessel characterizes all peripheral vascular
disease:
• Pump failure- inadequate peripheral blood
flow
• Alteration in blood and lymphatic vessels-
damage arteries, thromboembolus occluding
the vein, incompetent venous valve, reduction
in the effectiveness of the pumping action of
the surrounding muscles
 ASSESSMENT
• Intermittent claudication- muscular, cramp-like pain
in the extremities- peripheral arterial insufficient
• Cool and pale extremities
-rubor-20sec to 2 minutes after extremity is place in
dependent position
-cyanosis
• Reduced nutrient supply to tissues:
-Hair loss
-Brittle nails
-Dry and scaly skin
-Atrophy and
-Ulcerations
• Gangrenous changes- appear after prolonged,
severe ischemia
• Absent pulses
 Diagnostic evaluation
• Doppler ultrasound flow studies-hand held
device that emits a continuous signal through
the patients tissues.
-signals are reflected by “echo off” the moving
blood cells and are received by the device
-the filtered-output doppler signal is then
transmitted to a loud speaker or headphones
where it can be heard for interpretation
• Exercise testing- ankle systolic BP is taken-little
or no drop in BP is normal
• Duplex ultrasonography- imaging of the tissue,
organs and blood vessels and permits
estimation of velocity changes by the use of a
pulsed doppler
• Computed tomography-provides images of the
soft tissue and visualize the area of volume
changes to an extremity and the compartment
where changes takes place
• MRI- useful in pts with impaired renal function
• Angiography- arteriogram-to confirm the
diagnosis of occlusive arterial disease. Contrast
agent is injected into the vascular system to
visualize the vessel
• Contrast phlebography- also known as
venography
-injects contrast agent into the venous system to
check for thrombus
-injection of contrast media cause brief pain and
inflammation of the vein
• Lymph angiography- provides a way of
detecting lymph node involvement
- Lymph vessel in each foot is injected with
contrast media, then series of x-rays will be taken
after 24 hours and periodically thereafter
• Lymphoscintigraphy- a radioactively labelled
colloid is injected subcutaneously in the
second interdigital space. The extremity is then
exercised to facilitate uptake of the colloid by
the lymphatic system and serial images are
obtained at preset interval