The Circulatory

System
 General Overview
• The circulatory system is frequently divided into:
– the cardiovascular system
consists of
•

 Blood Vessels - routes through which blood travels

 Heart – pumps or pushes blood through body
 Blood – carries important “ stuff ” through body

– the lymphatic system,

• consists of
– lymph vessels

– lymph nodes
– Lymph fluid
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 Functions of the circulatory system:

Distribute nutrients
Transport and exchange O2 &Co2
Remove waste materials,

Prevent excessive bleeding,

Prevent infection, and
Regulate body temperature.
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 The blood

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 Components of Blood
 when we separate blood withdrawn from a vein and
collected in a tube by a machine called centrifuge, we will
get 3 layers.
• Erythrocytes (or red blood cells)
– form the lower layer of the centrifuged blood
– typically make up about 44% of a blood sample
• Buffy coat
– makes up the middle layer
– thin, slightly gray-white layer composed of cells called leukocytes
(or white blood cells) and cell fragments called platelets
– forms less than 1% of a blood sample
• Plasma
– straw-colored liquid that rises to the top
– generally makes up about 55% of blood
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From left to right:
 Red blood cell (erythrocyte);
Platelet (thrombocytes)
White blood cell (leukocyte).

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 Red Blood cells (erythrocytes)
• are produced in the red marrow of bones.
• are biconcave, disc-shaped that provides a large area for oxygen
exchange.
 Lack nucleus, i.e. have no nucleus
 are involved in the transport of oxygen and carbon dioxide
 function exclusively within the vascular system
 Contain red pigmented molecule called hemoglobin.
 are quite flexible, allows to adapt to the small diameters of capillaries.

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 White blood cells or leukocytes:
 constitute an important part of the immune systems of the
body and they migrate to the tissue where they perform
multiple functions.
 There are five types of leucocytes, traditionally divided into two
main groups based on their shape and cytoplasmic granules.
A. Granulocytes or granular leukocytes.
Neutrophils.
 Eosinophils.
 Basophils.
B. Agranulocytes or agranular or mononuclear leukocytes.
 Lymphocytes
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Monocytes Berhanu K. 9
 Platelets
• Also called thrombocytes
• Irregular, membrane-enclosed cellular fragments
– about 2 micrometers in diameter (less than ¼ times the size
of an erythrocyte).
• Continually produced in the red bone marrow by parent
cells called megakaryocytes.
• Important during trauma to a blood vessel; causes the
blood to coagulate, or clot.

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 The Heart
– hollow, muscular, 4 chambered organ
– 2 cm long, 9cm wide & 6 cm thick
– Weighs about 300g
- has size of individuals self clenched fist .

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 Pericardium
Fibrous sac that contains the heart in the mediastinum
Restricts heart movements
Prevents the heart from overfilling with blood.
• Pericardium has outer fibrous and inner serous parts
• Outer portion ; called the fibrous pericardium
– tough, dense connective tissue
– attached to both the sternum and the diaphragm
• Inner portion; called the serous pericardium
– thin, double-layered serous membrane
• parietal layer ; outer layer of serous membrane
• visceral layer; inner layer of serous membrane
• In-between the two layers is the pericardial cavity
containing pericardial fluid.
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• Layers of the heart wall
– contain 3 distinct layers:
 Epicardium
• thin, external membrane around the heart
• In old ages this layer becomes thicker and more fatty
Myocardium
 middle layer of the heart wall
 composed chiefly of cardiac muscle tissue.
 thickest of the three heart wall layers.
 responsible for the ability of the heart to contract
Endocardium
 a thin, innermost layer of heart and covers external surfaces of
valves.
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 Chambers of the heart

 The heart has four chambers

• two upper chambers- called atria
• two lower chambers – called ventricles
 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
atriums.
– blood passes from the right atrium in to the right ventricle
through a valve called tricuspid valve, it consists of three leaflets
of cusps
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• Left atrium
– forms most of the base of the heart
– 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.
• 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
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• Left ventricle
– forms the apex of the heart
– Largest of the four heart chambers.
– The thicker, most muscular chamber
– 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.

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• Heart Valves:
– prevent back flow of blood and ensure that blood flows
in the proper direction through the heat.
– The valves function to maintain blood flow in one
direction.
– Valves open and close in response to changes in pressure
• There are 4 heart valves
– Atrioventricular (AV) valves
• tricuspid and
• bicuspid (mitral) valves
– Semilunar valves; - prevent back flow of blood form
arteries to ventricles during ventricular diastole.
• Aortic valve
• Pulmonary valve
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 Heart Sounds
• Lubb
– first heart sound
– occurs during ventricular systole
– Atrioventricular valves closing
• Dupp
– second heart sound
– occurs during ventricular diastole
– pulmonary and aortic semilunar valves closing
• Murmur – abnormal heart sound

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• Innervation of the Heart
– Autonomic Innervation (cardiac plexus)
• Vagus Nerve (parasympathetic)
• cardioinhibitory center
– Sympathetic trunks
• cardioaccelatory center

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• 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.

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 Principal Arteries of the body
• Aorta; The largest artery in the body
• Ascending aorta
– ascends from the heart (left ventricle)
– The coronary arteries are the only branch of the ascending aorta
• Aortic arch
• Three vessels arise from the aortic arch:
– the brachiocephalic artery–supplies the upper limbs and
head regions
– left common carotid artery
– left subclavian artery
• Descending aorta; has thoracic and abdominal portions
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• 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.

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 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.

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• The brain is supplied by four arteries:
– paired vertebral arteries
– paired internal carotid arteries.
1. 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.

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2. 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.
The external carotid
 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. Occipital artery - to occipital region of head
5. Maxillary artery- to maxillary region of face
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Superficial temporal artery - to superficial temporal region of head
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 Arteries of the upper limbs

• Right subclavian- from brachiocephalic.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.

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• The brachial artery bifurcates at the cubital fossa into:
• Radial artery- supplies muscles on the radial side of the
forearm. It is the site of measuring pulse.
• Ulnar artery – supplies muscles on the ulnar side of the
forearm.
• Both arteries form; palmar arch in the palm and digital arteries
supplying the digits.

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 Thoracic portion of the descending aorta

– It is a continuation of the aortic arch

– descends though the thoracic cavity to diaphragm
– gives branches to the muscles and organs of thoracic
region;
– e. g. Pericardial artery – to pericardium of heart,
– Bronchial artery – systemic circulation to the lungs.

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 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)
• Left gastric artery ( to stomach)
• Common hepatic artery (to liver)
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2. Superior mesenteric artery
– to the small intestine (except the duodenum), cecum,
appendix, transverse, and ascending colons
3. Inferior mesenteric artery
– last unpaired branch just before bifurcation into the
common iliac arteries.
• Supplies the descending, and sigmoid colons, rectum.
Paired branches
– Renal artery– to kidney
– Suprarenal artery - to adrenal glands
– Testicular artery to testes
– ovarian artery- to ovaries
– Inferior phrenic arteries
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The 3 Unpaired branches of abdominal aorta
Arteries of the pelvis and lower limbs
– the abdominal aorta terminates by bifurcating into
• right common iliac artery
• left common iliac artery
– The common iliac artery divides into;
• internal iliac artery and
• external iliac artery.

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 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 vesicular 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
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 The external iliac artery
– 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 becomes the popliteal artery as it
passes across the posterior aspect of the knee.

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 The popliteal artery
– divides into the
• anterior tibial artery and
• the posterior tibial artery
 the anterior tibial artery; at the ankle it becomes
• the dorsal pedal artery and
• 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.

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The posterior tibial artery
– forms the large fibular artery which supplies the
peroneal muscles of the leg.
– At the 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 foot.

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Venous drainage of the body

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 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 atrium.
 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

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 Superficial veins

• are the basilic and cephalic veins

 basilic vein
– drains blood from ulnar side of forearm, medial side
of arm
– merges with brachial vein near the head of the
humerus to form the axillary vein
 cephalic vein
– drains superficial region of hand and forearm on
radial 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 venipuncture
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 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 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 vertebral column
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 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
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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 into the
femoral vein.

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 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
– in the abdomen has tributaries corresponding to the
branches of the abdominal aorta .
– (Exceptions: the left testicular vein, left ovarian vein and
the left suprarenal vein drain into the left renal vein)

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 Cont`d…
Other veins in the abdomen
 4 paired lumbar veins
 renal veins -from kidney
 right and left testicular veins -from testeses
 right and left ovarian veins –from ovaries
 right and left suprarenal veins –from adrenal glands
 inferior phrenic vein – from diaphragm
 right and left hepatic veins – from liver

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 Hepatic portal system
• A portal system is one in which the veins that drain one
group of capillaries delivers blood to another group of
capillaries, which in turn are drained by systemic veins that
carry blood to the 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 (sinusoids).
• right and left hepatic veins that drain the liver into the
inferior vena cava

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 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).
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1. Which one of the following Atrioventricular valve is located between
right atrium & right ventricle?
A. Tricuspid valve C. Aortic valve
B. bicuspid valves D. Pulmonary valve
2. Which one of the following artery is the first branch of aorta?
C. Brachiocephalic artery C. left subclavian artery
D. Left common carotid artery D. Coronary artery
3. The vertebral artery is branch of
E. Common carotid artery C. brachiocephalinc trunk
F. subclavian artery D. External carotid artery
4. From the following alternatives one is not branch of external carotid
artery?
G. Superior thyroid artery C. Axillary artery
H. Ascending pharyngeal artery D. Maxillary artery
5. From the following artery one is very important site for blood
pressure measurement?
I. Right subclavian C. Brachial artery
The lymphatic system
 Components of the Lymphatic System
 Lymphatic system assists the cardiovascular system by
transporting excess interstitial fluid (lymph) through lymphatic
vessels.
 Components include:
 Lymph
 Lymphatic Vessels
– Lymphatic Capillaries
– Lymphatic Vessels
– Lymphatic Trunks
– Lymphatic Ducts
 Lymphatic Organs
– Thymus
– Lymph Nodes
– Spleen
– Tonsils
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 Functions of the Lymphatic System
 Fluid and nutrient transport
 lymphocyte development
 immune response
 Reabsorbs excess interstitial fluid:
returns it to the venous circulation
maintain blood volume levels
prevent interstitial fluid levels from rising out of
control.
 Transport dietary lipids:
transported through lacteals
drain into larger lymphatic vessels
eventually into the bloodstream.

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 Lymphatic Capillaries
• The lymphatic network begins with microscopic vessels
called lymphatic capillaries.
– closed-ended tubes that are found in most blood
capillary networks
– consist highly permeable simple squamous epithelium
and tissue fluid can ready enter.

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 Lymphatic vessels
– Lymphatic capillaries converge to form the lymph
vessels. (similar to veins in layers and valves)
– Lymphatic vessels empty into two principal ducts:
thoracic duct and right lymphatic duct.
– Thoracic duct (larger) – drains from lower limbs,
abdomen, left thoracic and left upper limb, left side of
the head and neck
• ascends along the spinal column and empties into left
subclavian vein
– Right lymphatic duct (shorter) - drains right upper limb, right
thoracic region, right side of head and neck
• Empties into right subclavian near the internal jugular vein.

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 Lymphatic Cells
• Lymphatic cells are also called lymphoid cells.
• Located in both the lymphatic system and the
cardiovascular system.
• Work together to elicit an immune response.
• Types of lymphatic cells are:
– macrophages
– epithelial cells
– dendritic cells
– lymphocytes

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 Types and Functions of Lymphocytes
• T-lymphocytes (also called T-cells).
 helper T-lymphocytes
 cytotoxic T-lymphocytes
• B-lymphocytes (also called B-cells).
• NK cells.
• Migrate through the lymphatic tissues and monitor for the
presence of antigens.
• Identified according to the tissue or organ where they
mature:
– T-lymphocytes mature in the Thymus
– B-lymphocytes mature in the Bone marrow

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 Lymph Nodes
 Filter and attack antigens.
 Afferent lymphatic vessels carry lymph to the lymph nodes,
whereas efferent lymphatic vessels carry away from the
lymph nodes.
 Lymphatic nodules within the lymph nodes are the sites of
lymphocyte production.
 In some areas of the body, many lymphatic nodules group
together to form larger structures.
– mucosa-associated lymphatic tissue (MALT) or
– tonsils

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 Cont`d…
MALT: detect antigens and initiate an immune response
– very prominent in the mucosa of the small intestine,
primarily in the ileum named as Peyer patches
– also prevalent in the appendix

• Some of the principal groups of lymph nodes are:

– Popliteal and inguinal lymph nodes – drain lower limb
– Lumbar lymph nodes - drain pelvic region
– Cubital and axillary lymph nodes – drain upper limb
– Thoracic lymph nodes –drain chest
– Cervical lymph nodes – drain neck

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 Tonsils
• Large clusters of lymphatic cells and extracellular matrix.
• Several groups of tonsils form a protective ring around the pharynx.
– pharyngeal tonsils (or adenoids) are in the posterior wall of the
nasopharynx
– palatine tonsils are in the posterolateral region of the oral cavity
– lingual tonsils are along the posterior one-third of the tongue

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 Thymus
• a bilobed organ located in the anterior mediastinum
• in infants and young children, it is quite large and extends
into the superior mediastinum.
• continues to grow until puberty.
• cells of the thymus regress, and it is eventually replaced by
fat.
• in adults, it atrophies and becomes almost nonfunctional
 Spleen
• Largest lymphatic organ in the body.
• Located in the upper left quadrant of the abdomen,
inferior to the diaphragm and posterior to ribs 9–11.
• Deep red organ lies lateral to the left kidney and
posterolateral to the stomach.
• Contain white and red pulp internally.

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 Functions
• Initiates an immune response when antigens are found in the
blood (a white pulp function).
• Serves as a reservoir for erythrocytes and platelets (red pulp
function).
• Phagocytizes old, defective erythrocytes and platelets (red pulp
function).
• Phagocytizes bacteria and other foreign materials.