Blood vessels and lymphatics introduction.
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| What is included in the tunica interna (intima)? | Endothelium and connective tissue.
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| What is included in the tunica media? | Muscle and connective tissue.
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| What is included in the tunica externa (adventitia)? | Thick layer of connective tissue.
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| What lines the tunica interna? | Lined by specialized simple squamous epithelium called the endothelium.
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| What does endothelium release and what does it do? | Releases endothelins that constrict the smooth muscle within the walls of the vessel to increase blood pressure.
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| What is the function of the basal lamina? | Effectively binds the endothelium to the connective tissue.
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| What do large arteries also have? | A distinct layer of elastic fibres known as the internal elastic membrane at the boundary with the tunica media.
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| What is the function of the internal elastic membrane in larger arteries? | It provides the structure while allowing the vessel to stretch.
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| How does the tunica media in veins compare to in arteries? | It is the thickest layer in arteries and it is much thicker in arteries than it is veins.
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| What is the tunica media composed of? | Concentric layers of helically arranged smooth muscle cells.
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| What is the function of elastic fibres in the tunica media? | To support the muscle cells.
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| What is vasoconstriction? | Contraction of the circular muscles in the tunica media.
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| What is vasodilation? | Relaxation of the circular muscles in the tunica media.
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| What is the tunica externa? | A sheath of longitudinally orientated connective tissue composed primarily of collagen (type 1) fibres.
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| How does the tunica externa in veins compare to in arteries? | This is normally the thickest in veins and may be thicker than the tunica media of some larger arteries.
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| What are the large arteries mainly composed of? | Elastic tissue.
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| How do the large arteries maintain blood pressure? | They expand during systole, while elastic recoil during diastole helps drive blood onwards.
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| What is the structure of muscular arteries? | Have a relatively thick layer of circular smooth muscle in their tunica media.
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| What is the function of muscular arteries? | Control distribution of blood to regions and organs.
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| How do muscular arteries carry out their function? | They regulate blood flow by constriction or relaxation of their walls.
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| How do muscular arteries prevent a haemorrhage? | By contracting.
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| Can muscular arteries accommodate an increase in diameter? | Yes.
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| What are the arteries from the top of the arm to the bottom? | Subclavian, Axillary, Brachial and then Radial and Ulnar.
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| Where do the radial and ulnar arteries lead to in the hand? | In the hand, the deep and superficial palmar arches are derived from both the radial and ulnar arteries.
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| What does arterial anastomosis ensure? | Ensures supply to the hand and fingers in any position of the upper limb.
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| What is an anastomoses? | A communication between two blood vessels without an intervening capillary network.
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| What are the three descending large arteries of the trunk? | Descending thoracic aorta, abdominal aorta and common iliac artery.
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| Where does the femoral artery lie? | In the groin, the femoral artery lies with its vein medially, and the femoral nerve laterally.
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| When are the relations between the different vessels in the groin important? | When taking blood or inserting arterial cannulae.
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| What are the descending lower limb arteries above the knee? | (Aorta), common iliac, internal iliac, external iliac, (common) femoral, profunda femoris, (superficial) femoral and popliteal.
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| What are the descending lower limb arteries below the knee? | Popliteal, anterior tibial, tibio-peroneal trunk, peroneal and posterior tibial.
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| Why is smooth muscle present in the media of all arteries? | The elements of control over distribution and flow remain crucial.
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| What defines an arteriole? | Arteries less than 0.5mm in diameter.
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| What is the structure of a metarteriole? | Same diameter as capillaries, but with one layer of smooth muscle cells in their walls.
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| What is the structure of capillaries? | Tube of endothelium only supported by basal lamina. No smooth muscle on their walls.
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| What is the function of capillaries? | Allow exchange of oxygen, carbon dioxide, nutrients and hormones between cells/interstitial fluid and blood.
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| How do capillaries allow exchange? | The basal lamina splits to enclose pericytes.
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| What regulates blood flow through the capillary? | The pre-capillary sphincter.
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| How are veins usually classified? | According to size; the smallest are venules.
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| What is the structure of venules? | The media is thin, with only a few smooth muscle fibres.
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| What do venules allow the passage of? | Leukocytes can pass through the walls of venules (diapedesis) and escape into surrounding connective tissue.
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| What is the structure of the valves in the venules? | Two valve leaflets can be seen in the lumen arising from the intima and covered by endothelium.
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| How do the valves in the venules work? | When the blood pressure proximal to the leaflets is greater than that distal to them they close, preventing backflow.
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| What are venae comitantes? | A vein that is paired with the sides of an artery. The pulsation of the artery therefore aids venous return to the heart.
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| How does a thrombus form? | Plaques of atheroma may form within arteries and lead to the formation of thrombus (blood clot) and vascular occlusion.
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| What are deep veins? | Accompany the limb arteries, which are situated deeply and have the same names as the arteries.
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| What are superficial veins? | Lie immediately under the skin.
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| What are the superficial veins in the lower limbs? | The Great (Long) Saphenous Vein and the Small (Short) Saphenous Vein.
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| What is the function of perforating veins? | To connect deep and superficial veins.
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| What is the direction of blood flow in veins? | Venous flow is from superficial to deep veins, due to valves in perforating veins.
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| What causes varicose veins? | Incompetency of the valves.
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| What factors help venous return to the heart against gravity? | The valves inside the veins, contraction of muscles, arterial pulsation and negative intrathoracic pressure.
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| What are superficial veins in the upper limbs used for? | Phlebotomy.
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| Define phlebotomy. | The surgical opening or puncture of a vein in order to remove blood or to infuse fluids.
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| Which veins in the upper limb can be used for phlebotomy? | The cephalic, the basilic and median cubital veins.
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| Why must care be taken when performing phlebotomy in the upper arm? | Not to puncture the brachial artery or median nerve posteriorly.
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| What is the function of the vena cava? | Drains the venous blood of the head, neck and upper limbs to the right atrium.
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| What does the azygos vein do? | Drains the venous blood of the thoracic wall to the superior vena cava.
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| What are the thoracic veins? | Superior vena cava, azygous vein and inferior vena cava.
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| Where does venous blood from the GI tract and the spleen go? | Into the (Hepatic) Portal Vein, which takes the venous blood through the liver before it joins the inferior vena cava.
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| What is the vasa vasorum? | The network of small blood vessels that supply the walls of large blood vessels, such as elastic arteries.
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| What is the lymphatic system part of? | The immune system of the body.
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| What is the lymphatic system formed of? | Lymph vessels, lymph nodes, tonsils, thymus, spleen and intestinal wall.
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| What is the function of the lymphatic system? | Helps veins to remove the interstitial fluid, which is then called lymph.
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| How is lymph formed? | Interstitial fluid is absorbed by lymph capillaries.
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| What is the structure of lymph capillaries? | Thin-walled, endothelial tubes.
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| What type of lymph vessels are associated with veins? | Superficial lymph nodes.
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| What type of lymph vessels are related to arteries? | Deep lymph nodes.
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| What does drainage in the lymphatic system depend on? | Drainage depends upon adjacent muscle activity and valves prevent backflow.
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| What disease can spread in the lymph nodes? | Tumour may well spread in the lymphatics and seed in the nodes.
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| What is the position of the inguinal lymph node? | Superficial, inferior to the inguinal ligament and alongside the great saphenous vein in the groin.
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| What is the position of the deep inguinal lymph node? | Alongside the femoral vein.
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| What drains into the inguinal lymph nodes? | Lower limb and buttock; external genitalia; lower back and abdominal wall below umbilicus.
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| Where does the superficial inguinal node drain into? | Into the deep inguinal nodes.
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| What is the position of the axillary lymph nodes? | Grouped in the axilla related to the axillary vein and artery; lateral to, deep to or medial to pectoralis.
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| What drains into the axillary lymph nodes? | Upper limb, anterior and posterior thoracic walls, plus upper abdominal wall above umbilicus (breast).
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| What is the position of the cervical lymph nodes? | Superficial: under jaw; over parotid; behind ear; occipital. Deep: alongside internal jugular vein (jugulo-digastric; jugulo-omohyoid).
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| What drains into the cervical lymph nodes? | The head and neck structures.
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| Which lymph nodes communicate with axillary and thoracic nodes? | Inferior deep cervical nodes.
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| Where does all lymph drain into? | Drained by lymph vessels that eventually return to the lymph to the venous system.
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| What is the largest lymph vessel? | The Thoracic Duct.
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| What is the position of the thoracic duct? | Opens at the junction of the left subclavian and internal jugular veins.
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