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How to get the most from the revision slides
- Have a pen & paper ready
- Answer every question
- Attempt to label all slides
- Mark your answer after answering
- Elaborate on each answer
- Add relevant clinical content
- If you have trouble, ask - you know where
Calibration
Community of Truth
What is my answer?
What is the correct answer?
I am am wrong, what was my error?
THUS: Find the truth
Philosophy 1
What is the least amount of work I can do so I can get out of here.
Philosophy 2
Today and Now I will do something for my future self.
Friday
Blah blah blah blah
Saturday
So, all we ever do is go ja ja ja
Sunday
Blah blah blah
Blah blah blah
Blah blah blah
Blah blah blah
Blah blah blah
Blah blah blah.....
Did I have to do something?
Date
Topic
Slide description
Create a context
Slide 92 vs Large vein
Which is more memorable?
Elaborate:Tunica intima
V Epithelium = endothelium
Bulging/Flat
V Subendothelium
v LEI
See X.Y
Content is connected
Concepts repeat
Existing knowledge matter
Generic issues
- Pen & Paper
- Annotations – as many as possible
- Don't obsess about neat
- Except surgery
Words
adipose, adventitia, arteriole, artery, blood, bundle, capillary, capsule, cell, circular, collagen, compact, connective, continuous, cross, distribute, elastic, elastic, endothelium, erythrocyte, fenestrated, fiber, fine, flap, ganglion, hilus, inner, internal, interspersed, intima, laminae, large, layer, longitudinal, loose, lumen, lymph, lymphatic, media, medium, membrane, muscle, muscular, narrow, nerve, node, oblique, pericyte, perineurium, red blood cell, sinusoid, small, smooth, sphincter, sub-endothelium, sympathetic, terminal, thick, thin, tissue, transverse, tunica, unmyelinated, valve, vasa vasorum, vasomotor, vein, venule, vessel, wall
Cells
erythrocyte
fat cell
nerve cell
pericyte
red blood cell
smooth muscle fiber
squamous cell
Tissues
adipose tissue
collagen fibres
elastic fibres
loose connective tissue
subendothelial connective tissue
Structures
arteriole, artery, capillary, capsule, continuous capillary, elastic laminae, endothelium, fenestrated capillary, internal elastic membrane, large vein, lumen, lymph node, lymph vessel, medium vein, muscular artery, nerve, nerve fiber, neurovascular bundle, perineurium, precapillary sphincter, sinusoidal capillary, sympathetic ganglion, tunica adventitia, tunica intima, tunica media, valve, vasa vasorum, vein, venule
Slides: Vessels
- Muscular artery and vein: Slide 69
- Muscular artery and vein: Slide 70
- Elastic artery: Slide 67
- Elastic artery: Slide 49
- Large vein: Slide 92
- Large vein: Slide 109
- Ductus thoracicus: Slide 75
- Ductus thoracicus: Slide 65
Slides: Accessory structure
- Semilunar valves in the blood vessels of cardiac muscle: Slide 47
Slides: Cardiac muscle
- Heart muscle (longitudinal section): Slide 20
- Heart muscle (cross section): Slide 77
- Heart muscle: Slide 86
Question to ponder
- What would happen if ALL capillaries were filled with blood?
- How does “stuff”* get into and out of blood?
- *Stuff = gasses, nutrients, cells, molecules
- How does the type of epithelium in arteries, capillaries, veins and lymph vessels differ?
- Where does atherosclerosis happen?
- Where does aneurysms happen?
Objective
- Compare and contrast the three tunics
- Distinguish between:
- Elastic arteries and muscular arteries
- Arteries and veins
- Identify capillaries
- Identify lymphatic vessels
- Identify nerves
- Identify small associated features
- Describe the functioning of the capillary bed
- Describe portal systems
- Describe end-arteries
Cardiovascular system
- O2 and nutrients are distributed by blood which the heart pumps through the blood vessels
- Lymphatic system collects surplus tissue fluid as lymph
Cardiovascular System 1/2
- Heart
- Combined 2 sided pump
- Cardiac muscle fibers
- Elastic arteries
- Receive blood under pressure from heart
- Elastic fibers
- Muscular arteries
- Distribute blood
- Smooth muscle
- Arterioles
- Reduce pressure
- Artery with narrow lumen
Cardiovascular System 2/2
- Capillaries
- Facilitate interchange
- Thin walls
- Metarterioles
- Rapid bypass of capillaries
- Blood pressure regulation
- Venules
- Looks like wide capillaries
- During acute inflammation produce plasma and leucocyte exudate
- Veins
General organisation
- Three concentric coats (tunics)
- Tunica intima
- Tunica media
- Tunica adventitia
Tunica intima
- Blood vessels
- Lining membrane = endothelium
- Underlying basement membrane (BM)
- Variable amount subendothelial connective tissue (CT)
- Internal elastic lamina
- Absent some small vessels
- Heart
- Tunica intima = endocardium
- Endothelium and CT
Tunica media
- Blood vessels
- Two components as concentric layers
- Smooth muscle fibers
- Elastic fibers
- Absent in smaller vessels
- Heart
- Highly developed muscle layer
Tunica adventitia
- Blood vessels
- Loose CT
- Some smooth muscle cells
- Own blood vessels
- Heart
- Epicardium
- CT + mesothelium
Heart 1/2
- Endocardium = tunica intima
- Endothelium
- BM
- Loose CT
- Dense CT
- Fat cells
- Branches of impulse conducting system
- Merge with endomysium of myocardium
- Myocardium = tunica media
- Cardiac muscle fibers
- Endomysial loose CT
- Contains capillaries and lymphatics
- Epicardium
- Fibroelastic CT
- Blood vessels, lymphatics, Nerve fibers, fat tissue
- Blends with endomysium
- Mesothelium
- Squamous epithelial cells
- Pericardial cavity
Heart 2/2
- Pericardial cavity
- Pericardium
- Serous pericardium
- Mesothelial serous lining
- Fibrous pericardium
- Fibro-elastic external layer
Valves
- Flap of intima
- Core
- Irregular dense CT
- Without blood vessels
- Some elastic fibres
- Covered with endothelium
Muscular artery
- Intima
- Thin
- Endothelium
- BM
- Thin subendothelial layer
- Internal elastic lamina
- Conspicuous wavy pink layer
- Media
- Thick
- Layers concentric smooth muscle
- Interspersed with some elastic fibers
- External elastic lamina
- Less conspicuous fenestrated layer elastin
- Adventitia
- Thickness vary but close to tunica media
- Elastic fibres with some collagen
- Contains vasa vasorum and lymphatics
Elastic artery
- Intima
- Thick = ¼ of wall of aorta
- Pale staining
- Endothelium
- Fenestrated elastic laminae mixed with elastic fibres
- Smooth muscle fibres and some fibroblasts
- Internal elastic lamina = first elastic lamina
- Media
- Thick
- Fenestrated elastic laminae ↑ with age
- Between laminae smooth muscle fibres that produce matrix
- Outer part supplied by vasa vasorum
- Inner part diffusion from lumen
- Indistinct external elastic lamina
- Adventitia
- Thin
- Elastic and collagen fibres
- Lymphatic capillaries and vasa vasorum
Arterioles
- Diameter < 100µm
- Wall thick relative to lumen (vs venule)
- Intima
- Endothelium
- BM
- Apposed internal elastic lamina
- Media
- One/Two layers smooth muscle
- Inconspicuous external elastic lamina
- Adventitia
- Few elastic and collagen fibres
Capillaries
- Small thin walled diameter 8 – 10µm
- Slightly wider than red blood cells
- Intima
- Lined with endothelium
- Resting on BM
- Lateral margins connected with tight junctions
- Do not extend around entire perimeter
- Slit-like intercellular clefts
- Tissue fluid and small molecules can pass through
- Brain: entire perimeter = blood-brain barrier with astrocytes
- Scattered pericytes
- Involved with blood-vessel growth
- Endo+BM+Pericytes = tunica intima
- No Media
- Adventitia with little CT
Capillaries
- Three types
- Continuous
- Most parts
- Endothelium uninterrupted
- Allow passage water and ions and small molecules
- Fenestrated
- Circular fenestrations (windows) in cytoplasm
- More permeable varies according to location
- Larger molecules
- Small intestine, kidneys, endocrine organs
- Sinusoids
- Thin-walled with wide lumen
- Associated population of macrophages
- Extensive intercellular gaps
- Incomplete BM
- Large molecules can pass
- Plasma proteins and cells
- Bone marrow, liver, spleen, lymph nodes, endocrine organs
Metarterioles
- Looks like wide capillaries
- Structure
- Endothelium
- Discontinuous layer smooth muscle cells
- Connect arteriole direct to venule
- At origin of capillary is pre-capillary sphincter
- Constrict – channel blood past capillary bed
Venules
- Slightly wider
- Thin walled
- Receive capillaries and metarterioles
- Acute inflammation
- Leak plasma and leucocytes
Veins
- Thin walled
- Wide lumen
- Flattened in sections
- Internal and external elastic laminae inconspicuous
- Small, medium and large are similar
Small and medium Veins
- Intima
- Thin
- Endothelium
- BM
- Trace CT
- Meager internal elastic lamina
- Sometimes valves
- Media
- Few circular layers smooth muscle
- Exception = veins of limbs and below heart
- Thick
- Resist distension from gravity
- Adventitia
- Thickest
- Collagen and elastic fibres
- Fibroblasts
- Smooth muscle cells
Large Veins
- Intima
- Thin
- Endothelium
- BM
- Trace CT
- Meager internal elastic lamina
- Sometimes valves
- Media
- Poorly developed layers circular smooth muscle
- Adventitia
- Wide bundles longitudinal bundles smooth muscle in larger veins example vena cava inferior
Lymphatic System
- Collects excess tissue fluid
- Filters through lymph nodes
- Return to blood
- Start as blind-ending vessels
Lymphatic Capillaries
- Lined with endothelium
- BM incomplete or absent
- Allows macromolecules to enter
- No associated pericytes
- Wider than blood capillaries
- Collagen anchors in surrounding tissue
- Keep vessels open with oedema
Lymphatic Vessels
- No blood cells in lumen
- Similar to small and medium veins
- Endothelium
- Thin external coat of loose CT
- Medium and large lymphatics 3 coats
- Difficult to distinguish layers
- Intima
- Endothelium and elastic fibres
- Media and Adventitia
- Smooth muscle cells and CT fibres
Muscular artery & Vein
Slides 69 & 70
Majority
Macroscopic anatomy
- Holds true at the microscopic level
- Blood vessels in sheath
- Artery + Vein + Nerve + Lymphatics
- Example femoral sheath
Elastic artery
Slides 67 & 49
Aorta
Large Vein
Slides 92 & 109
Ductus thoracicus
Slides 65 & 75
End arteries
- Normal histology
- Pathology – necrosis
- Symptom – chest pain
- Diagnosis – Myocardial infarct
- What happened – heart attack
End artery
- Heart - Heart attack
- Brain - Stroke
- Eye - Blindness
- Kidney - Kidney
attack failure
Portal System
Begin and Ends
In capillaries
Portal system
- Hepatic portal system
- Hypophyseal portal system
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