Chapter 18

Blood Vessels
and Circulation

Inner Surface of an Artery

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Functions of the Peripheral Circulation

The heart provides the major force that

causes blood to circulate
The peripheral circulation
1. Carries blood
2. Exchanges nutrients, waste products, and
gases with tissues
3. Helps regulate blood pressure
4. Directs blood flow to tissues

General Features of Blood Vessels

Arteries carry blood away from the heart

toward capillaries, where exchange between
the blood and interstitial fluid occurs

Blood flows from the heart through elastic arteries,

muscular arteries, and arterioles to the capillaries

Veins carry blood from the capillaries toward

the heart

Blood returns to the heart from the capillaries

through venules, small veins, and large veins

I. Anatomy

Veins

Arteries

Venules

Arterioles
Capillaries

Fig. 18.2

General Features of Blood Vessels

Blood vessels, except for

capillaries, have three layers

Inner: tunica intima

Middle: tunica media

Contains circular
smooth muscle and
elastic and collagen
fibers

Outer: tunica adventitia

Consists of
endothelium (simple
squamous epithelium),
basement membrane,
and internal elastic
lamina

connective tissue

The thickness and the

composition of the layers
vary with blood vessel type
and diameter

Arteries

Large elastic arteries

Muscular (distributing) arteries

Thick-walled with large diameters

Tunica media has many elastic fibers and little smooth
muscle
Thick-walled with small diameters
Tunica media has abundant smooth muscle and some elastic
fibers

Arterioles

Smallest arteries
Tunica media consists of one or two layers of smooth muscle
cells and a few elastic fibers

Arteries

Fig. 18.2

Capillaries

Capillaries consist only of endothelium

A capillary bed is a network of capillaries
Thoroughfare channels carry blood from
arterioles to venules
Blood can pass rapidly through
thoroughfare channels

Precapillary sphincters regulate the flow

of blood into capillaries

Fig. 18.3

 Artery Arteriole thoroughfare

channel capillary bed
origin of capillaries from thoroughfare
channel contain precapillary sphincter M
Precapillary sphincters

Capillary
beds

Three Types of Capillaries

continuous capillaries - occur in most tissues
endothelial cells have tight junctions forming a continuous tube
with intercellular clefts
allow passage of solutes such as glucose

fenestrated capillaries - kidneys, small intestine

organs that require rapid absorption or filtration
endothelial cells riddled with holes called filtration pores
(fenestrations)
allows passage of only small molecules

sinusoids (discontinuous capillaries) - liver, bone marrow,

spleen
allow proteins (albumin), clotting factors, and new blood cells
to enter the circulation

20-12

Continuous Capillary
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Pericyte
Basal
lamina
Intercellular
cleft

Pinocytotic
vesicle
Endothelial
cell
Erythrocyte

Tight
junction

Figure 20.5

20-13

Fenestrated Capillary
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Endothelial
cells
Nonfenestrated
area

Erythrocyte

Filtration pores
(fenestrations)

Basal
lamina

Intercellular
cleft

(a)

400 m

(b)

b: Courtesy of S. McNutt

Figure 20.6a

Figure 20.6b
20-14

Sinusoid in Liver
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Macrophage
Endothelial
cells

Erythrocytes
in sinusoid
Liver cell
(hepatocyte)
Microvilli

Sinusoid

Figure 20.7

20-15

Veins

Venules connect to capillaries and are

like capillaries, except they are larger in
diameter
Large venules and all veins have all
three layers
Valves prevent the backflow of blood in
the veins

Veins

Fig. 18.2

Valves extensions of tunica interna that

help to push blood toward the heart

Moving blood through veins

Since venous
pressure is low, it is
aided by two
methods
Skeletal muscle pumps
muscles compact
veins
Respiratory pressure
inhalation
abdominal pressure
increases

Varicose and spider veins

Treatment
Sclerotherapy
Laser

Spider veins

Fig. 18.2

Aging of the Arteries

Arteriosclerosis results from a loss of

elasticity in the aorta, large arteries, and
coronary arteries
Atherosclerosis is the deposition of
materials in arterial walls to form plaques

Aging of arteries
Arteriosclerosis hardening of the arteries
Atherosclerosis plaque formation in the
walls of arteries (form of arteriosclerosis)

Pulmonary Circulation

Moves blood to and from the lungs

Pulmonary trunk arises from the right
ventricle and divides to form the
pulmonary arteries, which project to the
lungs
From the lungs, four pulmonary veins
return blood to the left atrium

Systemic Circulation: Arteries

Arteries carry blood
from the left
ventricle of the heart
to all parts of the
body

Fig. 18.6

Aorta

Leaves the left ventricle to form the

Ascending aorta
Aortic arch
Descending aorta

Consists of the thoracic aorta and the

abdominal aorta

Coronary arteries branch from the aorta

and supply the heart

Aorta

Fig. 18.7

Arteries to the Head and the Neck

The following arteries branch from the

aortic arch to supply the head and the
upper limbs
Brachiocephalic

Divides to form the right common carotid and

the right subclavian arteries

Left common carotid

Left subclavian

Vertebral arteries branch from the subclavian

arteries

Arteries to the Head and the Neck

The common carotid arteries and the

vertebral arteries supply the head

The common carotid arteries divide to form the

external carotids: supply the face and mouth

internal carotids: supply the brain

Vertebral arteries join within the cranial cavity

to form the basilar artery, which supplies the
brain
The internal carotids and basilar arteries
contribute to the cerebral arterial circle

Arteries to the Head and the Neck

Fig. 18.9

Major
Arteries of
the Head
and Thorax

Fig. 18.8

Circle of willis

Fig.
18.10

Arteries of the Upper Limb

The subclavian artery continues (without

branching) as the axillary artery and then
as the brachial artery. The brachial artery
divides into the radial and ulnar arteries
The radial artery supplies the deep palmar
arch
The ulnar artery supplies the superficial
palmar arch

Both arches give rise to the digital arteries

Fig.
18.11

Fig.
18.12

Branches of the Aorta

Fig.
18.13

Thoracic Aorta/Branches

The thoracic aorta has

Visceral branches that supply the thoracic organs

Parietal branches that supply the thoracic wall

Fig.
18.13

Abdominal Aorta/Branches

The abdominal aorta has

Visceral branches that supply the abdominal organs

Parietal branches that supply the abdominal wall

Fig.
18.13

Abdominal Aorta/Branches

The visceral branches are paired and

unpaired
The unpaired arteries supply the stomach,
spleen, and liver (celiac trunk); the small
intestine and upper part of the large intestine
(superior mesenteric); and the lower part of
the large intestine (inferior mesenteric)
The paired arteries supply the kidneys,
adrenal glands, and gonads

Branches
of the
Aorta
Fig. 18.13

Major
Arteries
of the
Abdomen
and Pelvis
Fig. 18.14

Fig.
18.14

Arteries of the Pelvis

The common iliac arteries arise from the

abdominal aorta, and the internal iliac
arteries branch from the common iliac
arteries
The visceral branches of the internal iliac
arteries supply the pelvic organs
The parietal branches supply the pelvic wall
and floor and the external genitalia

Arteries of the Lower Limb

The external iliac arteries branch from the

common iliac arteries
The external iliac artery continues (without
branching) as the femoral artery and then as
the popliteal artery

The popliteal artery divides to form the anterior and

posterior tibial arteries

The posterior tibial artery gives rise to the fibular

(peroneal) and plantar arteries
The plantar arteries form the plantar arch, from which
the digital arteries arise

Arteries of
the Pelvis
and Lower
Limb

Fig.
18.15

Major Arteries of
the Lower Limb

Fig.
18.16

Systemic Circulation: Veins

The three major veins returning blood to

the heart are the
Superior vena cava (head, neck, thorax, and
upper limbs)
Inferior vena cava ( abdomen, pelvis, and
lower limbs)
Coronary sinus (heart)

Veins are of three types:

Superficial veins
Deep veins
Sinuses

Major Veins

Fig.
18.17

Veins of the Head and Neck

The internal jugular veins drain the dural

venous sinuses and the veins of the
anterior head, face, and neck
The external jugular veins and the
vertebral veins drain the posterior head
and neck

Fig.
18.18

Fig.
18.19

Fig.
18.20

Veins of the Upper Limb

The deep veins are the small ulnar and radial

veins of the forearm, which join the brachial
veins of the arm. The brachial veins drain into
the axillary vein
The superficial veins are the basilic, cephalic,
and median cubital

The basilic vein becomes the axillary vein, which

then becomes the subclavian vein. The cephalic
vein drains into the axillary vein
The median cubital connects the basilic and
cephalic veins at the elbow

Fig.
18.21

Fig.
18.22

Veins of the Thorax

The left and right
brachiocephalic
veins and the
azygos veins
return blood to
the superior vena
cava

Fig. 18.23

Veins of the Abdomen and Pelvis

Ascending lumbar veins from the abdomen join

the azygos and hemiazygos veins
Veins from the kidneys, adrenal glands, and
gonads directly enter the inferior vena cava
Veins from the stomach, intestines, spleen,
and pancreas connect with the hepatic portal
vein

The hepatic portal vein transports blood to the liver

for processing. Hepatic veins from the liver join the
inferior vena cava

Fig.
18.25

Fig.
18.26

Fig.
18.24

Veins of the Lower Limb

The deep veins are the fibular

(peroneal), anterior tibial, posterior tibial,
popliteal, femoral, and external iliac
veins
The superficial veins are the small and
great saphenous veins

Fig.
18.27

Fig.
18.28

Physiology of Circulation

Blood Pressure
A measure of the force exerted by blood
against the blood vessel wall. Blood moves
through vessels because of blood pressure
Can be measured by listening for Korotkoff
sounds produced by turbulent flow in
arteries as pressure is released from a
blood pressure cuff

Fig.
18.29

Fig.
18.30

Physiology of Circulation
Blood Flow Through a Blood Vessel
The amount of blood that moves through a vessel in
a given period.
Directly proportional to pressure differences and is
inversely proportional to resistance
Resistance is the sum of all the factors that inhibit
blood flow. Resistance increases when blood vessels
become smaller and viscosity increases
Viscosity is the resistance of a liquid to flow. Most of
the viscosity of blood results from red blood cells.
The viscosity of blood increases when the hematocrit
increases or plasma volume decreases

Physiology of Circulation
Blood Flow Through the Body
Mean arterial pressure equals cardiac output times
peripheral resistance
Vasomotor tone is a state of partial contraction of
blood vessels. Vasoconstriction increases
vasomotor tone and peripheral resistance,
whereas vasodilation decreases vasomotor tone
and peripheral resistance
Blood pressure averages 100 mm Hg in the aorta
and drops to 0 mm Hg in the right atrium. The
greatest drop occurs in the arterioles and
capillaries

Physiology of Circulation

Pulse Pressure and Vascular Compliance

Pulse pressure is the difference between systolic

and diastolic pressures. Pulse pressure increases
when stroke volume increases or vascular
compliance decreases
Vascular compliance is a measure of the change in
volume of blood vessels produced by a change in
pressure
Pulse pressure waves travel through the vascular
system faster than the blood flows. Pulse pressure
can be used to take the pulse

Fig.
18.31

Physiology of Circulation

Blood Pressure and the Effect of

Gravity
In a standing person, hydrostatic pressure
caused by gravity

Increases blood pressure below the heart

Decreases pressure above the heart

Physiology of Circulation

Capillary Exchange and Regulation of

Interstitial Fluid Volume

Capillary exchange occurs through or between

endothelial cells
Diffusion, which includes osmosis, and filtration are
the primary means of capillary exchange
Filtration moves materials out of capillaries and
osmosis moves them into capillaries
A net movement of fluid occurs from the blood into
the tissues. The fluid gained by the tissues is
removed by the lymphatic system

Fluid Exchange Across the Walls of Capillaries

Fig. 18.32

Control of Blood Flow

Blood flow through tissues is highly

controlled and matched closely to the
metabolic needs of tissues
Local Control
The response of vascular smooth muscle to
changes in tissue gases, nutrients, and
waste products
If the metabolic activity of a tissue
increases, the diameter and number of
capillaries in the tissue increase over time.

Control of Blood Flow

Nervous and Hormonal Control

The sympathetic nervous system (vasomotor center in the

medulla) controls blood vessel diameter. Other brain areas
can excite or inhibit the vasomotor center
Epinephrine and norepinephrine cause vasoconstriction in
most tissues. Epinephrine causes vasodilation in skeletal and
cardiac muscle
The muscular arteries and arterioles control the delivery of
blood to tissues
The veins are a reservoir for blood
Venous return to the heart increases because of the
vasoconstriction of veins, an increased blood volume, and
the skeletal muscle pump (with valves)

Fig.
18.33

Regulation of Mean Arterial Pressure

Mean arterial pressure (MAP) is proportional

to cardiac output times peripheral resistance
Short-Term Regulation of Blood Pressure

Baroreceptors are sensory receptors sensitive

to stretch
Located in the carotid sinuses and the aortic
arch
The baroreceptor reflex changes peripheral
resistance, heart rate, and stroke volume in
response to changes in blood pressure

Baroreceptor Reflex Control of Blood Pressure

Fig. 18.34

Regulation of Mean Arterial Pressure

Short-Term Regulation of Blood Pressure

(cont.)

Epinephrine and norepinephrine are released from the

adrenal medulla as a result of sympathetic stimulation.
They increase heart rate, stroke volume, and
vasoconstriction
Peripheral chemoreceptor reflexes respond to decreased
oxygen, leading to increased vasoconstriction
Central chemoreceptors respond to high carbon dioxide
or low pH levels in the medulla, leading to increased
vasoconstriction, heart rate, and force of contraction
(CNS ischemic response)

Adrenal Medullary Mechanism

Fig. 18.35

Chemoreceptor Reflex Control of Blood Pressure

Fig. 18.36

Regulation of Mean Arterial Pressure

Long-Term Regulation of Blood Pressure

Through the renin-angiotensin-aldosterone

mechanism

Renin is released by the kidneys in response to low

blood pressure
Promotes the production of angiotensin II, which
causes vasoconstriction and an increase in
aldosterone secretion

Aldosterone helps maintain blood volume by decreasing

urine production

The vasopressin (ADH) mechanism causes ADH

release from the posterior pituitary in response to a
substantial decrease in blood pressure

ADH causes vasoconstriction and helps maintain blood

volume by decreasing urine production

ReninAngiotensinAldosterone
Mechanism

Fig. 18.37

Vasopressin
(ADH)
Mechanism

Fig.
18.38

Regulation of Mean Arterial Pressure

Long-Term Regulation of Blood Pressure

(cont.)

The atrial natriuretic mechanism causes atrial

natriuretic hormone release from the cardiac
muscle cells when atrial blood pressure increases.
It stimulates an increase in urinary production,
causing a decrease in blood volume and blood
pressure
The fluid shift mechanism causes fluid shift, which
is a movement of fluid from the interstitial spaces
into capillaries in response to a decrease in blood
pressure to maintain blood volume

Fig.
18.39

Examples of Cardiovascular Regulation

Exercise

Local control mechanisms increase blood flow through

exercising muscles, which lowers peripheral resistance
Cardiac output increases because of increased venous
return, stroke volume, and heart rate
Vasoconstriction in the skin, the kidneys, the
gastrointestinal tract, and skeletal muscle (nonexercising and exercising) increases peripheral
resistance, which helps prevent a drop in blood pressure
Blood pressure increased despite an overall decrease in
peripheral resistance because of increased cardiac
output

Blood Flow in Response to Needs

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Aorta

Superior
mesenteric
artery
Dilated

Constricted
Reduced
flow to
intestines

Increased flow
to intestines

Common iliac
arteries

Constricted

Dilated

Reduced flow to legs

(a)

Increased flow to legs

(b)

arterioles shift blood flow with changing priorities

20-92

Examples of Cardiovascular Regulation

Circulatory Shock

Baroreceptor reflexes and the adrenal medullary

response increase blood pressure
The renin-angiotensin-aldosterone mechanism and
the vasopressin mechanism increase
vasoconstriction and blood volume. The fluid shift
mechanism increases blood volume
In severe shock, the chemoreceptor reflexes increase
vasoconstriction, heart rate, and force of contraction
In severe shock, despite negative-feedback
mechanisms, a positive- feedback cycle of
decreasing blood pressure can cause death