Module 4: Cardiovascular system:

Circulatory System

Jesse Noel V. Conjares, M.D., M.ortho., F.P.O.A.

1
 Blood Circulation
• Blood flows in two main circuits
– Systemic circulation
– Pulmonary circulation

• Blood vessels
– Artery- carries blood away from the heart
– Vein- carries blood toward the heart
– Capillaries

2
 Blood Vessels:
Artery and Vein
3 layers (from lumen side)
1. Tunica interna
1. Endothelium
2. Basement membrane
3. Internal elastic lamina
2. Tunica media
– Has smooth muscle and elastic
fibers
3. Tunica externa
– Has elastic and collagen fibers
– Contains nerves and the vasa
vasorum
– Anchors vessel to surrounding
tissue

3
 Blood Vessels:
Artery
Different types
according to size,
wall composition and
function
Elastic artery
Muscular artery
Arteriole

4
 Elastic artery
• Large caliber (e.g. aorta and its branches,
pulmonary artery)
• Thin walls (1/10th of diameter)
• Thick tunica media with more abundant elastic
fibers than smooth muscles
• Expands during ventricular systole
• Elastic recoil of walls constricting lumen propel
blood forward during ventricular diastole
• Conducting artery

5
 Muscular artery
• Medium-sized artery (e.g. brachial artery, radial
artery, femoral artery, specific organ arteries)
• Thick walls (3/4th of diameter )
• More abundant smooth muscles than elastic fibers
(up to 40 layers of smooth muscles), always in a
partial state of contraction (vascular tone)
• Readily vasoconstricts and vasodilates to regulate
blood flow, low recoil capability
• Distributing artery

6
 Arteriole
• Microscopic vessels which regulate blood flow
into capillary network
• Wall is ½ vessel diameter
• Tunica media has 1 -2 smooth muscle cell layers
with a precapillary sphincter at the metarteriole
(most distal region)-capillary junction
• Its small diameter and constriction of walls by
smooth muscle contraction increase resistance to
blood flow and decrease blood into capillaries
• Resistance artery

7
 Blood Vessels:
Capillaries
Capillaries-
Smallest of the blood vessels, measuring 5-
10μm in diameter, connect arterioles
and venules
No tunica media and tunica externa
Has a single-cell wall, the endothelium,
enables the interchange of water,
oxygen, carbon dioxide, other nutrient
and waste chemical substances driven by
hydrostatic and colloid osmotic pressures
inside the capillary and surrounding
tissues (cells and interstitial space)
Exchange vessels
RBC (diam=8μm) need to fold a little to pass
single file thru the capillaries

8
 Blood Vessels:
Capillaries
• Found near all the cells of the body
• Distribution dependent on the tissue’s metabolic
activity
• Higher metabolic activity (e.g. brain, muscles, liver,
kidneys, CNS), more oxygen and nutrient
requirements, the denser the capillary network vs.
lower metabolic activity tissues (e.g. tendons,
ligaments)
• Absent in epithelium, cartilage, lens and cornea

9
 Blood Vessels:
Capillaries
3 types
1. Continuous capillary- most of capillaries, wall is
a continuous endothelium interrupted by
intercellular clefts, found in brain, lungs, skeletal
and smooth muscle, connective tissue

2. Fenestrated capillary- with small pores (70-100

nm), found in the kidneys, villi of small intestine,
CNS choroid plexuses, ciliary processes in the
eye, endocrine glands

3. Sinsoids- widest of capillaries, very large

fenestrations, wider intercellular clefts,
incomplete basement membrane, walls have
phagocytic cells, allows blood cells and proteins
to pass back from interstitum to blood, found in
the bone marrow, liver, spleen, anterior
pituitary, parathyroid

10
 Microcirculation
• Refers to blood flow in the capillary network where exchange of
material between blood vessel and interstitium takes place
• Capillary exchange can be via any of the following:
– Simple diffusion
• Water-soluble substances (glucose, amino acids) pass thru intercellular
clefts and fenestrations
• Lipid-soluble substances (oxygen, carbon dioxide, steroid hormones) pass
thru lipid bilayer of endothelial cell plasma membranes
• Larger molecules of blood cells and proteins pass thru the larger “holes” of
sinusoids from interstitium to blood (e.g. plasma proteins and fibrinogen
from liver, blood cells from bone marrow)
– Transcytosis
• Via pinocytotic vesicles (endocytosis-exocytosis) for larger molecules (e.g.
insulin, maternal antibodies to fetal circulation)
– Bulk flow

11
 Microcirculation

Bulk flow
Factors affecting flow direction:
“pushes fluid out of blood vessel”
• blood hydrostatic pressure
“pushes fluid into blood vessel”
• interstitial hydrostatic pressure
“pulls fluid into blood vessel”
• blood colloid osmotic pressure
“pulls fluid into interstitium”
• interstitial fluid osmotic pressure

12
 Microcirculation
• Hydrostatic pressure
– Produced from the pressure of water in the blood
or interstitial fluid

• Colloid osmotic pressure

– Produced by the presence of large protein
molecules in the blood or interstitial fluid

13
 Microcirculation
• Arterial end:
net filtration occurs
(fluid flows into
interstitium)

• Venous end:
net reabsorption occurs
(fluid flows into the blood
vessel)

14
 Microcirculation
Overall, only 85% of fluid
filtered is reabsorbed.

Excess fluid is taken up by

the lymphatic
capillaries.

15
 Microcirculation
Edema results from:
• Increased capillary blood
pressure
• Increased capillary
permeability (proteins leak
into the interstitum)
• Decreased concentration of
plasma proteins (inadequate
synthesis, malnutrition, loss)
• Block in the lymphatic capillary
network

16
 Blood vessel:
Vein
• Changes in vessel wall not as
distinct as arteries
• Very thin walls (less than 1/10th of
diameter)
• VS. arteries:
– Thinner tunica interna with folds or
cusps (valves)
– Thinner tunica media, very sparse
smooth muscle cells and elastic
fibers
– Tunica externa is thickest of the 3
with collagen and elastic fibers
– Absent internal and external elastic
membrane

17
 Blood vessel:
Vein
Lumen larger than paired artery but
are collapsed when dissected
Walls allow distention but have very
little recoil
Lower blood pressure only allows slow
blood flow back to heart
Backflow prevented by valves
Forward flow is mainly via pump
action of heart, skeletal muscle
and respiration

18
 Blood vessel:
Vein
• More numerous than arteries, 2 veins can pair
with 1 muscular arrtery
• In the extremities, there are superficial and deep
groups of veins which anastomose.
– Superficial group- subcutaneous skin layer,
unaccompanied by arteries, dominant in upper limbs
– Deep veins- travel between muscles with partner
muscular arteries, dominant in lower limbs
– Valves in the connecting veins prevent backflow of
blood

19
 Blood vessel:
Vein
Different types
• Postcapillary venule- where reabsorption occurs
• Muscular venule- larger caliber (50-200 microns),
with 1-2 smooth muscle cell layers, transport of
blood
• Vein- largest caliber (.5-30 mm)

Venous sinus- vein with thin endothelium, very little

smooth muscle cell layer, dense connective tissue
provides added wall support (e.g. dural sinuses,
coronary sinus) 20
 Varicose veins
• Aka varices
• Incompetent venous valves
• Backflow of blood
• In the lower limbs, from the
deep system back into the
perforating veins and into the
superficial system
– Superficial veins become
dilated and tortuous
• Can also be found in the
esophagus and anal canal

21
 Blood Flow
• Blood leaving the left ventricle via the AORTA carries
bright red oxygenated blood into the arterial systemic
circulation. (arteries, arterioles and capillaries)
• As blood passes thru the capillary bed, it loses oxygen
to the tissues and gains carbon dioxide.
• Dark red deoxygenated blood then flows back into the
venous system of gradually widening post-capillary
venules, muscular venules and systemic veins in its
return trip to the right atrium via the SVC, IVC or
coronary sinus.

22
 AORTA
• Main exit from left ventricle
• Aortic valve prevents
backflow
• Recoil adds to forward flow
during diastole
• One continuous vessel
named into four parts
– Ascending
– Arch (T4-T5 disc)
– Thoracic (left of vert bodies)
– Abdominal (up to L4)

23
 Ascending Aorta
• Ascending Aorta
– R Coronary a
• Post interventricular
br (both vent)
• Marginal br (r vent)
– L Coronary a
• Anterior
interventricular br
(both vent)
• Circumflex br (l atr
vent)

24
 Arch of the Aorta
• Almost 2 inches in length, continuation of the
ascending aorta
• Emerges from the pericardium at the level of
the sternal angle
• Directed superiorly and posteriorly to the left
then inferiorly up to the 3rd and 4th thoracic
vertebrae then becomes the thoracic aorta

25
 Arch of the aorta
• Three main branches
– Brachiocephalic trunk- extends
superiorly then bends to the
right dividing into the R
common carotid a and the R
subclavian a at the right
sternoclavicular joint, supplies
the head and upper limb
– Left common carotid a
– Left subclavian a- divides into
the vertebral a and the vessels
of the left upper limb

26
 Arch of the aorta
• Arch of the aorta
– R brachiocephalic
trunk
• R subclavian
• R common carotid
– L common carotid
a
– L subclavian a

27
 Common Carotid
• Common Carotid
– Internal carotid a-
supplies the structures
internal to the skull
– External carotid a-
supplies the structures
external to the skull

28
 Internal carotid
(internal to the skull)
• No branches in the
neck.
• Enters skull thru carotid
foramen in the
temporal bone.
• Supplies eyeball other
orbital structures, ear,
cerebrum, pituitary
gland, external nose

29
 Internal carotid
(internal to the skull)
• Two terminal branches
– Anterior cerebral and middle cerebral aa
– Connected by the post communicating a to the
post cerebral a and basilar a

30
 Internal carotid
(internal to skull)
Main branches
• Anterior cerebral
(medial surface of
cerebrum and gray matter)
• Middle cerebral
(lateral surface of
cerebrum and gray matter)
• Posterior
communicating

31
 Cerebral Circle of Willis
• Anterior
communicating a
joins the 2 ACA
• Posterior
communicating a
joins the ICA with the
PCA (br Basilar a)
• Basilar a formed by
the union of the 2
vertebral aa

PCA and basilar aa supply the inferolateral surface of

temporal lobe, medial and lateral surface of occipital lobe
and their corresponding gray matter, midbrain 32
 Circle of Willis
REDUNDANT BLOOD SUPPLY
• Communicating arteries connecting the left
and right anterior circulation
• Anterior circulation (fr internal carotid aa)
connected to posterior circulation (fr vertebral
aa) via the basilar a

33
 External carotid
(external to the neck)

• Begins at the superior

border of the larynx until
the temporomandibular
joint where it divides in
the parotid gland and
branches as the
– Superficial temporal a
– Maxilla a

The carotid pulse can be palpated anterior

to the SCM at the superior border of larynx 34
 External carotid artery
Other branches
• Superior thyroid
• Asc. Pharyngeal
• Lingual
• Facial
• Occipital
• Post. Auricular
• Superficial Temporal
• Maxillary

35
 Subclavian artery
Gives off the
• Vertebral a- major
br to the brain,
passes thru the
transverse
foramina of
cervical vertebrae
C6 to C1 into the
foramen magnum
• Axillary a

36
 Cerebral Circle of Willis
• Joins the
vertebral a of
the other side
to form the
basilar a

37
 Subclavian steal syndrome

Subclavian steal
syndrome- proximal
stenosis of subclavian
artery, resulting in
retrograde flow from circle
of willis to vertebral artery
to supply the arm,
symptoms result from
hypoxia of the brain
38
 Axillary artery
• Continuation of the
subclavian artery into
the upper limb deep to
the clavicle after the
lateral border of the 1st
rib, divided by the
pectoralis minor m into
3:

39
 Axillary artery
1. 1st part (1 branch)- before the pectoralis minor m,
enclosed in the axillary sheath, 1 br: superior
thoracic a
2. 2nd part (2 branches)- under the pectoralis minor m,
2 brs: thoracoacromial a (medial to p minor), lat
thoracic a (lateral to p minor)
3. 3rd part (3 branches)- after the pectoralis minor m, 3
branches: subscapular a (largest axillary a branch),
anterior circumflex humeral a, posterior circumflex
humeral a

40
 Axillary artery

3 PARTS in relation to the pectoralis minor

Superior thoracic; Thoraco-acromial, lateral thoracic; Subscapular,
anterior and posterior circumflex arteries

41
 Axillary arterial anastomoses around the scapula

• Suprascapular a (fr thyrocervical a), dorsal scapular a (fr transverse

cervical a), subscapular a (fr axillary a)- provide alternative routes in
cases of blockages in blood flow
• Pofunda brachii a- alternate supply to arm when brachial a blocked

Thyrocervical and transverse cervical aa are small proximal

branches of the subclavian. 42
 Brachial artery
• Continuation of the axillary artery into
the arm
• Superficial, passes medial to the
humerus then anteriorly into the cubital
fossa
– Brachial a pulses can be palpated and
ausculatated here when taking the blood
pressure of a person.
43
 Brachial artery in the arm

• Anterior and posterior circumflex aa

• Brachial a and deep (profunda) br. of the brachial a
• Recurrent branches of radial & ulnar aa form anastomoses
around the elbow 44
 Radial and ulnar arteries
At the elbow, the
brachial artery divides
into:
• Radial artery- direct
continuation, along
the lateral border of
forearm, wrist and
hand
• Ulnar artery- bigger,
along the medial
border of the forearm,
wrist and hand

45
 Palmar arches
• Radial and ulnar aa
anastomose in the
hand via superficial
and deep palmar
arches.

46
 Palmar arches
• The arches
give rise to the
common
palmar digital
arteries to the
digits which
divide into an
ulnar and
radial palmar
digital artery.
47
 Thoracic aorta
• Continuation of the arch of
the aorta and is about 20 cm
long
• Begins about the level of the
T4-T5 disc to the left of the
vertebral column
• Moves closer to the midline
as it descends in the thorax
before it pierces the
diaphragm at the aortic
hiatus about the T12-L1 disc
• Gives off visceral br to the
thoracic viscera and parietal
br to the chest wall

48
 Thoracic aorta
Visceral branches
• Pericardial- 2 to 3 small
br to the pericardium
• Bronchial- 1 right and 2
left bronchial aa to the
bronchial tubes,
pleurae, lymph nodes
• Esophageal- 4 or 5 br to
the esophagus
• Mediastinal- several
small br to the
mediastinal structures

49
 Thoracic aorta
Parietal branches
• Posterior intercostal aa-
9 pairs to the
intercostal, p major, p
minor and serratus a
mm, skin and
subcutaneous tissue,
mammary glands,
vertebrae, spinal cord
and meninges
• Subcostal aa- 1 pair
• Superior phrenic aa- to
the superior and
posterior surfaces of the
diaphragm
50
 Thoracic aorta
Parietal branches
• Posterior intercostal
aa- 9 pairs
– dorsal br to spinal cord,
back muscles, spine
and skin;
– collateral br across ICS
along superior border
of rib
– anastomose with
anterior intercostal aa
• Subcostal aa- 1 pair
• Superior phrenic aa-
small branches to the
superior and posterior
surfaces of diaphragm
51
 Abdominal aorta

• Continuation of the thoracic aorta after it enters the

aortic hiatus up to the level of L4 where it divides
into L and R common iliac aa
• Gives off visceral and parietal branches
52
 Abdominal aorta

Gives off visceral and parietal branches 53

 Abdominal aorta
3 unpaired visceral branches
• Celiac trunk
• Superior mesenteric artery
• Inferior mesenteric artery
3 paired visceral branches
• Middle suprarenal
• Renal
• Gonadal

Superior suprarenal a from inferior phrenic a. Inferior

54
suprarenal a from the renal a.
 Abdominal aorta
Parietal branches (posterior
branches to the wall)
1 unpaired
• Median sacral artery- fr
posterior surface, 1 cm superior
to the bifurcation into common
iliac aa, supplies the sacrum and
coccyx

Paired branches
• Inferior phrenic arteries- first
branches of abdominal aorta,
superior to celiac trunk, to
inferior surface of diaphragm
and adrenal glands
• Lumbar arteries- 4 paired aa to
the lumbar vertebrae, spinal
cord and dura, lumbar muscles
and skin
55
 Celiac trunk (T12 level)

3 branches (2 left, 1 right)

Left gastric- smallest Common hepatic- right sided
Splenic- largest br
Pancreatic- pancreas Proper hepatic- liver, gallbladder,
stom
Left gastroepiploic- stom,
greater omentum Right gastric- stom
Gastroduodenal- stom, duodenum,
Short gastric- stom
greater omentum
56
 Celiac trunk (T12 level)
3 branches
• Left gastric
• Splenic (3)
– Pancreatic
– L gastroepiploic
– Short gastric
• Common hepatic
(3)
– Hepatic proper
– Right gastric
– Gastroduodenal

57
 Superior mesenteric (L1)

• 5 branches-Inferior pancreaticoduodenal, Jejunal and Ileal,

Ileocolic, Right colic, Middle colic
• Supplies the gut as described in their names

58
 Superior mesenteric (L1)
• Arises from the
anterior aorta, 1
cm inferior to
celiac trunk
• Extends anteriorly
and inferiorly
between layers of
mesentery
• Extensive
anastomoses
between its
branches

59
 Inferior mesenteric (L3)

3 branches
• Left colic- transverse and descending colon
• Sigmoid- descending and sigmoid colon
• Superior rectal- rectum

60
 Inferior mesenteric (L3)

3 branches
• Left colic- transverse and descending colon
• Sigmoid- descending and sigmoid colon
• Superior rectal- rectum
61
 Abdominal aorta
Paired visceral branches
• Middle suprarenal (L1)- to
the adrenal gland
• Renal (superior L2)-
– 1 cm inferior to SMA
– R longer and lower than the left,
posterior to R renal vein and IVC
– to the kidneys, adrenals and
ureters
• Gonadal (inferior L2)-
– Testicular a- pass thru the
inguinal canal and to the testis
– Ovarian a- much shorter, to the
ovaries, fallopian tubes, and
ureters

62
 Abdominal aorta
termination
3 terminal branches
Median sacral artery

Left and right common iliac

arteries

63
 Blood supply
pelvis and lower
limbs

At L4, abdominal
aorta bifurcates
into:
• Common iliac a
• After 2 inches,
they divide into:
– Internal iliac
– External iliac

64
 Blood supply
pelvis and lower
limbs
• Internal iliac-
main artery to
the pelvis, at
about the
sacroiliac joint
• External iliac-
larger, main
artery to the
lower limb
65
 Internal iliac
At the upper border of the
greater sciatic foramen, it
divides into:
• Anterior division • Posterior division
– Umbilical artery – Iliolumbar artery
– Obturator artery- medial – Lateral sacral artery
thigh mm
– Superior gluteal artery-
– Inferior vesical artery
gluteal mm
– Middle rectal artery
– Internal pudendal artery
– Inferior gluteal artery- gluteal
mm
– Uterine artery
– Vaginal artery

66
 External iliac
• Continues as the
femoral artery with
branches:
– Medial and lateral
circumflex-
anastomose around
femoral neck and
head
– Deep(profunda) br-
supplies the anterior
thigh

67
 Femoral artery
• Thru the femoral
triangle and
adductor canal goes
on as the popliteal a
behind the knee

68
 Popliteal artery
• At the popliteal fossa,
divides into the anterior
and posterior tibial aa of
the leg
– Anterior tibial- supplies
the anterior compartment
– Posterior tibial- supplies
the posterior
compartment and
• lateral compartments via
the peroneal br

69
 Dorsalis pedis artery
• Continuation of the
anterior tibial artery
• Give off arcuate and
dorsal metatarsal
aa
• Ends as digital aa to
the toes

70
 Posterior tibial artery
• Terminate as
medial and lateral
plantar arteries
forming a plantar
arch with branches
of the dorsal
metatarsal aa

71
 Venous system
• Veins may be superficial (subcutaneous) and
deep.
• Subcutaneous veins are important in blood
extractions, injections or setting up access for
medications or invasive intravascular
procedures.
• Deep veins usually travel alongside similarly
named arteries. May travel through irregular
networks and tributaries.

72
 Venous system
• 3 systemic veins return deoxygenated
blood to the heart
– Superior vena cava- blood from the head and
neck, upper limbs
– Inferior vena cava- blood from the rest of the
body inferior to the diaphragm
– Coronary sinus- from cardiac veins

73
 HEART
Venous drainage
Coronary sinus
receives
• Great cardiac
• Middle cardiac
• Small cardiac

Anterior cardiac venae cordis minimae- small anterior

veins that open directly to the right atrium

74
 Drainage from the head
Blood from the head eventually drains into 3 pairs
of veins:
– Internal jugular vein
– External jugular vein- superficial to SCM, travel at the
side of the neck, empty into subclavian vein at
midclavicle, drains external structures to cranium
(scalp, superficial and deep face)
– Vertebral vein- descend in the transverse foramina,
after C6 enter the brachiocephalic vein, drain the
deep neck (cervical vertebrae and cord, neck muscles)

75
 Drainage from the head
Internal jugular vein
Dural venous sinuses
• Cavernous sinus-
(sphenoid bone) drain
the ophthalmic and
cerebral vv
• Transverse sinus-
(occipital bone) drain
cerebrum, cerebellum,
cranial bones
• Sigmoid sinus- (temporal
bone)- drain transverse
sinus

76
 Drainage from the head
Internal jugular vein
Dural venous sinuses
• Superior sagittal sinus-
(frontal bone) drains the nasal
cavity, (occipital bone) drains
cerebrum, meninges and
cranial bones, usually to the
right transverse sinus
• Inferior sagittal sinus- (falx
cerebri) joined by the great
cerebral vein which drains
deep cerebrum and becomes
the
• Straight sinus-(tentorium
cerebelli) drains the inferior
sagittal sinus and superior
sagittal sinus
77
 Internal Jugular
• Drains also
Inf petrosal sinus
Facial
Pharyngeal
Lingual
Sup thyroid
Middle thyroid

78
 Drainage from the head
Internal jugular vein

Unite with the subclavian v to become the brachiocephalic 79

vein
 External jugular vein

Drains mainly structures external to the skull,

scalp, regions of the face

80
 Vertebral vein

Drains mainly deep structures in the neck, cervical

vertebrae, spinal cord and muscles

81
Drainage of the upper limb:
Brachial vein

Superficial system
82
 Thoracic drainage:
Azygous system
• May serve as a
bypass for the IVC
• 3 branches, very
variable
connections
– Azygous
– Hemiazygous
– Accessory azygous

83
 Thoracic drainage:
Azygous system
• Azygous-
– anterior to vert column,
right of midline
– junc of lumbar and
subcostal veins,
– arches over root of right
lung,
– empties into SVC
– drains the right posterior
intercostal, hemiazygous,
accesory hemiazygous,
esophageal, mediastinal,
pericardial and bronchial vv

84
 Thoracic drainage:
Azygous system
• Hemiazygous-
– Left of midline
– Junction of left lumbar
and subcostal veins
– Joins the azygous at T9
– Drains the left
posterior intercostal,
esophageal,
mediastinal and
accessory hemiazygous
vv

85
 Thoracic drainage:
Azygous system
• Accessory
Hemiazygous-
– Left of midline
– Begins at 4th or 5th
intercostal space
– Joins the azygous at T8
– Drains the 4th to 8th left
posterior intercostal,
bronchial and
mediastinal vv

86
 Superior Vena Cava

• Receives the left and right brachiocephalic veins

from the head and upper limbs and the azygous
system, empties into right atrium 87
Drainage of the abdomen and pelvis

88
 Inferior vena cava

• Receives blood from structures inferior to the

diaphragm except the GI tract, spleen, pancreas and
gallbladder 89
 Inferior vena cava
• Paired Common iliac
veins
• 2 pairs of Lumbar
veins
• Right gonadal vein
• Paired renal veins
• Right suprarenal vein
• Left inferior phrenic
vein
• Hepatic veins
90
Drainage from the lower limbs

Superficial
saphenous system

Deep venous
system

91
 Superficial saphenous venous system
• Great saphenous v
– Longest vein
– From medial dorsal
venous arches of foot to
groin
– Empty into femoral vein
– Useful for iv access and
vascular grafts
• Small saphenous vein
– Drain lateral foot and
posterior leg
– Connect with the great
saphenous vein in the
thigh

92
 Deep venous system
• Posterior tibial vein
– Drain deep plantar
aches of the foot,
posterior and lateral
leg
• Anterior tibial vein
• Unite at the
popliteal fossa to
form the popliteal
vein

93
 Hepatic Portal circulation
• Carries venous blood from
the lower third of the
esophagus to the anal
canal plus the spleen,
pancreas and gallbladder
• Hepatic portal vein
– From splenic and superior
mesenteric vv and other
tributaries
– Receives blood from
capillaries of the GI organs
and spleen
– Brings it to the sinusoids of
the liver

94
 Hepatic portal
vein
Receives blood from:
• Cystic vein
• L gastric vein
• R gastric vein
• Splenic vein
– Inferior mesenteric
vein
• Superior mesenteric
vein
• very small
paraumbilical veins
along the
ligamentum teres

95
 Hepatic Portal circulation
• In the liver,
– nutrients are stored and
modified,
– harmful substances
detoxified before
– bacteria phagocytosed
– oxygenated blood from
hepatic aa is mixed
– mixed blood is returned
to the general circulation
via hepatic veins and IVC

96
 Portal-Caval Anastomoses
• Presence of small
connections
between portal
and systemic
circulations
• Normal route:
portal vein – liver –
hepatic vein – IVC

97
 Portal-Caval Anastomoses
• If portal route is blocked:
Blood may drain to the IVC
via:
the esophageal vv of the Azygos
which connects with the
esophageal branch of L gastric
v
the middle rectal v of internal iliac
v & inferior rectal v of internal
pudendal v which connects
with the superior rectal v
the superficial vv of anterior
abdominal wall which connects
with the paraumbilical vv
the renal, lumbar and phrenic
veins which connect with the
veins of the ascending and
descending colon, duodenum,
pancreas and liver

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 Portal Hypertension
• Results from a severe and
chronic block of the portal
route (e.g. thrombosis of the
portal vein or liver cirrhosis)

• If dilated, the alternate

systemic route may manifest
with:
1. esophageal varices
2. hemorrhoids
3. caput medusae

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End of lecture

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