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ANA 209 Exam 2 Powerpoint Notes

by: Sharon Liang

ANA 209 Exam 2 Powerpoint Notes ANA 209

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Sharon Liang

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Midterm notes from powerpoints
Principles of Human Anatomy
Dr. April Hatcher
Study Guide
anatomy, Cardiovascular, Lymphatic, Muscles
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This 28 page Study Guide was uploaded by Sharon Liang on Sunday February 28, 2016. The Study Guide belongs to ANA 209 at University of Kentucky taught by Dr. April Hatcher in Winter 2016. Since its upload, it has received 235 views. For similar materials see Principles of Human Anatomy in Anatomy at University of Kentucky.


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Date Created: 02/28/16
ANA 209 Exam 2 Lecture Notes Muscles I Functions  Movement: muscles move body parts, control processes, and aid in communication  Stability: muscles maintain posture  Control of body openings/passages: muscles can regulate light to the eye or control movement of food through the digestive tract  Heat production: muscles produce 20-30% of our body heat  Glycemic control: skeletal muscle can serve a glucose-buffering action as it’s able to absorb, store, and use glucose Why are Muscles Special?  Contractile: cells can contract, generate pulling force  Excitable: nerve signals cause electrical impulse in plasma membrane of muscle cell which stimulates contraction  Extensible: muscle tissue can be stretched 2-3x their contracted length by contraction of opposing muscle  Elastic: recoils to original length after being stretched Three Muscle Types 1) Skeletal: voluntary striated muscle that you consciously control the movement and is typically attached to bones 2) Smooth: involuntary, non-striated muscle innervated by the autonomic nervous system and is found in walls of blood vessels, hollow internal organs, and layers throughout several other systems 3) Cardiac: involuntary striated muscle innervated by the autonomic nervous system and is found only in the walls of the heart Muscle Characteristics  Muscle groups are wrapped in deep fascia - Fascia is a sheet of CT that separates muscles groups from each other - Muscles are grouped into compartments, generally into groups with a similar function and/or innervation  Muscle has a hierarchical arrangement 1) Skeletal muscle: composed of bundles or fasciculi of muscle cells surrounded by perimysium 2) Muscle fasciculi: composed of muscle cells (or fibers) each surrounded by its own endomysium 3) Muscle/fiber cell: composed of myofibrils contained within its sarcolemma of each cell 4) Myofibrils: made up of actin and myosin or myofilaments - A-band: dark band - I-band: light band - Z-disc: composed of myofilaments, which are arranged in sarcomeres  Contraction is initiated at the neuromuscular junction - Each muscle cell makes contact with a nerve ending at the neuro- muscular junction (or synapse) between the nerve ending and the muscle cell - Depression the synaptic knob sits in on the muscle fiber is the motor end plate - Acetylcholine is released at the synapse and binds to a receptor on the sarcolemma to initiate contraction  Small motor units = fine control - One nerve ending and all the muscle cells it contacts is a motor unit or neuromotor unit - Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrig’s disease: progressive neurodegenerative disease of motor neurons leading to atrophy of voluntary muscles - Ratio of nerve fibers to muscle cells delineates a delicate from a non- delicate muscle: i. Eye muscle: 1 neuron to 3 muscle cells ii. Back muscle: 1 neuron to 100s of muscle cells  Generally defines the level of intricate control these muscle exert on the structures they move Sarcomeres  Smallest functional contractile unit in a muscle fiber  The thinner myofilaments (actin) slide in over the thicker myofilaments (myosin), pulling the Z lines behind them and thereby shorten the sarcomere  Muscles shorten when the z-lines are pulled closer to each other and the sarcomere shortens collectively  Sarcomeres shorten to facilitate muscle contraction  While each sarcomere shortens a miniscule amount, by multiplying that by millions the muscle contracts markedly Skeletal Muscles  Wrapped in CT from deep to superficial - Epimysium (superficial): dense CT surrounding entire muscle - Endomysium (deep): delicate, loose CT investing each muscle fiber - Perimysium: surrounds bundles of fibers or fascicles and is a pathway for blood vessels into muscle tissue  Voluntary and striated - Muscle cells are long, nucleated, cylindrical cells - Parallel striated muscle cells (fibers) surrounded and held together by CT fibers with capillary beds running parallel to fibers - The striated appearance of this muscle is due to the arrangement of various myofilaments found within the contractile units (sarcomeres) of the muscle - Contain satellite cells (stem cells) capable of regenerating muscle tissue  Structure - Sarcoplasm: cytoplasm of muscle cell and is limited due to numerous myofibrils - Myofibril: composed of myofilaments (actin and myosin), which are arranged in sarcomeres - Peripheral nuclei: muscle cells are multinucleated - Sarcoplasmic reticulum: calcium reservoir for contraction - Sarcolemma: plasma membrane surrounding muscle cell Cardiac Muscle  Involuntary and striated - Cardiac muscle cells are often referred to as cardiocytes - Exhibit a single, centrally located nucleus - Contain regularly arranged myofibrils (in sarcomeres) like skeletal muscle so exhibit the same banding - Incapable of division and lack satellite cells so no regeneration after injury - Cardiac muscle cells also branch and rejoin each other via intercalated discs (specialized junctions between adjacent cardiocytes) consisting of: i. Desmosomes into which the myofibrils anchor forming a bridge between cells so all cells pull together when their sarcomeres contract ii. Gap junctions which allow ions and molecules to move between cells providing communication between cells  Intercalated discs occur at the Z lines of the cardiac muscle sarcomere Smooth Muscle  Involuntary and non-striated - Cells are short, spindle shaped and have a single central nucleus - Named smooth muscle because it lacks organized sarcomeres and also lacks banding pattern (striations) - Responds to norepinephrine and acetylcholine - Each neurotransmitter initiates contraction in some smooth muscle and relaxation in others - Will contract in response to stretch of lumen it surrounds - Slow to contract than skeletal muscle and stays contracted much longer  Exhibits rhythmicity - Pattern of repeated contractions - Results from self-exciting fibers which spreads to adjacent cells Muscles II Muscle Proximal Attachment Distal Attachment Frontalis Superficial tissue of forehead Skin of forehead above and frontal bone eyebrows Orbicularis oculi Frontal and maxilla Encircles eye Orbicularis oris Superficial tissue around Encircles lips mouth Zygomaticus major Zygomatic arch Corner of mouth Depressor anguli oris Mandible Corner of mouth Masseter Zygomatic, temporal Angle of mandible (zygomatic arch) Temporalis Frontal, parietal Coronoid process of mandible Medial pterygoid Medial surface of lateral Medial surface of angle of pterygoid plate mandible Lateral pterygoid Lateral surface of lateral Mandibular condyle pterygoid plate Sternocleidomastoid Sternum and clavicle Mastoid process Cranial Nerves - Arise from brainstem - CN VII innervates muscles of facial expression - CN V3 innervates muscles of mastication Facial Expression  Frontalis: raises eyebrows and/or wrinkles forehead  Orbicularis oculi: closes eyes  Orbicularis oris: closes mouth  Zygomaticus major: elevates corner of mouth aka smiling  Depressor anguli oris: depresses the corner of mouth aka frowning  Platysma: tenses the skin and fascia of neck aka shaving muscle  The 2 orbicularis muscles are “sphincters” that act to tightly close the eye or the mouth  The remaining numerous muscles act on various regions of the face to elevate or depress. These muscles lack tendons so instead, they insert from the bones of the skull directly into the skin of the face  Aponeurosis: broad, sheet-like arrangement of fascia attaching muscle to muscle or bone Mastication  These 4 muscles act directly on (are attached to) the mandible for chewing. 1) Temporalis: elevates (closes) and retracts mandible 2) Medial pterygoid: elevates mandible 3) Lateral pterygoid: depresses (opens) mandible 4) Masseter: elevates mandible Muscles of Head: Oral Cavity  Genioglossus protracts the tongue  Innervated by cranial nerve 12, the hypoglossal nerve Muscles of Head: Orbit  Extraocular muscles - Rectus muscles (lateral, medial, superior, inferior) - Superior/inferior oblique  These muscles act on the eyeball moving it around within the body orbit. Pneumonic is LR (SO6) . 4on’t worry; this is not an actual chemical equation. th This just means the lateral rectus is innervated by the 6 CN (abducens); superior oblique is innervated by the 4 CN (trochlear); the rest of the extraocular muscles are innervated by the 3 CN (oculomotor). Muscles of Neck  The key muscle of the neck is the sternocleidomastoid - Innervated by the 11 CN (accessory). It rotates and orients the face cranially. - It divides the neck into 2 triangles (anterior and posterior). The anterior is located between the 2 sternocleidomastoid is an upside down triangle. - The attachments of this muscle are outlined in its name: sternum (sterno), clavicle (cleido) and mastoid process.  The hyoid bone is a convenient bony landmark of the neck. It has numerous muscles that attach to it, that are for the most part, thin, flat, and strap-like in shape. They’re divided into suprahyoids (above hyoid bone) and infrahyoids (below hyoid bone) - These muscles assist in swallowing and can move the larynx superiorly by elevating and depressing the hyoid Muscles of the Trunk  Thoracic wall - Composed of 3 layers superficial to deep 1) External intercostals 2) Internal intercostals 3) Innermost intercostals - As the name implies, they’re found between ribs. Their innervation is directly from the ventral ramus of the spinal nerve at each level, and they function in elevating the ribs during respiration.  Anterolateral abdominal wall - 3 layers of muscle from superficial to deep 1) External oblique 2) Internal oblique 3) Transversus abdominus - One straight muscle on each side of the midline of the abdomen (rectus abdominis). These muscles are also innervated by the ventral rami of spinal nerves. - They function to compress the abdominal viscera.  Superficial back muscles - Concerned with the upper limb 1) Splenius capitis 2) Levator scapulae 3) Rhomboids 4) Trapezius  Deep back muscles - Collectively referred to as the erector spinae muscle mass - Postural muscles responsible for flexing/extending the spine - Serratus posterior superior and inferior act as fascial retinacula holding this deeper muscle group in place - Muscles also innervated segmentally by the dorsal ramus of each spinal nerve they cross Muscles III Terminology  Tendon: cord-like fascial extension at end of the muscle attaching it to bone  Sharpey’s fibers: the collagen fibers of the periosteum that insert into the underlying bone. The collagen fibers of tendons blend with those of the periosteum which in turn blend with Sharpey’s fibers, thus forming a contractile unit Muscle Proximal attachment Distal attachment Splenius capitis Cervical vertebrae Occipital Trapezius Occipital bone, thoracic Scapula and clavicle vertebrae Rhomboid major Thoracic vertebrae Medial border of scapula below spine Rhomboid minor Thoracic vertebrae Medial border of scapula above spine Pectoralis minor Ribs 4-6 Coracoid process Pectoralis major Clavicle, sternum, costal Anterior surface of cartilages 1-6 proximal humerus Serratus anterior Anterior chest wall (on Anterior surface of medial ribs) border of the scapula Deltoid Scapula, clavicle Deltoid tuberosity of the humerus Supraspinatus Posterior scapula Greater tubercle (supraspinatus fossa) Infraspinatus Posterior scapula Greater tubercle (infraspinatus fossa) Teres minor Lateral border and Greater tubercle posterior surface of scapula Subscapularis Anterior surface of scapula Less tubercle (subscapular fossa) Biceps brachii Long head: supraglenoid Radial tuberosity tubercle Short head: coracoid Coracobrachialis Coracoid process Anterior surface of proximal humerus Brachialis Anterior of distal humerus Coronoid process of ulna Triceps brachii Long head: infraglenoid Olecranon process of ulna tubercle Medial and lateral heads: posterior humeral shaft Flexor digitorum Medial epicondyle, Middle phalanges of digits superficialis superior half of radius II-V Flexor digitorum profundus Proximal ulna and Distal phalanges of digits interosseous membrane II-V Extensor digitorum Lateral epicondyle Distal phalanges of digits II-V Extensor digiti minimi Lateral epicondyle Distal phalanx of digit V Muscles Acting on the Scapula  Anterior Group - Pectoralis minor: attaches to the coracoid process of the scapula - Serratus anterior: attaches to the anterior aspect of the medial border of the scapula  Winged scapula: damage to the long thoracic nerve  Both act to protract the scapula. Serratus anterior is also responsible for rotating the scapula so that the glenoid fossa is oriented cranially.  Posterior Group - The trapezius attaches to the head, the spine of the scapula, and the spinous processes of cervical and thoracic vertebrae - The rhomboids attach to the medial border of the scapula and spinal processes - The levator scapulae attaches to the superior aspect of the medial border of the scapula and elevates it  The rhomboids and trapezius retract and elevate the scapula. Trapezius can also depress the scapula Muscles Acting on the Humerus  9 muscles cross the shoulder joint to insert on the humerus  The pectoralis major and the latissimus dorsi bear the primary role for attaching the upper limb to the trunk. The pectoralis major adducts and medially rotates the humerus while the latissimus dorsi extends the humerus.  The deltoid wraps around the top of the shoulder. It’s a presence on both the anterior innervated by the axillary nerve. It raises (abducts) the limb to 90 degrees.  The teres major is also on the posterior side.  Rotator Cuff Muscles: composed of tendons from 4 scapular muscles (SITS) 1) Supraspinatus (abducts) 2) Infraspinatus (laterally rotates) 3) Teres minor (laterally rotates) 4) Subscapularis (internally rotates) - Supraspinatus and infraspinatus are innervated by the suprascapular nerve - The teres minor is innervated by the axillary nerve - Subscapularis is innervated by subscapular nerve  Note that ¾ “SITS” muscles are on the posterior surface of the scapula. Only the subscapularis is on the anterior surface. Supraspinatus, infraspinatus, and teres minor all laterally rotate the upper limb. Subscapularis medially rotates the upper limb.  Anterior compartment of the arm - Biceps brachii is a superficial flexor of the elbow and the major supinator of the forearm. Note its 2 superior heads both attach to the scapula (the long head to the supraglenoid tubercle and the short head to the coracoid process) - The coracobrachialis also attaches to the coracoid process of the scapula - Both the biceps and the coracobrachialis are innervated by the musculocutaneous nerve (major branch of the brachial plexus). Both are prime flexors of shoulder. Muscles Acting on the Forearm  Anterior compartment of the arm - Elbow and forearm exhibit 4 motions 1) Flexion 2) Extension 3) Pronation 4) Supination - Prime movers for flexion of the forearm are the biceps brachii and the brachialis muscles. They’re both innervated by the musculocutaneous nerve.  Posterior compartment of the arm - Prime mover for extension of the arm and forearm is the triceps brachii - The triceps had 3 heads and only the long head crosses the shoulder joint to insert on the scapula. This is the only head that extends the arm at the shoulder. It’s innervated by the radial nerve from the brachial plexus.  Muscles with bellies in the forearm - While the biceps is a major, supinator, the remaining supinator and both pronator muscles have bellies in the forearm - The pronator teres and the pronator quadratus are both on the anterior aspect of the forearm and are innervated by the median nerve of the brachial plexus - Note that the supinator comes from the posterior aspect and wraps around into the forearm. Because of this, it’s innervated by the radial nerve. Muscles Acting on the Wrist and Hand  Anterior compartment (aspect) - Muscles in the forearm will exert actions on the wrist and digits (fingers) in the hand - Muscles here flex the wrist and fingers - If the name of the muscle has “carpi,” then it’ll attach to the carpals or wrist bones and serve to flex the wrist if located in the anterior compartment - The name flexor digitorum superficialis indicates a superficial muscle group that flexes the digits - Innervation of the flexor digitorum superficialis and medial epicondyle originate from 2 major branches of the brachial plexus (the median nerve {muscles on thumb side} and ulnar nerve {muscles on the little finger side}) - The brachioradialis is innervated by the radial nerve and is a major flexor of the elbow  Anterior compartment (superficial layer) 1) Flexor carpi radialis: flexor of the wrist on the thumb side that’s so powerful that it abducts the hand 2) Palmaris longus: weakly flexes the wrist but tenses the palmar aponeurosis 3) Flexor carpi ulnaris: flexor of the wrist on the little finger side and is so powerful it adducts the hand - Both the flexor carpi radialis and the palmaris longus are innervated by the median nerve while the flexor carpi ulnaris is innervated by the ulnar nerve - The final muscle is the flexor digitorum superficialis. This muscle flexes the wrist, metacarpophalangeal (MCP) joints and the proximal interphalangeal joint of digits II-V and as such is also inserted into the medial epicondyle of the humerus. It’s also a weak flexor of the elbow. This muscle is also innervated by the median nerve.  Anterior compartment (deep layer) - Contains 2 deep flexors which also contribute to wrist flexion 1) Flexor pollicis longus: long flexor of the thumb and is innervated by the median nerve 2) Flexor digitorum profundus (deep flexor of the digits): flexes the wrist, MCP joints and all interphalangeal joints of digits II-V. This muscle has a dual innervation meaning that it gets innervation from both the median and ulnar nerves. This portion of the muscle on the little finger side is the ulnar while the rest is median.  Posterior compartment (superficial layer) - Muscles are predominantly wrist and finger extensors that share a common attachment to the lateral epicondyle of the humerus. Muscles include: i. Extensor carpi radialis longus ii. Extensor carpi radialis brevis iii. Extensor carpi ulnaris iv. Extensor digitorum v. Extensor digiti minimi - All these muscles are innervated by the radial nerve and their actions are clearly indicated by their specific name  Posterior compartment (deep layer) - Contains 1 muscle that extends the index finger (extensor indicis) and 3 that act on the thumb 1) Abductor pollicis longus (abducts thumb) 2) Extensor pollicis brevis (extends thumb) 3) Extensor pollicis longus (extends thumb)  pollex means thumb Intrinsic Muscles of Hand  Assist the flexors and extensors of the forearm and make finger movements more precise. There are 3 groups: 1) Thenar (base of thumb) - Muscles comprise the fleshly bulge at the base of the thumb - Adductor pollicis forms the web between thumb and palm - 4 muscles include: a. Abductor pollicis brevis (abducts thumb) b. Adductor pollicis (adducts thumb) c. Flexor pollicis brevis (flexes thumb) d. Opponens pollicis (deepest muscle and opposes thumb) - Innervation of the thenar muscles is by the median nerve except for the adductor pollicis, which is by the ulnar nerve 2) Hypothenar (base of little finger) - Form the fleshly mass at the base of the little finger and are all concerned with movement of that digit - There are 3 muscles a. Abductor digiti minimi (abducts digit V) b. Flexor digiti minimi brevis (flexes digit V) c. Opponens digiti minimi (opposes digit V) - All innervated by the ulnar nerve 3) Midpalmer (group in between) - Spans the hollow of the palm and includes: a. Dorsal interossei mm (DAB): abduct fingers b. Palmar interossei mm (PAD): adduct fingers c. Lumbrical mm: flex MCP joints and extend interphalangeal joints - These are all innervated by the ulnar nerve except the first 2 lumbricals are innervated by the median nerve The Carpal Tunnel  As the median nerve passes down into the hand, it crosses under the thick flexor retinaculum (roof of the carpal tunnel) that keeps the flexor muscle tendons from bow stringing across the wrist  Compression of the median nerve in this relatively narrow space results in pain and wasting of the thenar muscles (carpal tunnel syndrome) Muscles IV Muscle Proximal Attachment Distal Attachment Quadriceps femoris Iliac crest Quadriceps tendon into (rectus femoris) superior surface of patella Quadriceps femoris Medial and posterior shaft Quadriceps tendon into (vastus medialis) of femur superior surface of patella Quadriceps femoris Lateral and posterior shaft Quadriceps tendon into (vastus lateralis) of femur superior surface of patella Quadriceps femoris Anterior and lateral shaft Quadriceps tendon into (vastus intermedius) of femur superior surface of patella Semitendinosus Ischial tuberosity Medial surface of proximal tibia Semimembranosus Ischial tuberosity Medial surface of proximal tibia Biceps femoris Long head: ischial Lateral surface of proximal tuberosity tibia Short head: posterior femur Gastrocnemius Medial and lateral Calcaneal tendon epicondyle of femur Soleus Posterior tibia and fibula Calcaneal tendon Muscles Acting on the Hip and Femur  Anterior muscles of the hip - Most muscles that act on the femur originate on the hip bone. The 2 principal anterior muscles are the iliacus and the psoas major. They insert jointly on the lesser trochanter of the femur as the iliopsoas - Both function in flexing the hip joint on the thigh, the iliacus is innervated by the femoral nerve while the psoas major receives segmental innervation from lumbar plexus  Lateral muscles of the hip - The only one muscle on the lateral aspect is the tensor fascia lata - The muscle embedded in a thickening of the fascia lata of the thigh is the iliotibial band - The tensor fascia lata contracts to tighten the iliotibial band and assist in bracing the knee when you raise the opposite foot in normal gait (walking)  Posterior muscles of the hip - There are 3 gluteal muscles 1) Gluteus maximus 2) Gluteus medius 3) Gluteus minimus  The maximus is a major hip extensor and is innervated by the inferior gluteal nerve. The medius and minimus are abductors and medially rotate the femur and are both innervated by the superior gluteal nerve. - Lateral rotator 1) Piriformis 2) Superior gemellus 3) Obturator internus 4) Inferior gemellus 5) Quadratus femoris  These muscles rotate the femur laterally and oppose medial rotation by the gluteus medius and minimus. They’re all innervated segmentally by the sacral plexus. Muscles Acting on the Knee and Leg  Anterior compartment of the thigh - Composed of muscles that extend the leg. These muscles are all innervated by the femoral nerve and consist of: i. Sartorius ii. Quadriceps femoris 1) Rectus femoris (also flexes hip) 2) Vastus lateralis 3) Vastus medialis 4) Vastus intermedius  4 members of the quadriceps femoris share a common tendon (quadriceps tendon). It has the patella embedded in it and subsequently attaches to the tibial tuberosity as the patellar ligament.  Medial compartment of the thigh - Composed of muscles that adduct the thigh and are all innervated by the obturator nerve 1) Adductor longus 2) Adductor brevis (under the longus) 3) Adductor magnus (also extends hip) 4) Gracilis 5) Pectineus - Abduction: movement away from midline - Adduction: movement toward midline  Posterior compartment of the thigh - Composed of muscles that extend the hip and flex the knee and are all innervated by the sciatic nerve 1) Semitendinosus 2) Semimembranosus 3) Biceps femoris Muscles Acting on the Foot  Anterior compartment of the leg - Dorsiflexes the ankle keeping the toes from scraping the ground while walking and are all innervated by the deep fibular nerve. Muscles include 1) Tibialis anterior 2) Extensor digitorum longus 3) Extensor hallucis longus 4) Fibularis tertius  Posterior compartment of the leg (superficial) - These muscles are plantar flexors innervated by the tibial nerve including: 1) Gastrocnemius 2) Soleus 3) Plantaris  The gastrocnemius and soleus share a stout common tendon (calcaneal or Achilles tendon) anchoring the 2 muscles to the calcaneus tarsal bone  Posterior compartment of the leg (deep) - 3 muscles of the plantar flexor and invert the foot. These muscles are innervated by the tibial nerve. 1) Tibialis posterior 2) Flexor digitorum longus 3) Flexor hallucis longus  Lateral (fibular) compartment of the leg - There are only 2 muscles in the lateral compartment of the leg. They’re plantar flexors, evert the foot, and are innervated by the superficial fibular nerve 1) Fibularis longus 2) Fibularis brevis Intrinsic Muscles of the Foot  Has 3 layers of plantar surface innervated by the medial and lateral plantar nn ranging from superficial to deep 1) Most superficial layer of the foot with 3 main muscles a. Flexor digitorum brevis b. Abductor digiti minimi c. Abductor hallucis 2) Has 2 muscles a. Quadratus plantae: flexes the toes b. 4 lumbricals: flex the MCP joints and extend the interphalangeal joints  Note that 2 large tendons (flexor digitorum longus and flexor hallucis longus) from long flexor muscles in the posterior compartment of the leg pass through this layer 3) Has 3 muscles a. Adductor hallucis b. Flexor digiti minimi brevis c. Flexor hallucis brevis  Note that the adductor hallucis has 2 separate bellies and resembles the number 7. The flexor hallucis brevis also has 2 separate bellies. Cardiovascular I Blood Vessels  Has 3 layers 1) Tunica intima (inner): simple squamous epithelium, elastic layer 2) Tunica media (middle): smooth muscle, elastic CT, thickest layer in arteries - In elastic arteries (closest to the heart) the tunica media is composed of more elastic tissue (sheets) - In muscular arteries the tunica media is predominantly smooth muscle with less elastic tissue 3) Tunica adventita: thin, CT of elastic and collagen fibers  Receive autonomic innervation - The smooth muscle in the tunica media is innervated by the sympathetic nervous system - Vasoconstriction (narrowing of lumen): sympathetic stimulation causes contraction - Vasodilation (widening of lumen): lack of sympathetic stimulation  Arteries - Carry blood away from heart - Consist of elastic and muscular arteries - Elastic to handle high pressure - Retain round shape even when empty - Branch to form arterioles  Arterioles - Branch from arteries - Smaller than arteries, primarily composed of smooth muscle - Contains less than 5 layers of smooth muscle cells - Control blood distribution to various regions of the body by contracting or relaxing their smooth muscle  Capillaries - Exchange vessels of the CV system - Single layer of squamous epithelial cells and a basement membrane (tunica intima only) - Semipermeable: allow passage of substances between bloodstream and tissue fluid - Absent in the cornea and cartilage - Capillaries form capillary beds or branched networks within tissues and organs - Regulate blood flow into tissues - Contain precapillary sphincters to regulate flow into capillary bed - Solutes cross capillary wall primarily by diffusion - Filtration forces formation of tissue fluid in interstitial space results from hydrostatic pressure - Plasma proteins are too big so they stay in lending to osmotic pressure - Capillaries are continuous or fenestrated (contain holes called filtration pores)  Venules - Merge to form veins - Only scattered muscle cells in tunica media  Veins - Formed as venules merge into larger vessels - Path of veins parallels that of arteries - Same 3 layers as arteries with a much smaller tunica media - Lower pressure in veins; therefore sometimes arranged in “vena comitantes” - Collapse when empty - Muscle contraction helps to move blood in veins toward heart  Valves - Lower pressure in veins; therefore sometimes arranged in “vena comitantes” - Blood may pool here, acts as a reservoir - Permit unidirectional flow (prevents backflow), found in veins and lymphatic vessels Sympathetic vs Parasympathetic  Sympathetic “fight or flight” - Heart rate increases - Breathes faster - Pupils dilate - Digestion slows - Cold, sweaty skin - Liver releases sugars into blood  Parasympathetic “rest and digest” - Heart rate decreases - Breathing slows - Pupils constrict - Blood flow to digestive system increases Coronary Circulation 1) Right coronary artery (RCA) - Marginal artery - Posterior interventricular artery 2) Left coronary artery (LCA) - Circumflex coronary artery - Anterior IV artery  The branches of these arteries anastomose on the surface of heart Blood Flow  Pulmonary arteries take deoxygenated (oxygen-poor) blood to lungs for oxygenation  Pulmonary veins return oxygenated (oxygen-rich) blood back to heart Systematic Circulation  Begins as oxygenated blood enters the aorta and is pumped throughout the body  Includes arteries that deliver oxygenated blood throughout the body and the veins that drain deoxygenated blood from these regions back to right atrium  These arteries/veins are named for the regions they supply/drain, respectively Hepatic Portal System  Drains blood from the digestive tract back to the liver  Also drains blood from the spleen and accessory digestive organs (gallbladder and pancreas)  The liver screens for nutrients and toxins in the blood before is returned to the heart via the inferior vena cava Cardiovascular II Heart Location  Found in the mediastinum (space between lungs)  Most of the heart is found to the left of the median plane of body  Anchored to the diaphragm inferiorly  Heart is bordered posteriorly by the vertebral bodies and anteriorly by the sternum Great Vessels  The base of the heart faces posteriorly, superiorly, and towards the right shoulder  The superior vena cava, aorta, and pulmonary trunk arise from the base of the heart  The apex of the heart is the portion that tapers to a point inferiorly Pericardium  Double walled fibro-serous sac  Encloses the heart and roots of the great vessels (superior vena cava, ascending aorta, and pulmonary trunk)  The fibrous layer is the outer covering that’s made of dense irregular CT - Non-stretchable, protects heart from overfilling - Inferiorly this layer is fused to the central tendon of the diaphragm  The serous layer (epicardium) is the internal layer of the pericardium and reflects onto the heart  The parietal layer is fused to the fibrous pericardium.  The fluid-filled space between the parietal and serous layers is the pericardial cavity 4 Chambers  The heart has 2 atria and 2 ventricles left and right  The chambers are separated by valves  Oxygen-poor (deoxygenated) blood enters the right side of the heart and is pumped to the lungs for oxygenation  Oxygen-rich (oxygenated) blood returns to the left side of the heart to be pumped out to the body via aorta Right Atrium  The superior and inferior vena cava deliver deoxygenated blood from the upper and lower body to the right atrium  The right atrium also receives oxygen blood from the heart muscle via the coronary sinus  The right atrium has an auricle, an ear-like projection that’s a remnant of the embryological atrium  The right atrium consists of: - Pectinate muscles that make up the rough portion - Sinus venarum that composes the smooth portion  The SVC, IVC, and coronary sinus empty into the right atrium  The fossa ovalis is an embryological remnant in the interatrial septum Fossa Ovalis  In the embryo, the foramen ovale is a shunt that allows oxygenated blood from the mother to flow from the right to left atrium without going into the lungs  This shunt exists because the developing lungs aren’t ready to oxygenate blood yet  At birth, this opening closes to separate the atria  If foramen ovale doesn’t close anatomically, an opening remains that allows communication between the atria, patent foramen ovale Right Ventricle  Receives blood from the right atrium and pumps it to the lungs to be oxygenated  Notable features include: - Papillary muscle: conical muscle that projects up from the floor to attach to chordae tendinae - Chordae tendinae: string-like chords attached to the cusps of the tricuspid valve - Trabeculae carnae: interwoven network of muscle that composes the floor of the ventricle - Septomarginal band: carries part of the conduction system of the heart - Tricuspid valve - Infundibulum Left Atrium  The 4 pulmonary veins empty into the left atrium; these carry oxygenated blood from lungs back to heart  Left auricle is ear-like extension of the left atrium  Pectinate muscles in the auricle only; smooth muscle in left atrium Left Ventricle  Forms most of apex of heart  Wall is twice as thick as right ventricular wall  Left ventricle features are: - Papillary muscle - Chordae tendinae (attached to bicuspid valve) - Trabeculae carnae - Aortic semilunar valve - Bicuspid (mitral) valve  Bolded means it’s not in right ventricle  Aortic vestibule contains the opening of the right and left coronary arteries Fibrous Skeleton  Skeleton of the heart is actually composed of dense white fibrous CT  Forms an annulus (ring) that surrounds the cardiac valves  Functions - Anchor valve cusps - Prevent overdilation of heart valves - Anchor heart muscle Valves  Atrioventricular (AV) valves - Separate the atria from ventricles i. Right AV valve (tricuspid) between right atrium and right ventricle ii. Left AV valve (bicuspid/mitral) between left atrium and left ventricle - These valves function to direct a one way direction of blood flow from the atria to ventricles  Semilunar valves - Regulate blood from ventricles into the great arteries and is in fact, found between the ventricles and great arteries i. Pulmonary semilunar valve is located between the right ventricle and pulmonary trunk ii. Aortic semilunar valve is located between the left ventricle and aorta - Each valve has 3 cusps that meet in the middle to close off the lumen Open Close AV valves Blood freely flows from atria to Blood prevented from flowing ventricles back to atria, similar to shape of umbrella or parachute Semilunar valves Blood is ejected from ventricle to Blood prevented from flowing outflow track back to ventricles as cusps “catch” the blood Blood Flow 1) Blood enters RA from superior and inferior venae cavae 2) Blood in RA flows through right AV valve into RV 3) Contraction of RV forces pulmonary valve open 4) Blood flows through pulmonary valve into pulmonary trunk 5) Blood is distributed by right and left pulmonary arteries to the lungs where it unloads carbon dioxide and oxygen 6) Blood returns from lungs via pulmonary veins to LA 7) Blood in LA flows through left AV valve into LV 8) Contraction of LV (simultaneous with step 3) forces aortic valve open 9) Blood flows through aortic valve into ascending aorta 10) Blood in aorta is distributed to every organ in the body where it unloads oxygen and loads carbon dioxide 11) Blood returns to heart via venae cavae Cardiac Conduction System  SA node - Pacemaker of heart - Located in wall of RA - Self-excitable cells  AV node - Located in the inferior aspect of interatrial septum - Electrical gateway to ventricles  AV bundles - Made of Purkinje fibers - Run in/through IV septum - Only bridge between atrial and ventricular myocardium - Composed of right and left bundle branches Impulse Pathway SA node: initiates impulse  conducted to walls of atria  atria contact  impulse enters AV node via small intermodal fibers  to the AV bundle and bundle branches  papillary muscles contract  ventricles contract Cardiovascular III Coronary circulation 1) Right coronary artery (RCA): lies in the coronary sulcus on the right side - Marginal artery - Posterior interventricular artery travels in the posterior interventricular groove 2) Left coronary artery (LCA): lies between the left auricle and pulmonary trunk - Circumflex coronary artery - Anterior interventricular artery; aka left anterior descending artery in the anterior interventricular groove Anastomoses  Between the circumflex artery and right coronary artery: this connection is located in the coronary sulcus on the posterior surface of the heart  Between the anterior and posterior IV arteries: this connection is toward the apex of the heart  Coronary artery disease results when plaque builds up in the coronary arteries, obstructing blood flow through the arteries that supply the heart tissue. Patients with this condition undergo surgery to bypass the blockage or to place a stint in the artery Coronary Sinus  The coronary sinus drains the veins of the heart into RA  Located in the coronary sulcus on the posterior surface of heart Lymphatic System Lymph  Essentially tissue fluid: formed at the post-capillary venule, percolates through cells taking up wastes and is collected by the lymphatic system  Functions - Fluid recovery - Lipid absorption - Immunity Flow of Lymph back to Heart Interstitial spaces  lymphatic capillaries  lymphatic vessels  lymph nodes  lymph trunks (n=6)  collecting ducts (n=2)  subclavian vein Deep Lymphatics  Deep nodes eventually coalesce into 2 main trunks 1) Thoracic duct - Responsible for draining over ¾ of the body - Lymph from both lower limbs and the abdomen collects at the cisternae chyli just under the diaphragm 2) Right lymphatic duct - Drains lymph from right thorax, upper limb, and head/neck  The thoracic and right lymphatic ducts drain into the junction of the internal jugular vein and the subclavian veins on their respective sides of the body  Before joining the venous system they’re joined by a jugular trunk (carrying lymph from head) and a subclavian trunk (carrying lymph from upper limb) Elephantiasis (Lymphatic Filariasis)  Tropical climates  Mosquito born round worm called fillariae  Swelling upstream of blockage  Skin becomes thickened and cracked  Resembling elephant’s hide Lipid Absorption  Lacteals are blind-ended lymphatic capillaries found in the center of the villi of the small intestine  Specialized for the absorption of chylomicrons (lipids), that are eventually dumped into venous system with the rest of the lymph Immunity  Immunity is defined as a defense capability of the body against pathogens  Antigen: molecule that provokes an immune response  Non-specific - Mechanical barriers - Phagocytosis - Inflammation/fever  Specific immunity - Humoral (antibody-mediated) - Cell-mediated (T-cells) Lymphatic Cells  Natural Killer (NK) cells - Immunological surveillance  T lymphocytes (T cells) - Cytotoxic T cells directly attach and kill other cells - Helper T cells help to activate defense mechanisms - Memory T cells provide long lasting memory of an antigen  B lymphocytes - Differentiate into plasma cells (secrete antibodies) - Some become memory B cells, which, of course, creates long lasting immunity  Macrophages - Develop from monocytes - Phagocytic cells (phagocytize tissue debris, dead cells, bacteria, etc.) - Display foreign fragments to cytotoxic and helper T cells  Dendritic cells - Branched macrophages  Reticular cells - Found in thymus - Contribute to stroma of lymphatic organs Lymphatic Tissues  Lymphatic nodule: structural and functional unit of lymphatic tissue and found in - Tonsils 1) Lingual tonsils: posterior aspect of tongue 2) Palatine tonsils: between anterior and posterior pillars 3) Pharyngeal tonsils (adenoids): posterior wall of nasopharynx  Waldeyer’s Ring: aggregations of lymphatic tissue in the oro- and nasopharynx that form a ring around the opening of the digestive and respiratory tracts - Peyer’s patches (wall of ileum) - Appendix (ring of nodules in wall)  Not enclosed in CT capsule  1 line of immunologic defense  Lymphatic nodules identify sites where B lymphocytes in loose areolar CT have encountered antigens  Germinal center is surrounded by corona, where activated B cells enlarge and divide into plasma cells Lymph Nodes  Filter lymph and produce antibodies  Contain lymphocytes and other immune function cells  Named for the location of nearby structures or areas  Possess afferent (incoming) vessels and efferent (outgoing) vessels found only in the hilus


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