ch.17-20 learning outcomes

Ch.17 leaning outcomes blood

1. List and describe the major functions of each component of the cardiovascular system (i.e., blood, heart, blood vessels).

1. Blood-5 main functions of blood

1. Transportation of dissolved substances: Gases, Nutrients, hormones, metabolic wastes

2. Regulation of pH and ion compositions of interstitial fluids 

3. Fluid losses at injury sites

4. Defense against toxins and pathogens

5. Stabilization of body temperature

2. Heart

Pumps blood both diastolically (to the lungs) to receive oxygen and systolically (to the body) to allow oxygen and carbon dioxide to be exchanged in cells. Pumps forcefully to push blood through the body. 

3. Blood Vessels

Transport blood throughout the body. Capillaries allow for exchange, Veins return blood to the heart, and arteries take blood away from the heart (diastolic: blood to the lungs, systolic: blood to the body).

2. Know the general properties of whole blood, including the normal pH range.

The normal temperature of blood is 38 degrees Celsius, or 100.4 degrees Fahrenheit. 

It has a high viscosity, about 5 times the thickness of water. 

The pH is slightly alkaline, with a range from 7.35 to 7.45

3. Describe the general composition of blood (e.g., plasma, formed elements).

Whole blood is composed of plasma and formed elements. Plasma makes up around 55% of blood, with the range being between 46% and 63%. Formed elements consist of Platelets, White blood cells, and Red blood cells and make up around 45% of blood, ranging from 37-54%

4. Describe the composition of blood plasma.

Plasma makes up around 55% of the whole volume of blood. Around 90% of plasma is water, and plasma proteins and other solutes make up the other 10%. 

Plasma is similar to interstitial fluid and allows the constant exchange of water, ions, and small solutes across capillary walls.

***This is why ADH has such an effect on blood volume- more water held on to = higher volume, less water = volume

5. Know the major types of plasma proteins and their general functions. 

Major plasma proteins (approximately 7% of blood): 

Albumins: osmotic pressure

Globulins: Antibodies and transport

Fibrinogen: blood clotting

Enzymes, and other hormones: (can be protein-based)

6. Define hematocrit and state the normal ranges for adult males and females.

Packed Cell volume- hematocrit is the percentage of formed elements in the blood. The normal male range is 40-54%, and the normal female range is 37-47%. When hematocrit is high, it is called polycythemia; when it is low, it is called anemia.

7. Know the formed elements and their general functions.

The formed elements in the blood are red blood cells (oxygen transport), platelets (blood clotting), and white blood cells (body defense)

8. Know the location of hemopoiesis and the significance of the hemocytoblast.

Hemopoiesis occurs in the red bone marrow and is the development of formed elements. 

Hemocytoblasts (hemo-blood, cyto-cell, blast-bulider). Comes from hematopoietic stem cells to build red blood cells

9. Explain the basic process of red blood cell formation (erythropoiesis), the significance of the reticulocyte, and regulation through erythropoietin (EPO).

Myeloid stem cells-> RBC

Myeloid stem cless, proerythroblast (before, red, build), erythroblast (red, build), reticulocyte (red blood cell with the neucleus ejected), Mature RBC

• Reticulocyte-if bp low it can be used as blood. Not as efficient.

Erythropoietin: released into plasma in responce to low tissue levels=hypoxia. (hypo-below, oxy-presence of oxygen)

• Stimuli: anemia, reduced blood flow to kidneyes, lung damage, O2 content in lungs decresed from disease or high altitude. 

10. State the normal ranges for hematocrit, hemoglobin, and RBC count in adult males and females. 

Hematocrit: male-40-54%    female- 37-47%

Hemoglobin: male-14-18%   female-12/16 g/dL

RBC count: male4.5-6.3 millin cells/mL    female- 4.2-5.5 million cells/mL

11. List the characteristics and functions of red blood cells, and describe the structure and functions of hemoglobin.

Red blood cells are biconcave in shape-they have thinner centers and thicker sides (this increases the surface area)

This shape impacts the function:

1. Large surface area to volume ratio (packed with hemoglobin)-allows more O2 exchange

2. Disks form stacks (roleaux)

3. flexible-RBC’s can bend and flex entering small capillaries.

Primary function is RBC-transports respiratory gasses. 

Hemoglobin: quaternary structure, 4 globular protein subunits-each has one molecule of heme (each heme contains one iron ion)

• Oxyhemoglobin:bright red hemoglobin with bound oxygen

• Deoxyhemoglobin: oxygen binding is reversed easily, hemoglobing not bound to O2 is dark red in color. 

12. Describe how the components of aged or damaged red blood cells are recycled, including the typical lifespan for an RBC.

If a blood cell is englufed by a macrophage before it ruptures (hemolysis), its parts can be recycles. This occurs in the spleen, liver, or bone marrow. Typical life span is 120 days.

Macrophages break blood cells down into its components

• Glodular protein chains to amino acids

• Heme to bibiverdin to bilirubin (wuth ends up in the liver)

• Iron recycling

  • Iron is removied from heme leaving the biliverdin

  • Iron is transferred away from the liver by transport protein, transferrin.

  • Iron is then used and incorporated into ew Hemoglobin molecules (in the red bone marrow)

13. Explain the role of surface antigens on erythrocytes in determining blood groups.

Surface antigens are present on all erythrocytes except type O. These blood surface antigens represent the blood type; the presence of other antigens are reactive when incompatible blood types are mixed due to the antibodies. These surface antigens can be A or B, or in the case of type AB blood, both. 

14. List the type of antigen and the type of antibodies present in each ABO blood type.

Type A blood has A surface antigens and B antibodies. (It has anti B-will react if in contact with type B)

Type B blood has B surface antigens and A antibodies. (It has anti A-will react if in contact with type B)

Type AB blood has A and B surface antigens and no antibodies. AB blood is considered the universal recipient. 

Type O blood has no surface antigens but has both A and B antibodies. (It has anti-A and anti-B that will react to both type A, type B blood, and type AB blood.) It is considered the universal donor, specifically B-

15. Describe how the presence or absence of Rh antigen results in blood being classified as positive or negative. 

While there are many other surface antigens, Rh is the only one that impacts blood type compatibility (it can also be called D antigen). Rh is tested for its presence. Rh positive means it is present; Rh negative means it is not. 

16. Describe the development and clinical significance of anti-Rh antibodies.

The clinical significance of anti-Rh is hemolytic disease of the newborn. This involves and anti-Rh mother and and Rh+ baby. With the first child mom’s immune system is not stimulated to produce anti-Rh antibodies and there is no problem, but during birth mom is exposed to baby’s blood and these antibodies are produced (this is called sensitization).

Then in the second pregnancy mom has anti-Rh antibodies that can cross the placenta to attack or even destroy fetal RBC’s.

HDN can be prevented by giving mom RHoGM-which is an anti-Rh antibody- this is given at weeks 26-28 and later durring/after delivery.

17. Predict which blood types are compatible and what happens when the incorrect ABO or Rh blood type is transfused.

Type A+ blood: Compatible with A+, A-, O+ or O-

Type A- blood: Compatible with A- or O-

Type B+ blood: Compatible with B+, B-, O+, or O-

Type B- blood: Compatible with B- or O-

Type AB+ blood: Compatible with A+, A-, B+, B-, AB+, AB-, O+, or O-

Type AB- blood: Compatible with A-, B-, AB-, or O-

Type O+ blood: Compatible with O+ or O-

Type O- blood: Compatible with O-

When the incorrect ABO or Rh blood type is mixed, the surface antibodies react tot he foreign blood type, causing coagulation (agglutination), or a clumping of the blood. This blocks blood vessels and does not allow the cells to receive proper oxygen levels. This can also cause hemolysis, which is when the blood cells burst. 

18. List the five types of White Blood Cells (leukocytes) and describe their major functions.

Myeloid stem cells:

1. Neutrophils (neutrophils-numerous): 50%-70% of circulating white blood cells. These are very active, they are the first to attack bacteria. They engulf and digest pathogens and release cytotoxic enzymes. After 1-2 dozen bacteria, these cells die, releasing pus. 

2. Eosinophils: 2-4% of curculating white blood cells. Attacks large parasites and excretes toxic compounds (nitrous oxide and cytotoxic enzymes). Sensitive to allergens. Controls inflamstions with enzymes that counteract the inflammatory effects of neutrophils and mast cells.

3. Basophils: Less than 1% of circulating white blood cells accumulate in damaged tissue and release histamine, which dilates blood vessels. Also releases heparin, which prevents blood clotting. 

4. Monocytes (Monocyte-Monster): 2-8% of circulating white blood cells. Large and spherical in shape, it enters peripheral tissues and becomes macrophages, which engulf large particles and pathogens. Secretes substances to attract immune system cells and fibroblast to injured areas. 

Lymphoid stem cells:

5. Lymphocytes: A specific defense system 20-40% of circulating white blood cells. Lymphoid stem cells. These are larger than red blood cells and migrate in and out of the blood; they are mostly in connective tissues and lymphoid organs (lymphatic system)

   1. T cells: all cell-mediated immunity, coordination of the immune system. They work by attacking foreign cells, directly controlling activities of other lymphocytes.

It’s a Karen: “Hey! You don't belong here!”

2. B cells: Humoral immunity. Differentiates into plasma cells and synthesizes antibodies.

It's the hitman: throwing something at it until it leaves.

3. Natural Killer (NK) cells: Immune surveilence, detects and destroys abnormal tissue cells (cancers)

It's an elaborate game of Where’s Waldo- constantly hunting for abnormal cells. 

19. Remember that a lymphocyte is a type of leukocyte. Don’t get these words confused. A leukocyte is not a type of WBC. It refers to all WBCs.

20. Name the 3 phases of blood clotting (hemostasis) and describe what happens during each phase generally. 

Hemostasis=blood/stay

• The vascular phase: first 30 min but concurrent. vascular spasm, smooth muscle contracts-this closes off the whole in the vessels. Releases chemicals/local hormones with ultimately cause the plasma membrane of the blood vessle to become “sticky” which seals it off. 

• The platelet phase: Begins with attachment of platelets to the exposed sticky end of the epithelium. (sticky endotheliam, basement membrane, exposed collagen fibers, other platelets). Platelets release chemicals that are essential to continuing the clotting process. 

• Coagulation phase: begins 30 seconds or more after injury. Coagulation (blood clotting) leads to the conversion of fibrinogen to fibrin.

Procoagulants: activatied enzymes lead to a chain reaction or a cascade, 2 pathways leaf to a common pathway (3 total), convert circulating fibrinogen int insoluble fibrin.

21. Describe the basic steps of coagulation resulting in the formation of the insoluble fibrin clot.

The coagulation phase begins 30 seconds or more after injury. Coaggulation (or blood clotting) involves a complex sequence of steps that ultimately leads to the conversion of fibrinogen to insoluble fibrin.

22. Know what leads to the start of the common pathway and describe the events of the common pathway that leads to the formation of fibrin.

Extrinsic and intrinsic pathway leads to the common pathway. 

Factor X forms complex prothrombyn activator, which turns prothrombin into thrombin, thrombin converts fibrinogen to fibrin. 

23. Know the term, fibrinolysis.

Fibrinolysis is the process of a blood clot dissolving. Begins with the activation of plasminogen by thrombin (common pathway) and the tissue plasmogen activation, or T-PA from damaged tissues. This produces plasmin, which erodes the clot. 

24. Describe why a Vitamin K deficiency affects blood clotting.

Vitamin K is required to synthesize clotting factors in the liver. Without clotting factors, blood cannot clot properly. 

Ch. 18 Learning Outcomes - The Heart and Cardiovascular Function

1. Compare and contrast the Pulmonary and Systemic Circuits and describe what they are.

The pulmonary circuit carries blood to and from the gas exchange surfaces of the lungs. Pulmonary arteries carry blood away from the heart to the lungs, exchange in alveoli of the lungs oxcygenates the blood, then it is carried back to the left atrium of the heart. 

The systemic circut carries this oxygenated blood to the body. Arteries take blood to cells, capillaries allow for exchange with the cells, and veins carry deoxygenated blood back to the heart for the process to begin again.

2. Compare and contrast arteries, veins, and capillaries, showing understanding of the functions of each.

• Arteries: take blood away from the heart and is usually oxygentated (only exception is the pulmonary arteries which take blood to the lungs!)

Arteries have thicker walls and a higher BP, they are also more elastic and have a small round lumen.

• Veins take blood twoards the heart and are usually deoxygenated (only exception is the pulmonary veins which take blood from the lungs to the RV!)

Veins have thinner walls and also have valves, which ensure one way flow. They have a larger, flatter lumen

• Capillaries are for exchange of gases! This is the only place exchange happens. 

Can be continuous, fenestrated, or sunusoid and this refers to how large the gaps are and what can transport through. 

3. Explain the structural and functional differences between atria and ventricles.

Artia have thinner walls than ventricles. They are sort of a holding reservoir for blood while the ventricles forcefully push blood out. Ventricle wall are much thicker and more muscular because of this.

4. Describe the position of the heart in the thoracic cavity and know the term, mediastinum.

The heart is centrally located within the thoracic cavity, turned slightly counterclockwise and over to the left. The base of the heart (top)- lies at the 2nd intercostal space on the left and 3rd on the right. The apex of the heart is at the 5th intercostal space on the left. (anatomical left (remember that))

• Mediastinum: central part of the thoracic cavity between the lungs. 

5. Identify and describe the location, structure, and function of the parietal and visceral layers of the serous pericardium, serous fluid, and the pericardial cavity.

The parietal layer is the outermost layer. -this forms the inner layer of the preicardial sac.

The visceral layer is the innermost layer (think visceral=viscera=organ)

Pericardial cavity is the space between these 2 layers. 

• Serous fluid is found here.

The paricardial sac is fibrous tissue that surrounds and protects the heart. 

6. Describe the structure and location of each layer of the heart wall (i.e., epicardium, myocardium, endocardium).

• Epicardium, the outermost layer of the heart wall. Visceral layer of the pericardium-covers the heart.

• Myocardium, middle later of the heart wall (myo=middle=muscluar) this is the muscular layer of the heart. Concentric layers of cardiac muscle tissue. 

• Endocardium, innermost layer of the heart wall, simple squamous epithelium and areolar tissue. (This is renamed endothelium inside the heart and vessels.)

7. Describe the cardiac muscle tissue, including the location and function of the intercalated discs.

Cardiac muscle tissue has a few distinguishing characteristics

1. Small in size

2. Singe, centrally located nucleus

3. Incarcelated disks-branching interconnections between cells (glorified gap junctions)

4. Specialized intercellular characteristics

Cardiac muscle tissue is found only in the heart- it is striated and is almost entirely dependent on aerobic metabolism (requires oxygen for energy). Has abundant mitochondria and myoglobin (stores O2) and has extensive capillaries. 

• Incarcerated disks: interconnect cardiac muscles cells. Plasma membranes are intertwines in adjacent muscle cells. These are secured by desmosones and linked by gap junctions, these gap junctions allow action potentials to spread from cell to cell-all function together as a functional unit (functions syncytium)

8. On the external surface of the heart identify the 4 chambers, the coronary sulcus, anterior interventricular sulcus, posterior interventricular sulcus, pulmonary veins, superior and inferior vena cavae, coronary sinus, apex and base.

9. Know where the ligamentum arteriosum and fossa ovalis are located and what they are. This will include knowing the term foramen ovale.

Fossa ovalis: an indention where- in utero there was a whole between the right and left artia permiting blood flow. The heart is simply a means for blood to pass through before you are bodn and does not function to oxygenated blood, as oxygenated blood is passed to baby from mom. This is called the foramen ovale before it closes off. 

Ligamentum atreriousum: a small vessel between the pulmonary trunk and the aorta that allows blood to circle through. Part of fetal circulation.

Both of these close off from pressure at birth

10. Describe the blood flow to and from the heart wall, including the location of the openings for the left and right coronary arteries, left coronary artery and its major branches, right coronary artery and its major branches, cardiac veins, and coronary sinus.

Openings of left and right coronary arteries:

Left coronary artery and major branches: supplies blood to the left ventricle, left atrium, and linterventricular septum.

Main branches: anterior inteventricular artery (left anterior descending artery-LAD) (this is also called the widowmaker, if bloodflow is blocked here there is no O2 in tissues and you die) and the circumflex artery (follows coronary sulcus to the left, meets branches or right coronary artery posteriorly)

Right coronary artery and major branches: right coronary artery supplies blood to the right atrium, parts of both ventricles, and partc of cardiac (electrical) conducting system

Main branches: margina arteries (supply right ventricle) and posterior interventricular artery (runs posterior to the interventricular sulcus)

Coronary sinus: expanded vein that returns blood from the myocardium to the right atrium. Collects blood from all other cardiac veins.

Cardiac veins:

• Great cardiac vein: in the anterior interventricular sulcus. Drains area supplied by the anterior interventricular artery and empties into the coronary sinus posteriorly. 

  • Middle cardiac vein, posterior cardiac vein, and small cardiac vein empty into here. 

• Anterior cardia veins: drain anterior surface of righ ventricle-empties directly into the right atrium.

11. Identify and describe the structure and function of the primary internal structures of the heart, including chambers, septa, valves, pectinate muscles, papillary muscles, chordae tendineae, and venous and arterial openings.

• Chambers: hold blood-atria push into ventricles, ventricles contract to push out into body right to lungs, left to body.

• Septa: inner atrial septum-separates right and left atria. Interventricular septum-separates right and left ventricles.

• Valves: AV valves- between atria and ventricles, allows blood to flow only 1 way. Semilunar valves: at exit from each ventricle: allows one way flro from ventricle out into aorta or pulmonary trunk.

• Pectinate muscles: in the right atrium, contains prominent muscular ridges-on anterior atrial wall and inner surface of right auricle. pectinate=atrium.

• Papillary muscles: muscles in ventricles contract papilary=ventricles

• Chordae tendonae: Connects valves to papillary muscles. Corde tighten to prevent backflow. 

• Venous and atrial openings: blood flow out of/into heart.

12. Trace the path of blood through the right and left sides of the heart, including its passage to the lungs and through the heart valves, and indicate whether the blood is oxygen-rich or oxygen-poor.

Superior and inferior vena cava

Right atrium

Tricuspid valve

Right ventricle

Pulmonary semilunar valve

Pulmonary trunk

Pulmonary artery

Lungs

13. Define arteriosclerosis, and explain its significance to health.

This is a thickening or toughening of arterial walls. Leads to coronary artery disease (CAD) which is areas of partial or complete blockage of coronary circulation (reduces blood flow to area, also called coronary ischemia)

This is usually caused by atherosclerosis in the coronary artery or associated blood clot (thrombus)

Early symptoms include angina pectorialis, exertion or emotional stress=pressues, chest constriction, pain. 

• Sever cases lead to myocardial infarction (heart attack)-part of coronary circulation becomed blocked and cardiac muscle cells die from lack of oxygen. Death of affected tissue creates a non-functional area called an infarct, and pain is presistant even at rest. 

14. Define cardiac cycle, systole, and diastole. 

Cardiac cycle: 1 heartbeat to the next. Starts with ventricular contraction to the start of the next

Systole: contraction-blood leaves the chamber

Diastole: relaxation-chamber refills

15. Describe the phases of the cardiac cycle including ventricular filling, isovolumic (isovolumetric) contraction, ventricular ejection, and isovolumic (isovolumetric) relaxation.

Cardiac cycle: normally around 800 mesc. Defined at the period between the start of one heartbeat to the next. Systole: contraction. Diastole: relaxation

Starts with all 4 chambers relaxed (ventricles passively filling-diastole)

1. Atria contract together (atrial systole), pushes blood into the ventricles.

2. Atrial diasotle

3. Ventriculat systole: ventricles contract, build pressure, closes AV valves but not enough to open semilunar valves. (isovolumetric contraction) iso=same, no change in volume

   1. Ventricular ejection-when the ventricle pressure exceed vessel pressure. This opens semilunar valves and blood leaves the ventricle

4. Ventricular diastole: early, pressure drops, semilunar valves close (blood in aortal pulmonary trunk backflows and closes them), ventricles relax. 

   1. Isovolumenetric relaxation: when ventricular pressure is still greater than atrial pressure. All valves are closed and no volume exchange (this is between when SL valves close and AV valves open), blood is passivly filling the atria.

   2. When atrial pressure exceded ventricular pressure, AV valves open (to 70%), ventricles and atria are passively filling. Late stage ventricular diastole

16. Explain how atrial systole is related to ventricular filling.

Atrial systole is the contraction of the atria. While some of ventricle filling is passive, the atrial contraction, forces blood into the ventricle. Pushes it and gives it umph. 

17. Relate the opening and closing of specific heart valves in each phase of the cardiac cycle to pressure changes in the heart chambers and the great vessels (i.e., blood vessels entering and leaving the heart). 

See answer in #15

18. Relate the heart sounds to the events of the cardiac cycle. 

S1: lubb- when the AV valves close: this is the start of ventricular contraction

S2: dupp- when the semilunar valves close. 

Sounds 3 and 4 are rarely heard in adults 

S3: blood flowing into the ventricles

S4: atrial contraction

19. Explain the significance of the plateau phase in the action potential of a cardiac contractile cell.

The plateau phase occurs because of 2 factors. 

1. Fast sodium channels close and the potential nears +30mV. Cell actively pumps Na+ out. 

2. Voltage gated slow potassium channels open. Ca2+ influx (opens slow and stays open)

   1. This keeps the voltage right around 0mV-prevents tetanus from occurring 

20. List the parts of the electrical conduction system of the heart in the correct sequence for one contraction and explain how the electrical conduction system functions.

1. The sinoatrial node is the pace maker of the heart, and generates action potentials for heart beats. This beets at 80-100 bpm and is located in the posterior wall of the right atrium. This begins atrial activation

2. Step 2 is distributing signal through btoh aorta-this connects the SA and AV node. 

3. AV node is located in the junction between atria and ventricles it slows the signal down by about 100 msec, and relays signal from atria to ventricles-delays the impulse (step 3)

4. Atrial contraction begins

5. AV bundle-located in the septum, carries impulses to the left and right bundle branches (which conduct to purkinje fibers), and to the moderator, which conducts to papillary muscles. 

6. Bundle branches, left and right, conducting cells transmit impulses to the apex of the heart, then spreading into the ventricle walls. 

7. Purkinje fibers: distribute action potentials. Atrial contraction is completes, ventricular contraction begins.

21. Know the differences in the SA node and the AV node.

• SA node: the pacemaker of the heart. Each heartbeat begins with an action potential generated here. 80-100 bpm.

• AV node: the backup pacemaker, can take over if SA is failing. Slower heart beat 40-60 action potenetials/minute

22. Name the waveforms in a normal electrocardiogram (ECG or EKG) and explain the electrical events represented by each waveform.

• P wave: atrial depolarization

• QRS complex: ventricular depolarization

• T wave: ventricular repolarization

Intervals:

• P-R interval: period from start of atrial depolarization to start of ventricular depolarization.

  • Increased length may mean damage to conducting pathways or AV node (>200)

• Q-T interval: Time for ventricles to undergo a complete cycle

  • Electrical disturbances, medications, conduction problems, coronary ischemia, myocardial damage.

23. Know about the 6 heart arrhythmias discussed.

• Premature atrial contraction: normal atrial rhythm momentarily interrupted by a “suprise” contraction. This is normal and occurs in healthy people. Can be caused by stress, caffine, various drugs.

• Paroxymal artial tachcardia: triggers flurry of atrial activity (from premature artial contractions)-ventricles keep pace, HR abt 180bpm

• Atrial fibrilation: impulses move over martial surface at up to 500bpm. Atria quivers-not an organized contraction. The ventricular rate cannot follow, may remain normal. The artia are non-functional but ventricles may fill passively, person may not realize

• Premature ventricular contractions: purkinje cell or ventricular myocardia cell depolarizes-this triggers premature contraction. A single PVC is common, not dangerous, frequently increased by epinephering, stimulants, etc.

  • Cell responsible is called an ectopic pacemaker (pacemaker other than SA node)

• Ventricular Tachycardia (VF or V-Tach): 4 or more PVC’s without intervening normal beats. Indicates serious cardiac problems. 

• Ventricular fibrillation: cardiac arrest-rapidly fatal, ventricles quiver but cannot pump any blood. 

24. Know the terms: bradycardia and tachycardia

Bradycardia: heartbeat slower than normal <60bpm

Tachycardia: heartbeat faster than normal <100 bpm

25. Describe the role of the autonomic nervous system in the regulation of cardiac output.

Affects resting heart rate- keeps it in the normal range. 

1. Cardioinhibitory center: Controls parasympathetic neurons, slows heart rate. Parasympatheitc supply to the heart via the vagus nerve. 

2. Cardioacceletratory center: controls sympathetic neurons, increases heart rate.

26. Define cardiac output (CO), stroke volume (SV) and state their units of measurement.

Cardiac output is the amount of blood pumped from the LV each minute. 

Stroke volume is the amount of blood leaving the heart each stroke. Calculated by 

end diastolic vloume (how much to fill it up) -  end systolic volume (how mych is left after contraction)

27. Calculate cardiac output, given stroke volume and heart rate.

Cardiac output = HR x Stroke volume

28. Predict how changes in heart rate (HR) and/or stroke volume (SV) will affect cardiac output (CO).

Both will affect cardiac output.

Decreased heart rate=less blood return to the heart and less being pumped out (less need for oxygenated blood, it doesnt move as quickly)

Decreased stroke volume= less blood moving out of heart with each beat, less blood going out of the heart each minute. 

Increased would do the opposite for both. Would increase cardiac output. 

Both have a strong effect on casrdiac output, especially when combined. 

29. Define end diastolic volume (EDV) and end systolic volume (ESV), and calculate stroke volume (SV) given values for EDV and ESV. 

Stroke volume is the amount of blood leaving the heart each stroke. Calculated by 

end diastolic vloume (how much to fill it up) -  end systolic volume (how mych is left after contraction)

EDV-ESV=SV

30. Define venous return, preload, and afterload, and explain the factors that affect them.

• Venous return: the amount of venous blood that returns to the right atrium

• Preload: the amount of myocardial strech (more stretch=hearder contraction)

• Afterload: Ventricular tension required to open semilunar valves and empty.

31. Explain how venous return, preload, and afterload each affect end diastolic volume (EDV), end systolic volume (ESV), and stroke volume (SV)

Venous return affects the amount of blood availible to push through the heart. 

• EDS-how much blood fills the ventricle-this affects stroke volume

Preload affects the strength of contraction.

• ESV- how much left after contraction- stronger contraction forces more blood out increasing stroke volume

Afterload- how much does it take to open semilunar valves

• Could affect SV-not as much force=not as much able to leave. Also could leave more blood left after contraction (ESV)

Ch. 19 Learning Outcomes - Blood Vessels and Circulation

1. List the three layers (tunics) associated with most blood vessels and describe the composition of each layer (tunic). 

1. Tunica intima: NOT present in veins. This is the innermost layer and includes endothelial lining, connective tissue with elastic fibers, and in arteries the outer margin has elastic fibers. In arteries this is the internal elastic membrane

2. Tunica media: this si the moddle layer middle=M=Muscle. Concentric sheets of smooth muscle. responsible for vasoconstriction and vasodilation. External elastic membrane separated this from the tunica externa (only in arteries)

3. Tunica externa: this is the outside layer. In arteries=collagen and elastic fibers, in veins=thicker than tunica media, networks or elastic fibers and bundles of smooth muscle cells. 

   1. Large vessel walls contain vasa vasorum (vessles of vessels)- little vessels that provide O2 to great vessels (ex. Superior vena cava)

2. Compare and contrast arteries and veins, including the differences in the layers (tunics) found in each.

• Arteries: more elastic, has a small round lumen. Thicker walls and higher bp

• Veins: valves, large flat lumen

Tunica media is much thinker in arteries than in veins. Veins also do not have elastic layer in tunica intima.

3. Distinguish between elastic arteries, muscular arteries, arterioles, venules, medium-sized veins, and large veins and understand their general locations and relationships to each other.

• Elastic arteries: Large vessels close to the heart, these arteries accommodate the most stretch. 

• Muscular arteries: medium sized arteries (ex. Brachial artery, femoral artery)

• Arterioles: poorly defined tunica extgerna and tunica media is only 1-2 smooth muscles calls thick.

• Venules: No tunica media, resembles expanded capillaries-collects blood from capilaries

Thin tunica media with thicker tunica externa

• Medium sized veins:

• Large veins: ex. superior and inferior vena cava

4. List types of capillaries, state where in the body each type is located, and correlate their anatomical structures with their functions.

• Continuous capillaries: the endothelial cells form a complete lining and this is found in all tissues except epithelia and cartilage. 

  • Functions: permit diffusion of water, small solutes, and lipid-soluble material, blocks blood cells and plasma proteins

• Fenestrated capillaries: has pores “or windows” in endothelial lining. This is found in the choroid plexus (eye), endocrine organs, absorbtive areas of interstitial tract, and kidney filtration sites

  • Functions: This permits the rapid exchange of water and larger solutes between plasma and interstitial fluid. 

• Sinusoids: Has gaps between adjacent endothelial cells and the basement membrane is thin or absent. This is found in the liver, bone marrow, spleen, and many other endocrine organs.

  • Functions: permits free exchange of water and larger plasma proteins.

5. Know the terms: arterial anastomosis, precapillary sphincters, vasomotion as they related to capillary beds. 

• Arterial anastomosis: Joining of blood vessles (ex. Collaterals which is arteries that are fused)

•  Allows continuous bloodflow even if an artery is blocked. Precapillary sphincters: bands of smooth muscle that contract and relax to control flow into capillary bed (gates controlling flow)

• Vasomotion: cycles of contraction and relaxation

6. Understand why valves are present in veins and not in arteries. Describe their function and how they generally work.

Arteries have much higer pressure and generally works with gravity. Veins, on the other hand do not. They have lower pressure and rely on muscle contraction to force blood twoards the heart. Without the valves in veins, blood could flow backwards or pool. Veins ensure efficiency and one way bloodflow. 

7. Define vasoconstriction and vasodilation.

Vasoconstriction: tightening of blood vessles (constrictions of smooth muscle), diameter gets smaller. Causes an increase in blood pressure and reduces the amount of blood in the venous system. Can maintain bloo volume in the arterial system. Contolled by the vasomotor center in the medulla oblongata and innervated by sympathetic nerves. 

Vasodialation: increases diameter or blood vessles, decrease blood pressure and increases amount of blood in venous system.

8. Define blood flow, blood pressure, and peripheral resistance.

• Blood flow: flow through vessles is influenced by resistance. Resistance increases as vessels get smaller. Blood flow in capillaries is very slow and pressure is low. This allows time for capillary exchange.

• Blood pressure: maintained by valves and muscular compression of peripheral veins. Peripheral resistance: determined by vascular resistance, blood viscocity, and turbulance.

9. Explain the effects of pressure, resistance, and venous return on cardiac output.

As blood moves towards heart, vessles get larger and it is ok that pressure is lower.

pressure=lower, resistance=decreases. Venous return, on average=cardiac output 

10. Describe the factors that influence total peripheral resistance.

1. Vascular resistance: friction between blood and vessel walls. 2 factors in this

   1. Vasular resistance: increased vessle length=increased surface area=increased friction or resistance

   2. Vessle luminal diameter: vessel diameter changes based on vasodilation and constriction. Smaller vessels=higher resistance, larger vessels=lower resistance.

2. Blood viscosity: blood is 5x as viscous as water. Normally a stable amount

3. Turbulence: swirling action that disturbs the smooth flow of liquid. Occurs in heart chambers and great vessels. Atherosclerotic plaques cause abnormal turbulence.

11. Describe the factors that determine blood flow.

Volume of blood flowing per unit of time through a vessle or a group of vessels. This is directly proportional to arterial pressure and inversely proportional to peripheral pressure

More important than absolute pressur is pressure gradient. 

This is the difference in pressure from one end of the vessel to another. 

The largest difference is from aorta to arterial end of capillary beds. 

12. Know how blood pressure and blood flow are related. Know how peripheral resistance and blood flow are related.

Flow is highest wehere pressure is highest. (highest in aorta, lowest in capillaries)

13. Know the terms: systolic pressure, diastolic pressure, hypertension, hypotension

Systolic pressure: peak pressure measured durring ventricular cycle

Diastolic pressur: minimal arterial pressure at the end of a ventricular contraction

Hypertension: abnormally high bp (>140/90)

Hypotension: abnormally low bp (90/60)

14. Describe the movement of fluids between capillaries and interstitial spaces using the following terms: diffusion, osmosis, filtration, capillary hydrostatic pressure, net filtration pressure, and blood colloid osmotic pressure

Capillary pressures and capilalary exchange is vital to homeostasis and involves a combination of diffusion, osmosis, and filtration.

Capillary hydrostatic pressure (CHP): blood pressure within the cappilary beds, this provides the driving force for filtration. Pushes water and small molecules out of the bloodstream and into interstitial fluid. 

Filtration: driven by CHP and is highest near the artiole. Water and small solutes are forced through the capillary wall into interstitial fluid. 

Net filtration pressure: difference between CHP and blood colloid osmotic pressure 

NFP=CHP-OCOP

Positive at beginning (CHP) and negative at end (OCOP)

Reabsorbtion: driven by blood colloid osmotic pressure: the the venule end, CHP<OCOP. This drives fluuid back into the capillary. More water leaves the bloodstream than is reabsorbed, the difference will enter lymphatic vessels and will be eventually returned to venous circulation.

15. Understand central regulation, autoregulation, and baroreceptor reflexes in response to changes in blood pressure and blood composition.

Autoregulation occours at he local level-vasodialaters an dprecapilary sphincters which

Central regulation- through the hypothalamus (bc nervous and endocrine system)

Neuromechanisms activate cardioaccerteratory center and vasomotor center. 

• Baroreceptors change in blood pressure whn bp is high CV decrece cardoi output and vasodialate, when bp is loe CV centerd increase cardio output and vasoconstrict. 

16. Explain the role of the precapillary sphincter in autoregulation.

Regulates bloodflow into capillary bed

17. Understand the relationship between vasoconstriction and vasodilation as it relates to blood pressure.

Vaso constriction increases blood pressure- when pressure is low, this is used to ensure proper blood flow to tissues

Vaso dialation decreases pressure- when pressure is high this can help decrease it.

18. Know how each of the following affect blood pressure: epinephrine and norepinephrine, ADH, Angiotensin II, Erythropoietin, Aldosterone, Atrial and Brain Natriuretic peptides

Immediate response:

• Epinephrine and norepinephrine: released from adrenal medulla, increases blood pressure. Activated durring the fight or flight responce, allows more O2 to cells.

Long term responses:

• ADH: Elevates BP and reduces water loss at kidneys. Responds to low blood volume, high plasma osmotic regulation, and circulating Angiotensin II.

• Angiotensin II: Release of renin produces this-responds to fall in renal BP, stimulates aldosterone and ADH production, thirst, cardiac output, and vasoconstriction.

• Erythropoetin: Released in kidneys in response to low bp and low O2 content in blood. Stimulates RBC production.

• Aldosterone: Released by the adrenal cortex, retain Na+ and releases potassium to maintain blood levels (where salt goes water does to. Keep salt=keep water)

• Atrial and brain natiuretic peptides: Atrial released from  right atrial walls, brain released from ventricular muscle cells. Promotes Na+ and water loss in urine, inhibits the release of renin, ADH, and aldosterone, overall effect is a reduction of blood volume and pressure.  

19. List the three general functional patterns as they related to pulmonary and systemic circuits.

1. Peripheral artery and vein distribution is the same on the right and the left, except near the heart

2. The same vessel may hev different names in different locations

3. Tissues and organs usually have multiple arteries and veins.

20. Describe the systemic and pulmonary circuits (circulations) and explain the functional significance of each. 

• Pulmonary circut:oxygentate blood

Deoxygenated blood arrives at heart from systemic circut, passes throught the RA and RV and enters the pulmonary trunk. This divides into right and left and then pulmosnry arteries branch into pulmonary arterioles, which become capillary networks that surround alveoli. 

Oxygenated blood returns tho the heart through venules-> 4 pulmonary veins, these empty into the left atrium. 

• Systemic circut: blood to tissues

all vessels originate in the aorta and dran into the SVC or IVC. pathway of blood through the body.

Arteries are deep, veins are deep and superficial-this is important for temperature control.

21. Identify the major arteries and veins of the pulmonary circuit.

RV->Pulmonary trunk->pulmonary artery->lungs->Pulmonary veins->LA

22. Identify the major arteries and veins of the systemic circuit.

Aorta, SVC, IVC

23. Identify the 3 branches of the aortic arch and name the areas each serves.

FIRST: coronary arteries, these are the 1st branch off the aorta and takes blood to the heart surface. O2 for the heart

1. Brachocephalic trunk: brachial artery, right common carotid: right upper extremity, head, neck

2. Left common carotid artery: brain and head

3. Left subclavian artery: Arm, shoulder, hand, left side of head and neck

24. Compare and contrast anterior and posterior circulation to the brain and know about the connection with the cerebral arterial circle.

Anterior circulation is through the internal carotid, posterior is through the vertebral and basilar arteries.

Circle of willis (also calle the cerebral arterial circle) an anastamosis between internal carotid and basilar arteries, allows blood flow even if vessles get blocked (important in the brain!)

25. Define a portal system.

Connection between 2 capilary beds

26. Describe the structure and functional significance of the hepatic portal system.

Hepatic portal system connects capillaries in the digestive syste to the liver sinusoids. Blood is precessed in the liver before it goes to the inferior vena cava.

Ch. 20 Learning Outcomes - 

1. Describe the two major functions of the lymphatic system.

There are 2 major functions of the lymphatic system. 

1. Immunity

   1. Ability to resist infection and disease

   2. Immune system

2. Maintaining normal blood volume and composition of interstitial fluid.

2. Know the components of the lymphatic system.

• Lymphocytes: the primary cells of the lymphatic system (a type of white blood cell). They are surrounded by lymph, which is interstitial fluid that has entered a lymphatic vessel. 

• Lymphatic vessels (lymphatics): Begin in peripheral tissues and end at connections to veins.

• Lymphoid tissues and organs:

  • Primary: sites where lymphocytes are formed or mature (Red bone marrow, thymus gland)

  • Secondary: Where lymphocytes are activated and cloned (lymph nodes, tonsils, MALT, appendix, spleen)

3. Compare and contrast lymphatic vessels and capillaries in terms of structure and function.

Lymphatic capillaries have overlapping endothelial cells, operlap region is a one way valve which permits entry of fluid and solutes and prevents return of these to the intercellular space 

Lymphatic vessels are valves locaged close together and bulge at each valve (which looks like pearls), these valves prevent backflow of lymph.

4. Know what lymphatic vessels are called in the small intestine and their significance.

Called lacteals in the small intestine- significant because it is important in the transport of lipids absorbed from the digestive tract. 

5. Describe the path of lymph circulation. Know specifically the 2 major collecting vessels and where they collect from. Also, know the term cisterna chyli.

2 major collecting vessels:

1. Thoracic duct. 

1. Drains into the left subclavian vein, collects lymph from the entire left side of the body and everything below the diaphragm. 

2. Right lymphatic duct

2. Drains into the right subclavian vein, collects lymph from the right above the diaphragm.

Cisternal chyli: an expanded chamber at the base of the thoracic duct. This receives lymph from the inferior part of the abdomen, the pelvis, and lower limbs. 

Sits right below the diaphragm.

6. Given a factor or situation (e.g., lymphedema), predict the changes that could occur in the lymphatic or immune system and the consequences of those changes (i.e., given a cause, state a possible effect).

Lymphedema is caused by blocked lymphatic drainage, interstitial fluids accumulate and affected area can become distended. 

Gentle “c” massage given to promote drainage and affected area is wrapped trightly to prevent reaccumulation of fluids. 

7. Describe the general functions of the various types of lymphocytes (e.g., helper T cells, cytotoxic T cells, regulatory [suppressor] T cells, B cells, plasma cells, memory cells). 

• Helper T cells: stimulate activation and function of T and B cells. Crucial for activation of B cells before they can produce antibodies. 

• Cytotoxic T cells: Attack foreign cells or body cells infected by viruses. Attack commonly involves direct contact. Primary cells involves in the production of cell mediated transfer. 

• Regulatory T cells: Moderates immune response Helps establish and control sensitivity of immune response. 

• Memory cells: Respond to antigens they have already encountered. Remain in body to give immunity. 

• B cells: Responsible for antibody mediated (humoral) immunity. 

  • Plasma Cells: These are activated immune cells that produce antibodies. Attacks targets throughout the body. 

8. Compare and contrast the formation of T and B cells through the process of lymphocytopoiesis.

Involves the red bone marrow, thymus, and peripheral lymphoid tissues. 

Lymphoid stem cells split into 2 groups

• Group 1: migrates to the thymus and will develop into T cell-Divides in response to thyamic hormones to produce all types of t cells. 

  • Blood thymus barrier isolates them from general circulation “we are gonna keep you here until you are a good T cell, you can’t leave until you do it right!” this is part of the selection process- ensures they won’t react to normal body cells.

    • Up to 98% of t-cells are descelected and die

    • mature t cells will re-enter the blood stream and travel to peripheral lymphoid tissues and organs.

• Group 2: stays in the red bone marrow and divides to produce:

B cells mature and move into lymph nodes, spleen and other lymphoid tissues

NK cells mature and migrate through the body, patrolling peripheral tissues

9. Describe the structure, function, and major locations of lymphatic nodules (e.g., mucosa-associated lymphoid tissue [MALT], tonsils).

Lymphoid tissues have no capsule! Densely packed lymphocytes in areas of areolar tissue. May cluster together to form larger masses. Connective modules dominated by lymphocytes

• Tonsils- Large lymphoid nodules un the walls of the pharynx. 3 types- pharengeal tonsils (or adenoid), palestine tonsils (left and right), lingual tonsils

Tonsillitis is inflammation of the tonsils.

• Mucosa-associated lymphoid tissue- protects epithelia of digestive, respiratory, urinary, and reporductive tracts from pathogens and toxins. Aggregated lymphoid nodules

• Appendix- contains a mass of fused lymphoid nodules

10. Describe the structure, functions, and major locations of the following lymphatic organs: lymph nodes, thymus, and spleen.

These organs do have a capsule

• Lymph node: functions as filters, roemoving 99% of pathogens from lymph before fluid returns to the bloodstream. 

  • Path of lymph through the lymph node:

    • Aferrent lymphatics: brings lymph into the nods on the opposite side from the hylum (indention)

    • Subscapular space: dendritic cells introduced in the immune system (not specific)

    • Outer cortex- B cells

    • Paracortex- T cells

    • Core (medullary sinus): B-cells and plasma cells

    • Hylum and efferent lymphatics: out of lymph node

• Thymus: in the mediastinum posterior to the sternum. 

  • Atrophies after puberty, decreasing the effectiveness of the immune system. 

  • Lymphocytes divide in the cortex and produce t cells-meture t cells leave the thymus by medullary blood vessles

  • Thymosins: hormones that are important in functions t cell evelopment

• Spleen: the largest mass of lymphoid tissue in the body. 3 main functions

  • Removes abnormal blood cells and other blood components bt phagocytosis

  • Stores iro recycled from red blood cells

  • Initiates immune responce by b-cells and t-cells in responce to antiges and circulating blood

If there in on spleen there is a much higher risk of infection.

11. Compare and contrast innate (nonspecific) with adaptive (specific) defenses.

Innate immunity: this is what you are born with, it reacts the exact same way to every antigen it encounters.

Adaptive immunity: this is specific and based on exposure-pathogens and vaccines. 

12. Know the general information about each of the innate (nonspecific) immunity components including physical barriers, phagocytes, immune surveillance, Interferons, Complement system, inflammation, and fever.

• Physical barriers: the skin and other epithelial linings. Found in digestive, respiratory, reproductive, and urinary tracts. Secretions (mucus, enzymes, and stomach acid) often ensnare, destroy, or wash away pathogens. Malt provides non-specific defense. 

• Phagocytes: this is the first line of defense against pathogenic invasion-can attack and remove microorganisma bedore lymphocytes detect their presence. They engulf and destroy foreign substances, pathogens, and cellular debris. 

Types: different types target different threats but function the same way.

• Neutrophils: phagocytize cellular debris or bacteria (eat and then they turn into pus)

• Eosinophils: phagocytize foreign compunds and antibody coated pathogens (specifically allergies)

• Monocyte-macrophage system: englufs things

  • Fixed macrophages: scattered among connective tissues-immobile within these tissues

  • Free macrophages: travel throughout the body

• Immune surveillance: Carried out by natural killer cells-recognise tumor specific antigens as abnormal and destroy them. Destroy foreign cells (bacteria, virus, cancer)

  • 4 steps: 1) recognition and adhesion, 2) realignment of golgi apparatus (turns) 3) secretion of perforins (perforates cell), 4) lysis of abnormal cell

  • This process is not perfect-primary tumor can be surrounded by a capsule and escape detection, this can lead to secondary tumors.

• Interferons: google: Interferons are essential proteins that help the body fight viral infections and other immune challenges. They have antiviral, immune-modulating, and anti-tumor properties

• Complement system: Complements (works together with) the immune system un defense (immunology)

• Inflammation: cardinal signs: local redness, heat, swelling, pain, sometimes loss of function.

• Fever: caused by pyrogens (circulating fever inducing proteins-these can be beneficial within limits, may inhibit come viruses and bacteria-increases metabolic rate which accelerates tissue defenses and repair process.

13. Know the differences between the types of adaptive immunity (active and passive, naturally acquired vs. artificially induced). Be able to recognize or give examples of each.

Adaptive immunity- exposed and cellxs actively fight and build memory. 

• Active immunity-develops after exposure to an antigen

  • Naturally acquired immunity- exposure to antigen (ex. Measles-immunity against future infection to that specific antigen)

  • Artificially induced- administered (vaccines-recieving antibodies, stimulates immune response to produce antibodies against that specific antigen)

• Passive immunity-produced by transferring antibodies from another source

  • Natrually acquired- born with some of mom’s antibodies, serves as initial protection. (mom to baby-at birth, breastmilk)

  • Artificially induced- give someone antibodies (not vaccine) (ex. Monoclonal antibodies given at the beginning of covid)

14. Know and describe the 4 properties of adaptive immunity.

• Specificity- each T cell and B cell responds only to a specific antigen and ignores all others. 

• Versatility- there are millions of lymphocytes, each sensitive to a specific antigen. When activated it divides (clones) to produce more lymphocytes specific to that antigen.

• Memory- “remembers” antigen, making future attacks faster, stronger, and longer lasting

• Tolerance- immune system ignores “self” but targets abnormal and foreign “non-self” cells and toxins

15. Be able to define antigen.

A molecule that initiates the production of an antibody anf causes an immune system response.

16. Compare and contrast antibody-mediated (humoral) and cell-mediated (cellular) immunity.

T-cells: cell mediated, cell to cell combat. Cell finds pathogen and attacks it and destroys is-at the same time it is communicating with B cells- b cells is like oh i know that I have a specific antibody for that. B cell becomes a plasma cell and clones to attack pathogen.

17. Know what an MHC protein is (major histocompatibility complex) in general terms. 

Basically the cells is infected and it is saying come and get me!

MHC prodein made in endoplasmec retigulum->golgi->surface of the cell=this is where it will signal that it is infected.

18. Describe where class I and class II major histocompatibility complex (MHC) proteins are found.  

Class 1: a cell that is infected-all cells can do this

Class 2: a phagocytic cell-eats infections- only in antigen presenting cells (APC’s) appears only when cell is processing antigens.

19. Summarize the integration of innate and adaptive immunity.

Exposure to antigens triggers both specific and non-specific defenses. Neither branch works alone-many times activities from each branch with strengthen each other. 

Responses vary based on antigen type.