Copyright 2008 Pearson Education Inc publishing as Benjamin

Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

SYSTEMA CIRCULATORIUS § KLASIFIKASI: § SISTEM KARDIOVASKULAR § § § SISTEM LIMFATIK § § PEMBULUH DARAH JANTUNG NODUS LYMPHATICUS PEMBULUH LIMFE HUBUNGAN STRUKTURAL/FUNGSIONAL: § SISTEM KARDIOVASKULAR BERHUBUNGAN DENGAN SISTEM LIMFATIK HISTOLOGI: § SELURUH SISTEM DIBATASI OLEH ENDOTEL Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

HUBUNGAN TIMBAL BALIK SISTEM LIMFATIK DAN SISTEM KARDIOVASKULER § SISTEM LIMFATIK § § SISTEM KARDIO-VASKULER DUCTUS THORACICUS ET DUCTUS LYMPHATICUS DEXTER BERMUARA DALAM VENA BESAR SEBAGAI BAGIAN SISTEM PEMBULUH DARAH SISTEM KARDIOVASKULER § § SISTEM LIMFATIK CAIRAN LIMFE DENGAN LIMFOSIT DALAM VENULA POST-CAPILER DALAM SETIAP NODUS LYMPHATICUS SEBAGAI BAGIAN DARI SISTEM PEMBULUH DARAH, MASUK SISTEM LIMFATIK, YANG PADA AKHIRNYA DITAMPUNG DALAM KEDUA SALURAN LIMFE BESAR Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

SYSTEMA CIRCULATORIUS JANTUNG DUCTUS THORACICUS ARTERIA BESAR ARTERIA SEDANG ARTERIA KECIL PEMBULUH KAPILER SISTEM LIMFATIKA VENA KECIL VENA SEDANG VENA BESAR Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings S I S T E M K A R D I O V A S K U L A R

SISTEM LIMFATIK KAPILER LIMFE BUNTU (vasa aferentia) NODUS LYMPHATICUS Vasa eferentia PEMBULUH LIMFE BESAR PEMBULUH DARAH VENA JANTUNG Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings DUCTUS THORACICUS ET DUCTUS LYMPHATICUS DEXTER

ALIRAN CAIRAN LIMFE § § § CAIRAN LIMFE (CAIRAN JARINGAN) § PLASMA § LIMFOSIT PEMBULUH LIMFE § DIMULAI DENGAN KAPILER LIMFE BUNTU § MENAMPUNG DARI CAIRAN JARINGAN NODUS LYMPHATICUS § MENAMPUNG KAPILER PADA PERMUKAAN CEMBUNG PEMBULUH LIMFE LEBIH BESAR § MENAMPUNG DARI VASA EFERENTIA N. LYMPHATICUS PEMBULUH LIMFE BESAR MENUJU KE JANTUNG § DIAMETER PEMBULUH LIMFE SEMAKIN BESAR § DUCTUS THORACICUS V. SUBCLAVIA SINISTRA § DUCTUS LYMPHATICUS DEXTER V. SUBCLAVIA DEXTRA Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

ALIRAN CAIRAN LIMFE ARTERI VENA NODUS LYMPHATICUS Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

SIRKULASI PLASMA DAN LIMFOSIT SISTEM LIMFE Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings SISTEM KARDIO VASKULER

DINDING VASA LYMPHATICA § VASA AFERENTIA § § § MASUK KE DALAM SINUS LYMPHATICUS DALAN NODUS LYMPHATICUS KELUAR DARI HILUS SEBAGAI VASA EFERENTIA § § § STRUKTUR DINDING SAMA DENGAN VASA AFERENTIA MENGANGKUT CAIRAN LIMFE DENGAN LIMFOSIT VASA LYMPHATICA § § MENAMPUNG CAIRAN JARINGAN DIAMETER LEBIH BESAR SEDIKIT DARI KAPILER DARAH SELAPIS SEL ENDOTEL TIPIS TIDAK ADA PERISIT MENERIMA BEBERAPA VASA EFERENTIA, DIAMETER BERTAMBAH BESAR DINDING BERTAMBAH TEBAL DI BAGIAN DALAM DILENGKAPI DENGAN VALVULA DUCTUS THORACICUS DAN DUCTUS LYMPHATICUS DEXTER Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

DINDING VASA LYMPHATICA VALVULA VENULA Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VASA LYMPHATICA BESAR § VASA LYMPHATICA BERDIAMETER >0, 2 mm § DILENGKAPI VALVULA § DIBEDAKAN 3 LAPISAN DINDING: § § TUNICA INTIMA TUNICA MEDIA § § § 2 LAPISAN SEL-SEL OTOT POLOS TUNICA ADVENTITIA § BANYAK MENGANDUNG SERABUT KOLAGEN DAN ELASTIS DUCTUS THORACICUS ET DUCTUS LYMPHATICUS DEXTER (PEMBULUH LIMFE TERBESAR) § DILENGKAPI DENGAN VALVULA § 3 LAPISAN DINDING YANG KURANG JELAS § § § TUNICA INTIMA: ENDOTIL DAN SERABUT KOLAGEN & ELAS TUNICA MEDIA : SEL OTOT POLOS TUNICA ADVENTITIA: SEL-SEL OTOT POLOS MEMANJANG Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VASA LYMPHATICA BESAR DUCTUS LYMPHATICUS DEXTER VENA CAVA SUPERIOR DUCTUS THORACICUS Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

§ Arteries § § Capillaries § § Elastic arteries Muscular arteries Arterioles Continuous Fenestrated Sinusoidal Veins § Veins, venules Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vessel Structure - General § § All vessels same basic structure 3 wall layers (or tunics) § Tunica adventitia (externa) elastic and laminar fibers § Tunica media § § § Tunica interna (intima) § § thickest layer elastic fibers and smooth muscle fibers endothelium – non-stick layer basement membrane internal elastic lamina Lumen - opening Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Structure of Blood Vessels § Composed of three layers (tunics) § Tunica intima – composed of simple squamous epithelium § Tunica media – sheets of smooth muscle § Contraction – vasoconstriction § Relaxation – vasodilation § § Tunica externa – composed of connective tissue Lumen § Central blood-filled space of a vessel Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Structure of Arteries, Veins, and Capillaries Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 1 a

Types of Blood Vessels § § Arteries – carry blood away from the heart Capillaries – smallest blood vessels § The site of exchange of molecules between blood and tissue fluid § Veins – carry blood toward the heart Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Types of Arteries § Elastic arteries – the largest arteries § § § Diameters range from 2. 5 cm to 1 cm Includes the aorta and its major branches Sometimes called conducting arteries High elastin content dampens surge of blood pressure Aorta, brachiocephalic, common carotid, subclavian, vertebral, pulmonary, common iliac Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vessel Structure – Elastic Arteries § Elastic (conducting) arteries § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Near heart Thick walls More elastic fiber, less smooth muscle Lose elasticity with aging

Vessel Structure - Elastic Arteries § Aorta and elastic arteries § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Can vasoconstrict or vasodilate Large arteries expand, absorb pressure wave then release it with elastic recoil Windkessel effect Help to push blood along during diastole With aging have less expansion and recoil

Types of Arteries Muscular (distributing) arteries § Lie distal to elastic arteries § Capable of grater vasoconstriction and vaodilation to adjust the blood flow § Diameters range from 1 cm to 0. 3 mm § Includes most named arteries § Tunica media is thick, More smooth muscle § Less elastic fibers § Many of the arteries anastomose § Unique features § Internal and external elastic laminae § Distribute blood to skeletal muscles & internal organs § Ex: external carotid, brachial, mesenteric, femoral Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 2 b

Types of Arteries Arterioles § Smallest arteries § Diameters range from 0. 3 mm to 10 µm § Larger arterioles possess all three tunics § Diameter of arterioles controlled by § Local factors in the tissues (02 levels) § Sympathetic nervous system § hormonal stimulation Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 2 c

Arterioles § § § Arterioles are small arteries that deliver blood to capillaries. Also have three layers as an artery. Tunica media 1 -2 layers of smooth muscle fibers A change in diameter of arterioles can significantly affect blood pressure. Through constriction and dilation, arterioles assume a key role in regulating blood flow from arteries into capillaries and in altering arterial blood pressure. Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vessel Structure - Capillaries § § § Allow exchange of nutrients and wastes between blood and tissue Capillary structure - simple § § Basal lamina - connective tissue Endothelial cells Structure/function Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Arteriole: structure 1. 2. 3. Metarteriole Activity 3 Arteriole Capillary Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillaries § Smallest blood vessels § Diameter from 8– 10 µm § Red blood cells pass through single file § Site-specific functions of capillaries § Lungs – oxygen enters blood, carbon dioxide leaves § Small intestines – receive digested nutrients § Endocrine glands – pick up hormones § Kidneys – removal of nitrogenous wastes Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillaries § § § Tempat pertukaran material nutrien antara darah dan jaringan. Tempat terjadinya mikrosirkulasi: aliran darah dari arteriole menuju venule malaui kapiler. capiller tidak berpori (continuous Capillaries) dan berpori ( fenestrated). Precappilary sphincters mengatur aliran darah melalui capillaries. Pada liver berupa sinusoid Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillaries § § Capillary walls are made of a single layer of endothelial cells and a basement membrane. They have no tunica media or tunica externa. Body tissues with high metabolic requirements, such as muscles, kidneys, liver and nervous system, have an extensive network of capillaries. Tissues with low metabolic requirements have fewer capillaries-tendons and ligaments. All covering and lining epithelia, cornea and lens of the eye-lack capillaries. Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Types of Capillaries § § True capillaries: emerge from arterioles and metarterioles. Continuous capillaries-found in skeletal and smooth muscle, connective tissues and the lungs. Fenestrated capillaries-kidneys, villi os the SI, choroid plexuses in brain, ciliary process, endocrine glands. Sinusoids: are wider and more winding than other capillaries. Present in liver, red bone marrow, pleen, ant. pit. Gland, and parathyroid glands. Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

RBCs in a Capillary Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 3

Capillary Beds § § Network of capillaries running through tissues Precapillary sphincters § Regulate the flow of blood to tissues § § Tendons and ligaments – poorly vascularized Epithelia and cartilage – avascular § Receive nutrients from nearby CT Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillary Beds Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 4 a

Capillary Beds Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 4 b

Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Local control of blood vessels § Sphincters contract or relax based on demand for: § § § nutrients (AA, glucose, fatty acids) Dissolved gases (O 2, CO 2 load, lactic acid) Additional capillaries grow in to area to satisfy increased energy demands Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillary Permeabillity § § Endothelial cells – held together by tight junctions and desmosomes Intercellular clefts – gaps of unjoined membrane § Small molecules can enter and exit § Two types of capillary § Continuous – most common § Fenestrated – have pores § Sinusoid Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Types of Capillaries § 3 types of capillaries 1. Continuous capillaries § § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings continuous endothelial cells except for cleft between cells tight junctions between endothelial cells prevent most things from leaving caps most capillaries in body

Structure of Capillaries – Cross Section Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 5 a

Types of Capillaries 2. Fenestrated capillaries § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings fenestrations (slits) allow for filtration of small substances glomerular capillaries in kidney

Structure of Capillaries – Cross Section Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 5 b

Routes of Capillary Permeability § Four routes into and out of capillaries § Direct diffusion § Through intercellular clefts § Through cytoplasmic vesicles § Through fenestrations Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Low Permeability Capillaries § Blood-brain barrier § Capillaries have complete tight junctions § No intercellular clefts are present § Vital molecules pass through § Highly selective transport mechanisms § Not a barrier against § Oxygen, carbon dioxide, and some anesthetics Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Types of Capillaries 3. Sinusoid capillaries § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings wider gaps between endothelial cells allowing RBC’s to exit the caps found in liver

Sinusoids § Wide, leaky capillaries found in some organs § Usually fenestrated § Intercellular clefts are wide open § Occur in bone marrow and spleen § Sinusoids have a large diameter and twisted course Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Sinusoids Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 5 c

Veins § § § Conduct blood from capillaries toward the heart Blood pressure is much lower than in arteries Smallest veins – called venules § Diameters from 8 – 100 µm § Smallest venules – called postcapillary venules § § Venules join to form veins Tunica externa is the thickest tunic in veins Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vessel Structure – Veins § § § § Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Interna thicker than arteries Media thinner, less muscle Externa thick Valves Pressure low High compliance change volume easily with small change in pressure Varicose veins

§ § § VENA CIRI § MENGANGKUT DARAH KE JANTUNG § JUMLAH LEBIH BESAR DARIPADA ARTERIA § MENDEKATI JANTUNG DIAMETER MAKIN BESAR § BIASANYA BERADA DI DEKAT ARTERINYA § KETEBALAN DINDING LEBIH TIPIS DENGAN VALVULA § BIASANYA PADA SEDIAAN DALAM KONDISI KOLAPS KLASIFIKASI: § VENA BESAR § VENA SEDANG § VENA KECIL = VENULA DINDING § TUNICA INTIMA § TUNICA MEDIA § TUNICA ADVENTITIA Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENA BESAR MIKROSKOPIS § TUNICA INTIMA ( 45 m - 68 m) § § § TUNICA MEDIA § § § ENDOTEL JARINGAN PENGIKAT SANGAT TIPIS TIDAK BERKEMBANG DENGAN BAIK SERINGKALI TIDAK ADA TUNICA ADVENTITIA § § MERUPAKAN BAGIAN UTAMA DARI DINDING JARINGAN PENGIKAT: SERABUT ELASTIS DAN SERABUT KOLAGEN YANG MEMANJANG § TERUTAMA MENGANDUNG SERABUT OTOT POLOS MEMANJANG CONTOH: VENA CAVA, VENA PORTAE, V. LIENALIS. Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENA BESAR OTOT POLOS TUNICA MEDIA CUKUP TEBAL Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENA SEDANG (2 - 9 mm) MIKROSKOPIS § TUNICA INTIMA (TIPIS) § § § TUNICA MEDIA (LEBIH TIPIS DARIPADA ARTERI SEDANG) § § SEL ENDOTEL JARINGAN PENGIKAT TIPIS SEDIKIT SERABUT ELASTIS TERUTAMA SEL OTOT POLOS SIRKULER OTOT POLOS DIPISAHKAN SER. KOLAGEN MEMANJANG SEDIKIT FIBROBLAS TUNICA ADVENTITIA (LEBIH TEBAL DARIPADA TUNICA MEDIA) § § JARINGAN PENGIKAT LONGGAR DENGAN BERKAS TEBAL SERABUT KOLAGEN MEMANJANG DAN ANYAMAN SERABUT ELASTIS BAGIAN DALAM SERING ADA BERKAS SEL-SEL OTOT POLOS MEMANJANG Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENA SEDANG (2 - 9 mm) Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

PERBANDINGAN STRUKTUR DINDING ARTERIA SEDANG DAN VENA SEDANG ARTERIA SEDANG Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENULA (15 m - 200 m) § § MENERIMA DARAH DARI KAPILER DINDING: § TUNICA INTIMA § § § TUNICA MEDIA § § 1 ATAU BEBERAPA LAPIS SEL-SEL OTOT POLOS TUNICA ADVENTITIA § § ENDOTEL JARINGAN PENGIKAT, BEBERAPA SEL OTOT POLOS, MAKIN BESAR DIAMETER: SEL-SEL MAKIN RAPAT FIBROBLAS DAN SERABUT TIPIS ELASTIS DAN KOLAGEN MEMANJANG SIFAT: § PERMEABILITAS CUKUP TINGGI Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

VENULA DENGAN KATUP (15 m - 200 m) KATUP Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

ARTERIOLA DAN VENULA MEMBRANA ELASTICA INTERNA Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Mechanisms to Counteract Low Venous Pressure § Valves in some veins § Skeletal muscle pump § Particularly in limbs § Muscles press against thin-walled veins § force blood back to heart § valves prevent back flow Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Figure 19. 6

Vascular Anastomoses § Vessels interconnect to form vascular anastomoses § Organs receive blood from more than one arterial source § Neighboring arteries form arterial anastomoses § Provide collateral channels § Veins anastomose more frequently than arteries Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vasa Vasorum § Tunica externa of large vessels have § Tiny arteries, capillaries, and veins § Vasa vasorum vessels of vessels § Nourish outer region of large vessels § Inner half of large vessels receive nutrients from luminal blood Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Arteries § § Sympathetic fibers of the ANS innervate vascular smooth muscle. An inc. in sympathetic stimulation typically stimulates the smooth muscle to contract-vasoconstriction. When sympathetic stimulation decreases, or in presence of certain chemicals-NO, K+, H+ and lactic acid, they relax-vasodilation. Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Vessel Structure - Function § Capillary Function § Site of exchange between blood and tissues § Delivery of nutrients and removal of wastes § Slow flow allows time for exchange § Mechanisms of nutrient exchange § Diffusion - O 2, CO 2, glucose, AA's, hormones diffuse down [ ] gradients § If lipid soluble, can travel through cell § If water soluble, between cells Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Capillary Fluid Exchange § Fluid movement § § § Forces driving the movement of fluid § § § Hydrostatic pressure capillary (HPc) Hydrostatic pressure interstitial fluid (HPif) Osmotic pressure capillary(OPc) Osmotic pressure interstitial fluid (OPif) Net filtration pressure (NFP) is a sum of all Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings Fluid filtered and reabsorbed across capillary wall Starling’s law of the capillaries

Capillary Fluid Exchange § On average 85% of fluid filtered at arteriole end is reabsorbed at venular end Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Normal Coronary Artery Cross Section Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

60% Narrowing of Coronary Artery Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

90% Blockage of Coronary Artery remaining lumen Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings calcified area

Atherosclerotic Plaque Histology cholesterol crystal (cleft) Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings foam cells

Thrombus Causing MI Thrombus ocluding artery Likely site of plaque rupture “Needle-Like” white spots are cholesterol crystals Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings

Myocardial Infarction Histology necrosed muscle cells Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings red blood cells

Myocardial Infarction Histology normal muscle cells remaining Copyright © 2008 Pearson Education, Inc. , publishing as Benjamin Cummings macrophages and the beginnings of scar tissue