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Critical closing pressure Irreversible shock in severe haemorrhage Importance of rapid volume replacement
Preferred order Blood Plasma Plasma expanders Saline
Capillaries
Exchange Short,(750mm), small diameter,(6-8mm) but many in parallel 75-80% are closed at rest Thin-walled (Laplace) Good for exchange but some vulnerability Variations in structure from Brain capillaries to liver sinusoids
Blood-Brain-Barrier
Mitochondrion
extra protection for the brain cells against false signals junctions between the endothelial cells are much tighter cells themselves have enhanced enzyme activity (to destroy possible neurotransmitters (like adrenaline and nor-adrenaline) before they can get across to send confusing signals
astrocytes, connective tissue cells of the brain, send processes which reinforce the barrier Known as the blood-brain barrier (NB important in HIV, BSE ?)
Sinusoids
liver, spleen and bone marrow- capillary vessels replaced by sinusoids lined with endothelial cells, but large gaps between the individual cells most tissues require that their walls be impermeable to proteins, essential for normal tissue fluid balance with sinusoids there is almost free exchange of protein, some exchange of cells for other tissues the only way back for proteins is lymphatics (q.v.)
Viscosity
resistance to flow mostly due to friction between the molecules of the liquid itself. Fluid flow in most systems in the body is streamline flow. Viscosity is a measure of the friction between the molecules in a solution Reduce friction between layers and reduce apparent viscosity
than most capillaries Rbcs line up and single file through lumen Like a piston Push a column of plasma in front of them Whole column of fluid moves together so all layers moving at the same speed Only frictional energy loss is between the vessel wall and the outer layer of plasma
50
Percentage of volume
40
30 Series1 20
10
0 Large arteries Arterioles Capillaries Venules and small veins Vessels Large veins Heart Pulmonary circulation
Veins
Variable reservoir Role in changing pressure Control of cardiac output? Valves
Great veins
Venae cavae and (to a lesser extent) pulmonary veins are sense organs! Passivity ensures that pressure within them depends on their degree of filling Stretch receptors in their walls, vital for body fluid volume control More later in these lectures and in next term kidney lectures
C mg/l
T secs
Flow meters
Electromagnetic or ultrasonic Placed round vessels Problem with aorta constant friction and erosion Ultrasonic better than electromagnetic Needs less tight fit Can be external to body
Would involve bigger rises in pressure in filling vessels Must be other mechanisms involved
Right and left vagal branches innervate the SA node, A.V node and atria ONLY
Stellate Ganglion
Both right and left cervical chains., via stellate ganglion, supply atria, nodes and ventricles. Superior. Middle and Inferior cardiac nerves from stellate receive contributions from higher thoracic ganglia
effect
Faster rise in iCa
the major effect of nor-adrenaline on the rate is at the sino-atrial node where it increases intracellular cAMP causing the opening of calcium channels sodium, and other ions, leak in through these channels and depolarise the cell. There is an increase in iCa
cardiac branches of the vagus, innervate mainly the atria with very few reaching either ventricle. effects of vagal stimulation are therefore confined to changes in rate
Slower decline in iK
Decreased iCa
mechanism seems to be by a decrease in cAMP causing a decrease in the calcium channel current, and by a G-protein linked increase in the potassium permeability of the pacemaker cells, This opposes the normal depolarisation and so slows the heart
(Adr) NAdr
N Adr receptor
Ca pumps
Adenylate cyclase
Starling effect and the catecholamine effect do not use the same pathways. Interact very effectively Produce a family of curves (Sarnoff)
RAP
CO
important all the curves are steep in the normal HR 120 low range of RAPs. Curve switching long before the plateau is HR 90 reached Stabilise RAP. HR 72 To stabilise RAP the sympathetic tone to the heart varies with activity HR 60 of the body. Heart is always on the steep part of a function curve RAP Starling mechanism can then always match the outputs of the ventricles