Regional circulations

By :
Dr. Dalia Abdel Ghaffar
 Capillary circulation
• Capillaries arise from meta-arterioles and are
encircled by smooth muscles called
“precapillary sphincter” widen to become
venules and then form veins
• Blood flows from the heart
to arteries,
narrow

• into arterioles, and then

narrow further

•
• capillaries.
(perfuse the tissue then has
been widen

venules
widen more to become

veins, which return blood to

the heart.
 Structure and role f capilaries
• A capillary is a blood vessel. It forms of single
endothelial layer and basement membrane
does not have any valves or
muscular/elastic tissue .

• connect arteries and venules, and enable the

moving of water, oxygen, carbon dioxide, as
well as many nutrients and waste chemicals
between blood and surrounding tissues
Mechanism of transcapillary exchange
of substances
• 1- Diffusion:
• It is a passive process depending on;
I. Concentration gradient f substance
II. Surface area of capillaries
III. Capillary permeability ; it is affected by
many factors such as “low level of plasma
proteins, serum ca , PH, O2 Lack and allergic
reaction.
• 2-filteration (bulk flow):
• It is involved in mass movement of fluids into and out
of capillary beds.
It involves two pressure-driven mechanisms:
I. Filtration: Volumes of fluid move from an area of
higher pressure in a capillary bed to an area of
lower pressure in the tissues .
II. Reabsorption. the movement of fluid from an area
of higher pressure in the tissues into an area of
lower pressure in the capillaries.
• Two types of pressure interact to drive each of
these movements: hydrostatic pressure & osmotic
pressure.
Pulmonary Circulation
 Pulmonary Blood Flow
• The lung receives blood flow via:
ØPulmonary Circulation
ØBronchial circulation
 Pulmonary circulation Bronchial blood flow

constitutes the whole cardiac

2% of the output of the left
output of the right ventricle
ventricle
(5L/min; at rest)

This blood undergoes gas supplies part of the tracheo-

exchange with the alveolar air bronchial tree with systemic
in the pulmonary capillaries arterial blood

Does not participate in gas

exchange

Dr. Nisreen Mansour

 Regulation of Pulmonary Blood Flow
• Intrinsic (autoregulation)
• Extrinsic mechanism:
1- COP { Increase PBF with increase COP}
2- Pulmonary compliance
3- pulmonary peripheral resistance
4- nervous factors
5- chemical factors
 Intrinsic (autoregulation)

• Decreased Alveolar O2 conc. VC of

adjacent blood vessels.
• Mechanism:
Hypoxia release of vc substances from
lung tissue
• Significance :
Shift of blood from poorly ventilated to well
ventilated alveoli
 2-Effect of Pulmonary compliance
• distensible and compressible Pulmonary
vessels buffer excessive changes in Pulmonary
blood pressure: such as
1- Effect of Change in Lung Volume:
Inspiration increase pulm. Capacity
2- effect of gravity: the blood flow at the apex is
very low and it is higher at the base.
3-pulmonary peripheral resistance

• Pulmonary vascular resistance (PVR) is about

1/6 of systemic VR
• A mean pulmonary pressure of about 15 mm
Hg drives the same 5 L of COP that driven by
the mean systemic arterial pressure of 90-100
mm Hg
 The Pulmonary Circulation is a
high flow, low-resistance system:
Why?
Because of:
Much thinner wall of pulmonary artery and its
branches

Much less vascular smooth muscle in walls of

pulmonary artery tree

They are also much more distensible and

compressible than systemic arterial vessels

Dr. Nisreen Mansour

 4-nervous factors
• Sympathetic activation increases
PVR .
• The physiologic role of
Parasympathetic innervation of
pulmonary vessels is unknown
 5-Chemical
• Decrease PVR • Increase PVR
(vasodilators) • (Vasoconstrictors)
Ø PGI2 Ø Noradrenalin &
Ø PGE1 Adrenaline
Ø NO Ø α-adrenergic
Ø Bradykinin agonists
Ø β-Adrenergic Ø PGE2 & PG2α
agonists Ø Endothelin
Ø ACh Ø ANG II
Ø Histamine (primary
pulmonary VC)
Dr. Nisreen Mansour
 Pulmonary Edema Safety Factor
1-Mean capillary hydrostatic pressure is about
8-10 mm Hg
2- Colloid osmotic pressure of PP is about 25-
28 mm Hg
This favors net fluid absorption which protects
alveoli from edema
3- the lungs have more extensive lymphatic
system than most organs that can drain any
fluid accumulated in interstitial space
Dr. Nisreen Mansour
Cerebral Circulation
Cerebral Circulation; Arterial Supply

Dr. Nisreen Mansour

 Cerebral Blood flow
• The brain receives ~ 14% of COP =
(750- 900 ml/min)
• Because The brain has high metabolic
activity which needs high O2
requirements (consumes 20% of total
O2 consumption).
• Therefore,
• The cerebral BF is tightly coupled to
O2 consumption

Dr. Nisreen Mansour

 Cerebral Blood flow

• The importance of CBF lies in that the most

common cause of brain injury is impaired
blood flow
• And that The brain is the least tolerant organ
to ischemia
• Interruption of cerebral blood flow for:
Ø 5 sec may lead to fainting (syncope)
Ø few minutes leads to irreversible neuronal
damage

Dr. Nisreen Mansour

 Regulation of Cerebral BF
I- Cerebral Pressure
Autoregulation

II- Nervous (sympathetic)

III- Mechanical (Role of ICP)

Dr. Nisreen Mansour

I- Cerebral pressure Autoregulation
• Between MBP (CPP) pressures of 70–150 mm Hg
(pressure autoregulatory range) CBF is relatively
constant.
Mechanism
1- the myogenic mechanism is well accepted theory
(↑ABP→ ↑ BF → stretch of vascular smooth
muscle → stretch-induced ms contraction → ↓
BF back to normal)
↓ ABP → ↓BF→ inhibition of smooth ms→
vasodilatation→ ↑BF back to normal
Dr. Nisreen Mansour
2- Metabolic theory
• The increased neuronal activity is associated with
increased production of
• K+ & H+ (involved in synaptic transmission)
• Adenosine as a metabolite
• CO2 (70%↑in PCO2 will double CBF; the response to
↑ CO2 is via ↑ H+ and not by CO2 itself)

• These molecules lead to VD→ linking neuronal activity

with blood flow
• This is beneficial to get rid off excess H+ that causes
depression of nervous system)
Dr. Nisreen Mansour
• Within physiological range, PaO2 has no effect
on CBF.

• A decrease in cerebral tissues PaO2 below 50

mm Hg stimulates VD of cerebral Bl.V

• PaO2 < 30 mm Hg will double CBF

Dr. Nisreen Mansour

II- Role of Sympathetic Innervation
• The cerebral vessels have rich sympathetic
innervations
• However, under normal conditions they have no
role in regulation of cerebral BF (overcom by
autoregulatory mechanism)

• Their importance is mainly protective in cases of

acute marked increase of ABP where they
constrict the large & medium sized vessels→ ↓
passive increase in blood flow, thus protecting
the smaller vessels from rupture.
Dr. Nisreen Mansour
III- Role of Intracranial Pressure (ICP)
• ICP is produced by presence of CSF
• Normally =7-15 mm Hg
• CPP = MAP-ICP

• increase ICP will decreases CPP & reduce cerebral

BF
• Marked rise in ICP >33 mm Hg will compress
cerebral Bl.V → marked reduction in cerebral BF
N.B:
• (CPP): Cerebral perfusion pressure is the net
pressure gradient that drives oxygen delivery to
cerebral tissue.
• (MAP) : the mean arterial pressure
Dr. Nisreen Mansour