Lab 2 In-Class Exercise: Exploring the Circulatory System

PTH_AS 2203 Lab 2: Circulatory System Station 1. Donor Along the upper limb, one continuous vessel is given three different names depending on where it is. These names are important, as they help to clearly define the location of branches and damage to this vessel in clinical settings. On the donor, find the following vessels: Subclavian artery Axillary artery Brachial artery The right subclavian artery is a branch of which vessel? Superior Vena cava What about the left subclavian artery? What are the branches of the brachial artery? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 1 of 23

Station 2. Donor The body wall is fed and drained by a series of arteries and veins. On this donor, locate the following structures (hint: start with the great vessels and follow their pathways): Intercostal arteries Intercostal veins Azygos vein Superior vena cava Aorta What is the primary source of the intercostal arteries? Into what vessel do the intercostal veins drain? Into what vessel does this vein that collects the intercostal veins ultimately drain? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 2 of 23

Station 3. Histology image of artery & vein in cross section You are consulting with a pathologist about a patient who may have atypical neurovasculature in her axilla. The pathologist shows you the biopsy slide and asks your opinion about the patient’s vessels. In order to understand her explanation, you need to be able to differentiate between arteries and veins in a histologic section. Which of the structures shown is a vein? Which is the artery? List three ways you can differentiate between an artery and a vein in a histological image like this. 1. 2 . 3. Why do arteries and veins differ in the structure of their walls? How could you identify a capillary? Which aspect of capillary structure is directly related to its function? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 3 of 23

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Station 4. Histology image of artery with wall Because different diseases or disorders may affect various parts of vessels, or affect the performance of those components, it is important to be able to identify the structure and location of the layers comprising the vessel walls. Identify the following in this image: Tunica media Tunica intima (interna) Tunica externa Which of these layers is composed of simple squamous epithelium? Which of these layers is composed of smooth muscle? Station 5. Model 16A4 On this model, identify which vessels represent arteries and which represent veins. What structures are found inside veins that are not found in arteries? Why are valves in veins important? Why aren’t they found in arteries? On a long plane flight, passengers are advised to flex and extend and roll their ankles, and to get up and move about periodically. Why do you think they are advised to do this? What would be a potential consequence of not doing so? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 4 of 23

Station 6. Model 24E9 Your middle-aged patient suffers from a tumor in his mediastinum that is compromising the great vessels. To understand what clinical symptoms he will experience, you must understand the location and distribution of these vessels. Identify the following structures: Aortic arch Ascending aorta Descending aorta Brachiocephalic trunk Left common carotid artery Right common carotid artery Left subclavian artery Right subclavian artery Which area(s) of the body do the common carotid arteries supply? Which area(s) of the body do the subclavian arteries supply? The left subclavian artery is a branch of which vessel? The right subclavian artery is a branch of which vessel? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 5 of 23

Station 7. Model 2A1/15A2 A femoral hernia, in which the abdominal contents protrude into the space where the femoral artery enters the thigh, can compress the femoral artery. Identify the femoral artery on the lower limb model. What is the source of this artery? Identify it on the two models. What is its branch in the thigh? And what region of the thigh does the branch supply? When the femoral artery passes behind the knee, what is it called? List the three branches of this vessel that branch off distal to the knee joint. Veins use several different mechanisms to ensure blood return to the heart from the extremities. In addition to the pumping of the heart itself, name two other mechanisms of venous return Station 8. Models 4C2 and 1A1 A middle-aged man undergoes a cardiac stress test. Based on his results, the cardiologist determines that he has an occluded (blocked) vessel in his coronary circulation. The cardiologist decides to perform angioplasty, a procedure during which a small balloon is inserted into the affected vessel to open it up. The balloon is threaded up to the heart through a catheter that has been inserted in the femoral vein. This pathway is chosen for the catheter because the femoral vein is large and superficial, and provides a relatively straight pathway to the heart. Locate the femoral vein on this model. Trace the pathway of the catheter from femoral vein to the right atrium. List the vessels the catheter will pass through on its way to the heart. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 6 of 23

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Find these vessels on the models to understand this pathway. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 7 of 23

Station 9. Model 4B3 Inadequate circulation in the hand may result from blockage in the arterial blood supply. This can result in significant pain and muscle weakness, impairing hand function in your patient. Which arteries supply blood to the hand? Identify them on this model. What is the primary source of each of these arteries? If one of these arteries is blocked, is circulation to the entire hand necessarily cut off? What is the term for arteries joining together ‘downstream’ so that one can take over for the other and ensure adequate blood supply to the region? Station 10. Model 24A1 The lymphatic system eventually drains into the great veins in the mediastinum. It is not symmetrical on the right and left sides of the body. On this model, identify the thoracic duct. Into which vein does it drain? Lymph from what portion of the body drains into the venous system through the thoracic duct? The rest of the body drains into the same place on the right side through the right lymphatic duct. Lymph from what portion of the body drains into the venous system through the right lymphatic duct? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 8 of 23

If a patient suffers from metastatic prostate cancer (the prostate sits in the pelvic cavity inferior to the bladder), would the cancer cells reach the venous system through the thoracic duct or through the right lymphatic duct? Station 11. Model 4B1 Muscular compartments are bounded by a dense connective tissue, called fascia. If an artery ruptures and bleeds into one of these compartments, pressure builds up and leads to severe pain and muscle weakness. This condition is called compartment syndrome. The fascia must be surgically opened to relieve the pressure. A rupture in which artery would lead to compartment syndrome in the anterior compartment of the arm? What about the posterior compartment of the arm? Within the forearm, the arteries run within the anterior compartment, but supply both anterior and posterior compartments. Which arteries are in the forearm? What are they a branch of? Identify all four of these arteries on this model. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 9 of 23

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Station 12. Model 4B2 The limbs have both superficial and deep veins. The deep veins accompany arteries of the same names. Blood is usually drawn from superficial veins because they are easy to see through the skin and to reach with the needle. Central lines used to deliver drugs to a patient are generally inserted into deep veins because they are stronger. On this model, identify the following structures: Basilic vein Cephalic vein Median cubital vein From which vein is blood usually drawn? Cephalic vein If a drug is injected into the cephalic vein, where does the medicine travel next (into which vessel)? Basilic vein The deep veins of the upper limb accompany the arteries. Identify the following veins: Radial vein Ulnar vein Brachial vein Which veins join to form the brachial vein? Subclavian and jugular Where does blood in the brachial vein go next? Azygos vein  superior vena cava PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 10 of 23

Station 13. Model 20A3 A lifetime tobacco chewer has a high risk of developing oral cancer. If this occurs, growing tumors may block one or more important vessels in his head. Identify the following structures on this model: Common carotid artery Internal carotid artery External carotid artery Facial artery Maxillary artery Superficial temporal artery Which area is supplied by the facial artery? The facial region What is the source of the facial artery (what it is a branch of)? The carotid artery Which artery would supply blood to the pterygoid muscles and deep structures of the face? Internal carotid Which area is supplied by the superficial temporal artery? Side of head, scalp What part of the body does the internal carotid artery supply? Brain, eyes PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 11 of 23

Station 14. No item Draw the arterial supply of blood from the descending aorta to the lower limb (all the way to the foot). Stick figure drawings are fine. Make sure you include all relevant vessels from your list. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 12 of 23

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Station 15. No item Draw the arterial supply of blood from the aorta to the upper limb (all the way to the hand). Stick figure drawings are fine. Make sure you include all relevant vessels from your list. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 13 of 23

Station 16. Histology images Different types of muscle have different structures that affect their function. Which of these images is cardiac muscle? A Give two distinctive features of cardiac muscle visible in this image. 1. The intercalated disks 2. straited, branch cells Is cardiac muscle voluntary or involuntary? involuntary Station 17. Donor heart + Model 16A3 Because they have different roles in circulation, the four chambers of the heart differ in their structure. Identify the chambers of the heart: Right atrium Right ventricle Left atrium Left ventricle Why is the myocardium of the atria so much thinner than the walls of the ventricles? The flow of blood pushed through the atria is much less than that that flows through the ventricle. Why is the myocardium of the left ventricle so much thicker than that of the right ventricle? The left ventricle pushes blood oxygenated through the entire body while the right ventricle is taking a smaller amount of blood to receive oxygen. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 14 of 23

PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 15 of 23

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Station 18. Model 16A2 A 15-year-old girl was brought to the clinic suffering from chronic fatigue and weakness. Tests revealed that she had an incompetent (malfunctioning) mitral valve due to a congenital malformation on one of the flaps of that valve. Surgeons replaced her defective mitral valve with an artificial one, and after recuperation her symptoms disappeared. The mitral (bicuspid) valve is located between which chambers of the heart? Left atrium and left ventricle Is the blood passing through this valve oxygenated or deoxygenated? Oxygenated The tricuspid valve is located between which two chambers? Right atrium and right ventricle Is the blood passing through this valve oxygenated or deoxygenated? deoxygenated Locate the mitral and tricuspid valves on this model. How many cusps (flaps) are in each of these valves? 3 PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 16 of 23

Station 19. Donor heart + Model 17A2 A heart murmur is the sound blood makes when it flows from a ventricle back into the atrium due to an incompetent atrioventricular valve. A normal, healthy heart valve is constructed so this does not happen. On the real heart from a human donor and on the model, identify the following: Atrioventricular valves (bicuspid/mitral & tricuspid) Papillary muscles Chordae tendineae What is the function of the atrioventricular valves? To snapshut to prevent back flow. To which structures do the valves attach? In between the right atrium and right ventricle. To which structures do the chordae tendineae attach? Papillary muscles What will happen to the patient if the valves are incompetent (not functioning correctly)? Blood will leak and cause a heart murmur. In your own words, describe how the papillary muscles and chordae tendineae function to maintain proper valve function. The chordae tendineae is connected to the papillary muscles. They help prevent the valve (which needs to flow one way or will cause a heart murmur) stay closed and sealed. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 17 of 23

Station 20. Model 17A1 A middle-aged man with a long history of smoking is diagnosed with a malfunctioning pulmonary semilunar valve. In normal function, the semilunar valves are flexible: when the ventricle contracts and ejects blood into the artery, the semilunar valve will collapse under the positive pressure and allow unimpeded outward flow. When the ventricle is relaxed, the valve will close to prevent blood from flowing backwards. Stiffening of the valve tissue can prevent the flaps from sealing off the vessel, allowing reflux of blood back into the ventricle. Identify the pulmonary valve on this model. Is the blood passing through this valve oxygenated or deoxygenated? deoxygenated Is the blood passing through this valve entering or exiting the heart? Exiting the heart (left ventrical) Where is this blood going? To the lungs Identify the aortic valve on this model. Is the blood passing through this valve oxygenated or deoxygenated? oxygenated Is the blood entering or exiting the heart? Entering the heart Where is this blood going? Right atrium PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 18 of 23

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Station 21. Model 7B5 When there is a pulmonary embolism (blood clot in the lungs), blood flow through the lung is blocked or restricted. This results in pulmonary hypertension (high blood pressure in the pulmonary system) which can then lead to chest pain and weakness throughout the body. Identify the pulmonary arteries on this model. The pulmonary arteries branch from what vessel? Which chamber of the heart does that vessel emerge from? The pulmonary arteries are heading toward which structure? Are these vessels carrying oxygenated or deoxygenated blood? Identify the pulmonary veins on this model. The pulmonary veins have just left which organ? The pulmonary veins are heading toward which structure? Are these vessels carrying oxygenated or deoxygenated blood? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 19 of 23

Station 22. Model 17B3 Blockage of the right coronary artery can restrict or cut off blood flow to the right atrium. Identify the following structures on this model: Right atrium Right ventricle Left atrium Left ventricle Left coronary artery Anterior interventricular artery (left anterior descending artery, LAD) Right coronary artery Posterior interventricular artery (posterior descending artery) Great cardiac vein Cardiac sinus What important structure is housed within the wall of the right atrium? Why would a patient suffering from right coronary artery blockage need a pacemaker? Which vessel drains blood from the vessels of the heart muscle into the right atrium? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 20 of 23

Station 23. Model 16A1 A 68-year-old man with a long history of smoking collapses while mowing his lawn. When paramedics arrived he was unconscious, not breathing, and without a pulse. CPR was successfully performed and the man was transported to the hospital. Once stable, an angiogram of his coronary circulation revealed that his anterior interventricular (LAD) artery was 95% blocked. He will need heart surgery, but the heart muscle has already been severely damaged. Identify the following vessels on this model: Right coronary artery Posterior interventricular artery (posterior descending artery) Left coronary artery Anterior interventricular artery (left anterior descending, LAD) Great cardiac vein Cardiac sinus The blockage in the anterior interventricular artery (LAD) has led to muscle death in the regions that vessel feeds. Which regions of the heart has this affected? What structure of the heart transmits the signal to contract to the ventricles? Station 24. Model 17A3 Pericarditis is a clinical condition in which the pericardial sac becomes inflamed, usually due to infection. Severe cases of pericarditis can result in cardiac tamponade, in which increased pressure on the heart restricts its ability to contract and expand naturally. On this model, identify the fibrous pericardium at its cut edge. Where would the serous layer of the pericardial sac be? What is the function of the serous pericardium? PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 21 of 23

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Station 25. Model 24B1 The lymphatic vessels drain extracellular fluid, which is fluid in the tissues that does not make it into the venous system after passing through capillary beds. This fluid is called lymph. The lymphatic vessels pass the lymph through lymph nodes that filter it, and eventually drain the lymph back into the venous system. For this reason, lymphatic vessels are common pathways for cancer metastasis (when cancer cells spread throughout the body). There is a large concentration of lymph nodes in the groin and axilla, as well as the neck. The axillary lymph nodes drain the upper limb as well as the breast, and so are common sites for breast cancer metastasis. Locate the lymph nodes in the groin and axilla on this model. If a surgeon has to remove cancerous lymph nodes from the axilla of a patient, what function of the lymph system would be disrupted? (The clinical name for this condition is lymphedema, and it the most common side effect of axillary lymph node removal and mastectomies.) What symptoms does a lymphedema patient experience? Station 26. No item REVIEW! Before you leave today, make sure you have completed all of today’s lab stations. Make sure you understood everything at each of these stations. If you didn’t, ask an instructor to explain it to you. Go over your list of Structures to Know for this week, and make sure you understand where each is and can identify it. Quiz your lab partners over the heart and vessels. Have them quiz you, too. Don’t leave until you’ve covered everything and understand this week’s material. PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 22 of 23

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PTH_AS 2203 – Lab 2 – Circulatory System – In-class Exercise modified 06/30/2021 – p. 23 of 23

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2203 Lab 2 In-Class Exercise

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