Venous system

FIGURE 19-1. The portal venous system. (From Timm EJ, Stragand JJ. Portal hypertension and cirrhosis. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 694, with permission.)... 

After the transport of aqueous humor into the posterior chamber, it flows through the pupil into the anterior chamber where it provides oxygen and nutrition to the avascular lens and cornea. Aqueous humor then exits the anterior chamber through the trabecular meshwork and drains into Schlemm s canal which drains aqueous humor into the episcleral venous system. 

A highly complex network of arteries, arterioles, and capillaries penetrates the dermis from below and extends up to the surface of, but not actually into, the epidermis. A matching venous system siphons the blood and returns it to the central circulation. Blood flow through the vasculature is linked to the production and movement of lymph through a complementary dermal lymphatic system. The dermis is laced with tactile, thermal, and pain sensors. 

The CSF flows through the ventricles, downward through the central canal of the spinal cord, and then upward toward the brain through the subarachnoid space that completely surrounds the brain and spinal cord. As the CSF flows over the superior surface of the brain, it leaves the subarachnoid space and is absorbed into the venous system. Although CSF is actively secreted at a rate of 500 ml/day, the volume of this fluid in the system is approximately 140 ml. Therefore, the entire volume of CSF is turned over three to four times per day. 

Compare the functions of the arterial system and venous system... 

It is this reduction in preload that, in some cases, is beneficial to patients experiencing heart failure or hypertension. Unlike a healthy heart, a failing heart is unable to pump all of the blood returned to it. Instead, the blood dams up and overfills the chambers of the heart. This results in congestion and increased pressures in the heart and venous system and the formation of peripheral edema. Because the failing heart is operating on the flat portion of a depressed cardiac function curve (see Figure 14.2), treatment with diuretics will relieve the congestion and edema, but have little effect on stroke volume and cardiac output. 

On the other hand, the heart can only pump whatever blood it receives. Therefore, in order to increase CO, VR must also increase. As with blood flow through a vessel, blood flow through the venous system is determined by Ohm s law (Q = AP/R). In other words, it depends on the pressure gradient in the venous system and venous resistance. Ohm s law may be rewritten to calculate VR ... 

The pressure gradient, or the inflow pressure minus the outflow pressure, is determined by the pressure at the beginning of the venous system (Pv) and right atrial pressure (Prblood flow the slightly stiffer large veins offer a small degree of resistance (Rv). 

Chylomicrons leave the absorptive cell by way of exocytosis. Because they are unable to cross the basement membrane of the blood capillaries, the chylomicrons enter the lacteals, which are part of the lymphatic system. The vessels of the lymphatic system converge to form the thoracic duct that drains into the venous system near the heart. Therefore, unlike products of carbohydrate and protein digestion that are transported directly to the liver by way of the hepatic portal vein, absorbed lipids are diluted in the blood... 

Radiographic contrast studies are the most accurate and reliable method for diagnosis of VTE. Contrast venography allows visualization of the entire venous system in the lower extremity and abdomen. Pulmonary angiography allows visualization of the pulmonary arteries. The diagnosis of VTE can be made if there is a persistent intraluminal filling defect on multiple x-ray films. 

The inhibition of sympathetic tone to the venous system (capacitance vessels) results in increased pooling of blood in the venous vascular bed with consequent decreased venous return to the heart and decreased cardiac output. This phenomenon is more pronounced in upright positions because of the effect of gravity. The hemodynamic effects of ganglionic blockers include decreases in cardiac output, renal blood flow, cerebral blood flow and orthostatic hypotension(20,21). 

Lignocaine s clearance by the liver is flow dependent. In heart failure cardiac output may be very low and therefore hepatic blood flow through both the hepatic artery and the portal venous system is also low. This meant a lower extraction of the drug from the blood and accumulation of lignocaine until the high plasma concentration produced the central nervous system toxicity. 

Rate, of uptake through the intestinal wall into the portal venous system... 

There are occasional anomalies to the rule that food reduces and delays peak plasma concentration. The anti-fungal drug, griseofulvin, has enhanced absorption if taken with a meal - possibly because it becomes emulsified by bile salts and passes more readily into the lymphatic drainage of the gut which bypasses the liver, entering the venous system directly. The immuno-suppressant cyclosporin, and calcium salts in general, show a similar increase in absorption when taken with a fatty meal. 

Conversely, the suppression of the biosynthesis of Ang II via ACE-inhibition will lead to vasodilatation, reduced release of aldosterone, blunting of sympathetic stimuli, and impairment of myocardial and vascular hypertrophy. The antihypertensive effect of the ACE-inhibitors is readily explained on the basis of vasodilatation, which occurs predominantly in the resistance vessels (arterioles) and, to a lesser extent, also in the venous system. Vasodilatation by... 

Epinephrine also has been used to lower intraocular pressure in open-angle glaucoma. Its use promotes an increase in the outflow of aqueous humor. Because epinephrine administration will decrease the filtration angle formed by the cornea and the iris, its use is contraindicated in angle-closure glaucoma under these conditions the outflow of aqueous humor via the filtration angle and into the venous system is hindered, and intraocular pressure may rise abruptly. 

Arteriolar and venous tone (smooth muscle tension) both play a role in determining myocardial wall stress (Table 12-1). Arteriolar tone directly controls peripheral vascular resistance and thus arterial blood pressure. In systole, intraventricular pressure must exceed aortic pressure to eject blood arterial blood pressure thus determines the systolic wall stress in an important way. Venous tone determines the capacity of the venous circulation and controls the amount of blood sequestered in the venous system versus the amount returned to the heart. Venous tone thereby determines the diastolic wall stress. 

Control of thyroid function via thyroid-pituitary feedback is also discussed in Chapter 37. Briefly, hypothalamic cells secrete thyrotropin-releasing hormone (TRH) (Figure 38-3). TRH is secreted into capillaries of the pituitary portal venous system, and in the pituitary gland, TRH stimulates the synthesis and release of thyrotropin (thyroid-stimulating hormoneTSH). TSH in turn stimulates an adenylyl cyclase-mediated mechanism in the thyroid cell to increase the synthesis and release of T4 and T3. These thyroid hormones act in a negative feedback fashion in the pituitary to block the action of TRH and in the hypothalamus to inhibit the synthesis and secretion of TRH. Other hormones or drugs may also affect the release of TRH or TSH. 

Portal hypertension most commonly occurs as a consequence of chronic liver disease. Portal hypertension Is caused by Increased blood flow within the portal venous system and increased resistance to portal flow within the liver. Splanchnic blood flow is increased in patients with cirrhosis due to low arteriolar resistance that is mediated by increased circulating vasodilators and decreased vascular sensitivity to vasoconstrictors. Intrahepatic vascular resistance is increased in cirrhosis due to fixed fibrosis within the spaces of Disse and hepatic veins as well as reversible vasoconstriction of hepatic sinusoids and venules. Among the consequences of portal hypertension are ascites, hepatic encephalopathy, and the development of portosystemic collaterals—especially gastric or esophageal varices. Varices can rupture, leading to massive upper gastrointestinal bleeding. 

Distribution is the phase in which the compound is carried to tissues by the bloodstream or lymphatic system. Compounds are usually first absorbed into the portal venous system after oral administration, directing them to the liver where they may be removed (extracted/ metabolized) (first-pass effect). The blood (plasma) level reflects the concentration at the... 

Blumenthal RS, Baranowski B, Dowsett SA Cardiovascular effects of raloxifene the arterial and venous systems. Am Heart J 2004 147 783-9. 

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