artery

動脈 　 　 　

WordNet

1. a major thoroughfare that bears important traffic
2. a blood vessel that carries blood from the heart to the body (同)arteria, arterial blood vessel
3. of or involving or contained in the arteries; "arterial disease"; "the arterial system"; "arterial blood"

PrepTutorEJDIC

1. 動脈 / (道路・水路・鉄道などの)勘線,(通信の)主チャンネル
2. 動脈の,動脈状の / 動脈血の / 幹線の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/02 11:45:09」(JST)

wiki en

[Wiki en表示]

For other uses, see Artery (disambiguation).

Artery
The human main arteries, part of the circulatory system.
Latin	Arteria (plural: arteriae)

Arteries (from the Greek ἀρτηρία - artēria, "windpipe, artery") are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries. The Effective Arterial Blood Volume (EABV) is that extracellular fluid (ECF) which fills the arterial system.

The circulatory system is extremely important for sustaining life. Its proper functioning is responsible for the delivery of oxygen and nutrients to all cells, as well as the removal of carbon dioxide and waste products, maintenance of optimum pH, and the mobility of the elements, proteins and cells of the immune system. In developed countries, the two leading causes of death, myocardial infarction and stroke, each may directly result from an arterial system that has been slowly and progressively compromised by years of deterioration. (See atherosclerosis).

Description

The arterial system is the higher-pressure portion of the circulatory system. Arterial pressure varies between the peak pressure during heart contraction, called the systolic pressure, and the minimum, or diastolic pressure between contractions, when the heart expands and refills. This pressure variation within the artery produces the pulse which is observable in any artery, and reflects heart activity. Arteries also aid the heart in pumping blood. Arteries carry blood away from the heart, whereas veins keep blood flowing towards the heart. Except pulmonary arteries, which carry blood to the lungs for oxygenation, all arteries carry oxygenated blood away from the heart to the tissues that require oxygen.

Anatomy

See also: Arterial tree

Diagram of an artery.

The anatomy of arteries can be separerated into gross anatomy, at the macroscopic level, and microscopic anatomy, which must be studied with the aid of a microscope.

Gross anatomy

The arterial system of the human body is divided into systemic arteries, carrying blood from the heart to the whole body, and pulmonary arteries, carrying blood from the heart to the lungs.

Systemic arteries

See also: Systemic circulation

Systemic arteries are the arteries of the systemic circulation, which is the part of the cardiovascular system which carries oxygenated blood away from the heart, to the body, and returns deoxygenated blood back to the heart.

Pulmonary arteries

See also: Pulmonary circulation

Pulmonary arteries are the arteries of the pulmonary circulation, which is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated blood back to the heart.

Microscopic anatomy

The outermost layer is known as the tunica externa formerly known as "tunica adventitia" and is composed of connective tissue. Inside this layer is the tunica media, or media, which is made up of smooth muscle cells and elastic tissue. The innermost layer, which is in direct contact with the flow of blood is the tunica intima, commonly called the intima. This layer is made up of mainly endothelial cells. The hollow internal cavity in which the blood flows is called the lumen.

Types of arteries

Pulmonary arteries

The pulmonary arteries carry deoxygenated blood that has just returned from the body to the heart towards the lungs, where carbon dioxide is exchanged for oxygen.

Systemic arteries

Systemics arteries can be subdivided into two types - muscular and elastic - according to the relative compositions of elastic and muscle tissue in their tunica media as well as their size and the makeup of the internal and external elastic lamina. The larger arteries (>10mm diameter) are generally elastic and the smaller ones (0.1-10mm) tend to be muscular. Systemic arteries deliver blood to the arterioles, and then to the capillaries, where nutrients and gasses are exchanged.

Aorta

The aorta is the root systemic artery. It receives blood directly from the left ventricle of the heart via the aortic valve. As the aorta branches, and these arteries branch in turn, they become successively smaller in diameter, down to the arteriole. The arterioles supply capillaries which in turn empty into venules. The very first branches off of the aorta are the coronary arteries, which supply blood to the heart muscle itself. These are followed by the branches off the aortic arch, namely the brachiocephalic artery, the left common carotid and the left subclavian arteries.

Arterioles

Arterioles, the smallest of the true arteries, help regulate blood pressure by the variable contraction of the smooth muscle of their walls, and deliver blood to the capillaries.

Arterioles and blood pressure

Arterioles have the greatest collective influence on both local blood flow and on overall blood pressure. They are the primary "adjustable nozzles" in the blood system, across which the greatest pressure drop occurs. The combination of heart output (cardiac output) and systemic vascular resistance, which refers to the collective resistance of all of the body's arterioles, are the principal determinants of arterial blood pressure at any given moment.

Capillaries

Main article: Capillaries

The capillaries are where all of the important exchanges happen in the circulatory system. The capillaries are a single cell in diameter to aid fast and easy diffusion of gases, sugars and other nutrients to surrounding tissues.

Functions of capillaries

Capillaries have no smooth muscle surrounding them and have a diameter less than that of red blood cells; a red blood cell is typically 7 micrometers outside diameter, capillaries typically 5 micrometers inside diameter. The red blood cells must distort in order to pass through the capillaries.

These small diameters of the capillaries provide a relatively large surface area for the exchange of gases and nutrients.

What capillaries do

• In the lungs, carbon dioxide is exchanged for oxygen
• In the tissues, oxygen and carbon dioxide and nutrients and wastes are exchanged
• In the kidneys, wastes are released to be eliminated from the body
• In the intestine, nutrients are picked up, and wastes released

Embryonic development

Arterial formation begins before the onset of blood flow, when endothelial cells begin to express arterial specific genes, such as Ephrin B2.

Pathology

A number of pathological conditions can affect arteries.

Blood pressure

Systemic arterial pressures, are generated by the forceful contractions of the heart's left ventricle. (See blood pressure)

Healthy resting arterial pressures, are relatively low, mean systemic pressures typically being under 100 mmHg, about 1.8 lbf/in², above surrounding atmospheric pressure (about 760 mmHg or 14.7 lbf/in² at sea level).

To withstand and adapt to the pressures within, arteries are surrounded by varying thicknesses of smooth muscle which have extensive elastic and inelastic connective tissues.

The pulse pressure, i.e. systolic vs. diastolic difference, is determined primarily by the amount of blood ejected by each heart beat, stroke volume, versus the volume and elasticity of the major arteries.

Over time, elevated arterial blood sugar (see Diabetes Mellitus), lipoprotein cholesterol, and pressure, smoking, and other factors are all involved in damaging both the endothelium and walls of the arteries, resulting in atherosclerosis.

Atheroma

An atheroma or plaque in the artery wall is a build up of cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.

History

Among the ancient Greeks, the arteries were considered to be "air holders" that were responsible for the transport of air to the tissues and were connected to the trachea. This was as a result of the arteries of the dead being found to be empty.

In medieval times, it was recognized that arteries carried a fluid, called "spiritual blood" or "vital spirits", considered to be different from the contents of the veins. This theory went back to Galen. In the late medieval period, the trachea, and ligaments were also called "arteries".

William Harvey described and popularized the modern concept of the circulatory system and the roles of arteries and veins in the 17th century.

Alexis Carrel at the beginning of 20th century first described the technique for vascular suturing and anastomosis and successfully performed many organ transplantations in animals; he thus actually opened the way to modern vascular surgery that was before limited to vessels permanent ligatation.

Theodor Kocher reported that atherosclerosis frequently developed in patients undergoing to thyroidectomy and suggested that hypothyroidism favors atherosclerosis, which was, in the 900's at the autopsies, more frequent in iodine-deficient Austrians compared to Icelanders, which are not deficient in iodine. Turner reported the effectiveness of iodide and dried extracts of thyroid in prevention of atherosclerosis in laboratory rabbits.

See also

• Arterial gush
• Blood
• Peripheral arteries
• Vein

References

External links

• Human Arterial System

UpToDate Contents

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• 1. 末梢動脈疾患（PAD）の疫学、危険因子、および自然経過 epidemiology risk factors and natural history of peripheral artery disease
• 2. 頸動脈ステントおよびその合併症 carotid artery stenting and its complications
• 3. 冠動脈ステント血栓症：臨床症状およびマネージメント coronary artery stent thrombosis clinical presentation and management
• 4. 現在開発中の冠動脈ステントの種類 coronary artery stent types in development
• 5. 膝窩動脈瘤の手術および血管内修復 surgical and endovascular repair of popliteal artery aneurysm

English Journal

• Association of morphologic and demographic features of intracranial aneurysms with their rupture: a retrospective analysis.

• Ghosh S, Dey S, Tjoumakaris S, Gonzalez F, Rosenwasser R, Pascal J, Jallo J.SourceDepartment of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
• Acta neurochirurgica. Supplement.Acta Neurochir Suppl.2013;115:275-8.
• Background: In spite of its common occurrence, the factors predictive of the rupture of intracranial aneurysms (IAs) remain poorly defined. Method: A retrospective analysis of patients admitted with a primary diagnosis of cerebral aneurysm in a single institution was done. The factors
• PMID 22890680

• Attenuation of Cerebral Vasospasm Following Experimental Subarachnoid Hemorrhage by the Bronchodilator KMUP-3.

• Winardi W, Wang CJ, Lin CL, Wu SC, Tsai HP, Kuo YH, Lee MY, Chen IJ, Kwan AL.SourcePoznan University of Medical Sciences, Poznan, Poland.
• Acta neurochirurgica. Supplement.Acta Neurochir Suppl.2013;115:239-46.
• Delayed cerebral vasospasm is a main cause of morbidity and mortality as well as poor outcome in patients following aneurysmal subarachnoid hemorrhage (SAH). In this study, the effect of the bronchodilator KMUP-3 (7-[2-[4-(4-nitrobenzene)piperazinyl]ethyl]-1,3-dimethylxanthine) on basilar artery nar
• PMID 22890675

• Inflammation in subarachnoid hemorrhage and delayed deterioration associated with vasospasm: a review.

• Provencio JJ.SourceDepartment of Neurology, Neuroinflammation Research and Cerebrovascular Centers, Cleveland Clinic, NC30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, provenj@ccf.org.
• Acta neurochirurgica. Supplement.Acta Neurochir Suppl.2013;115:233-8.
• Delayed deterioration associated with vasospasm (DDAV) after subarachnoid hemorrhage (SAH), (often called vasospasm) continues to be both a difficult entity to treat and a leading cause of morbidity in patients. Until recently, attention was focused on alleviating the vascular spasm. Recent evidence
• PMID 22890674

Japanese Journal

• 臨床研究・症例報告 下大静脈血栓症および肺動脈塞栓を発症したアンチトロンビン？欠損症type？の7歳女児例

• 谷口 周平,森本 哲,佐藤 優子 [他]
• 小児科臨床 65(9), 2027-2032, 2012-09
• NAID 40019378345

• 脂質低下療法による頸動脈プラーク安定化の評価 : 超音波integrated backscatter を用いたカラーマッピングシステムの開発と臨床応用

• 坂東 美佳,山田 博胤,西尾 進,玉井 利奈,平田 有紀奈,弘田 大智,中川 摩耶,林 修司,冨田 紀子,發知 淳子,小笠原 梢,高島 啓,山崎 宙,坂東 左知子,伊勢 孝之,仁木 敏之,上田 由佳,山口 浩司,岩瀬 俊,竹谷 善雄,添木 武,若槻 哲三,佐田 政隆,兼松 康久,里見 淳一郎,永廣 信治,Bando Mika,Nishio Susumu,Tamai Rina,Hirata Yukina,Hirota Daichi,Nakagawa Maya,Hayashi Shuji,Tomita Noriko,Hotchi Junko,Ogasawara Kozue,Takashima Akira,Yamasaki Hiromu,Bando Sachiko,Ise Takayuki,Niki Toshiyuki,Ueta Yuka,Yamaguchi Koji,Iwase Takashi,Taketani Yoshio,Soeki Takeshi,Wakatsuki Tetsuzo,Sata Masataka,Kanematsu Yasuhisa,Satomi Junichiro,Nagahiro Shinji
• 四国医学雑誌 68(3-4), 147-152, 2012-08-25
• … Methods and Results :Carotid ultrasound examination was performed and ultrasonographic RAW data of the plaqueswere obtained from８patients undergoing carotid artery endarterectomy. …
• NAID 120004688151

• 臨床経験 弓部大動脈瘤破裂に対するchimneyグラフトと頸部分枝バイパス術併用ステントグラフト内挿術

• 乗松 東吾,三岡 博,新谷 恒弘 [他]
• 胸部外科 65(9), 795-799, 2012-08
• NAID 40019390435

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Related Pictures

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★リンクテーブル★

国試過去問	「103C010」
リンク元	「100Cases 59」「arterial」「動脈」

「103C010」

　　[★]

• 組合せで誤っているのはどれか。

• a. 心房 － aorta
• b. 動脈 － artery
• c. 静脈 － vein
• d. 神経 － nerve
• e. 脊柱 － spine

[正答]

A

※国試ナビ4※　［103C009］←［国試_103］→［103C011］

「100Cases 59」

　　[★]

☆case59　尿中の血液

52歳　ビジネスマン

顕微鏡的血尿のため泌尿器科医に紹介があった。

主訴：顕微鏡的血尿

現病歴：6ヶ月前、new jofのためのisurance medicalで血尿を指摘された。以来、家庭医に2回血尿指摘された。以前の尿検査は正常だった。一度も顕微鏡は指摘されたことが無く、泌尿器系の症状もなかった。顕微鏡的血尿であることを除けば健康である。視覚、聴覚に問題なし。タバコ1日30本、アルコール35 unit/week(缶ビール(350ml)20本/週)

既往歴：特記無し。

家族歴：特記無し。腎臓病の家族歴無し

・身体所見

　栄養状態良く体調はよい。心拍：72/分、整。血圧：146/102 mmHg。心血管系、呼吸器系、腹部、神経学所見：異常なし。眼底鏡でarteriovenous nippingを認める。

・検査

(血液生化学)

　上昇：尿素、クレアチニン、γ-GTP

　

(尿検査)

蛋白：＋＋。血尿：＋＋。赤血球：>100 red cells

24時間尿蛋白：1.2g; 正常値 <200mg/24hr

(その他)

ECG：左室拡大。腎超音波検査：大きさは正常

(第一パラグラフ)

　・顕微鏡的血尿の原因は腎臓と尿路系のものがある(ex.前立腺病変、結石)。

　・顕微鏡的血尿　＋　高度のタンパク尿　＋　高血圧　＋　腎障害　＝　慢性糸球体腎炎の病態

　・γ-GTP高値はアルコールの過剰摂取による肝臓病であることに適合する

　・男性で推奨されるアルコール摂取の上限は、28unit/週 ()

(第二パラグラフ)IgA腎症

　・IgA腎症は先進国における一般的な糸球体腎炎。メサンギウム領域におけるIgAの蓄積が特徴的

　・患者はしばしば、上気道感染と同時におこる顕微鏡血尿のエピソードがある

　・IgA腎症は多くは特発性だけど、ヘノッホ-シェーンライン紫斑病(Henoch-Schonlein purpura)とアルコール性肝硬変(alcoholic cirrhosis)と関連するのが普通である。

　・IgA腎症の患者の20%は20年の経過で末期腎不全(end-stage renal failure)に陥る。

(第三パラグラフ)基底膜病・アルポート症候群

　・菲薄基底膜病はisolated microscopic hematuria、minimal proteinuria及び正常腎機能(悪化しない)をしめす家族性の疾患である。

　・電顕的にはびまん性の糸球体基底膜の菲薄化が見られる(300-400nm -> 150-225nm)

　・アルポート症候群は進行性糸球体病態であり、聴覚消失と視覚異常と関連している。ふつうX連鎖優性遺伝で、男性がひどく影響を受ける。

(第四パラグラフ)What further incestigations would you organize?

　・腎生検

　・age>50: 尿細胞診、前立腺特異抗原、膀胱鏡　→　除外診断のため(膀胱・前立腺病変)

　・肝超音波検査が必要で、肝生検を考慮するべき。

(第五パラグラフ)What advice would you give this patient

　・指導：禁酒、血圧のコントロール

　・経過観察：透析、腎移植に移行しうるため

　・血清/血漿クレアチニン：これはGFRが50%減らないと上昇しない　→　この症例では軽度のクレアチニンの上昇は腎機能は正常の腎機能の40%であることを示す。

　・治療：免疫抑制薬がIgA腎症の大部分で透析導入を遅らせるという証拠はない

■KEYPOINT

　・50歳以下の血尿のみを訴える患者はまず腎臓専門医に紹介すべき。

　・50歳以上の血尿のみを訴える患者は、膀胱や前立腺の疾患を除外するためにまず泌尿器科医に紹介すべき

　・血清/血漿クレアチニンのわずかな上昇は腎機能の大きな喪失を示している。

　・大量のアルコール摂取による肝障害は明らかな徴候なく起こるかもしれない。

■もっとも一般的な顕微鏡的血尿をきたす糸球体による原因

IgA腎症

菲薄基底膜病(thin basement membrane disease)

アルポート症候群(XR)

■高血圧の病理的帰結 HIM.1552

・高血圧が生み出すリスクファクター：粥状硬化症

・高血圧が悪化因子？(predisposing factor)となる疾患：心不全、冠動脈疾患、梗塞、腎臓病、末梢動脈疾患

　心臓：高血圧性心疾患は高血圧に対する機能的・構造的適応　→　左心室肥大、拡張期機能不全(diastolic dysfunction)、うっ血性心不全、血行異常(冠状動脈の粥状硬化・微小血管障害による)、不整脈

　左心室肥大(1遺伝的要因と血行動態要因による)　→　↑リスク：冠動脈心疾患、梗塞、慢性心不全、突然死

　拡張期機能不全：(左心室壁が肥厚して拡張期に十分拡張できないという意味での機能不全(written by s))

　脳：(高血圧は脳梗塞と脳出血のリスクファクター)

　　・認知症(脳梗塞による)

　　・高血圧脳症(autoreguration(50-150mmHg)が傷害され、重度の頭痛、悪心・嘔吐、巣状神経徴候(focal neurologic sign)、精神状態の変調をきたす)

　腎臓：高血圧は腎障害と末期腎臓病のリスクファクター。

　　・腎臓における粥状硬化性の高血圧に関連した血管損傷は、最初に糸球体の前の細動脈に及ぶ。これにより糸球体と糸球体の後の構造に虚血性の変化を起こす。

　　・糸球体の損傷は糸球体の高灌流による糸球体毛細血管の損傷の結果かもしれない。

　　・糸球体の病理は糸球体硬化症を呈し、そして尿細管は虚血により萎縮する。

　末梢動脈：長期にわたって持続する高血圧により、下肢の動脈を狭窄させる　→　跛行

　網膜：交差現象(http://www.1stretinalscreen.com/ra_DR_NonDR.asp )

AV nipping is indicative of hypertension and describes the changes which occur at arteriovenous crossings in the retina where an artery crosses a vein. In patients with hypertension and associated arteriolosclerosis (narrowing of the artery) the artery applies increased pressure on the vein at the point where it passes over the top of the vein.

■顕微鏡的血尿

　血尿のうち、肉眼的には血尿ではないが、尿沈渣で400倍毎視野1個以上の赤血球を認める場合をいう。 しかしそれでは再現性に乏しいので、一般的には5個以上の赤血球を認める場合を顕微鏡的血尿といい病的意義をもつ。

■glossary

modest adj. 謙虚な。慎み深い、控えめな、遠慮がちの。(主に女性が)しとやかにした、ひどく上品な。質素な、地味な。適度の、穏当な。大きくない、ささやかな。

「arterial」

　　[★]

• adj.

• 動脈性の、動脈の

関

arteriosus、artery

　 　

「動脈」

　　[★]

英

artery (Z)

ラ

arteria

関

静脈