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Time Completed: 01:07:02

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98
82

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Physiology

Cardiovascular

Question 147 of 180

Regarding autoregulation of local blood flow, which of the following statements is CORRECT:

Answer:

Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 - 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation.
  • The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+ channels and Ca2+ entry. A reduction in pressure and stretch closes these channels, causing vasodilatation.
  • The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.

Local Control of Blood Flow

In addition to central control of blood pressure, tissues can regulate their own blood flow to match their requirements via autoregulation, metabolic factors and local hormones (autocoids).

Autoregulation

Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 - 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation.

  • The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+ channels and Ca2+ entry. A reduction in pressure and stretch closes these channels, causing vasodilatation.
  • The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.

Metabolic Factors

Many factors may contribute to metabolic hyperaemia (increased blood flow), with the most important being K+, CO2 and adenosine, and in some cases hypoxia itself.

  • K+, released from active tissues and in ischaemia, causes vasodilation partly by stimulating the Na+ pump, thus increasing Ca2+ removal from smooth muscle cells and hyperpolarising the cell.
  • CO2 and acidosis cause vasodilation largely through increased nitric oxide production and inhibition of smooth muscle Ca2+ entry.
  • Adenosine, released from the heart, skeletal muscle and brain during increased metabolism and hypoxia, causes vasodilation by stimulating the production of cAMP in smooth muscle.
  • Hypoxia may reduce ATP sufficiently for K+ channels to activate causing hyperpolarisation.

Autocoids

Autocoids are mostly important under certain circumstances, for example:

  • In inflammation, local inflammatory mediators such as histamine and bradykinin cause vasodilation and increased permeability of exchange vessels, leading to swelling but allowing access by immune cells to damaged tissues.
  • In clotting, serotonin and thromboxane A2 released from activated platelets cause vasoconstriction to help reduce bleeding.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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