Presentations on the anatomy of the cardiovascular system. The cardiovascular system

Presentation ON ANATOMY ON THE TOPIC: CARDIOVASCULAR SYSTEM Prepared by a student of the 21st Sat group of KRVUZ Crimean Medical College Ibadlaeva Gulnara

Cardiovascular System Your cardiovascular system transports oxygen and nutrients between tissues and organs. In addition, it helps remove toxins from the body. The heart, blood vessels and blood itself form a complex network through which plasma and formed elements are transported in your body. These substances are carried by the blood through the blood vessels, and the blood drives the heart, which works like a pump. The blood vessels of the cardiovascular system form two main subsystems: the vessels of the pulmonary circulation and the vessels of the systemic circulation. The pulmonary circulation vessels carry blood from the heart to the lungs and back. The vessels of the systemic circulation connect the heart to all other parts of the body.

Blood vessels carry blood between the heart and various tissues and organs of the body. The following types of blood vessels exist: arteries arterioles capillaries venules and veins Arteries and arterioles carry blood away from the heart. Veins and venules deliver blood back to the heart.

Arteries and arterioles Arteries carry blood from the ventricles of the heart to other parts of the body. They have a large diameter and thick elastic walls that can withstand very high blood pressure. Before connecting with capillaries, arteries divide into thinner branches called arterioles. Capillaries are the smallest blood vessels that connect arterioles to venules. Due to the very thin wall of the capillaries, they allow the exchange of nutrients and other substances (such as oxygen and carbon dioxide) between the blood and the cells of various tissues. Depending on the need for oxygen and other nutrients, different tissues have different quantities capillaries Tissues such as muscles consume large amounts of oxygen and therefore have a dense network of capillaries. On the other hand, tissues with a slow metabolism (such as the epidermis and cornea) do not have capillaries at all. The human body has a lot of capillaries: if they could be unwoven and pulled into one line, then its length would be from 40,000 to 90,000 km!

Venules and Veins Venules are tiny vessels that connect capillaries to veins, which are larger than venules. Veins run almost parallel to the arteries and carry blood back to the heart. Unlike arteries, veins have thinner walls that contain less muscle and elastic tissue. The Importance of Oxygen The cells of your body need oxygen, and it is the blood that carries oxygen from the lungs to various organs and tissues. When you breathe, oxygen passes through the walls of special air sacs (alveoli) in the lungs and is captured by special blood cells (red blood cells). Oxygen-enriched blood travels through the pulmonary circulation to the heart, which pumps it through the systemic circulation to other parts of the body. Once in different tissues, the blood gives up the oxygen it contains and takes up carbon dioxide instead. Blood saturated with carbon dioxide returns to the heart, which pumps it again to the lungs, where it is freed from carbon dioxide and saturated with oxygen, thereby completing the gas exchange cycle.

How the Heart Works To pump blood through the heart, its chambers undergo alternating relaxations (diastole) and contractions (systole), during which the chambers fill with blood and push it out accordingly. Right atrium The heart receives oxygen-poor blood through two main veins: the superior vena cava and the inferior vena cava, as well as from the smaller coronary sinus, which collects blood from the walls of the heart itself. When the right atrium contracts, blood enters the right ventricle through the tricuspid valve. When the right ventricle is sufficiently filled with blood, it contracts and pumps blood through the pulmonary arteries into the pulmonary circulation. Blood enriched with oxygen in the lungs travels through the pulmonary veins to the left atrium. Once filled with blood, the left atrium contracts and pushes blood through the mitral valve into the left ventricle. After filling with blood, the left ventricle contracts and pumps blood into the aorta with great force. From the aorta, blood enters the vessels of the systemic circulation, carrying oxygen to all cells of the body.

The cardiovascular system

(abbreviated as CSS) is a system of organs that ensure blood circulation throughout the body.

The cardiovascular system includes blood vessels, veins (blood flows through

direction towards the heart), arteries (blood drains from the heart and goes to the organs), capillaries, and the main circulatory organ - the heart.

Meaning

The main importance of the cardiovascular system is to supply blood to organs and tissues. Blood continuously moves through the vessels, which gives it the opportunity to perform all vital functions. The circulatory system includes the heart and blood vessels - circulatory and lymphatic.

The heart represents biological pump, thanks to which the blood moves through closed system vessels. Every minute the heart pumps about 6 liters of blood into the circulatory system per day

Over 8 thousand liters, during life (with an average duration of 70 years) - almost 175 million liters of blood.

Diagram of the location of the largest blood vessels in the human body. Arteries are shown in red, veins in blue.

Location of the heart

The heart is in

chest behind the sternum and in front of the descending part of the arch

aorta and esophagus. It is attached to the central ligament

diaphragm muscles. WITH

There is one lung on both sides. At the top are the main blood vessels and the division of the trachea.

into the two main bronchi.

The heart is a hollow muscular organ capable of rhythmic

contractions due to the conduction system of the heart

(specialized muscle fibers), as well as ensuring continuous movement of blood inside the vessels. The human heart consists of two completely separated halves, each of which has a ventricle and an atrium.

Vessels are a system of hollow elastic tubes of various structures, diameters and mechanical properties filled with blood.

Structure of the heart

	The heart weighs about 300 g and
	shaped like a grapefruit;
	has two atria, two
	ventricle and four valves;
	receives blood from two vena cavae and
	four pulmonary veins, and
	throws it into the aorta and pulmonary
	trunk. The heart pumps 9 liters
	blood per day, making from 60 to 160
	beats per minute.
	The heart is covered with thick
	fibrous membrane -
	pericardium, forming
	serous cavity filled
	a small amount
	liquid, which prevents
	friction during its contraction.
	The heart consists of two pairs
	chambers - atria and
	ventricles, which act as
	independent pumps. Right
	half the heart is pumping
	venous, rich in carbon dioxide
	gases the blood through the lungs; This -
	pulmonary circulation. Left
	half throws away saturated
	oxygenated blood coming from
	lungs, in a large circle
	blood circulation

Functions of the SSS

The main function of the cardiovascular system is to move blood, which is ensured by heart contractions, through a closed chain of blood vessels.

Blood carries substrates necessary for their normal functioning to all cells and removes their waste products. All these substances enter the bloodstream and exit through the capillaries into the intercellular fluid.

In addition to the system of blood vessels, there is a system lymphatic vessels, which collects fluid and proteins from the intercellular space and transfers them to the circulatory system.

Valves

The valves ensure that blood flows through the heart in only one direction, preventing it from returning. Valves consist of two or three leaflets that close to close the passage once blood has passed through the valve. The mitral and aortic valves control the flow of oxygenated blood on the left side; The tricuspid valve and pulmonary valve control the passage of oxygen-deprived blood on the right side.

The inside of the heart cavity is lined with endocardium and is divided lengthwise into two halves by continuous interatrial and interventricular septa.

Heart automaticity system

As you know, the heart can contract or work outside the body, i.e. isolated. True, it can do this for a short time. When normal conditions (nutrition and oxygen) are created for its operation, it can shrink almost indefinitely. This ability of the heart is associated with a special structure and metabolism. In the heart, there are working muscles, represented by striated muscle, and special tissue in which excitation occurs and is carried out.

The special tissue consists of poorly differentiated muscle fibers. In certain areas of the heart, a significant number of nerve cells, nerve fibers and their endings have been found, which here form a nerve network. Clusters of nerve cells in certain areas of the heart are called nodes. These nodes are approached by nerve fibers from the autonomic nervous system(vagus and sympathetic nerves). In higher vertebrates, including humans, atypical tissue consists of:

1. located in the appendage of the right atrium, the sinoatrial node, which is the leading node (“pacemaker” of the first order) and sends impulses to the two atria, causing their systole;

2. atrioventricular node (atrioventricular node), located in the wall of the right atrium near the septum between the atria and ventricles;

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. The main function of the cardiovascular system is to ensure constant movement of blood through the vessels

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The cardiovascular system is represented by the heart, blood vessels, lymphatic vessels

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. HEART

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. sternum apex of the heart base of the heart midline 2/3 1/3 200 g - F 250 g - M

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. The heart is located in the pericardial sac - pericardium pericardium (outer layer) pericardium epicardium pericardial cavity Epicardium (inner layer)

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. Covers of the heart Epicardium (outer) Endocardium (inner) Myocardium (middle)

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; 3) protection from invading microorganisms and foreign cells. Chambers of the heart Right ventricle Left ventricle Right atrium Left atrium The human heart has four chambers: two atria - left and right and two ventricles - left and right. The atria are located above the ventricles.

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages RA LP RV LV Aorta Pulmonary arteries SVC IVC 4 pulmonary veins

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Valve - formed by the folds of its inner lining, ensures unidirectional blood flow by blocking the venous and arterial passages. Heart valves are formed by folds of the endocardium (inner lining of the heart). tricuspid valve - between the RA and RV bicuspid valve (mitral) - between the LA and LV semilunar valves - between the ventricles and the arteries of the RV LV RA LP aorta pulmonary artery

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ensure the movement of blood in one direction: from the atria to the ventricles, from the ventricles to the arteries Functions of heart valves

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transport of nutrients, gases, hormones, and metabolic products to and from cells; 2) regulation of body temperature; m Blood supply to the heart Oxygen and nutrients enter the heart with blood through the coronary arteries Coronary arteries

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The valve, formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. The conduction system of the heart consists of special neuromuscular cells. Featured: Fiber Bundles Nodes

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages Gradient of heart automation Sinus node (in the left atrium) Bundles Fibers Atrioventricular node 40-50 30-40 10-20 decrease in the ability of automaticity in cells of the conduction system of the heart as they move away from the sinus node 60-80

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due to the blocking of venous and arterial passages. Thanks to impulses arising in the sinus node - the natural pacemaker, the heart contracts at a frequency of 60-80 times per minute. Every year, about 600,000 devices are installed in the world. When the heartbeat slows down, the patient is given an artificial pacemaker - an electric pacemaker. This is a medical device that generates electrical impulses at a given frequency and is designed to maintain heart rhythm.

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Work of the heart The heart, working as a pump, ensures constant blood circulation in the body. The contractile activity of the heart is associated with the work of the valves and the pressure in its cavities. Contraction of the heart muscle is called systole, and relaxation is called diastole. In 1 minute the heart pumps 6 liters of blood

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The valve, formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Phase 3 is a general pause of the heart. Flap valves are closed. The chambers of the heart are in diastole. From the veins, blood enters the atria. During this phase, the heart itself receives oxygen and nutrients. Phase 1 – atrial systole. Blood from the atria passes into the ventricles. Ventricular diastole. Phase 2 – ventricular systole. The blood pressure in the cavities of the ventricles increases; the leaflet valves slam shut under the pressure of blood; the semilunar valves open; blood from the right ventricle passes into the pulmonary arteries, and from the left into the aorta. Atrial diastole. RA LA RV LV Aorta Pulmonary arteries SVC IVC Pulmonary veins Cycle duration 0.8 s

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Blood vessels

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Blood vessels Arteries are vessels through which blood flows from the heart. Veins are vessels through which blood flows to the heart. Veins lie more superficially, almost parallel to the arteries. Capillaries located in the intercellular spaces

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Features of the structure of blood vessels Arteries Veins The capillary wall contains many muscle and elastic fibers. wall contain fewer muscle and elastic fibers. On the inner wall there are valves in the form of pockets that prevent the reverse flow of blood. do not have muscle or elastic fibers. The wall consists of a single layer of cells. 5mm 4mm 0.006mm valve

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Metabolism of substances and gases in capillaries. The capillary wall has pores through which the exchange of substances and gases occurs between blood and tissue cells. pores red blood cell

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Circulatory circles Blood in the body moves through a closed circulatory system, which consists of the systemic and pulmonary circulation.

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CO₂ O₂ CO₂ O₂ RV Pulmonary arteries Pulmonary capillaries 4 pulmonary veins LA Pulmonary circulation LV Aorta Arteries Organ capillaries Superior and inferior vena cava RA Systemic circulation

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages Lymphatic vessels

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Valve - formed by the folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages. Lymphatic vessels: are found in all parts of the body, with the exception of the central nervous system, bones, cartilage and teeth; pass next to arteries and veins.; collect excess fluid (lymph) from tissues; have valves that prevent lymph from flowing in the opposite direction.

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages BLOOD

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folds of its inner shell, ensures unidirectional blood flow by blocking the venous and arterial passages Deposited Circulating Facilitates the work of the heart Amount of blood 4-6 liters 40% Participate in maintaining a constant amount of circulating blood. 60%

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages 1. Transport (oxygen, carbon dioxide, metabolic products, hormones). 2. Regulatory (ensures the constancy of the internal environment of the body and maintains body temperature). 3. Protective (provides immunity and blood clotting). Blood functions

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages Blood is a liquid tissue consisting of plasma and blood cells suspended in it Plasma vessel Leukocytes Red blood cells Platelets 45% 55%

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages Blood plasma - water - proteins other substances: electrolytes, metabolic products 92% 7% 1%

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages Blood serum Blood plasma devoid of the fibrinogen protein is called blood serum. It is obtained by settling blood without an anticoagulant. Blood serum is used to treat most infectious diseases and poisoning.

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7-8 µm Erythrocytes red blood cells top view side view 7-8 µm They have the shape of biconcave discs. They don't have a core. 1 ml of blood contains 5 million red blood cells

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages. The lifespan of red blood cells is 3-4 months. Red blood cells are formed in red bone marrow 320 billion red blood cells are produced per day Red blood cells are destroyed in the liver and spleen Every second from 2 to 10 million red blood cells are destroyed

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages. Red blood cells contain hemoglobin Globin (protein part) Heme (non-protein part, contains an iron atom) Hemoglobin Red blood cell

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages. Functions of red blood cells Transfer of O₂ from the lungs to the cells of the body and CO₂ from the cells to the lungs. Artery Vein Capillary Red blood cell with O₂ Red blood cell with CO₂

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages Leukocytes white blood cells 1 ml of blood contains 4-8 thousand leukocytes leukocytes are not the same in structure and function; easily change shape and can penetrate the wall of a blood vessel to the location of a foreign body. 8-10 µm monocyte lymphocyte eosinophil basophil neutrophil leukopenia leukocytosis

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages. The lifespan of leukocytes is several days to 5 months. Leukocytes are formed: in the red bone marrow, lymph nodes, spleen, thymus Leukocytes are destroyed in the liver, spleen, in areas of inflammation

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folds of its inner membrane, ensures unidirectional blood flow by blocking the venous and arterial passages Functions of leukocytes Provide immunity Phagocytosis Production of antibodies

In humans, the heart is located near the center of the chest cavity, it is shifted 2/3 to the left side. The weight of a man's heart is on average 300g, a woman's heart weighs
located near
chest center
cavity, it is 2/3
shifted to the left
side. Heart weight
men are equal in
average 300g,
women - 250g.

The heart is shaped like a cone
flattened in the anteroposterior
direction.
It distinguishes between the top and
base. The apex is the pointed part of the heart,
directed down and to the left and
a little forward. The base is the expanded part of the heart,
facing up and to the right and
a little back. Comprises
durable elastic fabric
heart muscle (myocardium),
which throughout
life rhythmically shortens,
sending blood through the arteries and
capillaries to body tissues.

Structure of the heart

HEART is a powerful muscular organ that pumps blood
through a system of cavities (chambers) and valves into a closed
distribution system called system
blood circulation
The wall of the heart consists of
three layers:
internal - endocardium,
middle - myocardium and
external - epicardium.

The endocardium lines the inside surface of the chambers of the heart, it
formed by a special type of epithelial tissue - endothelium.
The endothelium has a very smooth, shiny surface that
provides a reduction in friction during blood movement in the heart.
The myocardium makes up the bulk of the heart wall.
It is formed by striated cardiac muscle
fabric, the fibers of which, in turn, are located in
several layers. The atrial myocardium is much thinner than
ventricular myocardium. The myocardium of the left ventricle is three times thicker,
than the myocardium of the right ventricle. Degree of myocardial development
depends on the amount of work performed by the chambers of the heart.
The myocardium of the atria and ventricles is divided by a layer
connective tissue (fibrous ring), which makes it possible
alternate contraction of the atria and ventricles.
The epicardium is a special serous membrane of the heart formed
connective and epithelial tissue.

Chambers of the heart

Heart valves

Job
valves
hearts
provides
one-sided
movement
blood
in heart.

Blood vessels

represent
closed system
hollow elastic
tubes of various
structure, diameter and
mechanical properties.

vessels of the circulatory system

ARTERIES
CAPILLARIES
VIENNS
Arteries carry blood from the heart, and veins carry blood
returns to the heart. Between arterial and
venous sections of the circulatory system
the microcirculatory system connecting them is located
bed, including arterioles, venules,
capillaries.

ARTERIES

The artery wall consists of three membranes:
internal, middle and external.
The inner lining is the endothelium
(flat epithelium with very smooth
surface).
The middle layer is formed by smooth muscle
tissue and contains well-developed
elastic fibers. Due to smooth
muscle fibers are carried out
change in the lumen of the artery.
Elastic fibers provide
resilience, elasticity and strength
artery walls.
The outer shell consists of loose
fibrous connective tissue,
which plays a protective role and
promotes fixation of arteries in
certain position.
As the arteries move away from the heart, they become stronger
branch, eventually forming the smallest
- arterioles.

CAPILLARIES

The thin wall of capillaries is formed by only one
layer of flat endothelial cells. Through her
blood gases and metabolic products pass easily
substances, nutrients, vitamins, hormones
and leukocytes (if necessary).

Vienna

The structure of the vein wall
fundamentally the same as
arteries. But the peculiarity
is significantly smaller
wall thickness due to
subtleties of the middle layer. In him
much less muscle and
elastic fibers due to
low blood pressure in
veins
The second feature of veins is a large number of venous
valves on the inner wall. They are located
in pairs in the form of two semilunar folds. Venous
valves prevent blood from flowing back into
veins during the work of skeletal muscles. Venous
There are no valves in the superior vena cava, in the pulmonary veins,
veins of the brain and heart.

CIRCLES OF BLOOD CIRCULATION

Cardiac cycle.

The sequence of contractions of the chambers of the heart is called
cardiac cycle. During the cycle, each of the four
chambers goes through not only the contraction phase (systole),
but also the relaxation phase (diastole).
The atria contract first: first the right one, almost
immediately behind it is the left one. These cuts provide
rapid filling with blood of the relaxed
ventricles.
Then the ventricles contract, forcefully pushing out
the blood they contain.
At this time, the atria relax and fill
blood from the veins. Each such cycle continues for
on average 6/7 seconds.

Heart work in numbers

In children and adults, the heart contracts at different frequencies: in children under one year old - 100-200 contractions per
minute, at 10 years old - 90, and at 20 years old and older - 60-70; after 60 years the number of contractions becomes more frequent and
reaches 90-95. In athletes-runners, during running at sports competitions, the frequency
heart rate can reach up to 250 per minute, the running is over - the heart gradually
calms down, and soon its normal rhythm of contractions is established.
With each contraction, the heart ejects about 60–75 ml of blood, and per minute (at an average frequency
contractions 70 per minute) – 4–5 l. Over 70 years, the heart produces more than 2.5 billion contractions and
pumps approximately 156 million liters of blood.
The work of the heart, like any other work, is measured by the product of the weight of the lifted load (in
kilograms) per height (meters). Let's try to determine its work.
During the day, if a person does not do hard work, the heart contracts over 100,000 times; in a year -
about 40,000,000 times, and over 70 years of life - almost 3,000,000,000 times. What an impressive number - three
billion cuts!
Now multiply the heart rate by the amount of blood ejected, and you will see what
It pumps a huge amount of it. After making the calculation, you will be convinced that in an hour the heart
pumps about 300 liters of blood, per day - over 7000 liters, per year - 2,500,000, and over 70 years of life -
175,000,000 l. The blood that the heart pumps during a person's life can be filled with
4375 railway tanks. If the heart pumped not blood, but water, then from the pumped
In 70 years of water, they could create a lake 2.5 m deep, 7 km wide and 10 km long.
The work of the heart is very significant. So, with one blow, work is done, with the help of which
you can lift a load of 200 g to a height of 1 m. In 1 minute, the heart would lift this load 70 m, i.e.
the height of almost a twenty-story building. If it were possible to use the work of the heart, then in 8 hours
it would be possible to lift a person to the height of the Moscow University building (about 240 m), and in 30-31
day to the top of Chomolungma - the highest point on the globe (8848 m)!

BLOOD PRESSURE

The rhythmic work of the heart creates and maintains the difference
pressure in blood vessels. During the contraction of the heart, blood
under pressure is pushed into the arteries. During
blood passing through vessels pressure energy
is wasted. Because blood pressure gradually
decreases. In the aorta it is highest 120-150 mmHg, in
arteries - up to 120 mmHg, in capillaries up to 20, and in hollow
veins from 3-8 mmHg. to the minimum (-5) (below
atmospheric). According to the law of physics, liquid moves from
an area with higher pressure to an area with lower pressure.
Blood pressure is not constant
size. It pulsates in time with the contractions of the heart:
at the moment of systole the pressure rises to 120-130
mmHg. (systolic pressure), and during diastole
decreases to 80-90 mmHg. (diastolic). These
pulse pressure fluctuations occur simultaneously
with pulse fluctuations of the arterial wall.
A person's blood pressure is measured in the brachial
arteries, comparing it with the atmospheric one.

HOW IS BLOOD PRESSURE MEASURED?

The pressure gauge cuff is inflated
air while the pulse is on the wrist
won't disappear. Now shoulder
the artery is compressed by a large
external pressure and blood
it doesn't flow. After,
gradually releasing air from
cuffs, monitor the appearance
pulse At this moment the pressure
there is a little in the artery
greater than the pressure in
cuff, and blood, and with it
and the pulse wave begins
reach the wrist.
Pressure gauge readings in this
time and will characterize
blood pressure in brachial
arteries.

PULSE

Pulse. When contracting
ventricular blood
ejecting into the aorta,
increasing its pressure.
The wave that arises
while in its wall,
distributed from
certain speed
from the aorta to the arteries.
Rhythmic vibrations
artery walls.
Caused by the rise
pressure in the aorta during
systole is called
pulse.
Pulse can be determined in
places where large arteries
come close to
body surfaces (wrist,
temples, sides of neck).