Anaphysio

Anatomy and Physiology

The Human Body – An Orientation • Anatomy – study of the structure and shape of the body and its parts • Physiology – study of how the body and its parts work or function

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.1

Anatomy – Levels of Study • Gross Anatomy • Large structures • Easily observable

Figure 1.1 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.2a

Anatomy – Levels of Study • Microscopic Anatomy • Very small structures • Can only be viewed with a microscope

Figure 14.4 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.2b

Organ System Overview • Integumentary • Forms the external body covering • Protects deeper tissue from injury • Synthesizes vitamin D • Location of cutaneous nerve receptors Figure 1.2a Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.4

Organ System Overview • Skeletal • Protects and supports body organs • Provides muscle attachment for movement • Site of blood cell formation • Stores minerals Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 1.2b

Slide 1.5

Organ System Overview

• Muscular • Allows locomotion • Maintains posture • Produces heat

Figure 1.2c Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.6

Organ System Overview • Nervous • Fast-acting control system • Responds to internal and external change • Activates muscles and glands Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 1.2d

Slide 1.7

Organ System Overview • Endocrine • Secretes regulatory hormones • Growth • Reproduction • Metabolism Figure 1.2e Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.8

Organ System Overview • Cardiovascular • Transports materials in body via blood pumped by heart • Oxygen • Carbon dioxide • Nutrients • Wastes Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 1.2f

Slide 1.9

Organ System Overview • Lymphatic • Returns fluids to blood vessels • Disposes of debris • Involved in immunity

Figure 1.2g Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.10

Organ System Overview • Respiratory • Keeps blood supplied with oxygen • Removes carbon dioxide Figure 1.2h Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.11

Organ System Overview • Digestive • Breaks down food • Allows for nutrient absorption into blood • Eliminates indigestible material Figure 1.2i Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.12

Organ System Overview • Urinary • Eliminates nitrogenous wastes • Maintains acid – base balance • Regulation of materials • Water • Electrolytes Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 1.2j

Slide 1.13

Organ System Overview

• Reproductive • Production of offspring

Figure 1.2k Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 1.14

Essentials of Human Anatomy & Physiology

Basic Chemistry

Biochemistry: Essentials for • Life Organic compounds • Contain carbon • Most are covalently bonded • Example: C6H12O6 (glucose)

• Inorganic compounds • Lack carbon • Tend to be simpler compounds • Example: H2O (water) Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.21

Important Inorganic Compounds • Water • Most abundant inorganic compounds • Vital properties • High heat capacity • Polarity/solvent properties • Chemical reactivity • Cushioning Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.22

Important Inorganic Compounds • Salts • Easily dissociate into ions in the presence of water • Vital to many body functions • Include electrolytes which conduct electrical currents Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.23

Important Inorganic Compounds • Acids • Can release detectable hydrogen ions

• Bases • Proton acceptors

• Neutralization reaction • Acids and bases react to form water and a salt Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.24

pH • Measures relative concentration of hydrogen ions • pH 7 = neutral • pH below 7 = acidic • pH above 7 = basic • Buffers • Chemicals that can regulate pH change Figure 2.11 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.25

Important Organic Compounds • Carbohydrates • Contain carbon, hydrogen, and oxygen • Include sugars and starches • Classified according to size • Monosaccharides – simple sugars • Disaccharides – two simple sugars joined by dehydration synthesis • Polysaccharides – long branching chains of linked simple sugars Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.26

Important Organic Compounds

• Lipids • Contain carbon, hydrogen, and oxygen • Carbon and hydrogen outnumber oxygen

• Insoluble in water

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.29

Important Organic Compounds

• Proteins • Made of amino acids • Contain carbon, oxygen, hydrogen, nitrogen, and sometimes sulfur

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.33a

Important Organic Compounds • Account for over half of the body’s organic matter • Provides for construction materials for body tissues • Plays a vital role in cell function • Act as enzymes, hormones, and antibodies

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.33b

Enzymes • Act as biological catalysts • Increase the rate of chemical reactions

Figure 2.16 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.34

Important Organic Compounds • Nucleic Acids • Provide blueprint of life • Nucleotide bases • A = Adenine • G = Guanine • C = Cytosine • T = Thymine • U = Uracil • Make DNA and RNA Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.35

Important Organic Compounds • Deoxyribonucleic acid (DNA) • Organized by complimentary bases to form double helix • Replicates before cell division • Provides instruction for every protein in the body Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 2.17c

Slide 2.36

Important Organic Compounds • Adenosine triphosphate (ATP) • Chemical energy used by all cells • Energy is released by breaking high energy phosphate bond • ATP is replenished by oxidation of food fuels

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 2.37

Essentials of Human Anatomy & Physiology

Cells and Tissues

Cells and Tissues • Carry out all chemical activities needed to sustain life • Cells are the building blocks of all living things • Tissues are groups of cells that are similar in structure and function Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.1

Anatomy of the Cell • Cells are not all the same • All cells share general structures • Cells are organized into three main regions • Nucleus • Cytoplasm • Plasma membrane Figure 3.1a Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.2

The Nucleus • Control center of the cell • Contains genetic material (DNA)

• Three regions • Nuclear membrane • Nucleolus • Chromatin Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Figure 3.1b

Slide 3.3

Cytoplasmic Organelles

Figure 3.4 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.10

Cellular Physiology: Membrane Transport • Membrane Transport – movement of substance into and out of the cell • Transport is by two basic methods • Passive transport • No energy is required • Active transport • The cell must provide metabolic energy Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.20

Solutions and Transport • Solution – homogeneous mixture of two or more components • Solvent – dissolving medium • Solutes – components in smaller quantities within a solution

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.21

Passive Transport Processes • Diffusion • Particles tend to distribute themselves evenly within a solution • Movement is from high concentration to low concentration, or down a concentration gradient Figure 3.8 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.23

Passive Transport Processes • Types of diffusion • Simple diffusion • Unassisted process • Solutes are lipid-soluble materials or small enough to pass through membrane pores • Facilitated • Substances require a protein carrier for passive transport Slide

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

3.24a

Diffusion through the Plasma Membrane

Figure 3.9 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.25

Passive Transport Processes Osmosis – simple diffusion of water • Highly polar water easily crosses the plasma membrane

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.24b

Passive Transport Processes • Filtration • Water and solutes are forced through a membrane by fluid, or hydrostatic pressure • A pressure gradient must exist • Solute-containing fluid is pushed from a high pressure area to a lower pressure area Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.26

Active Transport Processes • Transport substances that are unable to pass by diffusion • Too large • Insoluble • Against a concentration gradient

• Two common forms of active transport • Solute pumping • Bulk transport Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.27

Active Transport Processes • Solute pumping • Amino acids, some sugars & ions • ATP energizes protein carriers,

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.28a

Active Transport Processes • Bulk transport • Exocytosis • Moves materials out of the cell • Material is carried in a membranous vesicle

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.29a

Active Transport Processes • Bulk transport • Endocytosis • Extracellular substances are engulfed by being enclosed in a membranous vescicle • Types of endocytosis • Phagocytosis – cell eating • Pinocytosis – cell drinking Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.30a

Cell Life Cycle • Cells have two major periods • Interphase • Cell grows • Cell carries on metabolic processes • Cell division • Cell replicates itself • Function is to produce more cells for growth and repair processes Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.31

Events of Cell Division • Mitosis • Division of the nucleus • Results in the formation of two daughter nuclei

• Cytokinesis • Division of the cytoplasm • Begins when mitosis is near completion • Results in the formation of two daughter cells Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.33

Stages of Mitosis • Interphase • No cell division occurs • The cell carries out normal metabolic activity and growth

• Prophase • First part of cell division • Centromeres migrate to the poles Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.34a

Stages of Mitosis

• Metaphase • Spindle from centromeres are attached to chromosomes that are aligned in the center of the cell

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.34b

Stages of Mitosis • Anaphase • Daughter chromosomes are pulled toward the poles • The cell begins to elongate

• Telophase • Daughter nuclei begin forming • A cleavage furrow (for cell division) begins to form Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.35

Stages of Mitosis

Figure 3.14; 1

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.36a

Stages of Mitosis

Figure 3.14; 2

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 3.36b

Integumentary system

The Integumentary System 

The integumentary system is composed of the:

– Skin – Appendages 

Largest organ of the body

Functions of the Integumentary system      

Gives shape to the body Protects the body from injury Serves as a barrier to infection Sensory reception Thermoregulation Maintenance of water balance

The EPIDERMIS 

Composed mainly of 4 layers: > stratum corneum: outermost > stratum granulosum: lucidum in thick skin > stratum spinosum > stratum basale

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Nerves: found in the epidermis- for pain and temperature sensation



Blood vessels: Avascular

Epidermal Cell Types (4) 

1– Keratinocytes

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2– Melanocytes

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3 – Langerhans

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4 - Merckel

Keratinocytes 

 

most numerous (85%) secrete keratin provides the barrier function of the epidermis

Melanocytes 



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found in the dermis and basal layer of the epidermis produce melanin protect from UV

Langerhans cells



members of the immune system, and functioning as antigenpresenting cells. Found in stratum spinosum.

Merckel cells 

found in the basal layer and functions as mechanoreceptors.

The DERMIS 

 

loose connective tissue, mainly collagen and elastic and reticular fibers blood vessels nerves

Two Dermal Layers

Subcutaneous Tissue 





Contains adipose tissue and larger blood vessels and nerves May contain the base of hair follicles and sweat glands Functions: caloric reserve, heat insulator, shock absorber

Sweat glands – 2 types 

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Eccrine: < 0.5mm diameter found anywhere except penis Function in thermoregulation

Sweat glands – 2 types 

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Apocrine: 3-5mm in diameter Modified sweat gland found in the axillary, areolar, anal regions secrete odorproducing discharges called “pheromones” functional at

Sebaceous or Oil glands    

secrete sebum anywhere except on the palms and soles lubricate hair follicles & skin surface hyperfunctional at puberty

Hair 

arises from hair follicles which are epidermal invaginations



Associated arrector pili muscle causes “goosebumps”

Nails 





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like hair, are modified stratum corneum keratin of nails is harder than that of hair stratum basale of the nail area continuously proliferates and rapidly keratinizes white cuticle of nails is called eponychium 

Pacinian corpuscle 





found within the dermis and hypodermis surround nerves and look like onions function as mechanorecept ors for pressure & vibration.

Meissner’s corpuscles 

 

 

present in the dermal papillae surrounds nerves function as mechanorecepto rs for fine touch

Musculoskeletal System

Skeletal system  



206 bones Axial skeleton= 80 Appendicular skeletons= 126 upper limbs= 64 lower limbs= 62

functions   

 

Supportive framework Protect vital organs Hemopoiesis or blood cell formation Storage of minerals Act as biomechanical levers

Types of Bone   

    

According to location: Axial – found along our midline axis Appendicular – found in our extremities According to shape: flat & irregular bones – many axial bones long and short bones – in our limbs pneumatic bones – have air spaces, e.g., skull sesamoid – in tendons, e.g., patella

classification  2. 3.



6. 7.

Based on dev’t. Membranous Cartilaginous Based on histology Compact spong

Types of cells   

Osteoblast- precursor cells Osteoclast- bone destroyers Osteocytes- mature cells

Classification of joints 

 

Synarthroses- barely movable or nonmovable Amphiarthroses- slightly movable Diarthroses- freely movable

TYPES OF MOVEMENT *origin – immovable *insertion – movable      

flexion - bending, decreasing the angle between 2 bones extension - straightening out, increasing the angle between 2 bones abduction - moving the bone away from the midline adduction - moving the bone toward the midline rotation - moving the bone around central axis circumduction - moving the bone so that the end





 

supination - moving the bones of the forearm so that the radius and ulna are parallel, posterior to anterior pronation - moving the bones of the forearm so that the radius and ulna are not parallel, anterior to posterior position eversion - moving the sole of the foot outward at the ankle and intertarsal joints inversion - moving the sole of the foot inward at the ankle and intertarsal joints

      

protraction - moving a part of the body forward on a plane parallel to the ground retraction - moving a part of the body backward on a plane parallel to the ground elevation - raising a part of the body depression - lowering a part of the body plantar flexion - pointing toes (as a ballerina) away from the body dorsiflexion - pointing toes toward the body apposition – move thumb to touch fingertips

 3. 4. 5. 6.

Bone maintenance Local stress-stimulates bone formation Vit. D- inc Ca by increasing GIT absorption PTH- inc blood Ca by inc bone resorption Calcitonin- inhibits bone resorption

Bone repair 



   

Hematoma & inflammation (TGFB,PDGF) Angiogenesis and cartilage formation Cartilage calcification Cartilage removal Bone formation(3-4 mos.) Remodeling( mos.-yrs)

Muscles -

tissue composed of fibers or cells able to contract causing movements Maintains posture Stabilizes joints Generates heat highly vascular, excitable, conductive and elastic

TYPES OF MUSCLE CONTRACTION *tension develops in the muscles accdg to the sliding filament model 1. isotonic - muscle shortens during contraction ie smiling, bending the knee - successful sliding of myofilaments 2.isometric - muscle does not shorten during contraction ie lifting a 400 pound dresser, pushing against the wall with bent elbows - muscle unable to slide

Tendon - attaches muscle to bone - provide durability and conservation of space - made up of tough collagenic fiber

ligament – binds joints together, connects articular bones and cartilage

cartilage - non vascular tissue - can be permanent or temporary - found chiefly in the joints, thorax, larynx and trachea

Bursae - Sac containing fluid that are located around the joints to prevent friction

The Skull 





8 cranial bones 14 facial bones 6 small bones in the middle ear

Neurocranium

     

Frontal Parietal Occipital Ethmoid Sphenoid Temporal

Viscerocranium        

Maxilla Nasal Zygomatic Mandible Vomer Lacrimal Palatine Inferior nasal concha

skull Sutures  Coronal- bet. Parietal & frontal bones  Sagittal- bet. 2 parietal bones  Lambdoid- bet. Parietal & occipital  Bregma- intersection of coronal & sagittal- ant. Fontanel  Pterion- where sphenoid, parietal, frontal & temporal bones converge  TMJ

Fontanelles or soft spots 





Fibrous connective tissue or cartilage that occur at the angles of the parietal bone Anterior – closes at 12-18 months Posterior – closes at 3-4 months

The Auditory Ossicles 

sense vibration



3 inner ear bones:



malleus or hammer – articulates with eardrum



incus or anvil – articulates with malleus & stapes



stapes or stirrup – articulates with oval window

Face      

Scalp- frontalis & occipitalis Ear- auricular Orbital rim- orbicularis oculi Nose- nasalis Neck-platysma Lips- labii superioris, zygomaticusdepressor labii/angularis, buccinator, orbicularis oris

Neck Bones  Cervical vertebrae- atlas,axis & C3-C7  hyoid Larynx  cricoid

Neck Anterior Triangle  internal jugular v.  Carotid a.  Vagus n.  Hypoglossal n.  Hyoid ms.  Submental nodes

Posterior triangle  Accessory n.  Branches of brachial plexus  Subclavian a  Subclavian v.

The Vertebral Column or Spine  

 

Supports the body & bears its weight Regions: – 7 cervical – 12 thoracic – 5 lumbar – Sacrum – Coccygeal S-shaped Vertebrae are attached to each other via synovial joints & by intervertebral discs

The Normal Spine   

Has normal curves: lordosis – cervical, lumbar concaving kyphosis – thoracic convexity



intervertebral discs – maintain flexibility, absorb shock; outer annulus fibrosis, inner gelatinous nucleus pulposus



With age, loss of H2O content causes decrease in disc height

Thorax 



ribs 1-7= true 8-10= false 11-12= floating Sternum Manubrium Sternal angle of louis Body of sternum

    

Muscles Internal intercostals- ant, inf External intercoastals- post, inf Subcostalis Transversus thoracis

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12 pairs of thoracic nerves11 intercostal n., 1 subcostal n. Intercostal arteries-12 pairs of post and ant, =11 inter, 1 subcostal Intercostal vessels Lymph drainage

Abdomen   

   

5 lumbar vertebrae Ilium- iliac fossa, tubercle & crest Pubis- symphisis, tubercle, crest Surface anatomy: Linea alba- fr xiphoid to pubis Linea semilunaris- bilateral, lat to rectus abdominis Inguinal groove

Muscles Anterior  Extrernal oblique- ant, inf  Internal oblique-post, inf  Transversus abdominis  Rectus abdominis Posterior  Quadratus luborum  Psoas major-chief flexor of hip  Iliacus- joins psoas 



Transversalis fascia- lines abd cavity, deep inguinal ring is an outpouching

Parts of the “Hip bone”

 

  

    

Looks like two fish eating a butterfly ASIS = anterior superior iliac spine, important landmark PSIS – lies deep to a dimple ischial tuberosity – part we sit on symphysis pubis – fibroelastic connection between two pubic bones acetabulum – depression for the head of the femur greater sciatic notch – opening for sciatic nerve lesser sciatic notch obturator foramen – for obturator nerve linea terminalis, or pelvic brim – separates “false pelvis” above from “true

Pelvis 





Pelvic girdle- anteriorly bounded by hip bone, posteriorly by sacrum and coccyx Pelvic cavity Major (false)- above pelvic brim Minor (True)- below Pelvic diaphragm- muscular floor Levator ani- pubococcygeus, puborectalis, iliococcygeus coccygeus

Female pelvis

 

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Broader and more shallow Pelvic inlet is larger & more circular Ischial spines are shorter with greater distance bet them Greater angle bet the pubic bones Adapted for a

The Upper Extremity 

Consists of 30 bones: – Humerus – upper arm – Ulna - forearm – Radius - forearm – Carpal bones wrist – Metacarpals palm – Phalanges -

Upper Limb

Hand bones, Palm: Carpals  

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

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8 short bones in 2 rows Proximal: (r-u) scaphoid, lunate, triquetrium, pisiform Distal: (r-u) trapezium, trapezoid, capitate, hamate “Scared Lovers Try Positions That They Can’t Handle” If you fall and land on your hand, which bone is most likely to break? Colle’s fx = dinner fork

The Lower Extremity 

Consists of 30 bones: – Femur – upper leg or thigh – Patella – or kneecap – Tibia & fibula – lower leg or shin – Tarsal bones – back part of foot & heel – Metatarsals – main part of the

Lower extremeties

Physiology of muscle contraction

Quiz 1. b. c. d. e.

This muscle Forms your buttocks Gluteus Sartorius Vastus brachii

2. Suture located between two parietal bones b. Sagittal c. Lambdoid d. Coronal suture e. bregma

3. Injury to the radial nerve, will cause this condition. b. erb-duchenne c. Klumpke’s d. Scapular winging e. Wrist drop

4. Bouchards nodes is found in b. Distal IP joint c. Proximal IP joint d. Medial IP joint e. Along the intertarsal joints

5. Patients who have well formed rectus abdominis muscles have distinct b. Linea alba c. Linea nigra d. Linea semilunaris e. Transversalis fascia



b. c. d. e.

This gland produces secretions which are non viscous, nonodorous Eccrine Appocrine Sebaceous prostate

7. Injury to this nerve will cause claw hand deformity? 8. This layer of the epidermis can only be found in thickened skin 9. The suture of the skull is an example of a______ type of joint? d. Amphiarthroses e. Diarthroses f. Synarthroses 10. The anterior fontanel closes at 18 mos of age. This structure becomes the ______. h. Bregma i. Lambdoid j. Pterion k. suture

The digestive system

The DIGESTIVE SYSTEM 

Alimentary tract composed of organs, the primary function of which is the ingestion, digestion and absorption of nutrients

The GIT The wall is divided into  Mucosa  Submucosa  Muscularis layer (inner circular and outer longitudinal)  and Serosa/adventitia

Fig. 16.2

GENERAL FUNCTIONS     

Ingestion of food into the mouth Moves food along the digestive tract Mechanically digests the food into small particles Chemically digests the food into simple molecules Absorbs nutrients into the portal and lymphatic circulation

The MOUTH  Extends

from the lips to the orophaynx  Initial digestion of carbohydrates occurs here (salivary amylase)  Contains the teeth, tongue, palate, salivary

Salivary glands 





1. Parotid= secretes purely serous, Stensen’s duct 2.Submandibular/submaxillay= secretes mixed saliva, with Wharton’s duct 3. Sublingual= secretes mixed saliva, with two ducts- duct of Rivinus and duct of Bartholin

The Esophagus  Muscular

collapsible tube extending from the pharynx to the stomach  With upper esophageal sphincter and lower esophageal sphincter

The GIT ANATOMY

The Esophagus  The upper third contains skeletal muscles  The middle third contains mixed skeletal and smooth muscles  The lower third contains smooth muscles and the esophagogastric/ cardiac sphincter is found here

The Esophagus

Function:

to propel food to the stomach

The Stomach 



J-shaped organ in the epigastrium Contains four parts- the fundus, the cardia, the body and the pylorus







The cardiac sphincter prevents the reflux of the contents into the esophagus The pyloric sphincter regulates the rate of gastric emptying into the duodenum

Cells in the stomach  1.

Mucus cells (mucus)  2. Chief cells ( pepsinogen)  3. Parietal Cells (IF, HCl)

Small intestine Characteristics:  Provided with mesentery  Presence of villi  Presence of plicae circularis  Lined by simple columnar

Fig. 16.14

Parts of Small Intestine  1.

DUODENUM- shortest part  2. Jejunum  3. Ileum- longest part

Parts of Small Intestine

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The intestinal glands secrete digestive enzymes that finalize the digestion of all foodstuff Enzymes for carbohydrates disaccharidases Enzymes for proteins dipeptidases and aminopeptidases Enzyme for lipids intestinal lipase

Large intestine Characteristics  Presence of haustra  Presence of taenia coli  Presence of appendices epiploicae  No villi  With mesocolon on the appendix, transverse colon and sigmoid colon

Parts of the large intestine Cecum  Appendix  Ascending colon  Transverse colon  Descending colon  Sigmoid colon  rectum 

The GIT Physiology   



Absorbs water Eliminates wastes Bacteria in the colon synthesize Vitamin K Appendix participates in the immune system

Anus  The

anal canal is the last portion of the tract, surrounded by an internal and external anal sphincter

The Peritoneum  Serous

membrane lining the abdominal cavity  Parietal peritoneumabdominal wall  Visceral peritoneumvisceral organs

Fig. 16.3

The Peritoneum  Retroperitoneal

organs are found posterior to the peritoneumkidney, pancreas, duodenum, ascending and descending colon, rectum

Mesentery  This

is a peritoneum folded upon itself extending from the organ to the abdominal wall

Blood supply of the GIT  Branches

of the celiac trunk  Left gastric artery  Hepatic artery  Superior mesenteric artery

Accessory organs Pancreas  A pistol-shaped organ both an endocrine and exocrine gland  Parts: head, body and tail  Ducts: major is

Pancreatic secretions

1. Bicarbonate- to neutralize the acidic chyme from the stomach- stimulated by secretin 2. Pancreatic amylasefor carbohydrate

Pancreatic secretions

3. Pancreatic lipasefor fat digestion 4. Trypsin and chymotrypsin- for protein digestion

Accessory organ Liver  Largest internal organ  Located on the right upper quadrant  With right and left lobes

Liver physiology and Pathophysiology Normal Function

Abnormality in function

1. Stores glycogen

= Hypoglycemia

2. Synthesizes proteins

= Hypo-proteinemia

3. Synthesizes globulins

=Decreased Antibody formation risk for INFECTION

4. Synthesizes Clotting factors

= Bleeding tendencies

5. Secreting bile

= Jaundice and pruritus

6. Converts ammonia to urea

=Hyper-ammonemia

7. Stores Vitamims and minerals

=Deficiencies of Vit and min

8. Metabolizes estrogen

= Gynecomastia, testes atrophy

Accessory organ Gallbladder  Pear-shaped organ on the right upper quadrant below the liver  Parts: fundus, body and neck  store & concentrate bile

PHYSIOLOY OF THE GIT

Movements Mouth and esophagus: Deglutition  1. Voluntary phase- food bolus is pushed by tongue to the pharynx  2. Pharyngeal phase- reflex action  3. Esophageal phase- peristaltic waves moves the food towards the stomach

Stomach movement Mixing

waves Peristaltic movements

Fig. 16.12

Regulation of stomach secretions

1. Cephalic phasestomach secretions are initiated by the sight, smell, thought and taste of food

Regulation of stomach secretions

2. Gastric phasesecretions are produced upon stomach distention

Regulation of stomach secretions 3. Intestinal phaseacidic chyme from the stomach passes into the duodenum causing inhibition of gastric secretions

Fig. 16.22

Large Intestine: secretion and movement

Mucus for mucosal protection Mass movementshort peristaltic movement

Large Intestine: secretion and movement

Defecation reflex- moves the feces to the internal anal sphincter, mediated by the parasympathetic nerves Distention causes the



End of GIT

1. Parts of the small intestine includes all of the following except b. c. d. e.

Duodenum Jejunum Ileum sigmoid

2. Mechanical digestion of fats occurs in b. Mouth c. Stomach d. Small intestine e. Large intestine

3. Chemical digestion of carbohydrates occurs in b. Mouth c. Stomach d. Small intestine e. Large intestine



b. c. d. e.

This is released in response to fatty food intake Amylase Cholecystokinin Histamine argentaffin



b. c. d. e.

All of the following are salivary glands except Parotid Sublingual Pharyngeal submaxillary



b. c. d. e.

6. this cause gallbladder contraction Cholecystokinin Secretin Gastrin Pepsinogen

7-11. name the four layers of the stomach or GIT 12. patients w/ short gut syndrome may suffer from c. Megaloblastic anemia d. Nutritional anemia e. Iron-deficiency anemia f. Cooley’s

13. The stomach chief cells secrete b. IF c. Pepsinogen d. Bicarbonate e. amylase

14. This is the most movable portion of the intestine b. rectum c. Sigmoid d. Appendix e. anus

15. The following are functions of the liver except b. Synthesizes clotting factors c. Stores glycogen d. Stores bile e. Synthesizes proteins

   

Hypochloremic metab acidosis Hypercl metab acdosis Hypocl metab alkalosis Hypercl metab alkalosis

Urinary System

Major functions  Eliminates

wastes  Controls blood and fluid volume  Regulates acid-base balance  Regulates RBC production by

The Kidney  Retroperitoneal

organ surrounded by capsule and fats  renal cortex ( where nephrons are located)  renal medulla ( where collecting ducts are found)

The Nephron Functional unit of the kidney that produces urine by filtration Composed of 

– – – – –

Efferent arteriole Glomerulus Afferent arteriole Bowman’s capsule Convoluted tubules- proximal, loop of Henle and distal

Special cells in the nephron

Juxtaglomerular cellssecretes renin and erythropoietin Podocytes

Blood supply of the kidney  Renal

artery- branch of the abdominal aorta  Renal vein- drains into the inferior venal cava

Renal pelvis  Funnel-shaped

expanded portion of the ureter  Formed by the calyces  Collects urine from the kidney

The Ureter Left and right  long slender tube  w/ smooth muscles and transitional epithelium  w/ innervations from the sympathetic and parasympathetic

The urinary bladder Hollow pyramid shaped organ located in the pelvis  Lined with transitional epithelium  With thick detrusor muscles 

Fig. 18.17

Urethra 

Tube extending from the urinary bladder to the external urethral orifice – 1 ½ inches in females



3 parts in Males 1. Prostatic urethra- most dilatable 2. Membranous urethra- least dilatable and shortest 3. Penile urethra- longest

Renal Physiology Urine formation  1. Urinary blood flow  2. Glomerular filtration  3. Tubular reabsorption  4. tubular secretion







Filtration- water and smaller solutes Secretion- water, glucose and amino acids Secretion- H, K, crea, drugs

Fig. 18.12

Fig. 18.13

Fig. 18.14



End of renal

Reproductive System

Internal Male reproductive organs 1. Testes 2. Ductsepididymis, vas deferens and ejaculatory duct 3. Glands- prostate and Cowper’s 4. Seminal vesicle

The testes  Male

gonad housed in the scrotum  Divided into lobules containing tubules and cells  Sperm cells are produced in the seminiferous tubules  Leydig cells secrete testosterone

Spermatogenesis Begins during puberty  Occurs in the seminiferous tubules  Spermatogonia---MITOSIS --primary spermatocytes--MEOSIS---secondary spermatocyte---spermatids---go to the epididymis--spermatozoa 

Ducts 1. Epididymis- coiled tube 2. Vas deferens- long tube from the epididymis to the seminal vesicle 3. Ejaculatory duct- formed by the union of the vas deferens and the duct of the seminal vesicle

Glands 1. Prostate gland- glandular and muscular tissue produces slightly acidic fluid (20% of semen) 2. Seminal Vesicle- convoluted pouch, secretes alkaline fluid and fructose (bulk of the semen) 3. Cowper’s glands- secrete mucus for lubrication

Fig. 19.5a

External genitalia 1. Scrotum- two chambered sac contains the testes 2. Penis- erectile tissue consists of two corpora cavernosa and one corpora spongiosa – With 3 parts- bulb, shaft and glans

SEMEN: – contains spermatozoa and fructose-rich nutrients. – During ejaculation, semen receives contributions of fluid from  Prostate gland  Seminal vesicle  Epididymis  Bulbourethral gland – Average pH = 7.5 – Ave. amt.= 2.5 -5 ml. It can live with in the female genital tract for about 24 to 72 hours. – (60-200 million/ml of ejaculation ave. of 400 million/ ejaculation ) – 90 seconds- cervix – 5 minutes.- end of fallopian tube

Parts of the Female reproductive system        

EXTERNAL (vulva) 1. Mons pubis 2. Labia majora 3. Labia majora 4. Clitoris 5. Hymen 6. Vestibule 7. Pudendal cleft

INTERNAL  1. Ovary  2. Fallopian tubes  3. Uterus  4. Vaginal canal 

The Internal organs 

OVARY – Firm almond shaped organ covered by the peritoneum – Two parts: – CORTEX- follicles are found – Medulla- connective tissue

The internal organs

Fallopian tubes  Bilateral ducts extends laterally from the uterus 4 parts 1. Infundibulum- funnel shape, with fimbriae 2. Ampulla- widest part; usual site of FERTILIZATION 3. Isthmus- narrowest part 4. Interstitial or Intramural- embedded in the uterine wall FUNCTION: Transport of ovum

Fig. 20.2

The Uterus Pear-shaped organ with a cavity 3 main parts 1. Fundus- upper dome-shape part 2. Corpus or Body- broad part 3. Cervix- narrow lower part 

– Isthmus- junction between the body and the cervix

POSITION: Anteverted and Anteflexed

The Uterus The uterine wall is made up of three layers 1. Epimetrium- superficial part surrounded by the perimetrium 2. Myometrium- thickest muscular part 3. Endometrium- inner layer  FUNCTION: Fetal development in pregnancy

The endometrium 3 layers of the endometrium 1. Stratum Functionale Stratum

compactum Stratum spongiosum

2. Stratum basale or germinativum

Uterine ligaments  Broad

ligament  Round ligament  Cardinal ligament  Utero-sacral ligament

Fig. 19.8

Vaginal canal Connects the cervix to the vestibule  Fibromuscular canal lined with mucus and covered with hymen  The remnant of hymen is called CARUNCULAE MYRTIFORMIS Function: organ of copulation and passageway of baby 

External genitalia 1. Vestibule- space between the labia minora 2. Pudendal cleft- space between the labia majora 3. Clitoris- erectile tissue, homologue of penis

External genitalia 4. Labia majora- thick fold of skin, homologue of scrotum 5. Labia Minora- thin fold of skin devoid of hairs 6. Mons pubis/veneris- elevated area above the labia

Mammary gland Modified sweat gland  Consists of glandular and adipose tissue  P-rolactin  O-xytocin  P-rogesterone  E-strogen





MENSTRUATION: Menstrual cycle/ female reproductive cycle- 30-80 cc (60 cc ave.) of blood, epithelial cells and mucus are being discharged 21-35 days

Maturation of Oocytes: – first formed in utero - 5 to7 million; – first 5 months in utero - 2 million immature oocytes per ovary – at birth - 2 million in BOTH ovaries – 7 yrs of age only - 500,000/ovary – 22y/o only - 300,000/ovary – Reproductive age only - 300–400 oocytes – Menopause - none

Fig. 19.14

The uterine cycle Consists of 3 phases 2. Menstrual phase 3. Proliferative phase 4. Secretory phase

Uterine Cycle: Menstrual phase  Day

1- day 5  Stratum functionale (compactum and spongiosum) is shed

Uterine cycle: proliferative Phase  Day

5- day 14  Epithelial cells of functionale multiply and form glands  Due to the influence of estrogen

Uterine cycle: Secretory phase Day 15- day 28  Endometrium becomes thicker and glands secrete nutrients  Uterus is prepared for implantation  Due to progesterone  If no fertilization constriction vessels menstruation 

OVARIAN cycle Consists of three phases  1. Pre-ovulatory : follicular phase  2. Ovulatory phase  3. Post-ovulatory : Luteal phase

Ovarian Cycle; preovulatory/follicular  Variable

in length: day 6-

day 13  Dominant follicle matures and becomes grafian follicle with primary oocyte  FSH increases initially then decreases because of estrogen increase

Ovarian cycle: Ovulatory phase  Day

14  Rupture of the grafian follicle releasing the secondary oocyte  Due to the LH surge  MITTELSCHMERZ- pain during rupture of follicle

OVARIAN cycle: Postovulatory: luteal phase Day 15- day 28  MOST CONSTANT 14 days after ovulation  Corpus luteum secretes Progesterone  If no fertilization, corpus luteum will become corpus albicans then degenerate  Decreased estrogen and progesterone 

Fig. 19.11

Hormonal cycle 1. Menstrual phase – Decreased Estrogen, decreased progesterone, decreased FSH and decreased LH 2. Proliferative/ Pre-ovulatory phase – Increased FSH and Estrogen in small amounts

Hormonal cycle 3. Ovulatory phase – Increased FSH, Increased LH (surge) Increased Estrogen 4. Post ovulatory/luteal Phase – Increased Estrogen, increased progesterone, decreased FSH and LH



End of reproductive

1.What is the percent value of fluid composition wt regards to total body weight? 2.What is the smallest fluid compartment? c. ICf d. ECF e. Interstitial f. Intravascular

3. passage of urine in the ureters is done by b. Peristalsis c. Ciliary action d. Gravity only e. filtration

4. What Is the structural & functional unit of the kidney 5. UTI often occurs in women due to c. Shorter ureter d. Poor hygiene e. Shorter urethra f. Too much sweets in the diet

6. After ovulation, the ruptured follicle b. Becomes a corpus luteum c. Replicates d. Sloughs off as waste products e. Heals

7. Most common site of ectopic pregnancy b. Abdominal c. Tubal d. Ovarian e. cornual



b. c. d. e.

The most consistent phase in the ovulatory phase pre-ovulatory Menstrual Ovulatory post-ovulatory





Movement of solute from high to low concentration Movement of solvent or water from low solute concntration to high concentration

Endocrine Sytsem

The ANATOMY of the Endocrine System Hypothalamus Pituitary Gland Endocrine gland Increased Hormones

ENDOCRINE GLANDS       

PITUITARY ADRENALS THYROID PARATHYROID PANCREAS OVARIES TESTES

Location of Major Endrocrine Organs

Figure 9.3 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 9.14

The ANATOMY of the Endocrine System The Hypothalamus  This part of the DIENCEPHALON is located below the thalamus and is connected to the pituitary gland by a

The PHYSIOLOGY of the Endocrine System: Hypothalamus Secretes

RELEASING HORMONES for the pituitary gland



Releasing hormones= hypothalamus

The PHYSIOLOGY of the Endocrine System: Hypothalamus  Secretes

OXYTOCIN

& Anti-Diuretic

Hormone or VASOPRESSIN that is

stored in the Posterior pituitary gland

Pituitary gland    

Master gland Located at the base of the brain Influenced by the hypothalamus Directly affects the function of other endocrine glands

The ANATOMY of the Endocrine System

The Pituitary Gland The optic chiasm passes over this structure

The ANATOMY of the Endocrine System The Pituitary Gland

 Is

divided into two parts- the anterior or adenohypophysis and the posterior or the neurohypophysis

The PHYSIOLOGY of the Endocrine System: Anterior Pituitary

Secretes the following:  1. Growth hormone  2. Prolactin  Gonadotrophins- LH and FSH  4. Stimulating hormones and trophic hormones – ACTH – TSH – MSH

The PHYSIOLOGY of the Endocrine System: Posterior Pituitary

Stores and releases  1. OXYTOCIN  2. ADH/Vasopressin

The PHYSIOLOGY of the Endocrine System: Thyroid  Produces

the thyroid hormones by the thyroid follicles: 1. Tri-iodothyronine or T3 2. Tetra-iodothyronine or thyroxine or T4

The PHYSIOLOGY of the Endocrine System: Thyroid  The

Parafollicular cells secrete CALCITONIN

The ANATOMY of the Endocrine System The PARAthyroid glands  Located at the back of the thyroid glands  Four in number

The PHYSIOLOGY of the Endocrine System: Parathyroid gland  Secretes PARATHYROID hormone (PTH) that controls calcium and phosphorus levels  PTH is stimulated by a DECREASED Calcium level

The PHYSIOLOGY of the Endocrine System: Parathyroids Parathyroid Hormone is released in HYPOCALCEMIA

Calcitonin is stimulated by HYPERCALCEMIA

Parathyroid hormone is NOT secreted in HYPERCALCEMIA

Calcitonin is inhibited by HYPOCALCEMIA

The ANATOMY of the Endocrine System The Adrenal Glands  Located above the kidneys  Composed of two partsthe outer Adrenal Cortex and the inner Adrenal medulla

ADRENAL CORTEX

Secretes three types of STEROID hormones:  1. Glucocorticoidslike Cortisol, cortisone and corticosterone

The PHYSIOLOGY of the Endocrine System: Adrenal Cortex  2. Mineralocorticoidslike Aldosterone  3. Sex hormones- like estrogen and testosterone

The PHYSIOLOGY of the Endocrine System: Adrenal Medulla  Essentially a part of the SYMPATHETIC autonomic system  Secretes Adrenergic Hormones:  1. Epinephrine  2. Nor-epinephrine



End of endo

Respiratory System

Respiratory Anatomy & Physiology 

The respiratory system consists of two main parts- the upper and the lower tracts

Respiratory Anatomy & Physiology 

   

The UPPER respiratory system consists of: 1. nose 2. mouth 3. pharynx 4. larynx

Respiratory Anatomy & Physiology 

   

The LOWER respiratory system consists of: 1. Trachea 2. Bronchus 3. Bronchioles 4. Respiratory unit

Upper respiratory tract

The Nose 



contains nasal bones and cartilages and numerous hairs called vibrissae There are numerous superficial blood vessels in the nasal mucosa

The Nose     

The functions of the nose are: 1. To filter the air 2. To humidify the air 3. To aid in phonation 4. Olfaction

The pharynx 

  

The pharynx is a musculomembranous tube that is composed of three parts 1. Nasopharynx 2. Oropharynx 3. Laryngopharynx

The pharynx  



The pharynx functions : 1. As passageway for both air and foods (in the oropharynx) 2. To protect the lower airway

Tonsils 

pair of prominent masses of lymphoid tissue that are located opposite each other in the throat

The larynx  

Also called the voice box Made of cartilage and membranes and connects the pharynx to the trachea

The larynx   



Functions of the larynx: 1. Vocalization 2. Keeps the patency of the upper airway 3. Protects the lower airway

The paranasal sinuses 



These are four paired bony cavities that are lined with nasal mucosa and ciliated pseudostratified columnar epithelium Named after their locationfrontal, ethmoidal, sphenoidal and maxillary

The paranasal sinuses 

The function of the sinuses: Resonating chambers in speech

The lower respiratory system     



1. Trachea 2. Main bronchus 3. Bronchial tree 4. Lungs- 3R/ 2L The trachea to the terminal bronchioles is called the conducting airway The respiratory bronchioles to the alveoli is called the respiratory acinus

The trachea 



A cartilaginous tube measures 1012 centimeters Composed of about 20 C-shaped cartilages, incomplete posteriorly

The trachea 



The function of the trachea is to conduct air towards the lungs The mucosa is lined up with mucus and cilia to trap particles and carry them towards the upper airway

Lobes of the Lungs (R) lung = 3 lobes - upper, middle, lower fissures: horizontal, oblique  (L) lung = 2 lobes - upper with lingula, lower fissure: oblique 

The Bronchus 



The right and left primary bronchi begin at the carina The function is for air passage

The primary bronchus 

  

RIGHT BRONCHUS Wider Shorter More Vertical



LEFT BRONCHUS



Narrower Longer More horizontal

 

The bronchioles 



The primary bronchus further divides into secondary, then tertiary then into bronchioles The terminal bronchiole is the last part of the conducting airway

The respiratory Acinus 

   

The respiratory acinus is the chief respiratory unit It consists of 1. Respiratory bronchiole 2. Alveolar duct 3. alveolar sac

The respiratory Acinus 

The function of the respiratory acinus is gas exchange through the respiratory membrane

The respiratory Acinus 





The respiratory membrane is composed of two epithelial cells 1.The type 1 pneumocyte- most abundant- where gas exchange occurs 2. The type 2 pneumocytesecretes lung surfactant

The respiratory Acinus 

A type III pneumocyte is just the macrophage that ingests foreign material and acts as an important defense mechanism

Accessory Structures The PLEURA  Epithelial serous membrane lining the lung parenchyma  Composed of two parts- the visceral and parietal pleurae  Pleural space

Accessory Structures The Thoracic cavity  The chest wall composed of the sternum and the rib cage  The cavity is separated by the diaphragm, the most important respiratory muscle

Pleural Cavities Costodiaphragmatic recesses : Spaces in the pleural cavities below each lung, superior to the diaphragm.

Accessory Structures The Mediastinum  The space between the lungs, which includes the heart and pericardium, the aorta and the vena cavae.

GENERAL FUNCTIONS OF THE Respiratory System 



Gas exchange through ventilation, external respiration and cellular respiration Oxygen and carbon dioxide transport

Mechanics of Ventilation INSPIRATION

EXPIRATION

respiratory muscles Respiratory muscles relax contract (diaphragm,intercostal m.) Decreased thoracic diameter increased thoracic diameter Decreased pressure Air goes in

Increased pressure Air goes out

Respiratory Rate (RR) 





Inspirationexpiration cycle is measured in cpm (cycles per minute) Normal adult RR: 1420cpm Children 20-30

Regulation of Respiration RESPIRATORY CENTER in the BRAINSTEM. - activated by dec ph  CO2 + H20  H2CO3 





CAROTID AND AORTIC CHEMORECEPTORS - help regulate breathing - High [pCO2] or low [pO2] --chemoreceptors --medulla and pons to inform the phrenic nerve Phrenic nerve stimulates the diaphragm to contract

Breathing Patterns 



BIOTS: breathing with irregularly alternating periods of apnea and hyperpnea e.g.meningitis and brain disorders that cause ⇑ ICP





CHEYNE-STOKES: common but usually abnormal periods of apnea lasting 10-60 seconds followed by gradual increase then decrease e.g. frontal lobe and diencephalic dysfunction

Breathing Patterns 



COGWHEEL



–

respiratory murmur, not continuous but broken into waves e.g. bronchitis and possible TB



KUSSMAUL – deep, gasping breathing e.g. diabetic ketoacidosis and coma

Circulatory System

Heart 

 



complex muscular pump Size of a clenched fist Beats 60-100 per minute The heart pumps about 7200 liters/day.

Layers of the wall 





Endocardium – innermost layer Myocardium – middle, thickest; contracting layer Epicardium – outer layer



2. 3. 

Pericardium -encloses epicardium Visceral Parietal Pericardial sac

Anatomy of the heart  





4 chambers 2 atria act as collecting reservoirs. 2 ventricles act as pumps. 4 valves for:  Pumping action of the heart.  Maintaining unidirectional blood flow.

MUSCLES WITHIN THE CHAMBERS 



PAPILLARY MUSCLES found within the chamber walls Extend into CHORDAE TENDINAE attached to valves

Blood Vessels 1. Right coronary artery a. posterior interventricular b. marginal artery - RA, RV, inferior portion of the LV, the posterior septal wall and AV (90%) and SA

2. Left coronary artery • • •

anterior interventricular circumflex arteries LA and the post. LV Left ant. descending artery – ant. wall of the LV, the anterior septum and the Apex of the left ventricle

3. cardiac veins -drain into the coronary sinus w/c in turn drain into right atrium

Peripheral vascular system

2 TYPES OF CONTROL SYSTEMS OF THE HEART: Neural regulation – autonomic nervous system Sympathetic- accelerates & strengthen heartbeat\ Parasympathetic- slows down 1.

Conduction system Electrical Conduction System/Nodal System - network of nerve fibers coordinate the contraction and relaxation of the cardiac muscle tissue to obtain an efficient, wave-like pumping action of the heart.

CARDIAC CYCLE 



sequence of events that occur when the heart beats Systole- diastole cycle

BLOOD FLOW THROUGH THE HEART 

Left LUNGS LA mitral valve opens LV mitral valve closes LV muscles contract AV opens aorta distribution



Right BODY RA tricuspid valve opens RV tricuspid valve closes RV muscles contract pulmonary valves open lungs

HEART SOUNDS 







Aortic valve: second ICS(intercostal space) R PSL(parasternal line) Pulmonic valve: second ICS L PSL Tricuspid valve: fourth ICS L PSL Mitral valve: fifth ICS L MCL(midclavicular line)

The Cardiovascular System The Heart sounds  1. S1- due to closure of the AV valves  2. S2- due to the closure of the semi-lunar valves  3. S3- due to increased ventricular filling  4. S4- due to forceful atrial contraction

Cardiac Output, Sroke Volume and Heat Rate  



STROKE VOLUME – amount of blood ejected per heartbeat HEART RATE – affected by ANS, baroreceptor activity, cathecolamines, thyroid hormone CARDIAC OUTPUT - amount of blood pumped out by each ventricle in 1 minute - product of heart rate and stroke volume

STROKE VOLUME 1. 

Preload – degree of stretch at the end of diastole Inc volume inc stretch inc preload greater contraction and inc stroke volume

2. Afterload – amount of resistance to ejection of blood from ventricle  Also called systemic vascular resistance  Inverse relationship with stroke volume 3. Contraction- force generated by contracting myocardium

The vascular System arteries - vessels that carry blood away from the heart to the periphery  veins -vessels that carry blood to the heart  capillaries are lined with squamos cells, they connect the veins and arteries 

The vascular System 

The lymphatic system collects the extravasated fluid from the tissues and returns it to the blood

Blood Vessels: The Vascular System • Taking blood to the tissues and back • Arteries • Arterioles • Capillaries • Venules • Veins Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 11.23

•BLOOD VESSEL: ANATOMY •Three layers (tunics) •Tunic intima •Endothelium •Tunic media •Smooth muscle •Controlled by sympathetic nervous system •Tunic externa •Mostly fibrous connective tissue

Pulse • Pulse – pressure wave of blood • Monitored at “pressure points” where pulse is easily palpated Figure 11.16 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 11.35

Blood components Formed elements:  RBC  WBC  Platelets Unformed  plasma

Erythrocytes (Red Blood Cells) • The main function is to carry oxygen • Anatomy of circulating erythrocytes • Biconcave disks • Essentially bags of hemoglobin • Anucleate (no nucleus) • Contain very few organelles

• Outnumber white blood cells 1000:1 Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.6

NV: RBC:4.0-5.5 (F) 4.5-6.2 (M) hgb:12-14 (F) 14-16 (M) Hct- 35-45 (F) 4252 (M)

Hemoglobin • Iron-containing protein • Binds strongly, but reversibly, to oxygen • Each hemoglobin molecule has four oxygen binding sites • Each erythrocyte has 250 million hemoglobin molecules Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.7

Leukocytes (White Blood Cells) • Crucial in the body’s defense against disease • These are complete cells, with a nucleus and organelles • Able to move into and out of blood vessels (diapedesis) • Can move by ameboid motion • Can respond to chemicals released by damaged tissues Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.8

WBC  NV- 5,000-10,000

 1.   granular

leukocytes

a.   neutrophil – 60-70% - primary line of cellular defense against bacterial invasion b.  eosinophil – 2-5 % - inc in allergic reaction c.  basophil – 0-1 % -supplement function of mast cells

2. agranular leukocytes a.  lymphocytes: B and T lymphocytes 20-30% - respond to invasion of the body by foreign substances and organism, newer phagocytes b. monocyte – 3-8%

c. Platelets/Thrombocytes -   150,000 – 450,000 per cu mm blood -  Thromboxane A2 – promotes platelet plug formation -  Prostacyclin – limits formation of platelet plug

Hematopoiesis • Occurs in bone marrow • All blood cells are derived from a common stem cell (hemocytoblast) • Hemocytoblast differentiation • Lymphoid stem cell produces lymphocytes • Myeloid stem cell produces other formed elements Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.14

Fate of Erythrocytes • Unable to divide, grow, or synthesize proteins • Wear out in 100 to 120 days • When worn out, are eliminated by phagocytes in the spleen or liver • Lost cells are replaced by division of hemocytoblasts Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.15

Control of Erythrocyte Production • Rate is controlled by a hormone (erythropoietin) • Kidneys produce most erythropoietin as a response to reduced oxygen levels in the blood • Homeostasis is maintained by negative feedback from blood oxygen levels Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.16

Developmental Aspects of Blood • Sites of blood cell formation • The fetal liver and spleen are early sites of blood cell formation • Bone marrow takes over hematopoiesis by the seventh month

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings

Slide 10.31

RED CELL INDICES 

Mean corpuscular volume: hematocrit/RBC – 82 to 92 cubic microns; macrocytosis or microcytosis; pernicious anemia

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Mean corpuscular hemoglobin (MCH): hemoglobin/RBC – 27 to 31 picograms



Mean corpuscular hemoglobin concentration (MCHC): hemoglobin/hematocrit – 32 to 36 g/dL; hyperchromia or hypochromia

Nervous system and special senses



PRINCIPAL DIVISIONS: 1. Central Nervous System (CNS) a. 

brain & the spinal cord control mechanism for the entire organism

2. Peripheral Nervous System (PNS) a. b. c.

12 cranial nerves (CN) 31 spinal nerves autonomic nerves a. sympathetic b. parasympathetic

The Neuron

 

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functional unit dendrites – receive neural msgs & transmit towards cell body axon – transmits neural msgs away from cell body cell body – contains nucleus, mitochondria, & other organelles myelin & cellular sheath produced by Schwann

TYPES OF NEURONS 

Sensory neurons typically have a long dendrite and short axon, carry messages from sensory receptors  central nervous system.

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Motor neurons have a long axon and short dendrites, transmit messages from central nervous system muscles (or to glands).

Nerves & Ganglia 

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nerve – a large bundle of axons wrapped in CT tracts or pathways – bundle of axons within the CNS ganglia – aggregation of nerve cell bodies w/in the PNS nuclei – collection of cell bodies w/in the CNS

Reflex Action simplest example of a neural response predictable, automatic response to stimuli  4 processes: -reception of the stimuli, - transmission of information, -integration (interpretation & determination of appropriate 



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BRAIN average human

brain weighs about 3 pounds (13001400 g). At birth, the human brain weighs less than a pound (0.78-0.88 pounds or 350-400 g). The human brain reaches its full size at about 6 years of age.

BRAIN 

 



2% of the body's weight, it uses 20% of the oxygen supply gets 20% of the blood flow. If brain cells do not get oxygen for 3 to 5 minutes, they begin to die. Cerebrospinal fluid (CSF) surrounds the brain.

Anatomy and Physiology I. THE CEREBRAL CORTEX  a) concept of the dominant and non dominant hemisphere.  Left Right  Dominant Non-dominant  Language Spatial concepts Calculation Recognition of faces

Anatomy and Physiology

Frontal

Parietal

Occipital

Learning Intellect Judgment Values Behavior & Emotion

Language Visual communicatio Imaging & n processing Speech Calculation Construction Recognition

Tempor al Audition & Memory

Anatomy and Physiology II. Basal Ganglia  Cell bodies in white matter  Smooth voluntary movement III. Thalamus  Relays sensory impulses to the cortex  Provides a pain gate

Anatomy and Physiology IV. Hypothalamus  Regulates autonomic responses (stress, sleep, appetite, body temp, emotions)  Responsible for production of hormones secreted by the pituitary V. Brainstem V.1. midbrain  Motor coordination  Visual reflex and auditory relay center

Anatomy and Physiology V.2. Pons  Regulates breathing- resp. center V.3. Medulla oblongata  Contains efferent/afferent fibers  Cardiac, respiratory, vomiting and vasomotor center( bld. vessel diameter)

Anatomy and Physiology VI. Cerebellum  Coordinates sm muscle mov’t  coordinates, posture, equilibrium and muscle tone VII. Spinal cord  Starts from C1-L2  Carries sensory and motor impulses  Ave. length 45 cms. or 17 inches

Spinal Cord

   

Spinal nerves 31 pairs Posterior roots- Efferent(motor) Anterior roots- Afferent(sensory)

HYDROCEPHALUS - congenital anomaly inc amount of CSF in ventricles.

Peripheral Nervous System 



made up of the sense organs, the sensory neurons, & the nerves that link the CNS with the effectors 2 systems:  somatic system – responsible for body balance in relation to outside world  autonomic system – responsible for internal body balance

all Nerves 



12 pairs emerge from the brain transmit information from sense receptors to the brain

I-olfactory- sensory for smell  II- optic-sensory for vision  III-oculomotor- motor to SR,IR,MR &IO; to internal eye ms which controls lens shape and pupil size  IV- motor to SO  VI- motor to LR  V- Trigeminal-sensory to 

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 

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VII-Facial- motor to mS of facial expression, senory to taste(ant. Tongue) VIII- sensory to hearing and balance IX- glossopharyngeal- motor to pharynx & saliva production, sensory to tase( post. Tongue) X- Vagus- sensory & motor to pharynx, larynx, abdominal and thoracic viscera XI- Accessory- motor to sternocleidomastoid and trapezius

Comparison of Sympathetic and Parasympathetic Actions on Selected Effectors Sympathetic Action

Parasympathetic Action

Heart

Increases rate and strength of contraction

Bronchial tubes Iris of eye

Dilates

Decreases rate; no direct effect on strength of contraction Constricts

Sex organs Blood vessels

Constricts blood vessels; ejaculation Generally constricts

Sweat glands

Stimulates

No innervation

Intestine

Inhibits motility

Liver metabolism

Stimulates glycogen breakdown

Stimulates motility and secretion No effect

Effector

Dilates (pupil becomes larger)

Constricts (pupil becomes smaller) Dilates blood vessels; erection No innervation for many

Adipose tissue Stimulates free fatty acid release from fat cells

No effect

Adrenal medulla

Stimulates secretion of epinephrine and norepinephrine

No effect

Salivary glands

Stimulates thick, viscous secretion

Stimulates profuse, water secretion

senses

External Anatomy of the Eye

EYE structures 1. 2. 3. 4. 5. 6. 7. 8. 9.

Pupil Conjunctiva Cornea Sclera Choroid Iris Ciliary body Lens aqueous chamber

10. vitreous chamber 11. vitreous humor 12. Retina 13. rods & cones 14. optic nerve 15. optic disc 16. macula 17. fovea centralis

CORNEA the transparent, avascular layer that covers the iris & the pupil at the front of the eye frequently referred to as the window of the eye function: to bend, or refract the rays of the light

Sclera 



the white of the eye tough, fibrous, connective tissue that extends from the cornea on the anterior surface of the eyeball to the optic nerve

Choroid 

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a layer inside the sclera made of black pigment cells that absorb light rays so that they are not reflected back rich in blood vessels that supply nutrients to the eye

Iris 



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the colored portion of the eye that surrounds the pupil smooth ms constrict the pupil in bright light & vice-versa color is determined by the amount of pigment present (blue has the least, brown has the most)

Ciliary Body And Lens 





located on each side of the lens, contains ms that can adjust the shape & thickness of the lens lens is a clear, crystalline body that may be thinned or flattened for distant vision & thickened for close vision refractive power of the lens is called accommodation

Anterior & Vitreous Chamber 



the lens lies at the rear of the anterior chamber filled with a fluid called aqueous humor that maintains shape & nourishes the structures within behind the lens is the vitreous chamber that is filled with a soft, jelly-like material, the vitreous humor

Retina  

the thin, delicate, and sensitive nerve layer of the eye contains specialized sensory cells, the rods & cones – rods: 120M, for vision in dim light or darkness & peripheral vision – cones: 6.5M, for vision in bright light, color vision, & central vision



cones are most concentrated in the fovea centralis and is the region of sharpest vision

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

Optic Nerve & Disc

light energy, when focused on the retina, causes a chemical change in the rods & cones  nerve impulses travel to the brain via optic nerve region where optic nerve meets the retina is called optic disc ( also known as blind spot due to absence of rods & cones)

Extraocular muscles of the Eye

Eye

Ears

Eustachian Tube 





connects the middle ear & the external environment through the throat equalizes the pressure on the two sides of the eardrum susceptible to bacterial infection  middle ear

Nose

Nose

TASTE 

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The sense of taste is perceived through the taste buds on the tongue and in various parts of the mouth. average of 10,000 taste buds in the normal adult mouth. As an individual gets older the number of taste buds gradually decreases. The taste buds are able to discriminate among four primary tastes: sweet, sour, salty, and bitter. Both the facial (CN VII) and the glossopharyngeal (CN IX) nerves transmit the sensory input to the brain.

Test 1. A px has doubling of vision. The image is farthest apart when she looks downward and to the left. PE showed her R eye can move directly to the left. but when it faces directly to the medial, it can not move downward. Which muscle of her R eye is not working properly? b. Superior rectus c. Inferior rectus d. Superior oblique e. Inferior oblique f. Lateral rectus

2. All of the following statements reg cavernous sinus are correct except b. It lies immediately lateral to pituitary c. Lies immediately medial to frontal lobe d. Drain blood fr facial vein e. IJV can drain blood fr the cavernous sinus

3. Injury or infection to this triangle is considered dangerous because it can cause thrombosis b. Codmans triangle c. Pott’s triangle d. Cavernous sinus e. Glenoid fossa

4. The jaw jerk is a DTR. It tsts sensory fibers of the b. CN V c. Facial nerve d. CN IX e. CN X f. CN VI

5. Palpation of masseter ms assess motor fibers of b. CN V c. Facial nerve d. CN IX e. CN X f. CN VI

Match the following 6. Macula 7. Tectorial membrane 8. B & W vision 9. Color vision 10. cupula

a. b. c. d. e.

Otolithic membrane Organ of corty Cristae ampularis Rods cones

11. During mirror laryngoscopy, an examiner notes paralysis of the right vocal cord. This indicates paralysis of muscles innervated by the b. CN V c. CN VII d. CN IX e. CN X

12. The patient is asked to stick out her tongue and left deviation of uvula and soft palate is noted. This is most probably due to injury to b. Left vagus nerve c. Left accessory nerve d. Right accessory e. Left glossopharyngeal

13. visual accomodation is due to b. Relaxation of iris muscles c. Inc tension of lens ligament d. Dec in curvature of lens e. Contraction of ciliary muscles

14. The portion of ventricular system found at the level of the brainstem is the • 3rd ventricle • 4th ventricle • Lateral ventricle • Subarachnoid

15. A px showed blindenss of right eye. This is due to compromise of which branch of internal carotid artery? b. Lenticulostriate c. Ophthalmic d. Middle cerebral e. Anterior cerebral

16. Occlusion of which artery would most severely compromise the blood supply to the visual cortex? b. Anterior cerebral c. Middle cerebral d. Posterior cerebral e. Ophthalmic artery

17. Absence of corneal reflex indicate involvement of the b. CN III c. CN IV d. CN V e. CN VII

18. Loss of taste on the anterior 2/3 of the tongue indicates damage to the b. CN V c. CN VII d. CN IX e. CN XII

19. Spina bifida is defined as b. Failure of formation of meninges c. Failure of closure of spinal column d. Dual spine e. Failure of neural tube morphogenesis

20. Neural tube defects in newborn may result from____ of the mother b. Folic acid deficiency c. Infection d. Trauma e. Abnormal curvature of spine

21. Disease or dysfunction of this is implicated in Parkinsons b. Medial geniculate nucleus c. Substantia nigra d. Cerebellum e. Spinothalamic tracts

22. Disease or dysfunction in the production or release of this is implicated in Parkinsons b. Serotonin c. Dopamine d. Acetylcholine e. adrenalin

23. Characteristics of an upper motor neuron lesion except b. (+)Babinski c. Exagerrated DTRs d. Hypertonia e. Spastic paralysis f. astereognosis

24. Paralysis and atrophy of the tongue is most likely due to the damage b. CN V c. CN VII d. CN X e. CN XII

25. Innervation of upper eyelid, which raises it b. CN III c. CN IV d. CN VI e. CN IX



b. c. d. e.

Patient is able to hear but can not speak. This is what type of aphasia broca’s Wernicke’s Alexia Conduction aphasia



b. c. d. e.

Patient is able to speak but can not hear & understand. This is what type of aphasia broca’s Wernicke’s Alexia Conduction aphasia

28. Normal CSF Volume 29. Normal IOP? 30. Posterior root compression will involve –Motor or sensory or mixed

Post test

1. visual accomodation is due to b. Relaxation of iris muscles c. Inc tension of lens ligament d. Dec in curvature of lens e. Contraction of ciliary muscles 2. Motor function of extensor ms of forearm & arm by which of this g. Radial h. Ulnar i. Median j. axillary

3. Prime mover for plantar flexion of foot muscles.”toe dancers” b. Soleus c. Gastrocnemius d. peroneus e. Achilles tendon 4. Forms most of the buttocks muscles g. Psoas h. Gluteus i. Quadratus j. Adductor longus

5. When you stick your thumb out( approve sign), what movement of the thumb are you doing b. Etension c. Flexion d. Adduction e. Apposition 6. After Ach attaches to its receptors at NMJ the next step is g. Na channel open h. Cross bridges formation i. Ca binds to regular protein j. Myosin head is exposed

7. example of pivot joint a. radio-ulna b. Carpal c. carpal-metacarpal d. Shoulders 8. Correct match g. short- wrist h. Long-leg i. Flat- cranium j. Irregular-sternum

9. Bone pain behind external auditory meatus probably involves b. Maxilla c. Sphenoid d. Temporal e. Lacrimal 10. Anatomical landmark for Lumbar puncture g. Coccyx h. Sacrum i. Symphisis pubis

11. Freshly oxygenated blood is first received by b. RV c. LV d. RA e. LA 12. Fats in atherosclerosis deposits in g. Tunica media h. Tunica intima i. Tunica Adventitia j. Tunica externa

13. In inhalation, the diaphragm b. retracts, moves inferior c. Retracts, moves superior d. Contracts, moves inferior e. Contracts, moves superior 14. All of the following are classified as COPD except g. Pneumonia h. Emphysema i. Bronchitis j. Sleep apnea

15. Chemical digestion of fats occurs where b. Mouth c. Stomach d. Small intestine e. Large intestine 16. Movement of thumb or fingers when picking up a pen g. Extension h. Flexion i. Apposition

18. Chemical digestion of carbohydrates occurs in b. Mouth c. Stomach d. Small intestine e. Large intestine 19. CCk release leads to g. Contraction of duodenal papillae h. Contraction pf gallbladder i. Inc. liver secretions j. Inc. pancreatic secretions

20. Hormones that act to dec blood glucose b. Insulin c. Glucagon d. Epinephrine e. Growth hormone 21. The endometrium is the g. Inner layer h. Middle layer i. Outer layer j. Outermost layer

22. This is the area between the anus and clitoris b. Peritoneum c. Perineum d. Vulva e. Labia 23. Which of the following is true g. Only 1 primary follicle is stimulated h. 1 vesicular follicle undergoes ovulatio i. 1 follicle secretes estrogen j. Only 1 ovary is stimulated

24. Hypertension may result from hypersecretion of b. Thyroxine c. Cortisol d. Aldosterone e. Glucagon 25. ANP has opposite effect to which hormone g. Aldosterone h. Epinephrine i. Acetylcholine j. testosterone

Match the following 26. Macula 27. Tectorial membrane 28. B & W vision 29. Color vision 30. cupula

a. b. c. d. e.

Otolithic membrane Organ of corty Cristae ampularis Rods cones

31-32. The abdominal aorta gives two main branches to supply the lower limbs. What are those two branches? 33-36. The aortic arch gives 3 main branches which supplies the upper extremities. What are those 3 branches?

37. Px was diagnosed wt dengue fever. It is mandatory to check the platelet count of patients with this disease. As you recall, the Normal platelet count is b. 100-200 c. 150-450 d. 200-400 e. 300-550

38. A 40/F Patient was diagnosed with nutritional anemia. The expected lab finding should be b. Hgb- <12 c. >12 d. Hct>45 e. Hct<55 39. Neutropenic precautions or reverse isolation should be implemented if g. plt count is < 200 h. WBC is < 5000 i. RBC is < 40 j. Patient has thrombocytosis



b. c. d. e.

40. CVP is a measure of your preload. The normal CVP is 4-10 cm H20 2-4 cm H20 10-15 cm H20 12-19 cm H20

Remember, you can’t steal second if you don’t take your foot off first…... mike todd