Anatomy and Physiology

by: S. Maravilla, RN, MAN

Nervous system Sensory receptor (sensory input) Integration (Brain and spinal cord) Motor output effector Receptor cellsspecialized cell at the end of dendrites Effector organsmuscles and glands Intracellular Na= <10 Na exchange with K+ (=intravascular=3.5-5) Na+ + K pump push the Na+ out; K+ inside the cell Acetylcholine Binds to next neyron Allow Na+ to come in Depolarization Neurotransmitter Acetylcholine (major transmitter of the PNS) - Usually excitatory; parasympathetic effe Dopamine (Basal Ganglia) - Restrains, affects behaviors (attention, emotions) and fine movements - Accessory movement - Facial expression Norepinephrine (major transmitter of SNS) - Excitatory; affects mood and overall activity Enkephalin, endorphin (Nerve terminals in spine, brain stem, thalamus, hypothalamus, pituitary gland) - Excitatory, pleasurable sensation, inhibits pain transmission - High adrenalin - Opioid effect -

Types of nerves AstrocytesBlood Brain Barrier - Endothelial cells are too small Microglial fights infection if it affects the brain tissue Parts of the brain

Temproalear Frontalanalytical thinking, intellect, pre-motor and motor - Brocas area- expressive aphasia Parietal - Wernickes- receptive aphasia - Global aphasiaall Cerebrum Brainstem - pons Cerebellum - coordination - maintenance of posture and equilibrium - turning to sides when sleeping forebrain - cerebrum - basal ganglia - diencephalon 1. thalamusstimuli sensory gate control theory 2. hypothalamus a. regulates visceral activities by integrating ANS SNSposterior and internal PNSanterior and medial ex. Control of body tempanterior heat loss control of GIT motility and see control of BP b. behavior and emotional response c. water balance

sec. ADHstored post pituitary thirst centerstimulated by osmolality of bld. d. Secretion of oxytocin Midbrain 1. Conncects hindbrain and forebrain 2. Reflex center Righting reflexconcerned and keeping head up Postural reflexconcerned and position of head in relation to the trunk Audiovisual reflexescauses head to turn to sound (corpora quadrigemina)dorsal 3. Origin of CN III and IV (ventralcer. peduncies) Hindbrain A. Pons B. Medulla 1. Vital Centerscardiac, vasomotor, respiratory 2. Reflex activitiessneezing, coughing, vomiting, winking swallowing 3. Cranial nerves arising from medulle9 10 11 12 4. Decussation or crossing center Brain Stemmedulla, pons and midbrain Reticular Formationnerve fibers that speread through the upper portion of spinal cord, brain stem and diencephalons. Coordinates muscle activity and to arouse the cerebral cortex via the wake center in the hypothalamusinitiates and maintain alter wakefulness called RAS Cerebellum 1. Coordination 2. Reflex centers for regulation of muscle tone, equilibrium, posture, orientation in space Adiadochokinesiainability to do alternate movements with R and left Optic chiasmwhere the nerves of the optic nerves cross - Operations to the pituitary could affect Movement of the eye - Rectus muscles (4) lateralmoves laterally - Oblique (2)inferiorelevates - TEST: follow fingers

Occulomotordilations, papillary reflex, accommodation reflex (changing the curvature of the lens) - Curve when near - Flat when far Trigeminal - Trigeminal neuralgiachewing hard food Extreme temp Injection of alcohol Facial - Ptosis, movement of face, taste (2/3 of tongue is affected) Glossopharyngial - Posterior 1/3 of the tongue, swallowing, parasympa fnx - Gag reflex Vagus - Longest (extends to rectum) - Parasympathetic Auto-regulation of blood flow - When cerebral oxygen tension falls below 50mm Hg, the cerebral arteries dilate to increase blood flow and oxygen delivery BP - Dec O2 Inc CO2 Dec pH cerebral vasodilation. With age and atherosclerosisauto regulation les responsive Blood Brain Barrier - Tight junctions in the endothelial cells of the brain. Capillariesmacromoluces cannot cross. Astrocytes Brain - 15% of cardiac output - 20% of O2 consumption - 25% of glucose consumption - No storage capacity Oxygen - Lack of O2 for 10secconfusion - 4-6 min.COMA - Brain death irreversible damage Glucosealmost exclusively the source of energy - <70mg/100mL= confusion - <20mg/100mL= COMA Flow of CSF Lateral ventricleforacle of Monroeaqueduct

Sinuses CSF - Similar to ECF (blood plasma) - Clear, colorless - Specific grvity 1.0007 - Minimal WBC no RBC Intracranial contents Brain tissue 88% Intravascular blood 2-11% CSF 9-10% Normal ICP 110- 140 mm H2O - 0-15cm H2O Lahat ng nerve- mixed nervesensory, motor 1st levelsensory impulses- remove from hot object\ 2nd level 3rd levellearned or conditioned reflexes; cerebral reflexbladder and bowel control

Spinal Nerve Plexus Plexuses Origin Cervical C1-4

Areas supplied a. Anterior branch anterior neck b. Posterior branch posterior neck c. Phrenic branchdiaphragm

Brachial

Herniated nucleus pulposuscompresses nerve root

Terminalrespiratory alveoli alveolar Right3 lobes Left 2 lobes Karinafor insertion of ET tube

When acidoticgive more CO2 Diabetic acidosiskausmuls respiration cavity of the larynx

Visceralnear an organ Concepts in the basic req of normal respite I. Ventilation - Adequate o2 environment - Air pressure variances - Airway resistanceBronchospasm (asthma) - Bronchodilation (bronchiectasis) Compliancemeasure of elasticity, expandability, distensibility of the lungs, determined by the surgace tension of alveoli and connective tissure (collagen and elastin) of the lungs Increased compliancelost of elasticity and lungs is overdistended (emphysema) Smoking decrease in Alpha-1 anti-trypsin Ventricular relaxclosed semi lunar; open AV valve Decreased compliancelungs and thorax are stiff (atelectasis, pulm, fibrosis, ARDS) Normal bellows of chest respiratory muscle (euro muscular disorders) Thoracic cage (skeletal disorders) II. Diffusion Volume changes Total lung cap6000mL Tidal vol 500mL IRV- inspiratory resere vol/ inspiratory capacity - Amount capable of being inhaled Types of breation 1. Abdominal deep 2. Coastal--shallow CARDIO VASCULAR SYSTEM SA nodeAV nodeBundle of His

Coronary artery fills during diastole Ectopic beat- does not come from the normal conduction system Cardiac output= SV x HR I. Stroke vol is determined by 1. Preloaddegree of ventricular filling during diastole Distending force stretching the ventricular muscle immediately prior to electrical excitation and contraction VENOUS RETURN Frank starlings law 2. Afterload- the pressure against which the ventricles must pump (aortic pressure)

Inc aortic pressure; dec vol pumped by L ventricle Peripheral vascular resistance 3. Contractility of cardiac muscle Inotropic agentsfactors that affect contractility of the heart or force of contraction +chronotropic Inc HR II. Heart Rate Factors affecting hr 1. Autonomic 2. Para sympa 3. Sympa EJECTION FRACTION - %end diastolic vol that is ejected with each stroke RV (42%) LV (50%) - NV 60-75% Good indicator of hearts ability to maintain contractility Cholecystokaminegallbladder contract Functions of the liver 1. Metabolism of CHON production of albumin, globulin and clotting factors 2. Metabolism of CHO - Glycogenensis - Glycogenolysis - Gluconeogenesis glucose from other sources (break down of fat) 3. Metabolism of fatsoxidation of fatty acid for energy and trigly synthesis 4. Metabolism and storage of vitamins and minerals (ADEK, B12, Fe) 5. Detox of exogenous substances like drugs 6. Detox of endogenous substance like sex steroids, aldosterone and ammonia 7. Bile production and excretion 8. Bilirubin metabolism 9. Drainage of blood from GIT 10. Immune functionkuppfer cells Blood vessels - Arteries 100-120mmHg - Capillaries 25mmHg. Exchange of nutrients through osmosis, diffusion, filtration (act of passing fluids through a porous medium)

Veins (RA)- o5mmHg. Distensible, allows accumulation of large vol of blood. With one way valves directed upwards LYmphosytes- viral Eosinophil- allergic WBC

Immunity Humural- antibody mediated immunity produced by Blymphocytes Cell mediated or cellularslower Types of anti-bodies IgG- abundantplacenta IgA- saliva and tears, decrease during stress, anti-viral activity IgE- mast cells and basophil for immediate hypersensitivity response

RH + antigen D RH - no antigen D FLUID AND ELECTROLYTES - Same kind of electrolytes in each of the different compartments. Amount differs Principal Cations: Na, K, Ca, Mg Anions: Cl, Phosphate, HCO3 - Life cannot be sustained unless body fluids contain exactly the right amount of each in the right concentration. Potassium (K) 3.5-5mEq/L - excitability of nerves and muscles - ICF osmotic pressure - Maintains acid-base balance and normal kidney fnx Calcium (ca) 4.5-5.5 mEq/L - 2 types Ionized Bound to plasma proteins - Free ionized Ca is needed for Blood coagulation Smooth, skeletal and cardiac muscle fnx Nerve fnx Bone and teeth formation - Vitamin D and PTH must be present for Ca to be absorbed from the GIT - Hypocalcemia Movement of fluids and electrolyte between compartments 1. Diffusion 2. Osmosis high conc. To lower concentration 3. Active transport 4. Flitration Movement of fluid between IT and IV 1. Hydrostatic pressure of blood 2. Colloid osmotic pressure of plasma 3. Capillary permeability Movement of fluid between IC and EC Crystalloid osmotic pressure - Na exters osmotic equilibrium in EC - K exerts osmotic equilibrium in IC SIADH

Water retained in renal tubules blood volume inc. coz of water Glucosuriaglucose in the urine