DIVISIONS OF THE NERVOUS SYSTEM

The nervous system can be divided into two major divisions: the central nervous
system and the peripheral nervous system . The central nervous system (CNS) consists
of the brain and spinal cord. The peripheral nervous system (PNS) consists of all the
nervous tissue outside the CNS (nerves and ganglia).

The PNS functions to link the CNS with the various parts of the body. The PNS
carries information about the different tissues of the body to the CNS and carries commands
from the CNS that alter body activities. The sensory division, or afferent (toward) division,of
the PNS conducts action potentials from sensory receptors to the CNS .

The neurons that transmit action potentials from the periphery to the CNS are
called sensory neurons. The motor division, or efferent (away) division of the PNS
conducts action potentials from the CNS to effector organs, such as muscles and glands.
The neurons that transmit action potentials from the CNS toward the periphery are
called motor neurons.
 
The motor division can be further subdivided based on the type of effector
being innervated. The somatic (bodily) nervous system transmits action potentials from
the CNS to skeletal muscles, and the autonomic (self-governing) nervous system
(ANS) transmits action potentials from the CNS to cardiac muscle, smooth muscle, and
glands. The autonomic nervous system, in turn, is divided into sympathetic and
parasympathetic divisions .

The enteric nervous system (ENS) is a unique subdivision of the peripheral

nervous system. The ENS has both sensory and motor neurons contained wholly within the
digestive tract. The ENS can function without input from the CNS or other parts of the PNS,
although it is normally integrated with the CNS by sensory neurons and ANS motor neurons.

THE AUTONOMIC NERVOUS SYSTEM

 
The autonomic nervous system (ANS) is actually part of the peripheral
nervous system in that it consists of motor portions of some cranial and spinal nerves.
Because its functioning is so specialized, however, the autonomic nervous system is usually
discussed as a separate entity, as we will do here.
 
Making up the autonomic nervous system are visceral motor neurons to smooth
muscle, cardiac muscle, and glands. These are the visceral effectors; muscle will either
contract or relax, and glands will either increase or decrease their secretions.
 
The  ANS  has  two  divisions:  sympathetic  and parasympathetic. Often, they
function in opposition to each other, as you will see. The activity of both divisions is
integrated by the hypothalamus, which ensures that the visceral effectors will respond
appropriately to the situation.

AUTONOMIC PATHWAYS
 
An autonomic nerve pathway from the central nervous system to a visceral effector
consists of two motor neurons that synapse in a ganglion outside the CNS . The first neuron
is called the preganglionic neuron, from the CNS to the ganglion. Thesecond neuron is
called the postganglionic neuron, from the ganglion to the visceral effector. The ganglia
are actually the cell bodies of the postganglionic neurons.

SYMPATHETIC DIVISION
 
Another name for the sympathetic division is thoracolumbar division, which tells us
where the sympathetic preganglionic neurons originate. 

Their cell bodies are in the thoracic segments and some of the lumbar segments
of the spinal cord. Their axons extend to the sympathetic ganglia, most of which are
located in two chains just outside the spinal column . Within the ganglia are the synapses
between preganglionic and postganglionic neurons; the postganglionic axons then go to the
visceral effectors. One preganglionic neuron often synapses with many postganglionic
neurons to many effectors. This anatomic arrangement has physiological importance: The
sympathetic division brings about widespread responses in many organs.

The sympathetic division is dominant in stressful situations, which include anger,

fear, or anxiety, as well as exercise. For our prehistoric ancestors, stress-ful situations
often involved the need for intense physical activity—the “fight or flight response.” The
heart rate increases, vasodilatation in skeletal muscles supplies them with more
oxygen, the bronchioles dilate to take in more air, and the liver changes glycogen to
glucose to supply energy.

At the same time, digestive secretions decrease and peristalsis slows; these are
not important in a stress situation. Vasoconstriction in the skin and viscera shunts blood to
more vital organs such as the heart, muscles, and brain. All of these responses enabled our
ancestors to stay and fight or to get away from potential danger. Even though we may not
always be in life-threatening situations during stress (such as figuring out our income taxes),
our bodies are prepared for just that.
 
PARASYMPATHETIC DIVISION
 
The other name for the parasympathetic division is the craniosacral division. The
cell bodies of parasympathetic preganglionic neurons are in the brain stem and the sacral
segments of the spinal cord. Their axons are in cranial nerve pairs 3, 7, 9, and 10 and in
some sacral nerves and extend to the parasympathetic ganglia. These ganglia are very
close to or actually in the visceral effector (see Fig. 8–12), and contain the post-ganglionic
cell bodies, with very short axons to the cells of the effector.
 
In the parasympathetic division, one preganglionic neuron synapses with just a few
postganglionic neurons to only one effector. With this anatomic arrangement, very localized
(one organ) responses are possible.

The parasympathetic division dominates in relaxed (non-stress) situations to

promote normal functioning of several organ systems. Digestion will be efficient, with
increased secretions and peristalsis; defecation and urination may occur; and the heart will
beat at a normal resting rate.

Notice that when an organ receives both sympathetic and parasympathetic impulses,
the responses are opposites. Such an arrangement makes maintaining an appropriate level
of activity quite simple, as in changing the heart rate to meet the needs of a situation. Notice
also that some visceral effectors or visceral motor receive only sympathetic impulses. In
such cases, the opposite response is brought about by a decrease in sympathetic impulses.
Secretion by the sweat glands is an example.
 
 
NEUROTRANSMITTERS
 
Recall that neurotransmitters enable nerve impulses to cross synapses. In
autonomic pathways there are two synapses: one between preganglionic and
postganglionic neurons, and the second between postgan
glionic neurons and visceral effectors.

Acetylcholine is the transmitter released by all preganglionic neurons, both

sympathetic and para sympathetic; it is inactivated by cholinesterase in postganglionic
neurons. Parasympathetic postganglionic neurons all release acetylcholine at the synapses
with their visceral effectors. Most sympathetic postganglionic neurons release the transmitter
norepinephrine at the synapses with the effector cells. Norepinephrine is inactivated by
either catechol-O-methyl transferase (COMT) or monoamine oxidase (MAO), or it may
be removed from the synapse by reuptake.

Cranial nerve

The cranial nerves are a set of 12 paired nerves that arise directly from the brain. The first
two nerves (olfactory and optic) arise from the cerebrum, whereas the remaining
ten emerge from the brain stem.

The names of the cranial nerves relate to their function and they are also numerically
identified in roman numerals (I-XII).

Origin of the Cranial Nerves

There are twelve cranial nerves in total. The olfactory nerve (CN I) and optic nerve
(CN II) originate from the cerebrum.
 Cranial nerves III – XII arise from the brain stem . They can arise from a specific part
of the brain stem (midbrain, pons or medulla), or from a junction between two parts:

 Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It
has the longest intracranial length of all the cranial nerves.

 Midbrain-pontine junction – oculomotor (III).

 Pons – trigeminal (V).

Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII).
Medulla oblongata – posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI).
Anterior to the olive: hypoglossal (XII).
The cranial nerves are numbered by their location on the brain stem (superior to inferior,
then medial to lateral) and the order of their exit from the cranium (anterior to posterior)

Modalities
Simplistically, each cranial nerve can be described as being sensory, motor or both. They
can more specifically transmit seven types of information; three are unique to cranial nerves
(SSS, SVS and SVM). See table for a summary of the cranial nerves, their modalities and
functions.

Sensory (afferent) Modalities:

General somatic sensory (GSS) – general sensation from skin.
General visceral sensory (GVS) – general sensation from viscera.
Special somatic sensory (SSS) – senses derived from ectoderm (e.g. sight, sound,
balance).
Special visceral sensory (SVS) – senses derived from endoderm (e.g. taste, smell).

Motor (efferent) Modalities:

General somatic motor (GSM) – skeletal muscles.

General visceral motor (GVM) – smooth muscles of gut and autonomic motor.
Special visceral motor (SVM) – muscles derived from pharyngeal arches.

Summary Table
Overview of the Spinal Nerves
Spinal nerves, a part of the peripheral nervous system (PNS), are mixed nerves that
send motor, sensory, and autonomic signals between the CNS and the body.

Key Points
Afferent sensory axons bring sensory information from the body to the spinal cord
and brain; they travel through the dorsal roots of the spinal cord.

Efferent motor axons bring motor information from the brain to the body; they travel through
the ventral roots of the spinal cord.

All spinal nerves—except the first pair—emerge from the spinal column through an opening
between vertebrae, called an intervertebral foramen.

The spinal nerves are typically labeled by their location in the body: thoracic, lumbar, or
sacral.
Key Terms

ventral root: Also called the anterior root, it is the efferent motor root of a spinal nerve.

autonomic: Acting or occurring involuntarily, without conscious control.

dorsal root: Also known as the posterior root, the afferent sensory root of a spinal nerve.

intervertebral foramen: The foramen allows for the passage of the spinal nerve root, dorsal
root ganglion, the spinal artery of the segmental artery, the communicating veins between
the internal and external plexuses, recurrent meningeal (sinu-vertebral) nerves, and
transforaminal ligaments.

Spinal Nerve Anatomy

The term spinal nerve generally refers to a mixed spinal nerve that carries motor, sensory,
and autonomic signals between the spinal cord and the body.

Humans have 31 left–right pairs of spinal nerves, each roughly corresponding to a segment
of the vertebral column: eight cervical spinal nerve pairs (C1–C8), 12 thoracic pairs (T1–
T12), five lumbar pairs (L1–L5), five sacral pairs (S1–S5), and one coccygeal pair. The
spinal nerves are part of the peripheral nervous system (PNS).

Location

Each spinal nerve is formed by the combination of nerve fibers from the dorsal and ventral
roots of the spinal cord. The dorsal roots carry afferent sensory axons, while the ventral
roots carry efferent motor axons.

he spinal nerve emerges from the spinal column through an opening (intervertebral foramen)
between adjacent vertebrae.

This is true for all spinal nerves except for the first spinal nerve pair, which emerges between
the occipital bone and the atlas (the first vertebra). Thus the cervical nerves are numbered
by the vertebra below, except C8, which exists below C7 and above T1.

The thoracic, lumbar, and sacral nerves are then numbered by the vertebra above. In the
case of a lumbarized S1 vertebra (i.e., L6) or a sacralized L5 vertebra, the nerves are
typically still counted to L5 and the next nerve is S1.

Spinal Nerve Innervation

Outside the vertebral column, the nerve divides into branches. The dorsal ramus contains
nerves that serve the dorsal portions of the trunk; it carries visceral motor, somatic motor,
and somatic sensory information to and from the skin and muscles of the back (epaxial
muscles).

The ventral ramus contains nerves that serve the remaining ventral parts of the trunk and the
upper and lower limbs (hypaxial muscles); they carry visceral motor, somatic motor, and
sensory information to and from the ventrolateral body surface, structures in the body wall,
and the limbs.

The meningeal branches (recurrent meningeal or sinuvertebral nerves) branch from the
spinal nerve and re-enter the intervertebral foramen to serve the ligaments, dura, blood
vessels, intervertebral discs, facet joints, and periosteum of the vertebrae.

The rami communicantes contain autonomic nerves that serve visceral functions, such as
carrying visceral motor and sensory information to and from the visceral organs.

Cervical Nerves

The posterior distribution of the cervical nerves includes the suboccipital nerve (C1), the
greater occipital nerve (C2), and the third occipital nerve (C3). The anterior distribution
includes the cervical plexus (C1–C4) and brachial plexus (C5–T1).

The muscles innervated by the cervical nerves are the sternohyoid, sternothyroid, and
omohyoid muscles.

A loop of nerves called ansa cervicalis is also part of the cervical plexus.

Thoracic Nerves

Thoracic nerve branches exit the spine and go directly to the paravertebral ganglia of the
autonomic nervous system, where they are involved in the functions of organs and glands in
the head, neck, thorax, and abdomen.

Anterior Divisions

The intercostal nerves come from thoracic nerves T1–T11, and run between the ribs. The
subcostal nerve comes from nerve T12, and runs below the twelfth rib.

Posterior Divisions

The medial branches (ramus medialis) of the posterior branches of the upper six thoracic
nerves run between the semispinalis dorsi and multifidus, which they supply.

They then pierce the rhomboid and trapezius muscles, and reach the skin by the sides of the
spinous processes. This branch is called the medial cutaneous ramus.

The medial branches of the lower six thoracic nerves are distributed chiefly to the multifidus
and longissimus dorsi, occasionally they give off filaments to the skin near the middle line.
This sensitive branch is called the posterior cutaneous ramus.

Lumbar Nerves

The lumbar nerves are divided into posterior and anterior divisions.
Posterior Divisions

The medial branches of the posterior divisions of the lumbar nerves run close to the articular
processes of the vertebrae and end in the multifidus muscle. The lateral branches supply the
erector spinae muscles.

Anterior Divisions

The anterior divisions of the lumbar nerves (rami anteriores) consist of long, slender
branches that accompany the lumbar arteries around the sides of the vertebral bodies,
beneath the psoas major.

The first and second, and sometimes the third and fourth, lumbar nerves are each connected
with the lumbar part of the sympathetic trunk by a white ramus communicans.

The nerves pass obliquely outward behind the psoas major, or between its fasciculi,
distributing filaments to it and the quadratus lumborum.

The first three and the greater part of the fourth are connected by anastomotic loops and
form the lumbar plexus.

The smaller part of the fourth joins with the fifth to form the lumbosacral trunk, which assists
in the formation of the sacral plexus. The fourth nerve is named the furcal nerve, from the
fact that it is subdivided between the two plexuses.

Sacral Nerves

There are five paired sacral nerves, half of them arising through the sacrum on the left side
and the other half on the right side. Each nerve emerges in two divisions: one division
through the anterior sacral foramina and the other division through the posterior sacral
foramina.

The sacral nerves have both afferent and efferent fibers, thus they are responsible for part of
the sensory perception and the movements of the lower extremities of the human body.

The pudendal nerve and parasympathetic fibers arise from S2, S3, and S4. They supply the
descending colon and rectum, urinary bladder, and genital organs. These pathways have
both afferent and efferent fibers.

Coccygeal Nerve

The coccygeal nerve is the 31st pair of spinal nerves and arises from the conus medullaris.
Its anterior root helps form the coccygeal plexus.

Human Nervous system

The neurons are the basic units of the nervous system. They help in conducting the stimuli in
between the receptor organs - spinal cord, brain and effector organs. The neurons conduct
the stimulus as electrochemical events.

Nervous Co-ordination
 All living animals maintain a constant inner state, irrespective of changes happening in the
environment. This phenomenon is named as homoeostasis. It is achieved due to
coordination of response. The coordination is due to the animal body, acting as a self-
regulating system capable of making appropriate responses to stimuli.
 
The coordinating system of the body contains suitable structures for detecting stimuli,
transmitting information and responding to stimuli. There are feedback mechanisms that
ensure that degree of responses is related to the intensity and direction of the stimuli.
 
Mammals have two main coordinating systems, namely the nervous system and the
endocrine system.

Nervous system

 The neurons are the basic units of the nervous system. They help in conducting the
stimuli in between the receptor organs - spinal cord, brain and effector organs. The neurons
conduct the stimulus as electrochemical events. These sequential events involve migration
of 'Na' and 'K' ions outside and inside the neuronal cells. This phenomenon is known
as Sodium-Potassium pump. This sequence of electro chemical events is known as
the impulse.

The junctions of neurons in nerve pathway are called the synapses. A synapse is

formed between the bulb-like end structure of the axon called boutons and the cyton or
dendrite of the adjacent neuron. At the junction there is a gap called the synaptic cleft,
which is usually about 10 to 20 nm. At this point, transmission of stimulus happens through
transmitter substances such asacetylcholine.
 
In the nervous system the bundles of parallel axons of the nervous tissue having
myelin sheath constitute the white matter. Collection of neurons having unmyelinated axons
form the grey matter.
 
The axons make up the white matter of the CNS for nerve tracts. They propogate
action potentials. The grey matter performs integrative functions. The outer surface of the
brain (cortex) and the central area of the spinal cord consist of grey matter. Within the brain,
collections of grey matter form centers called nuclei.

The brain
There are more than a thousand million neurons in the adult human brain. An
estimate shows that the cerebral cortex alone has about 102783000 synapses. Thus the
brain is a complex organ.
On structural and functional basis the brain can be divided into 3 regions. They are
(1). Fore brain, (2). Midbrain, (3). Hind brain.
Fore Brain (Prosencephalon) :- This region of the brain comprises Diencephalon and
the cerebrum.
 
The diencephalon is formed of thalamus and hypothalamus.

Thalamus :- It is the largest part of the diencephalon. This region contains a cluster of
nuclei. Most of the sensory inputs are conducted to the cerebral cortex through the
thalamus. Axons carrying auditory, visual and other sensory informations synapse with
specific nuclei of this region. This region may also influence mood and general body
movements due to strong emotions such as fear or anger.

 Hypothalamus :-

 
This region contains small nuclei and nerve tracts. The nuclei called mamillary
bodies are involved in olfactory reflexes and emotional responses to odours. The funnel
shaped infundibulum from the hypothalamus connects it to the
posterior pituitary orneurohypophysis. This region controls the secretions of the pituitary
gland.
The hypothalamus receives inputs from several sensory systems such as tongue,
nose and external genitalia. It is associated with emotional and mood relationships. It
provides a relaxed feeling. Feeling good after a meal, rage and fear are also due to this
region. It also coordinates responses to the sleep-wake cycle with other areas.

Cerebrum :-

It is the largest part of the brain. It weighs about 1400g in males and 1200g in
females. Larger brains are normally associated with larger bodies and not with greater
intelligence.
 

The grey matter on the outer surface of the cerebrum is the cortex. It forms clusters
deep inside the brain called nuclei. The inner part of the brain, in between the cortex and
the nuclei has white matter named as cerebral medulla.

Cerebral cortex :-
The cortex contains several primary sensory areas. These areas include taste
area, primary auditory cortex for processing auditory stimuli, visual cortex for perceiving
visual images and areas for other cutaneous sensations.
The cortical areas adjacent to the primary sensory centers are called
the association areas. These areas are involved in the process of recognition. For example
the sensory stimulus from the retina of the eye reaches the visual association area of the
cortex. Here the visual information is compared with past experiences. Further this area has
connections with other parts of the cortex, which influence decisions. Thus visual information
is judged several times. This may be one of the reasons why two people who witness the
same event can present somewhat different versions of what happened.

The primary motor area of the cortex controls many voluntary movements,

especially the finer motor movements of the hands. Muscle groups such as facial muscles,
that have many motor units have greater innervation. They are represented by a large area
of the motor cortex.

Anterior to the primary motor area are the premotor area. It is the staging area in
which motor functions are organized before they are initiated in the motor cortex. For
example, if a person decides to lift a hand, the neurons of the premotor area are stimulated
first. This area determines the order and the degree to which the muscles must contract.
 The prefrontal area provides motivation and foresight to plan and initiate movements. This
area is well developed only in primates and especially in humans. Our emotional behaviour
and mood are controlled by this area.
The midbrain or Mesencephalon :-

The roof of this region contains four nuclei. The nuclei form mounds. They are
collectively called corpora quadrigemina. It is formed of 2 superiour colliculi or mounds
and 2 inferior colliculi or mounds. The superior colliculi are involved in visual reflexes. They
control eye and head movements. They aid in visual tracking of moving objects. The inferior
colliculi are involved in hearing.

The hindbrain or Rhombencephalon :-

 
This part of the brain comprises Cerebellum, Pons and Medulla oblongata.
Cerebellum :-
This region communicates with other region of the CNS through three large nerve
tracts called the cerebellar peduncles.

The cerebellum consists of following three parts

Parts                              Control
1. flocculonodular                   balance and maintenance
of muscle tone.
2. vermis - anterior part        motor coordination and muscle tone.
 
3. vermis - posterior part and fine motor coordination and
lateral hemispheres              muscle tone.
 
Cerebellar disfunction may cause decreased muscle tone, imbalance and lack of co-
ordination.

Pons :-
 This region relays information from the cerebrum to the cerebellum. It also contains sleep
center and respiratory centers. These centers along with medulla help to control respiratory
movements.

Medulla oblongata :-
It is the most inferior part of the brain stem. It acts as a conduction pathway for both
ascending and descending nerve tracts. The nuclei inside medulla oblongata function as
centers of several reflexes involved in the regulation of heart rate, blood vessel contractions,
breathing, swallowing, vomiting, coughing and sneezing.

Type of Memory

The term 'memory' denotes a specific brain function of storing and retrieving of
informations related to experiences. The duration of memory varies from few seconds or
hours, to several years.

Types of memory :-

1. Sensory memory :- It means the ability to retain sensory signals in the sensory areas of
the brain for a short interval of time following the actual sensory experience. This is the initial
stage of memory process.

2. Primary memory :- It is the memory of facts, words, numbers, letters or other
information. The information in this memory is instantaneously made available so that a
person need not search through his or her mind for it.

3. Secondary memory :- It is the storage in the brain of information that can be recalled at
some later time(hours, days, months or years later). This is also called long-term memory,
fixed memory or permanent memory.

4. Physiology of memory :- Certain anatomical, physical or chemical changes occur in the

pre synaptic terminals (a part in the neuron) or perhaps in whole neurons that permanently
facilitate the transmission of impulses at the synapses.

All the synapses (nerves junctions) are thus facilitated in a thought circuit. This circuit
can be re-excited by any one of many diverse signals at later dates thereby causing
memory. The overall facilitated circuit is called a memory engram or a memory trace.
Amnesia :- Amnesia means memory loss. It is the inability to recall memories from the past.

Meninges - Nervous System

Meninges

Three connective tissue membranes, the meninges (mĕ-nin′

jēz; meninx, membrane) (figure 8.34), surround and protect the brainand spinal cord. The
most superficial and thickest of the meninges is the dura mater (doo′ ră mā′ ter; tough
mother).

 The dura mater around the brain consists of two layers, which function as a single
layer but are physically separated into several regions to form dural folds and dural venous
sinuses. Folds of dura mater extend into the longitudinal fissure between the two cerebral
hemispheres and between the cerebrum and the cerebellum. The folds help hold the brain in
place within the skull. The dural venous sinuses collect blood from the small veins of the
brain and empty into the internal jugular veins, which exit the skull.

Within the skull, the dura mater adheres tightly to the cranial bones. In contrast,
within the vertebral canal is an epidural space between the dura mater and the vertebrae .
The epidural space is clinically important as the injection site for epidural
anesthesia of the spinal nerves, which is often given towomen during childbirth.

  The second meningeal membrane is the very thin, wispy arachnoid (ă-rak′noyd;

spiderlike, as in cobwebs) mater. Thespace between the dura mater and the arachnoid
mater is the sub-dural space, which is normally only a potential space containinga very
small amount of serous fluid.

 The spinal cord extends only to approximately the level of the second lumbar
vertebra. Spinal nerves surrounded by meninges extend to the end of the vertebral column.
Because there is no spinal cord in the inferior portion of the vertebral canal, a needlecan be
introduced into the subarachnoid space at that level without damaging the spinal cord.
Health professionals use such a needle to inject anesthetic into the area as a spinal
block or to take a sample of cerebrospinal fluid in a spinal tap. The cerebrospinal fluid can
then be examined for infectious agents (meningitis) or for blood (hemorrhage).

 The third meningeal membrane, the pia mater (pı̄ ′ ă, pē′ ă; affectionate mother), is
very tightly bound to the surface of the brain and spinal cord. Between the arachnoid mater
and the pia mater is thesubarachnoid space, which is filled with cerebrospinal fluid and
contains blood vessels.

SPINAL CORD
The spinal cord extends from the foramen magnum at the base of the skull to the
second lumbar vertebra (figure 8.15). Spinal nerves communicate between the spinal cord
and the body. The inferior end of the spinal cord and the spinal nerves exiting there
resemble a horse’s tail and are collectively called the caudaequina .

Spinal Cord
The spinal cord is the major conduit and reflex centre between the peripheral nerves
and the brain and transmits motor information from the brain to the muscles, tissues
and organs, and sensory information from these areas back to the brain. 

The spinal cord in an adult is approximately a 45 cm long, cylindrical structure

that is slightly flattened anteriorly and posteriorly. [2]  The spinal cord lies within the
vertebral canal, extending from the foramen magnum to the lowest border of the first
lumbar vertebra.

It is enlarged at two sites, the cervical and lumbar region. Its upper end is
continuous with the medulla, the transition is defined to occur just above the level of
exit of the first pair of cervical nerves.

Its tapering lower end, the conus medullaris, terminates at the level of the L3
vertebra in neonates, and at the level of the L1-2 intervertebral disk in adults.

The conus medullaris is continuous at its lower end with the threadlike filum
terminale, composed mainly of glial and connective tissue, which, in turn, runs through
the lumbar sac amidst the posterior and anterior roots of the spinal nerves, collectively
called the Cauda Equina (“horse’s tail”), and then attaches to the dorsal surface of the
coccyx. 
Sensory Nerve Fibres enter the Spinal Cord via the Posterior (Dorsal) Root. The
cell bodies for these neurons are situated in the Dorsal Root Ganglia. Motor and
Preganglionic Autonomic Fibres exit via the Anterior (Ventral) Root.

A cross section reveals that the spinal cord consists of a superficial white matter
portion and a deep gray matter portion .The white matter consists of myelinated axons, and
the gray matter is mainly a collection of neuron cell bodies. The white matter in each half of
the spinal cord is organized into three columns, called
the dorsal (posterior), ventral (anterior), and lateral columns. Each column of the spinal
cord contains ascending and descending tracts, or pathways. Ascending tracts consist of
axons that conduct action potentials toward the brain, and descending tracts consist of
axons that conduct action poten-tials away from the brain. Ascending tracts and descending
tracts are discussed more fully in “Sensory Functions” and “Motor Functions” later.

The gray matter of the spinal cord is shaped like the letter H, with posterior
horns and anterior horns. Small lateral horns exist in levels of the cord associated with
the autonomic nervous system. Thecentral canal is a fluid-filled space in the center of the
cord.

 Spinal nerves arise from numerous rootlets along the dorsal and ventral surfaces of
the spinal cord (figure 8.16a). The ventral rootlets combine to form a ventral root on the
ventral (anterior) side of the spinal cord, and the dorsal rootlets combine to form a dorsal
root on the dorsal (posterior) side of the cord at each seg-ment. The ventral and dorsal roots
unite just lateral to the spinal cord to form a spinal nerve. The dorsal root contains a
ganglion, called the dorsal root ganglion (gang′ glē-on; a swelling or knot).

 The cell bodies of pseudo-unipolar sensory neurons are in the dorsal root ganglia .
The axons of these neurons originate in the periphery of the body. They pass through spinal
nerves and the dorsal roots to the posterior horn of the spinal cord gray matter. In the
posterior horn, the axons either synapse with interneurons or pass into the white matter and
ascend or descend in the spinal cord.
  The cell bodies of motor neurons, which regulate the activi-ties of muscles and
glands, are located in the anterior and lateral horns of the spinal cord gray matter. Somatic
motor neurons are in the anterior horn, and autonomic neurons are in the lateral horn. 

Axons from the motor neurons form the ventral roots and pass into the spinal nerves.
Thus, the dorsal root contains sensory axons, and the ventral root contains motor axons.
Each spinal nerve therefore has both sensory and motor axons.

 An example of a converging pathway involves a motor neuron in the spinal cord that
stimulates muscle contraction (figure 8.17a). Sensory fibers from pain receptors carry action
potentials to the spinal cord and synapse with interneurons, which in turn synapse with a
motor neuron. Neurons in the cerebral cortex, controlling conscious movement, also
synapse with the same motor neuron by way of axons in descending tracts. Both the
interneurons and the neurons in the cerebral cortex have axons that converge on the motor
neuron, which can therefore be stimulated either through the reflex arc or by conscious
thought.

 An example of a diverging pathway involves sensory neurons within the spinal cord .
The axon of a sensory neu- ron carrying action potentials from pain receptors branches
within the spinal cord. One branch produces a reflex response by synaps-ing with an
interneuron. The interneuron, in turn, synapses with a motor neuron, which stimulates a
muscle to withdraw the injured region of the body from the source of the pain. The other
branch synapses with an ascending neuron that carries action potentials through a nerve
tract to the brain, where the stimulation is inter-preted as pain.

Spinal Cord Reflexes

Knee-Jerk Reflex
The simplest reflex is the stretch reflex, in which muscles contract in response to a
stretching force applied to them. The knee-jerkreflex, orpatellar reflex(figure 8.18), is a
classic example of thestretch reflex. When the patellar ligament is tapped, the quadriceps
femoris muscle tendon and the muscles themselves are stretched. Sensory receptors within
these muscles are also stretched, and the stretch reflex is activated. Consequently,
contraction of the muscles extends the leg, producing the characteristic knee-jerk response.

Clinicians use the knee-jerk reflex to determine if the higher CNS centers that
normally influence this reflex are functional. Descending neurons within the spinal cord
synapse with the neu-rons of the stretch reflex and modulate their activity. This activity is
important in maintaining posture and in coordinating muscular activity. Following a severe
spinal cord injury, all spinal reflexes are lost below the level of injury. By about 2 weeks after
the injury, the knee-jerk reflex returns, but it is often exaggerated. When the stretch reflex is
absent or greatly exaggerated, it indicates that the neurons within the brain or spinal cord
that modify this reflex have been damaged.

Withdrawal Reflex

The function of the withdrawal reflex, or flexor reflex, is to remove a limb or another

body part from a painful stimulus. The sensory receptors are pain receptors . Following
painful stimuli, sensory neurons conduct action potentials through the dorsal root to the
spinal cord, where the sensory neurons synapse with interneurons, which in turn synapse
with motor neurons (figure 8.19). These neurons stimulate muscles, usually flexor mus-cles,
that remove the limb from the source of the painful stimulus.

THE EAR

The ear consists of three areas: the outer ear, the mid-dle ear, and the inner ear (Fig.
9–7). The ear contains the receptors for two senses: hearing and equilib-rium. These
receptors are all found in the inner ear.

OUTER EAR

The outer ear consists of the auricle and the ear canal. The auricle, or pinna, is made of
cartilage cov-ered with skin. For animals such as dogs, whose ears are movable, the auricle
may act as a funnel for sound waves. For people, however, the flat and stationary auricle is
not important. Hearing would not be nega-tively affected without it, although those of us who
wear glasses would have our vision impaired without our auricles. The ear canal is lined
with skin that con-tains ceruminous glands. It may also be called theexternal auditory
meatus, and is a tunnel into the temporal bone, curving slightly forward and down.

MIDDLE EAR

The middle ear is an air-filled cavity in the temporal bone. The eardrum, or tympanic

membrane, is stretched across the end of the ear canal and vibrates when sound waves
strike it. These vibrations are transmitted to the three auditory bones: the malleus, incus,
and stapes (see Fig. 9–7). The stapes then transmits vibrations to the fluid-filled inner ear at
the oval window.
The eustachian tube (auditory tube) extends from the middle ear to the nasopharynx and
permits air to enter or leave the middle ear cavity. The air pressure in the middle ear must be
the same as the external atmospheric pressure in order for the eardrum to vibrate properly.
You may have noticed your ears “popping” when in an airplane or when driving to a higher or
lower altitude. Swallowing or yawning cre-ates the “pop” by opening the eustachian tubes
and equalizing the air pressures.

The eustachian tubes of children are short and nearly horizontal and may permit bacteria to
spread from the pharynx to the middle ear. This is why otitis media may be a complication
of a strep throat.

INNER EAR

Within the temporal bone, the inner ear is a cavity called the bony labyrinth (a labyrinth is a
series of interconnecting paths or tunnels, somewhat like a maze but without dead ends; see
Fig. 9–7), which is lined with membrane called the membranouslabyrinth. Perilymph is the
fluid found between bone and membrane, and endolymph is the fluid within the
membranous structures of the inner ear. These struc-tures are the cochlea, concerned with
hearing, and the utricle, saccule, and semicircular canals, all concerned with equilibrium .

Cochlea 
The cochlea is shaped like a snail shell with two-and-a-half structural turns. Internally, the
cochlea is parti-tioned into three fluid-filled canals. The medial canal is the cochlear duct, the
floor of which is the basilar membrane that supports the receptors for hearing in the organ
of Corti (spiral organ). The receptors are called hair cells (their projections are not “hair,” of
course, but rather are specialized microvilli called stereocilia), which contain endings of the
cochlear branch of the 8th cranial nerve. Overhanging the hair cells is the tectorial
membrane.

The Eye - Structure, Anatomy and Physiology

THE EYE

The eye contains the receptors for vision and a refracting system that focuses light rays on
the recep-tors in the retina. We will begin our discussion, how-ever, with the accessory
structures of the eye, then later return to the eye itself and the physiology of vision.

EYELIDS AND THE LACRIMAL APPARATUS

 The eyelids contain skeletal muscle that enables the eyelids to close and cover the front of
the eyeball. Eyelashes along the border of each eyelid help keep dust out of the eyes. The
eyelids are lined with a thin membrane called the conjunctiva, which is also folded over the
white of the eye and merges with the corneal epithelium. Inflammation of this membrane,
called conjunctivitis, may be caused by allergies or by certain bacteria or viruses, and
makes the eyes red, itchy, and watery.

Tears are produced by the lacrimal glands, located at the upper, outer corner of the

eyeball, within the orbit (Fig. 9–3). Secretion of tears occurs constantly, but is increased by
the presence of irri-tating chemicals (onion vapors, for example) or dust, and in certain
emotional situations (sad or happy).

Small ducts take tears to the anterior of the eyeball, and blinking spreads the tears
and washes the surface of the eye. Tears are mostly water, with about 1% sodium chloride,
similar to other body fluids.

Tears also contain lysozyme, an enzyme that inhibits the growth of most bacteria on

the wet, warm surface of the eye. At the medial corner of the eyelids are two small openings
into the superior and inferior lacrimal canals.

These ducts take tears to the lacrimal sac (in the lacrimal bone), which leads to
the nasolacrimal duct, which empties tears into the nasal cavity. This is why crying often
makes the nose run.

EYEBALL

Most of the eyeball is within and protected by the orbit, formed by the lacrimal, maxilla,
zygomatic, frontal, sphenoid, and ethmoid bones. The six extrin-sic muscles of the eye
(Fig. 9–4) are attached to this bony socket and to the surface of the eyeball.

There are four rectus (straight) muscles that move the eyeball up and down or side to
side; the name tells you which direction. The medial rectus muscle, for example, pulls the
eyeball medially, as if to look at the nose. The two oblique (slanted) muscles rotate the eye.

The cra-nial nerves that innervate these muscles are the oculo-motor, trochlear, and
abducens (3rd, 4th, and 6th cranial nerves, respectively). The very rapid and com-plex
coordination of these muscles in both eyes is, for-tunately, not something we have to think
about.
 The convergence of both eyes on an object is very impor-tant to ensure a single
image (that is, to prevent dou-ble vision) and to give us depth perception and a three-
dimensional world.

Layers of the Eyeball

In its wall, the eyeball has three layers: the outer sclera, middle choroid layer, and
inner retina (Fig. 9–5). The sclera is the thickest layer and is made of fibrous connective
tissue that is visible as the white of the eye.

The most anterior portion is the cornea, which differs from the rest of the sclera in
that it is transparent. The cornea has no capillaries, covers the iris and pupil inside the eye,
and is the first part of the eye that refracts, or bends, light rays.

The choroid layer contains blood vessels and a dark blue pigment (derived from
melanin) that absorbs light within the eyeball and thereby prevents glare (just as does the
black interior of a camera).

The anterior portion of the choroid is modified into more specialized structures: the
ciliary body and the iris. The ciliary body (muscle) is a circular muscle that surrounds the
edge of the lens and is connected to the lens by suspensory ligaments.

The lens is made of a transparent, elastic protein, and, like the cornea, has no
capillaries. The shape of the lens is changed by the ciliary muscle, which enables the eye to
focus light from objects at varying distances from the eye.

Just in front of the lens is the circular iris, the col-ored part of the eye; its pigment is a form
of melanin.

What we call “eye color” is the color of the iris and is a genetic characteristic, just as skin
color is. Two sets of smooth muscle fibers in the iris change the diame-ter of the pupil, the
central opening.

Contraction of the radial fibers dilates the pupil; this is a sympathetic response.
Contraction of the circular fibers constricts the pupil; this is a parasympathetic response
(oculo-motor nerves). Pupillary constriction is a reflex that protects the retina from intense
light or that permits more acute near vision, as when reading.

The retina lines the posterior two-thirds of the eyeball and contains the visual receptors, the
rods and cones (Fig. 9–6). Rods detect only the presence of light, whereas cones detect
colors, which, as you may know from physics, are the different wavelengths of visible light.
Rods are proportionally more abundant toward the periphery, or edge, of the retina. Our best
vision in dim light or at night, for which we depend on the rods, is at the sides of our visual
fields.

Cones are most abundant in the center of the retina, espe-cially an area called
the macula lutea directly behind the center of the lens on what is called the visual axis.
 The fovea, which contains only cones, is a small depression in the macula and is the area
for best color vision. 

An important cause of vision loss for people over 65 years of age is age-related macular
degeneration (AMD), that is, loss of central vision, and some cases seem to have a genetic
component. In the dry form of AMD, small fatty deposits impair circulation to the macula, and
cells die from lack of oxygen. In the wet form of AMD, abnormal blood vessels begin leaking
into the retina, and cells in the macula die from the damaging effects of blood outside its
vessels. The macula, the center of the visual field, is the part of

the retina we use most: for reading, for driving, for recognizing people, and for any kind of
close work. People of all ages should be aware of this condition and that smoking and
exposure to ultraviolet rays are risk factors.

When light strikes the retina, the rods and cones generate impulses. These impulses are
carried by gan-glion neurons, which all converge at the optic disc(see Figs. 9–5 and 9–6)
and pass through the wall of the eyeball as the optic nerve. There are no rods or cones in
the optic disc, so this part of the retina is sometimes called the “blind spot.” We are not
aware of a blind spot in our field of vision, however, in part because the eyes are constantly
moving, and in part because the brain “fills in” the blank spot to create a “complete” picture.

Cavities of the Eyeball

There are two cavities within the eye: the posterior cavity and the anterior cavity. The
larger, posterior cavity is found between the lens and retina and con-tains vitreous
humor (or vitreous body). This semi-solid substance keeps the retina in place. If the eyeball
is punctured and vitreous humor is lost, the retina may fall away from the choroid; this is one
possible cause of a detached retina.

The anterior cavity is found between the back of the cornea and the front of the
lens, and contains aqueous humor, the tissue fluid of the eyeball. Aqueous humor is formed
by capillaries in the ciliary body, flows anteriorly through the pupil, and is reab-sorbed by
the canal of Schlemm (small veins also called the scleral venous sinus) at the junction of
the iris and cornea. Because aqueous humor is tissue fluid, you would expect it to have a
nourishing function, and it does. Recall that the lens and cornea have no capil-laries; they
are nourished by the continuous flow of aqueous humor.

Anatomy of the Extraocular Muscles1 2 3

There are six muscles (per eye) responsible for generating all movements of the eyes in
their bony orbits:

 Lateral Rectus (LR)

 Medial Rectus (MR)
 Superior Rectus (SR)
 Inferior Rectus (IR)
 Superior Oblique (SO)
 Inferior Oblique (IO)

When considered together, with the exception of the inferior oblique, these muscles take on
the shape of a cone. They attach to the eye at one end (opening of the cone) and converge
upon a tendenous ring called the annulus of Zinn (vertex of the cone). This can be seen in
figure 1, along with the inferior oblique's attachment to the nasal portion of the bony orbit.

The superior rectus and superior oblique muscles attach to the top of the eye. The inferior
rectus and inferior oblique attach to the bottom of the eye. The lateral rectus and medial
rectus attach the sides furthest from and closest to the nose, respectively. Despite the
superior oblique belonging to the cone, it takes an indirect route before joining the other
EOM at the annulus of Zinn; the SO attaches to the top of the eye, passes through a fibrous
ring, called the "trochlea," and then converges with the other EOM .

Agonist/Antagonist Pairs in the Same Eye

1. Lateral Rectus vs. Medial Rectus

2. Superior Rectus vs. Inferior Rectus
3. Superior Oblique vs. Inferior Oblique

We have already seen the pairings (albeit without the agonist/antagonist terminology) when
considering both eyes in our discussion of the cardinal directions of gaze (figures 3 - 10).
The table below summarizes the agonist pairs when considering both eyes, for your
reference:

TABLE . The paired agonist muscles across both eyes.

Right Eye Left Eye Movement

Lateral Rectus Medial Rectus Move the globe to the right

Medial Rectus Lateral Rectus Move the globe to the left

Superior Rectus Inferior Oblique Move the globe upward

Inferior Oblique Superior Rectus Move the globe upward

Superior Oblique Inferior Rectus Move the globe downward

Inferior Rectus Superior Oblique Move the globe downward

PHYSIOLOGY OF VISION

For us to see, light rays must be focused on the retina, and the resulting nerve
impulses must be trans-mitted to the visual areas of the cerebral cortex in the brain

Refraction of light rays is the deflection or bend-ing of a ray of light as it passes

through one object and into another object of greater or lesser density. The refraction of light
within the eye takes place in the fol-lowing pathway of structures: the cornea, aqueous
humor, lens, and vitreous humor. The lens is the only adjustable part of the refraction
system. When looking at distant objects, the ciliary muscle is relaxed and the lens is
elongated and thin. When looking at near objects, the ciliary muscle contracts to form a
smaller circle, the elastic lens recoils and bulges in the middle, and has greater refractive
power.

When light rays strike the retina, they stimulate chemical reactions in the rods and
cones. In rods, the chemical rhodopsin breaks down to form scotopsin and retinal (a
derivative of vitamin A). This chem-ical reaction generates an electrical impulse, and
rhodopsin is then resynthesized in a slower reaction. Adaptation to darkness, such as going
outside at night, takes a little while because being in a well-lit area has broken down most of
the rhodopsin in the rods, and resynthesis of rhodopsin is slow. The opposite situa-tion,
perhaps being suddenly awakened by a bright light, can seem almost painful. What happens
is this: In darkness the rods have resynthesized a full supply of rhodopsin, and the sudden
bright light breaks down all the rhodopsin at the same time. The barrage of impulses
generated is very intense, and the brain may interpret any intense sensation as pain. A few
minutes later the bright light seems fine because the rods are recycling their rhodopsin
slowly, and it is not breaking down all at once.

Chemical reactions in the cones, also involving retinal, are brought about by different
wavelengths of light. It is believed that there are three types of cones: red-absorbing, blue-
absorbing, and green-absorbing cones. Each type absorbs wavelengths over about a third of
the visible light spectrum, so red cones, for example, absorb light of the red, orange, and
yellow wavelengths. The chemical reactions in cones also generate electrical impulses.

The impulses from the rods and cones are trans-mitted to ganglion neurons (see
Fig. 9–6); these con-verge at the optic disc and become the optic nerve, which passes
posteriorly through the wall of the eye-ball. Ganglion neurons also seem to have a photo-
receptor chemical (called melanopsin) that may contribute to the daily resetting of our
biological clocks.

The optic nerves from both eyes come together at the optic chiasma (or chiasm),
just in front of the pituitary gland (see Fig. 8–11). Here, the medial fibers of each optic nerve
cross to the other side. This cross-ing permits each visual area to receive impulses from
both eyes, which is important for binocular vision.

ANATOMY AND HISTOLOGY OF THE DIGESTIVE SYSTEM

 The digestive system consists of the digestive tract, or gastro-intestinal (GI; gas′trō-
in-tes′tin-ăl) tract, plus specific associatedorgans. Because the digestive tract is open at the
mouth and anus, the inside of the tract is continuous with the outside environment, and food
entering the digestive tract may contain not only useful nutrients but also indigestible
components such as fiber, or harmful materials such as bacteria.

Therefore, the inner lining of the diges-tive tract serves as a protective barrier to
those indigestible and harmful materials and nutrients must be specifically transported
across the wall of the digestive tract. Once across the wall of the digestive tract, the nutrients
enter the circulation to access tissues of the body.

  The digestive tract consists of the oral cavity, pharynx, esophagus, stomach,
small intestine, large intestine, and anus. Accessory glands are associated with the
digestive tract . The salivary glands empty into the oral cavity, and the liver and pancreas are
connected to the small intestine.

The mouth is concerned with the reception of food and leads to the buccal cavity or
oral cavity . Mechanical digestion is initiated in the buccal cavity by chewing with the help of
teeth and tongue. Chemical digestion is through salivary enzymes secreted by the salivary
glands.

For our purpose the digestive system may be divided into two groups of organs:

1. The digestive tract, a continuous passageway beginning at the mouth, where food is
taken in, and terminating at the anus, where the solid waste products of digestion are
expelled from the body.

2. The accessory organ, which are necessary for the digestive process but are not a direct
part of the digestive tract. They release substances into the digestive tract through ducts.

Anatomy of the oral Cavity

The oral cavity or mouth, is the first part of the diges-tive tract. It is bounded by the lips and
cheeks and contains the teethand tongue. The lips are muscular structures, formed mostly
by theorbicularis oris  muscle .

The outer surfaces of the lips are covered by skin. The keratinized strati-fied
epithelium of the skin becomes thin at the margin of the lips. The color from the underlying
blood vessels can be seen through the thin, transparent epithelium, giving the lips a reddish-
pink appearance.

At the internal margin of the lips, the epithelium is continuous with the moist stratified
squamous epithelium of the mucosa in the oral cavity.

 The cheeks form the lateral walls of the oral cavity. The bucci-nator muscles (located
within thecheeks, flatten the cheeks against the teeth. The lips and cheeks are important in
the process of mastication or chewing. 
 They help manipulate the food within the oral cavity and hold the food in place while
the teeth crush or tear it. Mastication begins the process of mechanical digestion, which
breaks down large food particles into smaller ones. The cheeks also help form words during
the speech process.

 The tongue is a large, muscular organ that occupies most of the oral cavity. The
major attachment of the tongue is in the posterior part of the oral cavity. The anterior part of
the tongue is relatively free, except for an anterior attachment to the floor of the mouth by a
thin fold of tissue called the frenulum . . The anterior two-thirds of the tongue is covered by
papillae, some of which contain taste buds . The posterior one-third of the tongue is devoid
of papillae and has only a few scattered taste buds. In addition, the posterior portion does
contain a large amount of lymphatic tissue, which helps form the lingual tonsil .

 The tongue moves food in the mouth and, in cooperation with the lips and cheeks,
holds the food in place during mastication. It also plays a major role in the process of
swallowing. In addition, the tongue is a major sensory organ for taste, as well as one of the
major organs of speech.

Teeth

There are 32 teeth in the normal adult mouth, located in the mandible and maxillae.
The teeth can be divided into quadrants:right upper, left upper, right lower, and left lower. In
adults, each quadrant contains one central and one lateral incisor one canine , first and
second premolars , and first, second, and third molars . The third molars are
called wisdom teeth because they usually appear in the late teens or early twenties, when
the person is old enough to have acquired some degree of wisdom.

The teeth of adults are called permanent teeth, or second-ary teeth .Most of them

are replacements for the20 primary teeth, or deciduous  teeth, also called milk or baby
teeth, which are lost during childhood .

 Each tooth consists of a crown with one or more cusps (points), a neck, and

a root . The center of the tooth is a pulp cavity, which is filled with blood vessels, nerves,
and connective tissue, called pulp. The pulp cavity is surrounded by a living, cellular,
bonelike tissue called dentin . The dentin of the tooth crown is covered by an extremely
hard, acellular substance called enamel, which protects the tooth against abrasion and acids
produced by bacteria in the mouth. The surface of the dentin in the root is covered
with cementum , which helps anchor the tooth in the jaw.

The teeth are rooted within alveoli along the alveolar processes of the mandible and
maxillae. The alveo-lar processes are covered by dense fibrous connective tissue and moist
stratified squamous epithelium, referred to as the gingiva , or gums.

The teeth are held in place by periodontal , around the teeth) ligaments, which are
con-nective tissue fibers that extend from the alveolar walls and are embedded into the
cementum.

  Formation of dental caries , or tooth decay, is the result of the breakdown of enamel
by acids produced by bacteria on the tooth surface. Enamel is nonliving and cannot repair
itself. Consequently, a dental filling is necessary to prevent further dam-age. 

Periodontal disease is inflammation and degeneration of the periodontal ligaments,

gingiva, and alveolar bone. This disease is the most common cause of tooth loss in adults.

Palate and Tonsils

The palate (pal′ ăt), or roof of the oral cavity, separates the oral cavity from the nasal
cavity and prevents food from passing into the nasal cavity during chewing and swallowing.
The palate consists of two parts. The anterior part contains bone and is called
the hardpalate, whereas the posterior portion consists of skeletal muscle andconnective
tissue and is called the soft palate . The uvula (ū′vū-lă; a grape) is a posterior extension of
the soft palate.

 The tonsils (ton′ silz) are located in the lateral posterior walls of the oral cavity, in
the nasopharynx, and in the posterior surface of the tongue.
Salivary Glands

There are three major pairs of salivary glands: the parotid, submandibular, and

sublingual glands .A con-siderable number of other salivary glands are scattered throughout
the oral cavity, including on the tongue. Salivary glands produce saliva, which is a mixture
of serous (watery) and mucous fluids. The salivary glands are compound alveolar glands.
They have branching ducts with clusters of alveoli, resembling grapes, at the ends of the
ducts .

The largest of the salivary glands, the parotid glands, are serous glands located just
anterior to each ear. Parotid ducts enter the oral cavity adjacent to the second upper molars.

  Mumps  is an inflammation of the parotid glandcaused by a viral infection. The

inflamed parotid glands become swollen, often making the cheeks quite large. The virus
causing mumps can also infect other structures. Mumps in an adult male may involve the
testes and can result in sterility.

  The submandibular glands produce more serous than mucous secretions. Each

glandcan be felt as a soft lump along the inferior border of the mandible. The submandibular
ducts open into the oral cavity on each side of the frenulum of the tongue .

 The sublingual glands, the smallest of the three paired salivary glands, produce

primarily mucous secretions. They lie immediately below the mucous mem-brane in the floor
of the oral cavity. Each sublingual gland has 10–12 small ducts opening onto the floor of the
oral cavity.

The sublingual (sŭb-ling′ gwăl; below the tongue) glands, the smallest of the three

paired salivary glands, produce primarily mucous secretions. They lie immediately below
the mucous mem-brane in the floor of the oral cavity. Each sublingual gland has 10–12 small
ducts opening onto the floor of the oral cavity.
 Wharton’s duct and Bartholin’s duct or duct of Rivinis respectively in above
figure. The salivary juice secreated by the salivary glands reaches the mouth through these
ducts. The daily secretion of saliva from salivary glands ranges from 1000 to 1500mL

Saliva

Saliva (să-lı̄ ′ vă) helps keep the oral cavity moist and containsenzymes that begin
the process of digestion. Saliva is secreted at the rate of approximately 1 liter (L) per day.
The serous part of saliva, produced mainly by the parotid and submandibular glands,
contains a digestive enzyme called salivary amylase , which breaks the covalent bonds
between glucose molecules in starch and other polysaccharides to produce the
disaccharides maltose and isomaltose. Maltose and isomaltose have a sweet taste; thus, the
digestion of polysaccharides by salivary amylase enhances the sweet taste of food.

Pharynx

The pharynx or throat, which connects the mouth with the esophagus, consists of
three parts: the nasopharynx, the oro-pharynx, and the laryngopharynx . Normally, only the
oropharynx and laryngopharynx transmit food.

The posterior walls of the oropharynx and laryngopharynx are formed by the
superior, middle, and inferior pharyngeal constrictor muscles.

Esophagus
 The esophagus (̄gullet) is a muscular tube, lined with moist stratified squamous
epithelium, that extends from the pharynx to the stomach. It is about 25 centimeters (cm)
long and lies anterior to the vertebrae and posterior to the trachea within the mediastinum.

The upper two-thirds of the esophagus has skeletal muscle in its wall, while the lower
one-third has smooth muscle in its wall. It passes through the diaphragm and ends at the
stomach.

The esophagus transports food from the pharynx to the stomach. Upper and
lower esophageal sphincters, located at the upper and lower ends of the esophagus,
respectively, regulate the movement of food into and out of the esophagus.

The lower esophageal sphincter is sometimes called the cardiac

sphincter. Numerous mucous glands produce a thick, lubricating mucus that coats the inner
surface of the esophagus.

Anatomy of the Stomach

The stomach is an enlarged segment of the digestive tract in the left superior part of
the abdomen. The opening from the esophagus into the stomach is called
the gastroesophageal opening. The region of the stomach around the gastroesophageal
opening is called the cardiac region because it is near the heart. The most supe-rior part of
the stomach is the fundus .

The largest part of the stomach is the body, which turns to the right, forming
a greatercurvature on the left and a lesser curvature on the right. The opening from the
stomach into the small intestine is the pyloric  opening, which is surrounded by a relatively
thick ring of smooth muscle called the pyloric sphincter. The region of the stomach near
the pyloric opening is the pyloric region.

The muscular layer of the stomach is different from other regions of the digestive
tract in that it consists of three layers: an outer longitudinal layer, a middle circular layer, and
an inner oblique layer. These muscular layers produce a churning action in the stomach,
important in the digestive process.

The submucosa and mucosa of the stomach are thrown into large folds called rugae 
when the stomach is empty. These folds allow the mucosa and submucosa to stretch, and
the folds disappear as the stomach is filled.

 The stomach is lined with simple columnar epithelium. The mucosal surface forms
numerous tubelike gastric pits ,which are the openings for the gastric glands. The
epithelial cells of the stomach can be divided into five groups.

The first group consists of surface mucous cells on the inner surface of the
stomach and lining the gastric pits. Those cells produce mucus, which coats and protects the
stomach lining. The remaining four cell types are in the gastric glands.

They are

1.         mucous neck cells, which produce mucus;

2.         parietal cells, which produce hydrochloric acid andintrinsic factor;
3.         endocrine cells, which produce regulatory chemicals; and
4.         chief cells, which produce pepsinogen . aprecursor of the protein-digesting
enzyme pepsin .
 Anatomy of the Small intestine
The small intestine is about 6 meters (m) long and consists of three parts: the
duodenum, the jejunum, and the ileum . The duodenum . is about 25 cm long(the
term duodenum means 12, suggesting that it is 12 in. long). The jejunum . is about 2.5 m
long and makes up two-fifths of the total length of the small intestine. The ileum . is about
3.5 m long and makes up three-fifths of the small intestine.

The duodenum nearly completes a 180-degree arc as it curves within the abdominal
cavity. Part of the pancreas lies within this arc. The common bile duct from the liver and
the pancreatic duct from the pancreas join and empty into the duo-denum .

The small intestine is the major site of digestion and absorption of food, which are
accomplished due to the presence of a large surface area. The small intestine has three
modifications that increase its surface area about 600-fold: circular folds, villi, and microvilli.
The mucosa and subm ucosa form a series of circular folds that run perpendicular to the
long axis of the digestive tract. Tiny, fingerlike projections of the mucosa form
numerous villi  which are 0.5–1.5 mm long .

Each villus is covered by simple columnar epithelium. Within the lMost of the cells
composing the surface of the villi have numerous cytoplasmic extensions, called microvilli .
  The mucosa of the small intestine is simple columnar epi-thelium with four
major cell types: (1) absorptive cells, which have microvilli, produce digestive enzymes,
and absorb digested food; (2) goblet cells, which produce a protective mucus;(3) granular
cells, which may help protect the intestinal epi-thelium from bacteria; and (4) endocrine
cells, which produce regulatory hormones.

 The epithelial cells are located within tubular glands of the mucosa, called intestinal
glands or crypts of Lieberkühn, at the base of the villi. Granular and endocrine cells are
located in the bottom of the glands. The submucosa of the duodenum contains mucous
glands, called duodenal glands, which open into the base of the intestinal glands.

 The duodenum, jejunum, and ileum are similar in structure. However, progressing
from the duodenum through the ileum, there are gradual decreases in the diameter of the
small intestine, in the thickness of the intestinal wall, in the number of circular folds, and in
the number of villi. Lymphatic nodules are common along the entire length of the digestive
tract, and clusters of lym-phatic nodules, called Peyer patches, are numerous in the ileum.
These lymphatic tissues help protect the intestinal tract from harmful pathogens.

The site where the ileum connects to the large intestine is called
the ileocecal  junction. It has a ring of smooth muscle, the ileocecal sphincter, and
an ileocecal valve which allow the intestinal contents to move from the ileum to the large
intestine, but not in the opposite direction.

The large intestine consists of the cecum, colon, rectum, and anal canalCecum.

The cecum is the proximal end of the large intestine where it joins with the small intestine at
the ileocecal junction. The cecum is located in the right lower quadrant of the abdomen near
the iliac fossa. The cecum is a sac that extends inferiorly about 6 cm past the ileocecal
junction. Attached to the cecum is a tube about 9 cm long called the appendix.

Colon

The colon is about 1.5–1.8 m long and consists of four parts: the ascending colon, the
transverse colon, the descending colon, and the sigmoid colon (figure 16.21).
The ascending colon extends superiorly from the cecum to the right colic flexure, near the
liver, where it turns to the left. The transverse colon extends from the right colic flexure to
the left colic flexure near the spleen, where the colon turns inferiorly; and the descending
colon extends from the left colic flexure to the pelvis, where it becomes the sigmoid
colon. The sigmoid colon forms an S-shaped tube that extends medially and then inferiorly
into the pelvic cavity and ends at the rectum.

 The mucosal lining of the colon contains numerous straight, tubular glands
called crypts, which contain many mucus-producing goblet cells. The longitudinal smooth
muscle layer of the colon does not completely envelop the intestinal wall but forms three
bands called teniae coli . 

Rectum

The rectum is a straight, muscular tube that begins at the termina-tion of the sigmoid colon
and ends at the anal canal (figure 16.21). The muscular tunic is composed of smooth muscle
and is relatively thick in the rectum compared to the rest of the digestive tract.

Anal Canal

The last 2–3 cm of the digestive tract is the anal canal. It begins at the inferior end of
the rectum and ends at the anus (external diges-tive tract opening). The smooth muscle
layer of the anal canal is even thicker than that of the rectum and forms the internal
analsphincter at its superior end. The external anal sphincter at theinferior end of the anal
canal is formed by skeletal muscle.

 Hemorrhoids are enlarged or inflamed rectal, or hemor-rhoidal, veins that supply

the anal canal. Hemorrhoids may cause pain, itching, and/or bleeding around the anus.
Treatments include increasing bulk (indigestible fiber) in the diet, taking sitz baths, and using
hydrocortisone suppositories. Surgery may be necessary if the condition is extreme and
does not respond to other treatments.

Anatomy of the liver

  The liver weighs about 1.36 kilograms (kg) (3 lb) and is located in the right upper
quadrant of the abdomen, tucked against the inferior surface of the diaphragm. The posterior
surface of the liver is in contact with the right ribs 5–12. It is divided into two major lobes,
the right lobe and the left lobe, which are separated by a connective tissue septum,
the falciform ligament. 
 Two smaller lobes, the caudate (having a tail) lobe and the quadrate  lobe, can be
seen from an inferior view. Also seen from the infe-rior view is the porta, which is the “gate”
through which blood vessels, ducts, and nerves enter or exit the liver.

 The liver receives blood from two sources . The hepatic (associated with the
liver) artery takes oxygen-rich blood to the liver, which supplies liver cells with oxygen.
The hepatic portal vein carries blood that is oxygen-poor but rich in absorbed nutrients and
other substances from the digestive tract to the liver.

Liver cells process nutrients and detoxify harmful substances from the blood. Blood
exits the liver through hepatic veins, which empty into the inferior vena cava.

Many delicate connective tissue septa divide the liver into lobules with portal triads
at their corners. The portal triads contain three structures: the hepatic artery, the hepatic
portal vein, and the hepatic duct . 

Hepatic cords, formed by plate like groups of cells called hepatocytes , are located

between the centre and the margins of each lobule. The hepatic cords are separated from
one another by blood channels called hepatic sinusoids (resembling cavities).

The sinusoid epithelium contains phagocytic cells that help remove foreign particles
from the blood. Blood from the hepatic portal vein and the hepatic artery flows into the
sinusoids and mixes together.

The mixed blood flows toward the centre of each lobule into acentral vein. The
central veins from all the lobes unite to form the hepatic veins, which carry blood out of the
liver to the inferior vena cava.

A system of ducts from the liver to the duodenum serves as a pathway for bile and
other secretions . A cleftlike lumen, the bile canaliculus , is between the cells of each
hepatic cord. Bile, produced by the hepatocytes, flows through the bile canaliculi to the
hepatic ducts in the portal triads.

The hepatic ducts converge and empty into the right and left hepatic ducts, which
transport bile out of the liver. The right and left hepatic ducts unite to form a single common
hepatic duct.

 The gallbladder, a pear-shaped, hollow, saclike organ, 7.5 to 10 cm (3 to 4 in) long,

lies in a shallow depression on the inferior sur-face of the liver, to which it is attached by
loose connective tissue. The capacity of the gallbladder is 30 to 50 mL of bile. Its wall is
composed largely of smooth muscle. The gallbladder is connected to the common bile duct
by the cystic duct

The common bile duct joins the pancreatic duct and opens into the duodenum at
the duodenal papilla . The opening into the duodenum is regulated by a sphincter.

Apart from bile secretion, the liver also performs several functions
 
1.     Destroys aging and defective blood cells
 
2.     Stores glucose in the form of glycogen or disperses glucose into the blood stream with
the help of pancreatic hormones
 
3.     Stores fat soluble vitamins and iron
 
4.     Detoxifies toxic substances.
 
5.     Involves in the synthesis of non-essential amino acids and urea.

 THE PANCREAS

The pancreas, located in the upper abdomen, has endocrine as well

as exocrine functions . The secretion of pancreatic enzymes into the gastrointestinal tract
through the pancreatic duct represents its exocrine function. The secretion of insulin,
glucagon, and somatostatin directly into the bloodstream represents its endocrine function.

Exocrine Pancreas
The secretions of the exocrine portion of the pancreas are collected in the pancreatic
duct, which joins the common bile duct and enters the duodenum at the ampulla of Vater.
Surrounding the ampulla is the sphincter of Oddi, which partially controls the rate at which
secretions from the pancreas and the gallbladder enter the duodenum.
The secretions of the exocrine pancreas are digestive enzymes high in protein
content and an electrolyte-rich fluid. The secretions are very alkaline because of their high
concentration of sodium bicarbonate and are capable of neutralizing the highly acid gastric
juice that enters the duodenum. The enzyme secretions include amylase, which aids in the
digestion of carbohy-drates; trypsin, which aids in the digestion of proteins; and lipase,
which aids in the digestion of fats. Other enzymes thatpromote the breakdown of more
complex foodstuffs are also secreted.

Hormones originating in the gastrointestinal tract stimulate the secretion of these

exocrine pancreatic juices. Secretin is the major stimulus for increased bicarbonate
secretion from the pan-creas, and the major stimulus for digestive enzyme secretion is the
hormone CCK-PZ. The vagus nerve also influences exocrine pancreatic secretion.

Endocrine Pancreas
The islets of Langerhans, the endocrine part of the pancreas, are collections of cells
embedded in the pancreatic tissue. They are com-posed of alpha, beta, and delta cells. The
hormone produced by the beta cells is called insulin; the alpha cells secrete glucagon and
the delta cells secrete somatostatin.

INSULIN
A major action of insulin is to lower blood glucose by permitting entry of the glucose
into the cells of the liver, muscle, and other tissues, where it is either stored as glycogen or
used for energy. Insulin also promotes the storage of fat in adipose tissue and the synthesis
of proteins in various body tissues. In the absence of insulin, glucose cannot enter the cells
and is excreted in the urine. This condition, called diabetes mellitus, can be diagnosed by
high levels of glucose in the blood. In diabetes mellitus, stored fats and protein are used for
energy instead of glucose, with consequent loss of body mass. The level of glucose in the
blood normally regulates the rate of insulin secretion from the pancreas.
GLUCAGON
The effect of glucagon (opposite to that of insulin) is chiefly to raise the blood glucose
by converting glycogen to glucose in the liver. Glucagon is secreted by the pancreas in
response to a decrease in the level of blood glucose.

SOMATOSTATIN
Somatostatin exerts a hypoglycemic effect by interfering with re-lease of growth
hormone from the pituitary and glucagon from the pancreas, both of which tend to raise
blood glucose levels.

The Peritoneum

The abdominal cavity is lined with a thin, shiny serous membrane that also covers
most of the abdominal organs .The portion of this membrane that lines the abdomen is
called the parietal peritoneum; that covering the organ is called the visceral peritoneum.

In addition to these single layered portions of the peritoneum there are a number of
double-layered structures that carry blood vessels, lymph vessels, and nerves, and
sometimes act as ligaments supporting the organs. The mesentery is a double-layered
portion of the peritoneum shaped somewhat like a fan. The handle portion is attached to the
back wan, and the expanded long edge is attached to the small intestine.

Between the two layers of membrane that fOl1ll the mesentery are the blood vessels,
lymphatic vessels, and nerves that supply the intestine. The section of the peritoneum that
extends from the colon to the back wall is the mesocolon. A large double layer of the
peritoneum containing much fat hangs like an apron over the front of the intestine.

This greater omentum extends from the lower border of the stomach into the pelvic
part of the abdomen and then loops back up to the transverse colon. There is also a smaller
membrane, called the lesser omentum that extends between the stomach and the liver.

URINARY SYSTEM

ANATOMY OF THE KIDNEYS

The kidneys are bean-shaped organs, each about the size of a tightly clenched fist.

They lie on the posterior abdominal wall, behind the peritoneum, with one kidney on each
side of the vertebral column .

Structures that are behind the peritoneum are said to be retroperitoneal .A layer of
connective tissue called the renal (derived from the Latin word for kidney) capsule
surrounds each kidney. Around the renal capsule is a thick layer of adipose tissue, which
protects the kidney from mechanical shock.

On the medial side of each kidney is the hilum , where the renal artery and nerves
enter and where the renal vein, ureter, and lymphatic vessels exit the kidney . The hilum
opens into a cavity called the renal sinus, which contains blood vessels, part of the system
for collecting urine, and adipose tissue.

The kidney is divided into an outer cortex and an inner medul-la, which surround the

renal sinus. The bases of several cone-shaped renal pyramids are located at the boundary
between the cortex and the medulla, and the tips of the renal pyramids project toward the
center of the kidney.

A funnel-shaped structure called a calyx , surrounds the tip of each renal pyramid.
The calyces from all the renal pyramids join to form a larger funnel called the renal
pelvis. The renal pelvis then narrows to form a small tube, the ureter , which exits the
kidney and connects to the urinary bladder. Urine passes from the tips of the renal pyramids
into the calyces. From the calyces, urine collects in the renal pelvis and exits the kidney
through the ureter .

The functional unit of the kidney is the nephron , and there are approximately
1.3 million of them in each kidney. Each nephron consists of a renal corpuscle, a proximal
convoluted tubule, a loop of Henle, and a distalconvoluted tubule . Fluid is forced into
the renal corpuscle and then flows into the proximal convoluted tubule.

From there, it flows into the loop of Henle. Each loop of Henle consists of a
descending limb and an ascending limb. The limbs are further categorized into segments:
the thin segment of the descending limb, the thin segment of the ascending limb, and the
thick segment of the ascending limb.

The descending limb extends toward the renal sinus, where it makes a hairpin turn,
and the ascending limb extends back toward the cortex. The fluid flows through the
ascending limb of the loop of Henle to the distal convoluted tubule.

Several distal convoluted tubules empty into a collectingduct, which carries the

fluid from the cortex, through the medulla.Multiple collecting ducts empty into a
single papillary duct, and the papillary ducts empty their contents into a calyx.
 The renal corpuscle and both convoluted tubules are in the renal cortex (figure 18.4).
The collecting duct and loop of Henle enter the medulla. Approximately 15% of the
nephrons, called juxtamedullary(next to the medulla) nephrons, have loops ofHenle that
extend deep into the medulla of the kidney. The other nephrons (85%), called cortical
nephrons, have loops of Henle that do not extend deep into the medulla.

 The renal corpuscle of the nephron consists of the Bowman capsule and the
glomerulus .The Bowman capsule consists of the enlarged end of the nephron, whichis
indented to form a double-walled chamber. The glomerulus . is a tuft of capillaries that
resembles a ball of yarn and lies within the indentation of the Bowman capsule.

The cavity of the Bowman capsule opens into the proximal convoluted tubule, which
carries fluid away from the capsule. The inner layer of the Bowman capsule consists of
specialized cells called podocytes , which wrap around the glomerular capillaries. The outer
layer of the Bowman capsule consists of simple squamous epithelial cells.
 
 The glomerular capillaries
have pores in their walls, and the podocytes have numerous cell processes with gaps
between them.

 The endothelium of the glomerular capillaries, the podocytes, and the basement
membrane together form a filtration membrane In the first step of urine formation, fluid,
consisting of water and solutes smaller than proteins, passes from the blood in the
glomerular capillaries through the filtration membrane into the Bowman capsule. The fluid
that passes across the filtra-tion membrane is called filtrate.

Ureters

Attached to each kidney is a tube called the ureters. Ureters transport urine from the
renal pelvis to the urinary bladder. The ureters pass between the parietal peritoneum and the
body wall to the pelvic cavity, where they enter the pelvic cavity. It is narrow at the kidney
and widen near the bladder.

The lumen of the ureters is composed of three layers:

- Innermost, Tunica Mucosa

- The middle, Tunica Muscularis (made of smooth muscle)
- The outer, Tunica Adventitia

Urinary bladder

Urinary bladder is a hollow, muscular organ that collects urine from the ureters and
store until it is excreted. It usually accumulates 300 to 400 m.l. of urine but it can expand as
much twice. It is located on the floor of the pelvic cavity and like the kidneys and ureters. It is
Retroperitoneal. In males it is anterior to the rectum and above the prostate gland. In
females, it is located somewhat lower, anterior to the uterus and upper vagina.

The wall of urinary bladder is composed of three layers:

1) Tunica mucosa, the innermost layer lined with transitional epithelium.

2) Tunica muscularis, the middle layer, three layers of smooth muscle. This collectively
called deterusor muscles.

3) Tunica serosa (Adventitia), the outer layer derived from peritoneum and covers only the
upper and lateral surfaces of the bladder.

The opening of ureters and urethra in the cavity of the bladder outline triangular area
called the trigone. At the site where the urethra leaves the bladder, the smooth muscle in
the wall of the bladder forms spiral, longitudinal and circular bundles which contract to
prevent the bladder from emptying prematurely.

These bundles function as a sphincter called Internal Urethral Sphincter

(Involuntary). Far there along the urethra in the middle membranous portion a circular
sphincter of voluntary skeletal muscle form the external urethral sphincter.

Urethra

Urethra is a tube of smooth muscle lined with mucosal layer. It joins the bladder at its
inferior surface and transport urine outside the body during urination. It is 4 C.M in female
and 12 C.M. in length in male.

In females it opens between vagina and clitoris. In male it pass through prostate,
membranous portion (pelvic diaphragm muscle), spongy portion (that pass through corpus
spongosus) and open at the tip of penis. The spongy portion joined by ducts from bulbo-
uretheral gland (Mucus secreting gland).

Blood circulation:
Blood is supplied to the kidneys by renal artery and drainage is by renal vein.
Nerve supply
- By renal plexus of autonomic nervous system.

Male Reproductive System

The male reproductive system consists of the testes (sing. testis), a series of ducts,
accessory glands, and supporting structures. The ducts include the epididymides (sing.
epididymis), the ducta deferentia (vas deferens), and the urethra. Accessory glands include
the seminal vesicles, the prostate gland, and the bulbourethral glands. Supporting structures
include the scrotum and the penis . The sperm cells are very heat-sensitive and must
develop at a temperature slightly less than normal body temperature.
 The testes, in which the sperm cells develop, are located outside the body cavity in
the scrotum, where the temperature is lower. Sperm cells travel from each testis to the
prostate gland and then empty into the urethra within the prostate gland. The urethra exits
the pelvis, passes through the penis, and opens to the outside of the body.

Scrotum

The scrotum is a saclike structure containing the testes. It is divided into right and
left internal compartments by an incomplete connective tissue septum. Externally, the
scrotum consists of skin. Beneath the skin are a layer of loose connective tissue and a layer
of smooth muscle called the dartos muscle.
  In cold temperatures, the dartos muscle contracts, causing the skin of the scrotum to
become firm and wrinkled and reducing the overall size of the scrotum. At the same time,
extensions of abdominal muscles into the scrotum, called cremaster muscles, contract .

Consequently, the testes are pulled nearer the body, and their temperature is
elevated. During warm weather or exercise, the dartos and cremaster muscles relax, the
skin of the scrotum becomes loose and thin, and the testes descend away from the body,
which lowers their temperature.

The response of the dartos and cremaster muscles is important in regulating the
temperature in the testes. If the testes become too warm or too cold, normal sperm cell
development does not occur.

Testes

 The testes or male gonads are oval organs, each about 4–5 cm long, within the
scrotum . The outer part of each testis consists of a thick, white connective tissue capsule.
Extensions of the capsule project into the interior of the testis and divide each testis into
about 250 cone-shaped lobules .

The lobules contain seminiferous  tubules, in which sperm cells develop. Delicate

connective tissue surrounding the seminiferous tubules contains clusters of endocrine cells
called interstitial cells, or Leydig cells, which secrete testosterone.
 The seminifer ous tubules contain germ cells and sustentacular cells, or Sertoli
cells Sustentacular cells are large and extend from the periphery to the lumen of the
seminiferous tubule. They nourish the germ cells and produce a number of hormones.

Ducts

After their production, sperm cells are transported through the semi-niferous tubules and a
series of ducts to the exterior of the body.

Epididymis

The seminiferous tubules of each testis empty into a tubular net-work called the rete testis .
The rete testis empties into 15–20 tubules called the efferent ductules . The efferent
ductules carry sperm cells from the testis to a tightly coiled series of threadlike tubules that
form a comma-shaped structure on the posterior side of the testis called the epididymis .
The sperm cells continue to mature within the epididymis, developing the capacity to swim
and the ability to bind to the oocyte. Sperm cells taken directly from the testes are not
capable of fertilizing oocytes, but after maturing for several days in the epididymis, the sperm
cells develop the capacity to function as gametes. Final changes in sperm cells,
calledcapacitation , occur after ejaculation of semen into the vagina and prior to fertilization.

 Ductus Deferens

The ductus deferens or vas deferens, emerges from the epididymis and ascends

along the posterior side of the testis to become associated with the blood vessels and
nerves that supply the testis. These structures form the spermatic cord Each spermatic
cord consists of the ductus defer-ens, testicular artery and veins, lymphatic vessels, and
testicular nerve. It is surrounded by the cremaster muscle and two connective tissue
sheaths.

Each ductus deferens extends, in the spermatic cord, through the abdominal wall by
way of the inguinal canal. Each ductus deferens then crosses the lateral wall of the pelvic
cavity and loops behind the posterior surface of the urinary bladder to approach the prostate
gland . The total length of the ductus deferens is about 45 cm. 

Just before reaching the prostate gland, the ductus deferens increases in diameter to
become the ampulla of the ductus deferens . The wall of the ductus deferens contains
smooth muscle, which contracts in peristaltic waves to propel the sperm cells from the
epididymis through the ductus deferens.

Seminal Vesicle and Ejaculatory Duct

 Near the ampulla of each ductus deferens is a sac-shaped gland called the seminal
vesicle .A short duct extends from the seminal vesicle to the ampulla of the ductus deferens.
The ducts from the seminal vesicle and the ampulla of the ductus deferens join at the
prostate gland to form the ejaculatory duct. Each ejaculatory duct extends into the prostate
gland and ends by joining the urethra within the prostate gland .

Urethra

The male urethra extends from the urinary bladder to the distal end of the penis .
The ure-thra can be divided into three parts: the prostatic urethra, which passes through
the prostate gland; the membranous urethra, which passes through the floor of the pelvis
and is surrounded by the external urinary sphincter; and the spongy urethra, which extends
the length of the penis and opens at its end. The urethra is a passageway for both urine and
male reproductive fluids. However, urine and the reproductive fluids do not exit the ure-thra
at the same time. While male reproductive fluids are passing through the urethra, a
sympathetic reflex causes the internal uri-nary sphincter to contract, which keeps semen
from passing into the urinary bladder and prevents urine from entering the urethra.

Penis

The penis is the male organ of copulation and func-tions in the transfer of sperm
cells from the male to the female. The penis contains three columns of erectile tissue
.Engorgement of this erectile tissue with blood causes the penis to enlarge and become firm,
a process called erection .Two columns of erectile tissue form the dorsal portion and the
sides of the penis and are called the corpora cavernosa . The third, smaller erectile column
occupies theventral portion of the penis and is called the corpus spongiosum . It expands
over the distal end of the penis to form a cap, the glans  penis. The spongy urethra passes
through the corpus spongiosum, including the glans penis, and opens to the exterior as
the external urethral orifice.

   The shaft of the penis is covered by skin that is loosely attached to the connective
tissue surrounding the penis. The skin is firmly attached at the base of the glans penis, and a
thinner layer of skin tightly covers the glans penis. The skin of the penis, espe-cially the
glans penis, is well supplied with sensory receptors. A loose fold of skin, called
the prepuce , or foreskin, covers the glans penis .

 Glands

The seminal vesicles are glands consisting of many saclike structures located next to
the ampulla of the ductus deferens There are two seminal vesicles.

Each is about 5 cm long and tapers into a short duct that joins the ampulla of the
ductus deferens to form the ejaculatory duct, as previously mentioned.

 The prostate gland consists of both glandular and muscular tissue and is about the

size and shape of a walnut . The prostate gland surrounds the urethra and the two
ejaculatory ducts. It consists of a capsule and numerous partitions. The cells lining the
partitions secrete prostatic fluid. There are 10–20 short ducts that carry secretions of the
prostate gland to the prostatic urethra.
  The bulbourethral glands, or Cowperglands, are a pair of small, mucus-secreting
glands located near thebase of the penis .In young adults, each is about the size of a pea,
but they decrease in size with age. A single duct from each gland enters the urethra.

FEMALE REPRODUCTIVE SYSTEM

The female reproductive organs consist of the ovaries, the uterine tubes (or fallopian tubes),
the uterus, the vagina, the external genitalia, and the mammary glands . The internal
reproductive organs of the female are located within the pelvis, between the urinary bladder
and the rectum . The uterus and the vagina are in the midline, with an ovary to each side of
the uterus .The internal reproductive organs are held in place within the pelvis by a group of
ligaments. The most conspicuous is the broad ligament, which spreads out on both sides of
the uterus and attaches to the ovaries and uterine tubes.

Ovaries

The two ovaries are small organs suspended in the pelvic cavity by ligaments.

The suspensory ligament extends from each ovary to the lateral body wall, and
the ovarian ligamentattaches the ovary to the superior margin of the uterus. In addition, the
ovaries are attached to the poste-rior surface of the broad ligament by folds of peritoneum
called the mesovarium . The ovarian arteries, veins, and nerves traverse the suspensory
ligament and enter the ovary through the mesovarium.

 A layer of visceral peritoneum covers the surface of the ovary. The outer part of the
ovary is composed of dense connective tissue and contains ovarian follicles (figure 19.10).
Each of the ovarian

Uterine tubes

A uterine tube, also called a fallopian  tube or oviductoviduct  is associated with

each ovary. The uterine tubes extend from the area of the ovaries to the uterus. They open
directly into the peritoneal cavity near each ovary and receive the secondary oocyte. The
opening of each uterine tube is surrounded by long, thin processes called fimbriae . 
  The fimbriae nearly surround the surface of the ovary. As a result, as soon as the
secondary oocyte is ovulated, it comes into contact with the surface of the fimbriae. Cilia on
the fimbriae surface sweep the oocyte into the uterine tube. Fertilization usually occurs in the
part of the uterine tube near the ovary, called the ampulla  The fertilized oocyte then travels
to the uterus, where it embeds in the uterine wall in a process called implantation.

Uterus

The uterus ( womb) is as big as a medium-sized pear . It is oriented in the pelvic

cavity with the larger, rounded part directed superiorly. The part of the uterus superior to the
entrance of the uterine tubes is called the fundus . The main part of the uterus is called
the body, and the narrower part, the cervix , is directed inferiorly. Internally, the uterine
cavity in the fundus and uterine body continues through the cervix as the cervical
canal, which opens into the vagina. The cervical canal is lined by mucous glands.

  The uterine wall is composed of three layers: a serous layer, a muscular layer, and a
layer of endometrium . The outer layer, called the perimetrium .or serouslayer, of the uterus
is formed from visceral peritoneum. The middle layer, called the myometrium ,
or muscularlayer, consists of smooth muscle, is quite thick, and accounts forthe bulk of the
uterine wall. The innermost layer of the uterus is the endometrium , which consists of
simple columnar epithelial cells with an underlying connective tissue layer. Simple tubular
glands, called spiral glands, are formed by folds of the endometrium. The superficial part of
the endometrium is sloughed off during menstruation.

  The uterus is supported by the broad ligament and the round ligament. In addition
to these ligaments, much support is provided inferiorly to the uterus by skeletal muscles of
the pelvic floor. If ligaments that support the uterus or muscles of the pelvic floor are
weakened, as may occur due to childbirth, the uterus can extend inferiorly into the vagina, a
condition called a prolapsed uterus. Severe cases require surgical correction.

Vagina

The vagina is the female organ of copulation; it receives the penis during

intercourse. It also allows menstrual flow and childbirth. The vagina extends from the uterus
to the outside of the body. The superior portion of the vagina is attached to the sides of the
cervix, so that a part of the cervix extends into the vagina.

   The wall of the vagina consists of an outer muscular layer and an inner mucous
membrane. The muscular layer is smooth muscle and contains many elastic fibers. Thus,
the vagina can increase in size to accommodate the penis during intercourse, and it can
stretch greatly during childbirth. The mucous membrane is moist stratified squamous
epithelium that forms a protective surface layer. Lubricating fluid passes through the vaginal
epithelium into the vagina.

 In young females, the vaginal opening is covered by a thin mucous membrane called
the hymen (membrane). In rare cases, the hymen may completely close the vaginal orifice
and it must be removed to allow menstrual flow. More commonly, the hymen is perforated by
one or several holes. The openings in the hymen are usually greatly enlarged during the first
sexual intercourse. The hymen can also be perforated or torn earlier in a young female’s life
during a variety of activities, including strenuous exercise. The condition of the hymen is
therefore an unreliable indicator of virginity.

   The region between the vagina and the anus is the clinical perineum (; area
between the thighs). The skin andmuscle of this region can tear during childbirth. To prevent
such tearing, an incision called an episiotomy is sometimes made in the clinical perineum.
Traditionally, this clean, straight incision has been thought to result in less injury, less trouble
in healing, and less pain. However, many studies report less injury and pain when no
episiotomy is performed.

Mammary Glands

The mammary ( relating to breasts) glands are the organs of milk production and

are located in the breasts . The mammary glands are modified sweat glands. Externally,
each of the breasts of both males and females has a raised nipple surrounded by a circular,
pigmented area called the areola .
  In prepubescent children, the general structure of the male and female breasts is
similar, and both males and females possess a rudimentary duct system. The female
breasts begin to enlarge during puberty, under the influence of estrogen and progesterone.
Some males also experience a minor and temporary enlargement of the breasts at puberty.
Occasionally, the breasts of a male can become permanently enlarged, a condition
called gynecomastia . Causes of gynecomastia include hormonal imbalances and the
abuse of anabolic steroids.

 Each adult female breast contains mammary glands con-sisting of usually 15–20
glandular lobes covered by adipose tissue . It is primarily this superficial adipose tissue that
gives the breast its form. Each lobe possesses a single lactiferous duct that opens
independently to the surface of the  nipple. The duct of each lobe is formed as several
smaller ducts, which originate from lobules, converge. Within a lobule, the ducts branch and
become even smaller. In the milk-producing, or lactating, mammary gland, the ends of these
small ducts expand to form secretory sacs called alveoli. Myoepithelial cells sur-round the
alveoli and contract to expel milk from the alveoli .

 The breasts are supported by suspensory ligaments that extend from the fascia over
the pectoralis major muscles to the skin over the breasts .

 The nipples are very sensitive to tactile stimulation and contain smooth muscle.
When the smooth muscle contracts in response to stimuli, such as touch, cold, and sexual
arousal, the nipple becomes erect.
Function

Spinal nerve motor functions are summarized in the table below.

ctions of the spinal nerves

Level Motor Function

C1–C6 Neck flexors

C1–T1 Neck extensors

C3, C4, C5 Supply diaphragm (mostly C4)

C5, C6 Move shoulder, raise arm (deltoid); flex elbow (biceps)

C6 Externally rotate (supinate) the arm

C6, C7 Extend the elbow and wrist (triceps and wrist extensors); pronate wrist

C7, C8 Flex wrist; supply small muscles of the hand

T1–T6 Intercostals and trunk above the waist

 ctions of the spinal nerves

Level Motor Function

T7–L1 Abdominal muscles

L1–L4 Flex thigh

L2, L3, L4 Adduct thigh; extend leg at the knee (quadriceps femoris)

L4, L5, S1 Abduct thigh; flex leg at the knee (hamstrings); dorsiflex foot (tibialis anterior); extend toes

L5, S1, S2 Extend leg at the hip (gluteus maximus); plantar flex foot and flex toes

Branches of Spinal Nerves

The spinal nerves branch into the dorsal ramus, ventral ramus, the meningeal branches, and the rami communicantes.
Intercostal Nerves

The anterior divisions of the thoracic spinal nerves (T1–T11) are called the intercostal
nerves.

Key Points
The intercostal nerves are part of the somatic nervous system. This enables them to control
the contraction of muscles, as well as provide specific sensory information regarding the skin
and parietal pleura.

Intercostal nerves connect to the appropriate ganglion in the sympathetic trunk through rami
communicantes and serve the thoracic pleura and the abdominal peritoneum.

Unlike most other anterior divisions of spinal nerves, the intercostal nerves do not form a
plexus.

Key Terms
thoracic spinal nerves: The spinal nerves emerging from the thoracic vertebrae. Branches
also exit the spine and go directly to the sympathetic chain ganglia of the autonomic nervous
system where they are involved in the functions of organs and glands in the head, neck,
thorax, and abdomen.

sympathetic trunk: Also called the sympathetic chain or gangliated cord, these are a paired
bundle of nerve fibers that run from the base of the skull to the coccyx.

abdominal peritoneum: The serous membrane that forms the lining of the abdominal
cavity. It covers most of the intra-abdominal organs. It is composed of a layer of
mesothelium supported by a thin layer of connective tissue. The peritoneum supports the
abdominal organs and serves as a conduit for their blood and lymph vessels and nerves.

The intercostal nerves are part of the somatic nervous system and arise from anterior
divisions (rami anteriores, ventral divisions) of the thoracic spinal nerves T1 to T11. The
intercostal nerves are distributed chiefly to the thoracic pleura and abdominal peritoneum.

Intercostal nerves: An image of the intercostal brachial nerves.

They differ from the anterior divisions of the other spinal nerves in that each pursues an
independent course without plexus formation.

First Thoracic Nerve

The anterior division of the first thoracic nerve divides into two branches:
The larger branch leaves the thorax in front of the neck of the first rib and enters the brachial
plexus.

The other smaller branch, the first intercostal nerve, runs along the first intercostal space
and ends on the front of the chest as the first anterior cutaneous branch of the thorax.

The Upper Thoracic Nerves (2nd–6th)

These are limited in their distribution to the parietes (wall) of the thorax. The anterior
divisions of the second, third, fourth, fifth, and sixth thoracic nerves, and the small branch
from the first thoracic, are confined to the walls of the thorax and are named thoracic
intercostal nerves.

Near the sternum, they cross in front of the internal mammary artery and transversus
thoracis muscle, pierce the intercostales interni, the anterior intercostal membranes, and
pectoralis major, and supply the integument of the front of the thorax and over the mamma,
forming the anterior cutaneous branches of the thorax.

The branch from the second nerve unites with the anterior supraclavicular nerves of the
cervical plexus.

The Lower Thoracic Nerves (7th–12th)

The seventh intercostal nerve terminates at the xyphoid process, at the lower end of the
sternum.

The anterior divisions of the seventh, eighth, ninth, tenth, and eleventh thoracic intercostal
nerves are continued anteriorly from the intercostal spaces into the abdominal wall; hence
they are named thoraco-abdominal nerves or thoracicoabdominal intercostal nerves.

The tenth intercostal nerve terminates at the umbilicus.

The twelfth (subcostal) thoracic nerve is distributed to the abdominal wall and groin.

Unlike the nerves from the autonomic nervous system that innervate the visceral pleura of
the thoracic cavity, the intercostal nerves arise from the somatic nervous system. This
enables them to control the contraction of muscles, as well as provide specific sensory
information regarding the skin and parietal pleura.

This explains why damage to the internal wall of the thoracic cavity can be felt as a sharp
pain localized in the injured region. Damage to the visceral pleura is experienced as an
unlocalized ache.

Dermatomes

A dermatome is an area of skin that is supplied by a single spinal nerve, and a myotome is a
group of muscles that a single spinal nerve root innervates.
SENSORY PATHWAY

The impulses involved in sensations follow very pre-cise pathways, which all have the
following parts:

1. Receptors—detect changes (stimuli) and generate impulses. Receptors are usually very

specific with respect to the kinds of changes they respond to. Those in the retina detect light
rays, those in the nasal cavities detect vapors, and so on. Once a spe-cific stimulus has
affected receptors, however, they all respond in the same way by generating electri-cal
nerve impulses.

2. Sensory neurons—transmit impulses from recep-tors to the central nervous system.

These sensory neurons are found in both spinal nerves and cranial nerves, but each carries
impulses from only one type of receptor.

 3. Sensory tracts—white matter in the spinal cord or brain that transmits the impulses to a
specific part of the brain.

 4. Sensory areas—most are in the cerebral cortex. These areas feel and interpret the
sensations. Learning to interpret sensations begins in infancy, without our awareness of it,
and continues through-out life.

CHARACTERISTICS OF SENSATIONS

Certain characteristics of sensations will help you understand how the sensory areas work
with informa-tion from the receptors.

1. Projection—the sensation seems to come from the area where the receptors were
stimulated. If you touch this book, the sensation of touch seems to be in your hand but is
actually being felt by your cere-bral cortex. That it is indeed the brain that feels sensations is
demonstrated by patients who feel phantom pain after amputation of a limb. After loss of a
hand, for example, the person may still feel that the hand is really there. Why does this hap-
pen? The receptors in the hand are no longer pres-ent, but the severed nerve endings
continue to generate impulses. These impulses arrive in the parietal lobe area for the hand,
and the brain does what it has always done and creates the projection, the feeling that the
hand is still there. For most amputees, phantom pain diminishes as the severed nerves heal,
but the person often experiences a phantom “presence” of the missing part. This may be
helpful when learning to use an artificial limb.

2. Intensity—some sensations are felt more distinctly and to a greater degree than are
others. A weak stimulus such as dim light will affect a small num-ber of receptors, but a
stronger stimulus, such as bright sunlight, will stimulate many more recep-tors. When more
receptors are stimulated, more impulses will arrive in the sensory area of the brain. The
brain “counts” the impulses and projects a more intense sensation.

 
3. Contrast—the effect of a previous or simultaneous sensation on a current sensation,
which may then be exaggerated or diminished. Again, this is a func-tion of the brain, which
constantly compares sensa-tions. If, on a very hot day, you jump into a swimming pool, the
water may feel quite cold at first. The brain compares the new sensation to the previous one,
and since there is a significant differ-ence between the two, the water will seem colder than it
actually is.

4. Adaptation—becoming unaware of a continuing stimulus. Receptors detect changes, but

if the stim-ulus continues it may not be much of a change, and the receptors will generate
fewer impulses. The water in the swimming pool that seemed cold at first seems to “warm
up” after a few minutes. The water has not changed temperature, and the recep-tors for cold
have no changes to detect, therefore they generate fewer impulses. The sensation of cold
lessens, and we interpret or feel that as increasing warmth. For another example, look at
your left wrist (or perhaps the right one). Many of us wear a watch and are probably unaware
of its presence on the arm most of the time. The cuta-neous receptors for touch or pressure
adapt very quickly to a continuing stimulus, and if there is no change, there is nothing for the
receptors to detect.

5. After-image—the sensation remains in the con-sciousness even after the stimulus has
stopped. A familiar example is the bright after-image seen after watching a flashbulb go off.
The very bright light strongly stimulates receptors in the retina, which generate many
impulses that are perceived as an intense sensation that lasts longer than the actual
stimulus.

6. ENDOCRINOLOGY

Thyroid Gland - Endocrine Glands and Their Hormones

Thyroid Gland

The thyroid (thı̄ ′royd; shield-shaped) gland is made up of two lobes

connected by a narrow band called the isthmus (is′mŭs; a constriction). The lobes are
located on each side of the trachea, just inferior to the larynx (figure 10.15a,b). The thyroid
gland is one of the largest endocrine glands. It appears more red than the surrounding
tissues because it is highly vascular.

It is surrounded by a connective tissue capsule. The main function of the

thyroid gland is to secrete thyroid hormones, which bind to nuclearreceptors in cells and
regulate the rate of metabolism in the body (table 10.2). Thyroid hormones are synthesized
and stored within the gland in numerous thyroid follicles, which are small spheres with
walls composed of simple cuboidal epithelium .

Each thyroid follicle is filled with the protein thyroglobulin (thı̄ -rō-glob′ū-lin), to
which thyroid hormones are attached. Between the follicles is a network of loose connective
tissue that contains capillaries and scattered parafollicular cells, or C cells, which secrete the
hormone calcitonin. 

Thyroid hormone secretion is regulated by hormones from the hypothalamus

and pituitary. The hypothalamus secretes TSH-releasing hormone, also known as TRH,
which travels to the anterior pituitary and stimulates the secretion of thyroid-stimulating
hormone (TSH) .

In turn, TSH stimulates the secretion of thy-roid hormones from the thyroid
gland. Small fluctuations in blood TSH levels occur on a daily basis, with a small increase at
night. Increasing blood levels of TSH increase the synthesis and release of thyroid
hormones from thyroglobulin. Decreasing blood levels of TSH decrease the synthesis and
release of thyroid hormones.

The thyroid hormones have a negative-feedback effect on the hypothalamus

and pituitary, so that increasing levels of thyroid hormones inhibit the secretion of TSH-
releasing hormone from the hypothalamus and inhibit TSH secretion from the anterior
pituitary gland.

Decreasing thyroid hormone levels allow additional TSH-releasing hormone

and TSH to be secreted. Because of the negative-feedback effect, the thyroid hormones
fluctuate within a narrow concentration range in the blood. However, a loss of nega-tive
feedback will result in excess TSH.

This causes the thyroid gland to enlarge, a condition called agoiter (goy′ter).

One type of goiter develops if iodine in the diet is too low. As less thyroid hormone is
synthesized and secreted, TSH-releasing hormone and TSH secretion increase above
normal levels and cause dramatic enlargement of the thyroid gland.

  Without a normal rate of thyroid hormone secretion, growth and development

cannot proceed normally. A lack of thyroid hor-mones is called hypothyroidism . In infants,
hypothyroidism can result in cretinism ,characterized by mental retardation, short stature,
and abnormally formed skeletal structures.

In adults, the lack of thyroid hormones results in a decreased metabolic rate,

sluggishness, a reduced ability to perform routine tasks, and myxedema ,which is the
accumulation of fluid and other molecules in the subcutane-ous tissue. An elevated rate of
thyroid hormone secretion, known as hyperthyroidism , causes an increased metabolic
rate, extreme nervousness, and chronic fatigue. Gravesdisease is a type of hyperthyroidism
that results when the immunesystem produces abnormal proteins that are similar in structure
and function to TSH. Graves disease is often accompanied by bulging of the eyes, a
condition called exophthalmia  (see Systems Pathology, “Graves Disease”).

 The thyroid gland requires iodine to synthesize thyroid hor-mones. Iodine is taken up by the
thyroid follicles. One thyroid hormone, called thyroxine , or tetraiodothyronine , contains four
iodine atoms and is abbreviated T4. The other thyroid hormone, triiodothyronine contains
three iodine atoms and is abbrevi-ated T3. If insufficient iodine is present, production and
secretion of the thyroid hormones decrease.

 A lack of iodine in the diet results in reduced T3 and T4 synthesis. A deficiency of iodine is
not as common in the United States as it once was. Table salt with iodine added to it
(iodized salt) is available in grocery stores, and vegetables grown in soil rich in iodine can be
shipped to most places.

 In addition to secreting thyroid hormones, the parafollicular cells of the thyroid gland secrete
a hormone called calcitonin . Calcitonin is secreted if the blood concentration of
Ca2+ becomes too high, and it causes Ca2+ levels to decrease to their normal range
.Calcitonin binds to membrane-bound receptors of osteoclasts and reduces the rate of
Ca2+ resaborption (breakdown) from bone by inhibiting the osteoclasts. Calcitonin may
prevent blood Ca2+ levels from becoming overly elevated following a meal that contains a
high concentration of Ca2+.

Calcitonin helps prevent elevated blood Ca2+ levels, but a lack of calcitonin secretion does
not result in a prolonged increase in those levels. Other mechanisms controlling blood
Ca2+ levels compensate for the lack of calcitonin secretion.

Parathyroid Glands - Endocrine Glands and Their Hormones

Parathyroid Glands

Four tiny parathyroid  glands are embedded in the posterior wall of the thyroid gland . The
parathyroid glands secrete a hormone called parathyroid hormone(PTH), which is
essential for the regulation of blood calcium levels. In fact, PTH is more important than
calcitonin in regulating blood Ca2+ levels. PTH has many effects:

1.         PTH binds to membrane-bound receptors of renal tubule cells, which increases

active vitamin D formation.Vitamin D causes the epithelial cells of the intestine to increase
Ca2+ absorption.

 2.         PTH binds to receptors on osteoblasts. Substancesreleased by the osteoblasts

increase osteoclast activity and cause reabsorption of bone tissue to release Ca2+ into the
circulatory system.

3.         PTH binds to receptors on cells of the renal tubules and decreases the rate at which
Ca2+ is lost in the urine.

 Vitamin D is produced from precursors in the skin that are modified by the
liver and kidneys. Ultraviolet light acting on the skin is required for the first stage of vitamin D
synthesis, and the final stage of synthesis in the kidney is stimulated by PTH. Vitamin D can
also be supplied in the diet.

 Decreasing blood Ca2+ levels stimulate an increase in PTH secretion (figure

10.17). For example, if too little Ca2+ is consumed in the diet or if a person suffers from a
prolonged lack of vitamin D, blood Ca2+levels decrease, and PTH secretion increases. The
increased PTH increases the rate of bone reabsorption. Blood Ca2+ levels can be
maintained within a normal range, but prolonged reabsorption of bone results in reduced
bone density, as manifested by soft, flexible bones that are easily deformed in young people
and porous, fragile bones in older people.
4.         PTH acts on its target tissues to raise blood Ca2+ levels to normal.

Increasing blood Ca2+ levels cause a decrease in PTH secretion (figure 10.17). The
decreased PTH secretion leads to reduced blood Ca2+ levels. In addition, increasing blood
Ca2+ levels stimulate cal-citonin secretion, which also causes blood Ca2+ levels to decline.

  An abnormally high rate of PTH secretion is called hyper-

parathyroidism. One cause is a tumor in a parathyroid gland. The elevated blood levels of
PTH increase bone reabsorption and elevate blood Ca2+levels. As a result, bones can
become soft, deformed, and easily fractured. In addition, the elevated blood Ca2+ levels
make nerve and muscle cells less excitable, resulting in fatigue and muscle weakness. The
excess Ca2+ can be deposited in soft tissues of the body, causing inflammation. In addition,
kidney stones can result

Adrenal Glands - Endocrine Glands and Their Hormones

 Adrenal Glands

The adrenal  glands are two small glands located superior to each kidney .Each adrenal
gland has an inner part, called the adrenal medulla (marrow, or middle), and an outer part,
called the adrenal cortex (bark, or outer). The adrenal medulla and the adrenal cortex
function as separate endocrine glands.

Adrenal Medulla

The principal hormone released from the adrenal medulla is epinephrine  or

adrenaline .Small amountsof nor epinephrine are also released. The adrenal medulla
releases epinephrine and norepinephrine in response to stimulation by the sympathetic
nervous system, which becomes most active when a person is excited or physically active
.These hormones bind to membrane-bound receptors in their target tissues. Stress and low
blood glucose levels can also cause increased sympathetic stimulation of the adrenal
medulla. Epinephrine and nor epinephrine are referred to as the fight-or-flight hormones
because of their role in preparing thebody for vigorous physical activity. The major effects of
the hormones released from the adrenal medulla are

1.         Increases in the breakdown of glycogen to glucose in the liver, the release of the
glucose into the blood, and the release of fatty acids from adipose tissue. The glucose and
fatty acids serve as energy sources to maintain the body’s increased rate of metabolism.

2.         Increased heart rate, which causes blood pressure to rise

3.                       Stimulation of smooth muscle in the walls of arteries supplying the internal

organs and the skin, but not those supplying skeletal muscle. Blood flow to internal
organs and the skin decreases, as do the functions of the internal organs. Blood flow
through skeletal muscles increases.

4.         Increased blood pressure due to smooth muscle contraction in the walls of blood
vessels in the internal organs and the skin
 

5.         Increased metabolic rate of several tissues, especially skeletal muscle, cardiac

muscle, and nervous tissue

Responses to hormones from the adrenal medulla reinforce the effect of the
sympathetic division of the autonomic nervous system. Thus, the adrenal medulla and the
sympathetic division function together to prepare the body for physical activity and to
produce the fight-or-flight response and many other responses to stress.

Adrenal Cortex

The adrenal cortex secretes three classes of steroid hormones: mineralocorticoids,

glucocorticoids, and androgens. The molecules of all three classes of steroid hormones
enter their target cells and bind to nuclear receptor molecules. However, the hormones and
the receptors of each class have unique structural and functional characteristics.

 The first class of hormones, secreted by the outer layer of the adrenal cortex,
the mineralocorticoids , helps regulate blood volume and blood levels of K+ and
Na+. Aldosterone is the major hormone of this class. Aldosterone primarily binds to
receptor molecules in the kidney, but it also affects the intestine, sweat glands, and salivary
glands. Aldosterone causes Na+ and water to be retained in the body and increases the rate
at which K+ is eliminated.

 Blood levels of K+ and Na+ directly affect the adrenal cortex to influence aldosterone
secretion. The adrenal gland is much more sensitive to changes in blood K+ levels than to
changes in blood Na+ levels. The rate of aldosterone secretion increases when blood
K+ levels increase or when blood Na+ levels decrease.

 Changes in blood pressure indirectly affect the rate of aldosterone secretion. Low blood
pressure causes the release of a protein molecule called renin (rē′ nin) from the kidney.
Renin, which acts as an enzyme, causes a blood protein called angiotensinogen to be
converted to angiotensin I .Then, a protein called angiotensin-converting enzyme causes
angiotensin I to be converted to angiotensin II. Angiotensin II causes smooth muscle in
blood vessels to constrict, and angioten-sin II acts on the adrenal cortex to increase
aldosterone secretion. Aldosterone causes retention of Na+ and water, which leads to an
increase in blood volume (figure 10.20). Both blood vessel constriction and increased blood
volume help raise blood pressure.

 The second class of hormones, secreted by the middle layer of the adrenal cortex,
the glucocorticoids , helps regulate blood nutrient levels. The major glucocorticoid
hormone is cortisol , which increases the breakdown of proteins and lipids and increases
their conversion to forms of energy the body can use. For example, cortisol causes the liver
to convert amino acids to glucose, and it acts on adipose tissue, causing lipids to be broken
down to fatty acids. The glucose and fatty acids are released into the blood, taken up by
tissues, and used as a source of energy. Cortisol also causes proteins to be broken down to
amino acids, which are then released into the blood.
 Cortisol reduces the inflammatory and immune responses. A closely related
steroid, cortisone , or other similar drugs are often given to reduce inflammation caused by
inju-ries. Cortisone can also reduce the immune and inflammatory responses that result from
allergic reactions or abnormal immune responses, such as rheumatoid arthritis or asthma.

 In response to stressful conditions, cortisol is secreted in larger than normal amounts; thus,
it aids the body by providing energy sources for tissues. However, if stressful conditions are
prolonged, the immune system can be suppressed enough to make the body susceptible to
stress-related conditions .

Adrenocorticotropic hormone (ACTH) molecules from the anterior pituitary bind to

membrane-bound receptors and regulate the secretion of cortisol from the adrenal cortex .
When blood glucose levels decline, cortisol secretion increases. The low blood glucose acts
on the hypothalamus to increase the secretion of the ACTH-releasing hormone, which, in
turn, stimulates ACTH secretion from the anterior pituitary. ACTH then stimulates cortisol
secretion. Without ACTH, the adrenal cortex atrophies and loses its ability to secrete cortisol.

 The third class of hormones, secreted by the inner layer of the adrenal cortex, is composed
of the androgens , which stimulate the development of male sexual characteristics. Small
amounts of androgens are secreted from the adrenal cortex in both males and females. In
adult males, most androgens are secreted by the testes. In adult females, the adrenal
androgens influence the female sex drive. If the secretion of sex hormones from the adrenal
cortex is abnormally high, exaggerated male characteristics develop in both males and
females. This condition is most apparent in females and in males before puberty, when the
effects are not masked by the secretion of androgens by the testes.

The Pituitary Gland

The pituitary gland or hypophysis, formerly called the "Master gland", secretes several
polypeptide hormones that directly or indirectly regulate a wide variety of metabolic and
physiologic processes essential to normal growth and development as well as to the
maintenance of homeostasis. Many of the hormones secreted by the pituitary gland are
critical to the activity of target glands, including the thyroid, adrenal and gonads.

Anatomy
The pituitary gland (hypophysis cerebri) is located at the base of the brain,
resting with in the sella turcica of the sphenoid bone. The pituitary gland maintains elaborate
neural and vascular connections with the hypothalamus of the brain, which plays a central
role in the integration of neuroendocrine activity . The pituitary gland has two major divisions:
The anterior lobe (adenohypophysis) and the posterior lobe (neurohypophysis). The
hormones released from each lobe .

Adenohypophysis
The adenohypophysis is served by an elaborate vascular system, including
the hypothalamohypophyseal portal system, which transports hypothalamic regulating
hormones (hypophyseotropic hormones) to the glandular cells of the adenohypophysis. The
classification of cells in the adenohypophysis is based on specific immunohistochemical
techniques. Accordingly, there are at least five recognized cell types.
1. Somatotrophs, which secrete growth hormone (hGH) or somatotropin.
2. Lactotrophs, which secret prolactin (PRL).
3. Corticotrophs, which produce corticotropin (ACTH) and beta-lipotropin (beta-LPH)
4. By splitting a large peptide pro-hormone, proopiomelanocortin (POMC).
5. Thyrotrophs, which secrete thyrotropin (TSH).
6. Gonadotrophs, which produce follicle stimulating hormone ( FSH) and luteinizing
hormone (LH)

Neurohypophysis

The neurohypophysis, which is connected directly to the hypothalamus by the

infundibular (Pituitary) stalk, is rich in nerve fibers of hypothalamic origin (the
hypotahlamohypophyseal tract). Neurosecretory cells in the supraoptic and paraventricular
nuclei of the hypothalamus produce two hormones: antidiuretic hormone (ADH or
Vasopressin) and oxytocin.

These hormones are then transported along the axons of the hypothalamo
hypophyseal tract to the posterior lobe of the pituitary gland for storage and ultimate release
under hypothalamic control.

Hormones of the Adenohypophysis

The secretion of hormones by the adenohypophysis is controlled by hypothalamic regulatory
(hypophyseotropic) hormones that are transported to the pituitary gland by the
hypothalamohypophyseal portal system.

There are six recognized hypophyseotropic hormones

secreted from the median eminence of the hypothalamus:
• Growth hormone-releasing hormone (GHRH; somatocrinin)
• Growth hormone-inhibiting hormone (GHIH; somatostatin)
• Corticotropin-releasing homone (CRH)
• Thyrotropin-releasing hormone (TRH)
• Gonadotropin-releasing hormone (GnRH)
• Prolactin-inhibiting hormone (PIH)

It is probable that a prolactin-releasing hormone (PRH) also exists; however, the

exact substance has yet to be clearly identified. Some hypophyseotropic hormones influence
the secretion of more than one adenohypophyseal hormone. Gn- RH stimulates secretion of
FSH and LH. TRH stimulates the secretion of TSH and prolactin. Somatostatin inhibits the
secretion of growth hormone and TSH.

1. Growth Hormone (GH); Somatotropin (STH)

Human growth hormone (hGH) is a peptide hormone composed of 191 aminoacids, and is
secreted by thesomatotrophs of the denohypophysis primarily under hypothamic control.
The wide variety of factors that may affect GH secretion is summarized below.

Control of Secretion
Factors Promoting GH Secretion
- GHRH (Somatocrinin)
- Hypoglycemia and fasting
- Elevated plasma levels of amino acids (e.g., arginine)
- Stress (physical or psychological)
- Exercise
- Deep sleep
- Levodopa
- Glucagon

Factors Inhibiting GH Secretion

- GHIH (Somatostatin)
- Hyperglycemia
- Elevated plasma levels of free fatty acids
- REM sleep
- Cortisol
- Alpha-adrenergic blocking agents
- GH (negative feedback mechanism): GH secretion in response to hypoglycemia, fasting,
and exercise appears to be reduced by obesity.

Actions
Effects on Growth: Growth is a complex phenomenon influenced by genetic, nutritional,
and hormonal factors. In addition to growth hormone, the thyroid hormones, insulin,
androgens, and estrogens play important roles in normal human growth and development at
various times of the life cycle. GH accelerates overall body growth by increasing the mass of
both skeletal and soft body tissues through hyperplasia (increased cell number) and
hypertrophy (increased cell size).

effects of GH are particularly evident in skeletal tissues where chondrogenesis

(cartilage formation) and osteogenesis (bone formation) are enhanced, leading to an
increase in linear growth and stature before epiphyseal closure and increased bone
thickness following closure of the epiphyses.

Growth hormone stimulates certain tissues, notably the liver, to produce

somatomedins or insulinlike growth factors (IGF-Iand IGF-II). These low-molecular-weight
peptides mediate the growth-promoting effects of GH, including the stimulation of collagen
synthesis and chondrogenesis.

Metabolic Effects :

Protein metabolism: GH increases protein synthesis and nitrogen retention by enhancing

the incorporation of amino acids into protein. The protein anabolic action results from

1) accelerated entry of amino acids into cells and

2) increased ribonucleic acid ( RNA) synthesis. In muscle and liver, the
protein anabolic effects are attributed directly to GH.
 However, in cartilage, bone, and other body tissues, the protein anabolic and growth-
promoting actions are mediated by insulinlike growth factors (somatomedins).

Lipid metabolism:
GH stimulates the mobilization and utilization of fats by promoting lipolysis in adipose
tissue, thus enabling the body to use stored fats as an energy source.

The elevation of plasma levels of free fatty acids resulting from the hydrolysis of triglycerides
(stored neutral fats) is potentially ketogenic.

Carbohydrate metabolism: GH elevates blood glucose levels by increasing the hepatic

output of glucose (gluconeogenesis) and impairing glucose transport into muscle and
adipose tissue ("anti-insulin" action). Excessive secretion of GH may precipitate or increase
the severity of clinical diabetes mellitus ("diabetogenic" effect).

2. Prolactin (PRL)

Control of Secretion Prolactin (PRL) is a peptide hormone composed of 199 amino acids.
Its secretion by the lactotrophs of the adenohypoiphysis is tonically suppressed by dopamine
(also known as PIH) of hypothalamic origin. Dopamine antagonists (eg, antipsychotic drugs)
promote PRL secretion by blocking dopamine receptors, whereas dopamine agonists (eg,
bromocriptine) inhibit PRL secretion by activating dopamine receptors. Secretion of PRL
increases during pregnancy, peaking near the time of parturition. Sucking and tactile
stimulation of the nipple increase PRL secretion. Prolactin facilitates the secretion of
dopamine in the hypothalamus, thereby regulating its own secretion by a negative feedback
mechanism.

Actions
Prolactin initiates and maintains milk secretion from breasts primed for lactation by other
hormones such as estrogens, progesterone, and insulin. It also appears to inhibit the effects
of the gonadotropins and may prevent ovulation in lactating women. Excessive production of
PRL (hyperprolactinemia), which may accompany some pituitary tumors, may cause
anovulation and amenorrhea in women, and may lead to impotence and infertility in men.

3. Follicle-Stimulating Hormone (FSH)

Control of Secretion
Follicle-stimulating hormone (FSH) is a glycoprotein gonadotropic hormone whose secretion
is stimulated by hypothalamic GnRH. Inhibit, a polypeptide produced by testicular sertoli
cells in the male and follicular granulosa cells in the female, acts directly on the
adenohypophysis to inhibit FSH secretion.

Actions
Follicle-stimulating hormone directly stimulates the sertoli cells
in testicular seminiferous tubles, there by promoting spermatogenesis in the male. In the
female, FSH stimulates follicular growth and development within the ovaries. The actions of
FSH are mediated by cyclic AMP.

4. Luteinizing Hormone (LH; Interstitial Cell Stimulating Hormone; ICSH)

Control of Secretion
Like FSH, LH is a glycoprotein hormone whose secretion is stimulated by GnRH.
Testosterone inhibits LH secretion through a direct action on the adenohypophysis, as well
as indirectly by inhibiting hypothalamic GnRH production.

The effects of female hormones on LH secretion are more complex. Constant,

moderate levels of estrogen (without progesterone) have a negative feedback effect on LH,
whereas high estrogen levels exert a positive feedback that leads to a surge in LH
production. High levels of progesterone and estrogen (luteal phase of the ovulatory cycle)
inhibit LH secretion.

Actions
In the male, this hormone stimulates testosterone production by testicular interstitial
cells (of Leydig); hence the alternate name, interstitial cell stimulating hormone (ICSH).

In the female, LH promotes maturation of ovarian follicles and sustains their secretion
of estrogens. LH is also responsible for ovulation and the formation of the corpus luteum.
The actions of LH are mediated by cyclic AMP.

5. Thyroid-Stimulating Hormone (Thyrotropin; TSH)

Control of Secretion
Thyrotropin-releasing hormone (TRH) and cold (especially in infants) promote
secretion of TSH by the thyrotrophs of the adenohypophysis. Elevated plasma levels of free
thyroid hormones (T3 and T4) inhibit thyrotropin secretion. Stress also inhibits TSH
secretion.

Actions
Thyroid-stimulating hormone maintains the structural integrity of the thyroid gland
and promotes the synthesis and release of thyroid hormones thyroxine (T4) and
triiodothyronine (T3). The actions of TSH on the thyroid gland are mediated by cyclic AMP,
and they are detailed in the section on the thyroid gland.

6. Adrenocorticotropic Hormone (Corticotropin; ACTH)

Control of Secretion
Adrenocorticotropic hormone (ACTH) is secreted in irregular bursts that follow a
diurnal circadian rhythm, with peak production in the early morning. ACTH secretion is
regulated by the hypophyseotropic hormone corticotropin-releasing hormone (CRH) the
increased production of ACTH in response to many stressors appears to be mediated
through
the hypothalamus and CRH. Elevated plasma free glucocorticoid (cortisol) levels inhibit both
CRH and ACTH secretion.

Action
Adrenocorticoptropic hormone exerts its tropic effects on the adrenal glands,
promoting structural integrity and steroidogenesis in the adrenal cortex. The stimulation of
corticosteroid production (Steroidogenesis) in response to ACTH is mediated by the second
messenger, cyclic AMP.
Hormones of the Neurohypophysis
1. Antidiuretic Hormone (ADH; Vasopressin)

Control of Secretion Antidiuretic hormone (ADH) is a polypeptide hormone of hypothalamic

origin that is stored in and released from the neurohypophysis in response to a variety of
stimuli. Included among these are increased plasma osmolality, reduced extracellular fluid
(ECF) volume, pain, emotional stress, and such pharmacologic agents as morphine,
nicotine, barbiturates, and certain general anesthetics.

Decreased plasma osmolality, increased ECF volume, and alcohol inhibit ADH
secretion. Osmoreceptors found in the anterior hypothalamus monitor changes in plasma
osmolality, whereas ECF volume changes are detected by volume ("Stretch") receptors
located in the wall the left atrium. The osmoreceptors and volume receptors work in concert
to exert precise control over ADH secretion, thus forming a delicate homeostatic feedback
mechanism for the regulation of ECF
volume and concentration.

Actions
The principal physiologic role of ADH is to regulate extracellular fluid volume and
osmolality by controlling the final volume and concentration of urine. ADH increases the
permeability of the distal nephron (late distal convoluted tubules and collecting ducts) to
water.

The enhanced reabsorption of water from the renal tubules results in the production a
concentrated urine that is reduced in volume. Pharmacologic amounts of ADH produce a
pressor (hypertensive) effect that results from a direct constrictor action of the hormone on
vascular smooth muscle. The early observations that posterior pitutary extracts produce a
marked elevation of arterial blood pressure led to the initial naming of this hormone as
vasopressin.

Oxytocin
Control of Secretion and Actions
The two major physiologic actions of oxytocin are exerted on the female breast and uterus.
Oxytocin binds to a G-protein coupled receptor that ultimately brings about elevated
intracellular calcium levels.

Galactokinetic Action (Milk Ejection Reflex). The ejection of milk from a primed,
lactating mammary gland follows a neuroendocrine reflex in which oxytocin serves as
the efferent limb. The reflex is normally initiated by sucking, which stimulates cutaneous
receptors in the areola of the breast.

Afferent nerve impulses travel to the supraoptic and paraventricular nuclei of the
hypothalamus to effect the release of oxytocin from the neurohypophysis. Oxytocin is carried
by the blood to the mammary gland, where it causes contraction of myoepithelial cells
surrounding the alveoli and lactiferous ducts to bring about the ejection of milk (milk
letdown). In lactating women, tactile stimulation of the breast areola, emotional stimuli, and
genital stimulation may also lead to oxytocin release and activate the ejection of milk.
Oxytocic Action. Oxytocin acts directly on uterine smooth muscle to elicit strong, rhythmic
contractions of the myometrium. Uterine sensitivity to oxytocin varies with its physiologic
state and with hormonal balance. The gravid (Pregnant) uterus is highly sensitive to
oxytocin, particularly in the late stages of gestation. Uterine sensitivity to oxytocin is greatly
enhanced by estrogen and inhibited by progesterone. Oxytocin release appears to follow a
neuroendocrine reflex initiated by genital stimulation. It has been suggested that oxytocin
may facilitate sperm transport through the female genital tract.

Some Hormones of the Endocrine System.

Hormone Endocrine Gland Main Actions

Stimulates bone growth and

breakdown of fats; increases blood
Growth hormone Pituitary (anterior lobe) glucose

Stimulates milk production and

Prolactin Pituitary (anterior lobe) secretion

Thyroid-stimulating
hormone (TSH, or
thyrotropin) Pituitary (anterior lobe) Stimulates thyroid

Adrenocorticotropic
hormone (ACTH) Pituitary (anterior lobe) Stimulates adrenal cortex

Stimulates ovarian follicle in

Follicle-stimulating females, leads to spermatogenesis
hormone (FSH) Pituitary (anterior lobe) in males

Stimulates ovulation and formation

Luteinizing hormone of corpus luteum in females,
(LH) Pituitary (anterior lobe) interstitial cells in males

Hypothalamus (hormones
stored in and released from Stimulates mammary glands and
Oxytocin posterior pituitary) uterine contractions

Hypothalamus (hormones
Antidiuretic hormone stored in and released from
(ADH, vasopressin) posterior pituitary) Controls excretion of water

Stimulates and continues metabolic

Thyroxin Thyroid activities

Calcitonin Thyroid Inhibits bones' release of calcium

Some Hormones of the Endocrine System.

Hormone Endocrine Gland Main Actions

Stimulates bones' release of

calcium, activates vitamin D,
enhances absorption of calcium
Parathyroid hormone Parathyroid from intestine

Cortisol and other

glucocorticoids Adrenal cortex Affect metabolism of all nutrients

Aldosterone Adrenal cortex Affects salt-water balance

Increase rate and strength of

Adrenaline and heartbeat, dilate or constrict certain
noradrenaline Adrenal medulla blood vessels, increase blood sugar

Pancreas (islets of Increases glycogen storage, lowers

Insulin Langerhans) blood sugar

Stimulates breakdown of glycogen

Glucagon Pancreas to glucose

Melatonin Pineal Affects circadian rhythms

Develop and maintain sex

characteristics in females, promote
Estrogens Ovary, follicle buildup of uterine lining

Promotes continued buildup of

Progesterone Ovary, corpus luteum uterine lining

Develops and maintains sex

characteristics in males, promotes
Testosterone Testis spermatogenesis

7. RESPIRATORY SYSTEM
Nose

The nose consists of the external nose and the nasal cavity. The external nose is
the visible structure that forms a prominent feature of the face. Most of the external nose is
composed of hyaline cartilage, although the bridge of the external nose consists of bone .
The bone and cartilage are covered by connective tissue and skin.

 The nares , or nostrils, are the external openings of the nose, and the choanae are

the openings into the pharynx. The nasal cavity extends from the nares to the choanae .

The nasal septum is a partition dividing the nasal cavity into right and left parts.
A deviatednasal septum occurs when the septum bulges to one side. The hard
palate forms the floor of the nasal cavity, separating the nasal cavity from the oral cavity. Air
can flow through the nasal cavity when the oral cavity is closed or full of food.

 Three prominent bony ridges called conchae  are present on the lateral walls on
each side of the nasal cavity. The conchae increase the surface area of the nasal cavity and
cause air to churn, so that it can be cleansed, humidified, and warmed.

The paranasal sinuses are air-filled spaces within bone. They include the maxillary,

frontal, ethmoidal, and sphenoidal sinuses, each named for the bones in which they are
located. The paranasal sinuses open into the nasal cavity and are lined with a mucous
membrane. They reduce the weight of the skull, produce mucus, and influence the quality of
the voice by acting as resonating chambers.

  The nasolacrimal ducts, which carry tears from the eyes, also open into the nasal
cavity. Sensory receptors for the sense of smell are in the superior part of the nasal cavity .

 Air enters the nasal cavity through the nares. Just inside the nares, the lining of the
cavity is composed of stratified squamous epithelium containing coarse hairs. The hairs trap
some of the large particles of dust suspended in the air. The rest of the nasal cavity is lined
with pseudostratified columnar epithelial cells containing cilia and many mucus-producing
goblet cells . Mucus produced by the goblet cells also traps debris in the air. The cilia sweep
the mucus posteriorly to the pharynx, where it is swallowed. As air flows through the nasal
cavities, it is humidified by moisture from the mucous epithelium and warmed by blood
flowing through the superficial capillary net-works underlying the mucous epithelium.

Larynx :

The larynx or organ of voice is placed at the upper part of the air passage. It is

situated between the trachea and the root of the tongue, at the upper and forepart of the
neck, where it presents a considerable projection in the middle line. It forms the lower part of
the anterior wall of the pharynx, and is covered behind by the mucous lining of that cavity; on
either side of it lie the great vessels of the neck. Its vertical extent corresponds to the fourth,
fifth, and sixth cervical vertebræ, but it is placed somewhat higher in the female and also
during childhood. Symington found that in infants between six and twelve months of age the
tip of the epiglottis was a little above the level of the fibrocartilage between the odontoid
process and body of the axis, and that between infancy and adult life the larynx descends for
a distance equal to two vertebral bodies and two intervertebral fibrocartilages. According to
Sappey the average measurements of the adult larynx are as follows:
Until puberty the larynx of the male differs little in size from that of the female. In the female
its increase after puberty is only slight; in the male it undergoes considerable increase; all
the cartilages are enlarged and the thyroid cartilage becomes prominent in the middle line of
the neck, while the length of the rima glottidis is nearly doubled.

The larynx is broad above, where it presents the form of a triangular box flattened behind
and at the sides, and bounded in front by a prominent vertical ridge. Below, it is narrow and
cylindrical. It is composed of cartilages, which are connected together by ligaments and
moved by numerous muscles. It is lined by mucous membrane continuous above with that of
the pharynx and below with that of the trachea.

LUNGS

The lungs occupying major portions of the thoracic cavity,leave little space for the
heart, which excavates more of the left lung. The two lungs hold the heart tight between
them, providing it the protection it rightly deserves. There are ten bronchopulmonary
segments in each lung. The lungs are a pair of respiratory organs situated in the thoracic
cavity. Each lung invaginates the corresponding pleural cavity. The right and left lungs are
separated by the mediastinum. The lungs are spongy in texture. In the young, the lungs are
brown or grey in colour. Gradually, they become mottled black because of the deposition of
inhaled carbon particles. The right lung weighs about 700 g,; it is about 50 to 100 g heavier
than the left lung.

ldentify the lungs by the thin anterior border, thick posterior border, conical apex, wider base,
medial surface with hilum and costal surface with impressions of the ribs and intercostal
spaces. ln addition, the right lung is distinguished by the presence of three lobes, whereas
left lung eomprises two lobes only.

The impressions on the right lung are of superior vena cava, inferior vena cava, right
ventricle. Behind the root of lung are the impressions of vena azygos and oesophagus.

Features
Each lung is conical in shape , It has:
1 An apex at the upper end.
2 A base resting on the diaphragm.
3 Three borders, i.e. anterior, posterior and inferior.
4 Two surfaces, i.e. costal and medial.
The medial surface is divided into vertebral and mediastinal parts.
Arteriol Supply
1. The bronchial arteries supply nutrition to the bronchial tree and to the pulmonary
tissue.
 2. On the right side, there is one bronchial artery which arises from the third right
posterior intercostal artery.

3. On the left side, there are two bronchial arteries both of which arise from the
descending thoracic aorta, the upper opposite fifth thoracic vertebra and the lower
just below the left bronchus.

4. Deoxygenated blood is brought to the lungs by the two pulmonary arteries and
oxygenated blood is returned to the heart by the four pulmonary veins.

5. There are precapillary anastomoses between bronchial and pulmonary arteries.

These connections enlarge when any one of them is obstructed in disease.

Venous Drainage of the Lungs

1. The venous blood from the first and second divisions of the bronchi is carried by
bronchial veins.

2. Usually there are two bronchial veins on each side. The right bronchial veins drain
into the azygos vein.

3. The left bronchial veins drain into the hemiazygos vein.

4. The greater part of the venous blood from the lungs is drained by the pulmonary
veins.
Right Lobe

Upper lobe Middle lobe Lower lobe

1 Apical 4 Lateral 6 Superior

7. Medial basal
2 Posterior 5 Medial 8. Anterior basal
9 Lateral basal '
3 Anterior 10 Posterior basal

Left Lobe

Upper lobe Middle lobe Lower lobe

1 Apical 4 Superior 6 Superior

lingular 7. Medial basal
2 Posterior 8. Anterior basal
5 lnferior 9 Lateral basal '
3 Anterior lingular 10 Posterior basal

lymphatic Drainage
There are two sets of lymphatics, both of which drain into the bronchopulmonary nodes.

1. Superficial vessels drain the peripheral lung tissue lying beneath the pulmonary
pleura.

2. Deep lymphatics drain the bronchial tree, the pulmonary vessels and the
connective tissue septa.

Nerve Supply
1. Parasympathetic nerves are derived from the vagus.
These fibres are:
a. Motor to the broncl-rial muscles, and on stimulation cause bronchospasrn.
b. Secretomotor to the mucous glands of the bronchial tree.
c. Sensory fibres are responsible for the stretch reflex of the lungs, and for the cough reflex.

2 Sympathetic nerves are derived from second to fifth sympathetic ganglia. These are
inhibitory to the smooth muscle and glands of the bronchial tree. That is how
sympathomimetic drugs, like adrenalin, cause bronchodilatation and relieve symptoms of
bronchial asthma.

Both parasympathetic and sympathetic nerves first form anterior and posterior
pulmonary plexuses situated in front of and behind the lung roots: From the plexuses
nerves are distributed to the lungs along the blood vessels and bronchi.

Larynx
The larynx is a cartilaginous structure inferior to the laryngopharynx that connects
the pharynx to the trachea and helps regulate the volume of air that enters and leaves the
lungs . The structure of the larynx is formed by several pieces of cartilage. Three large
cartilage pieces—the thyroid cartilage (anterior), epiglottis (superior), and cricoid cartilage
(inferior)—form the major structure of the larynx. The thyroid cartilage is the largest piece
of cartilage that makes up the larynx. The thyroid cartilage consists of the laryngeal
prominence, or “Adam’s apple,” which tends to be more prominent in males. The thick
cricoid cartilage forms a ring, with a wide posterior region and a thinner anterior region.
Three smaller, paired cartilages—the arytenoids, corniculates, and cuneiforms—attach to
the epiglottis and the vocal cords and muscle that help move the vocal cords to produce
speech.
Trachea :

The trachea (windpipe) extends from the larynx toward the lungs . The trachea is
formed by 16 to 20 stacked, C-shaped pieces of hyaline cartilage that are connected by
dense connective tissue. The trachealis muscle and elastic connective tissue together form
the fibroelastic membrane, a flexible membrane that closes the posterior surface of the
trachea, connecting the C-shaped cartilages. The fibroelastic membrane allows the trachea
to stretch and expand slightly during inhalation and exhalation, whereas the rings of cartilage
provide structural support and prevent the trachea from collapsing. In addition, the trachealis
muscle can be contracted to force air through the trachea during exhalation. The trachea is
lined with pseudostratified ciliated columnar epithelium, which is continuous with the larynx.
The esophagus borders the trachea posteriorly.

Arterial Supply : Inferior thyroid arteries.

Venous Drainage :Into the left brachiocephalic vein.
Lymphatic drainage : To the pretracheal and paratracheal nodes

Nerve Supply :
Parasympathetic: Nerves through vagi and recurrent laryngeal nerves. It is:
a. Sensory and secretomotor to the mucous membrane.
b. Motor to the trachealis muscle.
2 Sympathetic: Fibres from the middle cervical ganglion reach it along the inferior thyroid
arteries and are vasomotor.

Bronchial tree

The trachea divides at the level of the lower border of the fourth thoracic vertebra into
two primary principal bronchi, one for each lung. The right principal bronchus is 2.5 cm long.
It is shorter, wider and more in line with the trachea than the left principal bronchus . Inhaled
particles or foreign bodies therefore, tend to pass more frequently to the right lung, with the
result that infections are more common on the right side than on the left.
 Each principal bronchus enters the lung through the hilum, and divides into
secondary lobar bronchi, one for each lobe of the-lungs. Thus there are three lobar bronchi
on the right side, and only two on the left side. Each lobar bronchus divides into tertiary or
segmental bronchi, one for each bronchopulmonary segment; which are 10 on the right side
and 10 on the left side. The segmental bronchi divide repeatedly to form very small branches
called terminal bronchioles.
Still smaller branches are called respiratory bronchioles.

Each respiratory bronchiole aerates a small part of the lung known as a pulmonary
unit. The respiratory bronchiole ends in microscopic passages which are termed:

1 Alveolar ducts
2 Atria.
3 Air saccules.
4 Pulmonary alveoli (Latin small cauity). Gaseous exchanges take place in the alveoli.

Rool of the lung

Root of the lung is a short, broad pedicle which connects the medial surface of the
lung to the mediastinum. It is formed by structures which either enter or come out of the lung
at the hilum (Latin depressiotr). The roots of the lungs lie opposite the bodies of the fi{th,
sixth and seventh thoracic vertebrae.

Contents :

The root is made up of the following structures.

1. Principal bronchus on the left side, and eparterial and hyparterial bronchi on the right
side
2. One pulmonary artery.
3. Two pulmonary veins, superior and inferior.
4. 4 Bronchial arteries, one on the right side and two onthe left side.
 5. Bronchial veins.
6. 6 Anterior and posterior pulmonary plexuses of nerves.
7. Lymphatics of the lung.
8. Bronchopulmonary lymph nodes.
9. Areolar tissue.

Clinical anatomy :
Usually the infection of a bronchopulmonary segment remains restricted to it,
although tuberculosis and bronchogenic carcinoma may spread from one segment to
another.

Paradoxical respiration: During inspiration the flail (abnormally mobile) segment of ribs are
pulled inside the chest wall while during expiration the ribs are pushed out.

Tuberculosis of lung is one of the commonest diseases. A complete course of treatment

must be taken under the guidance of a physician.

Bronchial asthma is a common disease of respiratory system. It occurs due to

bronchospasm of smooth muscles in the wall of bronchioles. Patient has difficulty especially
during expiration. It is accompanied by wheezing. Epinephrine, a sympathomimetic drug,
relieves the symptoms.

Auscultation of lung: Upper lobe is auscultated above 4th rib on both sides; lower lobes
are best heard on the back. Middle lobe is auscultated between 4th and 6th ribs on right
side.

Points to remember:

 Large spongy lungs occupy almost whole of thoracic cage leaving little space for the
heart and accompanying blood vessels, etc.

 Bronchopulmonary segments are independent functional units of lung.

 Lungs are subjected to lot of insult by the smoke of cigarette / bidis / pollution.

 Tuberculosis of lung is one of the commonest killer in an underdeveloped or a

developing country.

 Complete treatment of TB is a must, otherwise the bacteria become resistant to

antitubercular treatment.
S.No Organ Location Shape & colour Weight Blood Organ Ligament
Size supply Supply
1
2
3
4
5