Table of Contents

LECTURE 13: NERVOUS SYSTEM I NEUROHISTOLOGY 2

LECTURE 14: NERVOUS SYSTEM II SPINAL CORD 6
LECTURE 15 & 16: PERIPHERAL NERVOUS SYSTEM 9
LECTURE 17: BRAIN I 11
LECTURE 18: BRAIN II 14
LECTURE 19: CRANIAL NERVES & AUTONOMIC NERVOUS SYSTEM 17
LECTURE 20: VISUAL & AUDITORY SYSTEM 20
LECTURE 21: HEART I 22
LECTURE 22: HEART II 25
LECTURE 23: BLOOD VESSELS I 28
LECTURE 24: BLOOD VESSELS II 32
LECTURE 25: LYMPHATIC SYSTEM 34
LECTURE 26: BLOOD I 37
LECTURE 27: BLOOD II 39
Lecture 13: Nervous System I Neurohistology

A. Introduction
Central Nervous System (CNS)
A. *Brain
B. *Spinal Cord
Human Nervous System
Peripheral Nervous System
A. Somatic (Voluntary Division)
B. *Autonomic (Involuntary Division)

*Both the Brain & Spinal Cord contain components of the Autonomic Nervous System (ANS).

B. Neurohistology
The Nervous System Is composed of:
• Conducting elements or cells called neurons
• Accessory elements called neuroglia (supporting cells)
• Meninges (covering the brain & spinal cord)

1) Types of neurons
Neurons are responsible for receiving and transmitting information.
They are classified according to:

a. Functional Classification of Neurons

1. Sensory (afferent) - is unipolar
• Transmits impulse from periphery sensory receptor (PNS) to spinal cord or brain
(CNS).
• Cell body located In sensory ganglia.
• Fibers extend from sensory receptor (PNS) to brain or spinal cord (CNS)
2. Motor (efferent) - is multipolar
• Carries information from CNS to peripheral effectors: skeletal muscle, smooth muscle,
cardiac muscle & glands.
3. Associative (interneuron) = the link
• Located between sensory & motor neurons in CNS
• It modifies responses of, & replays info to, other neurons.
• Is inhibitory
b. Structural Classification of Neurons
Named by structure (number of processes that enter the nucleus)
1. Multipolar: most common type
• Have more than one processes & multiple dendrites
• Found in brain & spinal cord
• Motor neurons that control skeletal muscle
2. Bipolar: toe processes - one dendrite
• Involved in special sensation: retina of eye, inner ear, nose
3. Unipolar: single process attached to cell body.
• Found in ganglia, and clusters of ganglia along/adjacent to spinal cord.

2) Structure of a Typical Neuron

1) Cell body
• Contains organelles found typical in cells: mitochondria, Golgi complex except NO centrioles.
• Nissl bodies - chromatophilic bodies: RER (rough endoplasmic reticulum) or clustered of
ribosomes producing protein
o Neurotransmitter are made of protein
• Neurofibromas - the cytoskeleton: supports & maintains shape of the NCB (nerve cell body).
 2) Processes (fibers) of a Neuron
a. Dendrites:
• One or more per neuron
• Receives impulse & transmits info to cell body
b. Axon (nerve fiber)
• Only one per neuron
• Transmits Impulse away from cell body to another neuron or muscle.

C. Special Characteristics of Nerve Fibers

1. Myelin Sheath
c.Produced by: oligodendrocyte in CNS & by schwann cell In PNS.
d. Composed of: lipid (fat) gives it white color
e.Functions to: Insulate & increase transmission speed of electrical impluse.
2. Neurolemma: cell membrane of schwann cell (PNS) or oligodendrocyte (CNS)
3. Node of Ranvier: area of axon not covered by myelin.
*allows for RAPID CONDUCTION
4. Synaptic vesicles: structures that store neurotransmitters that are released at a synapse/voltage
gated sodium ion channels.

D. Communication between Neurons

1. Components of a Synapse
a. Presynaptic neuron - transmits impulse to synapse
b. Synaptic cleft - space between the presynaptic axon & dendrite of the post-
synaptic neuron
c.Postsynaptic neuron - receives impulse then will carry/conduct Impulse away
Neurotransmitter crosses the synaptic cleft & attaches to receptors on the dendrite. This results in transmission
of impulse from one neuron to another.
2. Conduction of a Nerve impulse
An electrical impulse travels on outside of axon. This promotes further transmission of impulse.
a. Resting membrane Is polarized
• (+) charge outside cell membrane
• Na+ ions outside cell membrane
b. Depolarization: caused by influx of Na+ ions into cell
• (-) charge on outside cell membrane
c."Wave of negativity" travels along cell membrane
d. Repolarization: caused by influx of K+ ions to outside of cell

At Node of Ranvier, membrane permeability changes & Na ions pass into axon/K ions pass
out of axon.
i. Continuous Conduction:
- along unmyelinated axons.
- action potential provokes another immediately adjacent
- continuous flow/moves down axon like a "wave"
ii. Saltatory Conduction"
- Impulse "jumps" along myelinated axons.
- Is conducted only at Nodes of Ranvier
- much more rapid transmission: "HOPPING"

E. Types of Nerve Fibers

1. A fibers
• Large myelin sheath
• Fast conduction
• Sharp, stabbing pain
2. B fibers
 • Intermediate amount of myelin
• Moderate speed
• Moderate pain
3. C fibers
• Least myelin or no myelin
• Slow speed
• Dull/aching pain
Additional Terminology:
Nuclei - cluster of neuron in CNS.
Ganglia (ganglion) - cluster of neurons in PNS
Nerve - bundles of axons in the PNS
Tract - bundles of axons in the CNS

Examples of Neurotransmitters:
A. Excitatory neurotransmitters - cause depolarization of postsynaptic neuron
I. Acetycholine (Ach): involved in muscle contraction & autonomics
II. Norepinephrine (NE): Involved in muscle contraction & autonomics
III. Serotonin: plays a role in constriction of smooth muscle, regulating cyclic body processes
and contributes to mood (feeling of wellbeing & happiness)
IV. Dopamine: helps control the brain's reward & pleasure centers and also helps regulate
movement and emotional responses. Dopamine deficiency results in Parkinson's
B. Inhibitory neurotransmitters - hyperpolarize the postsynaptic neuron preventing the transmission
of the nerve impulse across the synapse.
I. Gamma Aminobutyric acid (GABA): responsible for regulation muscle tone; inhibitory
II. Enkephalin - regulates pain perception on the body, bind to opiate receptors in the body.
III. Endorphins - group of hormones similar to Enkephalins, activate body's opiate receptors
and exert an analgesic effect
IV. Dopamine - see above

The proper balance between excitatory and inhibitory neurotransmitters is required for normal
function of the nervous system. A number of diseases result from an imbalance. Various
drugs can affect the transmission of impulses, e.g. caffeine increases the rate.

F. Types of Neuroglia in the CNS

A. Central Nervous System:
1. Oligodendrocytes: cell that produces a myelin covering (sheath) around axons in CNS
2. Microglia: phagocytic cell of CNS: engulfs cellular debris, microorganisms, dead or damaged
tissue.
3. Astrocyte - CNS: Assists in the nourishment of neurons In CNS & formation of the Blood Brain
Barrier.

Blood-Brain Barrier
Composed of:
• Endothelium = lining of capillaries
• Basement membrane
• Foot processes of astrocytes
Function:
1. Regulates permeability of capillaries to control enters the brain
2. Prevents large molecules from entering brain
3. Keeps toxic substances from entering brain cells.
However, alcohol & drugs of small molecular size can pass through this barrier. The barrier is not well formed in
babies, so they are more susceptible to injury from drugs & substances such as bilirubin.
4. Ependymal cells
- Cells line the ventricles (4 interconnected cavities) of the brain
 - Surface specializations of villa
- Responsible for regulation of CSF
B. Peripheral Nervous System Cells
1. Schwann cells (neurolemmocytes)
• Cells produce myelin sheath around nerve fibers (axons) in PNS
• Insulates & protects
2. Satellite Cells (PNS)
• Cells surround the nerve cell body
• Supply nourishment to nerve cell body
• Supports neuron
• helps in function of cell
Lecture 14: Nervous System II Spinal Cord

A. Gross Anatomy
1. Location of Spinal Cord:
• In vertebral column
• Enclosed by vertebrae (has vertebral foramen)
• In the vertebral canal (space where spinal cord passes thru)
2. Extent
• Foramen Magnum; Level of the medulla
• To the level of intervertebral disc btw L1 & L2.
3. Conus Medullaris
• Tapered, cone-shaped distal portion of spinal cord
4. Cauda equina
• Horse s Tail
• Composed of nerve roots
• Extends from distal end of spinal cord
5. Filum terminale
• A long filament of CT ‒ extension of pia mater
• It extends inferiorly from the conus medullaris
• Functions to anchor the spinal cord to coccyx
6. Cervical and lumbar enlargements
• Thickened regions containing neurons that control the skeletal muscle of the upper &
lower limbs
• Spinal nerves arranged in a collection of plexus originate from these enlargements
7. Spinal Nerves (31 pairs)
• Intervertebral Foramen
• Formed by alignment of more than one stacked vertebra in the column
• These exit the spinal cord through the intervertebral foramina in the cervical, thoracic,
lumbar & sacral regions.

B. Meninges: Protection of the Spinal Cord

Definition: three layers of connective tissue which covers & protect the brain & spinal cord
1. Dura mater: outer most layer; tough as parchment
2. Arachnoid: very thin middle layer; like cellophane
3. Pia mater: connective tissue covering that touches spinal cord & brain; like skin of an apple

Spaces associated with the meninges:

1. Subarachnoid space
- Location
- Deep to arachnoid of the brain & spinal cord (btw arachnoid & pia matter)
- Contents
- Cerebrospinal Fluid = CSF
- Ultra-filtrate of plasma produced in ventricles
- Characteristics of CSF
- Clear/colorless/odorless
- Serves t cushion & nourish the brain & spinal cord
CSF is produced by specialized capillaries called the choroid plexus in spaces called the
ventriles of the brain.
2. Epidural space
- It is located external to dura mater
- Contains fat & blood vessels which supply the spinal cord
3. Subdural space
- Deep to the dura
- Normally nothing is found in this potential space; arachnoid is pressed against dura.
 Clinical Consideration: Meningitis ‒ inflammation or infection of the meninges.
1. At which vertebral level could this produce be done safely without damaging the spinal cord?
a. Between L4 and L5 or L3/L4
2. What anatomical landmark would you use to help you locate this level?
a. Palpate the iliac crests. An imaginary line connecting crest passing through junction of
vertebrae L4 & L5.
3. List in order the structures your needle would have to pierce to reach the subarachnoid space.
a. Skin, subcutaneous tissue, ligaments, dura mater, arachnoid mater, subarachnoid space, pia
mater and spinal cord.
Note: Do not pierce the pia mater and the spinal cord

C. Spinal Segments: The spinal cord is divided into 31 segments

Cervical ‒ 8 Sacral ‒ 5
Thoracic ‒ 12 Coccygeal ‒ 1
Lumbar ‒ 5

Terminology Related to a spinal cord segment:

1. White matter
- White color due to myelin (lipid)
- Fiber bundles (tracts) of myelinated axons (often arranged in columns or fasciculi)
2. Gray matter
- Contains cell bodies of neurons located in regions called horns (h shaped) located in central
portion of the cord.
- Ex. Ventral Gray Horn ‒ contains cell bodies of MOTOR NEURONS
3. Dorsal root
- Extends laterally from spinal cord ‒ contains cell bodies of SENSORY neoruns
4. Dorsal root ganglion
- Attached to dorsal root.
- Contains cell bodies of sensory neurons
5. Ventral root
- Extends laterally from spinal cord ‒ contains MOTOR nerve fibers.
Spinal Nerve
The Dorsal/sensory root & the ventral/ motor root merge to form a spinal nerve.
What are the components of a spinal nerve? ‒ motor and sensory nerve fibers

Spinal Reflex
Simple, rapid, automatic and unconscious response to a stimulus to protect the body.
It is a conduction pathway w/ multiple component passes thru spinal cord and doesn t involve the brain!

Simple Stretch Reflex

Components and Location
A. Receptor in muscle spindle
B. Sensory Neuron in Dorsal Root Ganglion
C. Motor Neuron in ventral gray horn of
Spinal Cord
D. Effector ‒ Skeletal Muscle
Function or Action
Responds to stimulus and initiates
impulse
Transmits impulse to CNS (spinal cord)
Transmits impulse from CNS to PNS
(Spinal Nerve)
Muscle that responds to Motor Neuron
impulse

How many synapses are necessary for in a Stretch Reflex Arc?

- 1

How does a Withdrawal Reflex differ from a Stretch Reflex?

 - Generally, the receptor for a withdrawal flex is located in the skin. An associative or
interneuron transmits information from the sensory neuron to the motor neuron.
How many synapses are necessary for in a Withdrawal Reflex Arc?
- 2
Lecture 15 & 16: Peripheral Nervous System

The Peripheral Nervous System

• Includes cranial nerves
• Includes spinal nerves
• And the nerves/neurons ganglia and sensory receptors outside CNS

a. Examples of Sensory Receptors:

1. Photoreceptors ‒ rods and cones located in eye: respond to light
2. Chemoreceptors ‒ Respond to chemicals; located in nose (smell), tongue (taste), carotid
bodies in blood vessels (chemicals in blood)
3. Thermoreceptors ‒ respond to temperature changes; located in dermis of skin
- Organs of Ruffini
- Bulbs of Krause
4. Pressure Receptors ‒ respond to temperature changes; located in dermis
a. Meissner s Corpuscle or Tactile Corpuscle
- Light pressure
b. Pacinian Corpuscle or Lamellar Corpuscle
- Deep pressure
5. Pain Receptors
- Free nerve endings
- Most common
6. Proprioceptors
a. Another forms of mechanoreceptor: deformation
b. position sense detects changes in stretch in muscles, tendons or ligaments.
- Neuromuscular spindles
- Golgi tendon organs

b. Spinal Nerves
• 31 Pairs of Spinal Nerves:
8 cervical 12 thoracic
5 Lumbar 5 Sacral
1 Coccygeal
• Ventral & Dorsal rami extend from the spinal nerves
1. Ventral (Anterior) Ramus
– Sensory: skin of anterior & lateral trunk, Upper & lower extremity (UE & LE)
– Motor: muscles of anterior & lateral trunk, UE & LE, superficial muscles of
back
2. Dorsal (posterior) ramus
– Sensory: skin of posterior head, neck & back
– Motor: deep muscles of back

c. Dermatomes
Sensory fibers from a pair of spinal nerves, at a single level, supply a strip of skin called a
dermatome.
You must have:
• Loss of 3 adjacent dermatome levels to have complete loss of sensation at middle
dermatome level.
Example: to lose sensation at T4 (nipple area) damage is to levels T3, T4, and T5. To lose
sensation at umbilicus (T10 dermatome), you must wipe out T9, T10 & T11.

d. Referred Pain
Referred pain occurs when sensory neurons from skin (somatic) & the viscera (any organ)
enter the spinal cord using the same nerve pathway to the brain!
 Nerve Plexuses
Only the Ventral Rami from Plexuses (4): Cervical, brachial, Lumbar and sacral.
All plexuses carry BOTH sensory & motor info of muscles & overlying skin.
1. Cervical Plexus (c1 ‒ C4) ‒ supplies skin and muscles of neck
• Phrenic nerve (C3, C4 & C5) ‒ keeps you alive!
- Motor: diaphragm
- Sensory: skin of the neck

Note: Both the cervical & brachial plexus come from the cervical enlargement.
2. Brachial Plexus (C5 ‒ T1)
• Sensory: skin of shoulder & upper limb
• Motor: muscles of shoulder & upper limb
Branches of the Brachial Plexus
Nerve Structures Innervated Deficit
1. Axillary Sensory: skin of shoulder Inability to abduct deltoid muscle
Motor: Deltoid muscle (prime)
2. Musculocutaneous Sensory: skin of forearm Flexing the elbow & weak
Motor: posterior of Biceps brachii & supination.
Brachialis (muscles of anterior arm)
3. Radial Sensory: portions of posterior/lateral wrist drop ‒ cuz of loss of wrist
arm & forearm extensors
Motor: triceps, extensors of forearm
& wrist
4. Ulnar Motor: Flexor carpi ulnaris Chronic damage can cause claw
flexor digitorum (medial only) hand ‒ loss of lumbricals;
lumbricals (medial only, only in hand) inability to unflex lumbricals
5. Median Motor: flexors of wrist Carpal tunnel syndrome ‒ have
Thenar eminence distal damage
Lumbricals (lateral 2) Ape hand-causes loss of
opposition of the thumb

3. Lumbo-sacral plexus (L1-S4) ‒ supplies skin & muscles of the lower limb. All have
sensory & motor nerve
Nerve Structures Innervated Deficit
1. Femoral Motor: Quadriceps Extend knee, no patellar reflex
2. Obturator Motor: Adductors, muscles of Not adduct
medial thigh
Sensory: skin on medial thigh
3. sciatic Motor: Hamstrings Have difficulty & pain in motion

a. Tibial Motor: Gastrocnemius

Soleus
Tibialis posterior (all muscles in
posterior leg)
b. Common Fibular Has 2 branches: Deep fibular: foot Drop ‒ cuz of
(peroneal) Deep Fibular: motor- muscles of loss of dorsiflexion
anterior leg Superficial ‒ evert
Superficial fibular: motor ‒ muscles
of lateral leg
4. Pudendal Motor & sensory to the pelvic Incontinence
floor/diaphragm Prolapse
Lecture 17: Brain I

The human brain is composed of 3 major parts:

1. Cerebrum (cerebral hemisphere): left & right cerebrum
2. Cerebellum
3. Brain stem

Cerebrum
• large fiber bundle connecting
o left & right cerebral hemispheres
• allows for transfer of information rom one hemisphere to the other.
A. Layers of the cerebrum
1. Gray matter (cerebral cortex):
Neuron cell bodies (NCB) forms ridges grooves
a. Gyri: Ridges of brain, raised areas between sulci
b. Sulci: narrow grooves
c.Fissure: deep grooves
2. White matter: myelinated axons

Specific sulci & gyri as landmarks:

- Central sulcus: boundary btw precentral/postcentral gyri
- Lateral fissure: separates temporal lobe from the rest of brain

3. Lobes of the cerebrum

a. Frontal lobe: motor
b. Parietal lobe: general sense
c.Temporal lobe: auditory (hearing)
d. Occipital lobe: vision (sight)
e.Insula: regulating human emotions

Location & function of Broca s area

• Primary motor area (4): controls movement
• Primary sensory area (3,2,1): perception of sensory impulses
• Areas for hearing (41, 42) - Primary auditory area: perception & identifying sound
• Areas for vision (17, 18 & 19)
o Primary visual cortex: perception & identification of images
o Visual association area: relates present to past visual experiences
• Areas for language
o Broca s area (44, 45): motor speech, pre-plans voluntary muscles movements
o Wernicke s area (22): language & comprehension

Clinical consideration: Differentiation of area 22 from 44, 45

Wernicke s area ‒ area 22
After stroke:
Patient is unable to understand language (written
or spoken) can speak ‒ but cannot express
him/herself in sentences with any meaning.
Broca s ‒ area 44, 45
After stroke:
Patient will comprehend words & sentences but is
unable to pronounce & process words.

Homunculus ( Little Man )

Area/ region of:
- 1 somatomotor cortex
- 1 somatosensory cortex
Size (area distribution) & location on cortex responsible for either motor or sensory function of that area of brain
cortex.

Blood Supply
Arterial supply: the brain is supplied by 2 major pairs of blood vessels:
1. Internal carotid artery: goes internally to the base of brain
2. Vertebral artery: passes through transverse foramen of cervical vertebra
These join the circle of willis at the inferior/base of the brain.
- Two main paired branches of the ICA (Internal carotid artery):
1. Middle cerebral artery
- Blood to lateral surface of cerebrum
- If blocked: would loose sensation & motor function to upper limbs
• Anterior Cerebral artery:
- Blood to medical surface of cerebrum
- If blocked: would loose sensation & motor function to lower limbs
Venous drainage:
Venus channels found between layers of dura mater
- Receive blood from internal & external veins of the brain
- Receive CSF from subarachnoid space
- Empty into the internal jugular vein.
Have no muscle layer or valves.

Ventricular system

Choroid plexus:
• Specialized vascular complex of capillaries on the roof of the 3rd & 4th ventricles that ultra filters
blood to produce CSF
• Remember we learned CSF is normally: CLEAR/COLORLESS/ODORLESS and that microvillus
ependymal cells line the cavity

Drainage of CSF
1. Lateral venticles
2. Third ventricles
3. Cerebral aqueduct (of sylvius)
4. Fourth ventricles
5. Subarachnoid space: surrounding the brain & spinal cord

Arachnoid Granulations
- Specialized villous extension of arachnoid meninges inserts thru dura matter into superior sagittal
sinus
- CSf passes thru these structures returning it to venous blood.
Clinical consideration:
Hydrocephalus is an abnormal accumulation of CSF in the ventricles and/or subarachnoid space.
In some instances, it may be due to an excessive production of CSf or congenial deformities/blockage of the flow
of CSF at some point in the ventricular system.
- No escape for CSF, ventricles expands, pressure builds & causes deficits

There are structures deep to the cortex that serve a variety of important functions:
• Limbic system
- Formed by many parts of the brain
- Has many functions such as controlling: emotions, fear, sex drive, major memory center
(converts short term to long term memory)

• Function of Hippocampus:
 Deals with memory & spatial navigation.
Necessary for:
- Making new memories
- Helping us remember where we are.
In Alzheimer s disease, patients have trouble remembering what you just said to them & where
they are.
• Basal ganglia
- Initiates movements in an adult
- Controls movements of newborn babies
• Substania nigra
- Involved in gross movements
- When damaged, there is a decrease in the production of dopamine.
- Results in the development of Parkinson s disease.
Lecture 18: Brain II

Brain Stem

The brain stem forms the core of the brain. Nerve fibers pass from the cerebral hemispheres to the
spinal cord and vice versa through the the brain stem. In addition, the nuclei of the brain also nerves are located
here. The brain stem includes:
1. Diencephalon
a. Thalamus
§ Location
• Superior to midbrain
• Inferior to corpus callosum
§ Function
• Relay center for all sensations except smell
b. Hypothalamus
§ Location
• Superior to midbrain
• Inferior to thalamus
§ Contents: multiple nuclei
• Control sleep & wake cycle
• Hunger/thirst
• Temperature
§ Controls autonomic NS via
• Pituitary gland ‒ located beneath hypothalamus
2. Midbrain
a. Location
§ Superior to pons
b. Contents
§ Auditory & visual
§ Reflex centers
§ Nuclei of cranial nerves
3. Pons
a. Location
§ Superior to medulla oblongata
b. Contents
§ Part of respiratory center
§ Bridge to cerebellum
§ Nuclei of cranial nerves
4. Medulla oblongata
a. Location
§ Inferior most portion of brainstem at level of Foramen magnum
b. Contents
§ Cardiovascular & respiratory centers
§ Motor & sensory decussation (cross over)
§ Cranial nuclei

Additional structures:
A. Reticular Activating Center (RAS)
•
I Location
§ Column of neurons in the middle of brain stem from the thalamus to the medulla
II Contents
§ Neurons that maintain a conscious state
§ When damaged, coma may result
 B. Cerebellum
I Coordinates movement
§ Posture
§ Balance
§ Speech
§ Voluntary movements
II Examples: controls flexor & extensor muscles
BUT does NOT initiate them!

Pathways: Afferent (sensory) and Efferent (motor) connections between CNS & PNS
A. Dorsal column-medial lemniscus pathway
1. Fine touch & proprioception
2. 2 bundles in dorsal (posterior) & spinal cord: fasciculus Gracilis (lower body) &
cuneatus (upper body)
i. Origin: spinal cord (in dorsal column in either gracilis or cuneatus)
ii. Decussation: medulla
iii. Destination: area 3,1,2
B. Corticospinal tract (cortex to spinal cord) descending motor pathway
1. Origin: area 4 ‒ precentral gyrus
2. Decussation: medulla
Travels corticospinal tract
3. Destination
i. Spinal cord
ii. Ventral grey horns
Note: unlike sensory impulses, motor signals generally pass from the cortex to the spinal cord without
synapsing.

Clinical considerations: Impaired motor function

The innervation of skeletal muscle is dependent upon two neurons.
1. Upper motor neuron
• Cell body usually located in the gray matter of the cortex (precentral gyrus)
• Its axons synapse on a lower motor neuron
2. Lower motor neuron
• Cell body is the brain stem (motor neuron of a cranial nerve) or in ventral gray
horn of spinal cord
• Its axons synapse on skeletal muscle fibers (peripheral motor nerve)
Damage to either of these neurons can result in paralysis. The specific effects this damage has on muscular
activity depends upon the number of neurons damaged and their precise location. In the examples below list the
symptoms which would be associated with each type of damage.

A. Poliomyelitis ‒ lower motor neuron lesion

This disorder results from a viral infection which damages the lower motor neurons located in
the ventral gray horn of the spinal cord. Those neurons located in the lumbar enlargement are
most frequently affected resulting in symptoms associated with the lower limb.
• Flaccid paralysis
• Reflexes absent
• Muscles atrophy
b. Cerebrovascular accident (CVA or stroke) ‒ upper motor neuron lesion
2 types:
I. Hemorrhagic = rupture of cerebral artery
Pressure damages brain
II. Ischemic = blockage of cerebral arteries
No O2 to tissue, cell death
 If damage occurred to neurons of the motor cortex or corticospinal tract, you might expect
the following symptoms:
1. Spastic Paralysis
2. Reflexes intact
3. Babinski Response is present. (dorsi flexion of large toe when the sole of foot is stroked.)
Pathological in adult
Lecture 19: Cranial Nerves & Autonomic Nervous System

Cranial Nerves
I. Olfactory (sensory nerve): Formed by small rootlets that pass through the roof of the nasal
cavity. Sense of smell.

II. Optic (sensory nerve): Vision (formed by axons of the ganglion cells in the retina of the eye.

III. Oculomotor (motor nerve): Control skeletal muscles that move the eyeball. Also contains
autonomic nerve fibers that control the size of the pupil & shape of the lens of the eye.

IV. Trochlear (motor nerve): controls skeletal muscles that move the eyeball

V. Trigeminal (motor & sensory nerve): Sensation for skin of face & teeth. Motor for muscles of
mastication.

VI. Abducens (motor nerve): controls one extrinsic muscle of the eyeball (skeletal muscle)

VII. Facial (motor & sensory nerve): Controls muscles of facial expression. Carries taste from the
anterior 2/3 s of the tongue. Autonomic function: control secretion of some salivary glands
& the lacrimal (fear) glands of the eye.

VIII. Vestibulocochlear (sensory): Vestibular ‒ Sense of balance. Cochlear ‒ sense of hearing

IX. Glossopharyngeal (motor & sensory): Controls one muscle of pharynx - carries sensation
from posterior wall of the pharynx (throat), & carries taste from posterior 1/3 of tongue.
Autonomic function: control secretion of the parotid salivary gland.

X. Vagus (motor & sensory): controls skeletal muscles of larynx. Sensory for larynx. Function:
involved in the control of heart rate (cardiac muscle). Involved in the control of smooth
muscle in thorax, abdomen, pelvis & various glands.

XI. Accessory (motor nerve): controls trapezius and sternocleidomastoid muscles

XII. Hypoglossal (motor nerve): controls muscles of tongue.

Autonomic Nervous System

Motor:
Acts on
• Cardiac muscle
• Smooth muscle
• Glands

Unconscious
• INVOLUNTARY
• Automatic

Human Nervous System

Central Nervous System
 A. *Brain
B. *Spinal cord
***Both the Brain & Spinal Cord
Peripheral Nervous System
A. Somatic (Voluntary Division) contain components of the Autonomic
B. *Autonomic (Involuntary Division) Nervous System. (ANS)

CNS = Brain + Spinal Cord + ANS

ANS: Two Neuron Chain

1. Preganglionic Neuron:
• Located in the CNS
• Axon exits CNS through a cranial nerve or a spinal nerve & then synapses with…
2. Postganglionic Neuron:
• Located in an autonomic ganglion in PNS
• Its axon innervates smooth muscle, cardiac muscle or glands.
• Target tissues include: Heart, Lungs, GI tract, Salivary glands, etc.
SOMATIC Motor AUTONOMIC Motor
Conscious & Voluntary Not under conscious control: Involuntary
SINGLE neuron to effector(s) (MOTOR UNIT) TWO neuron chain: pre & post ganglionic
Thick/heavily myelinated Pre = myelinated, Post = unmyelinated
Rapid conduction of impulse innervates Skeletal Slow conduction of an impulse Smooth muscle,
muscle Cardiac & Glands
Always stimulatory Maybe stimulatory or Inhibitory

Sympathetic & Parasympathetic Nervous System

Are opposing systems that differ by:
• Location of preganglionic & postganglionic neurons
• Neurotransmitter used
• Effects on body

Sympathetic Nervous System

1. Location of components
• Preganglionic Neuron
o Location: thoracolumbar = gray matter of Thoracic & Lumbar spinal cord
o All thoracic nerves (T1 ‒ T12)
o Upper lumbar nerves (L1, L2)
• Preganglionic fibers synapse with Postganglionic neurons within the Sympathetic Chain Ganglia
paravertebral chain ganglion
• This is a vertical interconnected chain of ganglia located alongside the spinal cord
• If in head, neck & thorax: will Synapse in chain
However, some neurons go THROUGH the chain, but DON T synapse.
• If in abdomen & Pelvis: will Synapse in other ganglia found in those cavities
2. Neurotransmitters
• Preganglionic Neuron = Acetylcholine
• Postganglionic Neuron = Norepinephrine
3. General Effect
• Fight or Flight response
o Ex. Increase heart rate, sweating, dilate bronchioles
• Active during vigorous exercise, excitement, emergency or stress
• Blood shunted to skeletal muscle
• Short term response
 • Requires increased energy

Adrenal Medulla
• Also contributes to sympathetic response
• Adrenal Glands = located on superior pole of kidneys
• The medulla (central portion) secretes Epinephrine & Norepinephrine
• Travel through bloodstream as hormones
• adrenaline surge

Summary
1. Synapse with a post ganglionic neuron in the paravertebral sympathetic chain (ascend/same level/
descend)
2. Pass through chain & synapse in abdominal/pelvic prevertebral ganglion
3. Synapse with postganglionic neurons in adrenal medulla

Parasympathetic Division CranioSacral

1. Preganglionic Neuron locations
1. Nuclei of Cranial Nerves in the Brainstem
• III Oculomotor
• VII Facial
• IX Glossopharyngeal
• X Vagus
2. Nuclei in Sacral region of Spinal Cord
2. Neurotransmitters
1. Preganglionic = Acetylcholine
2. Postganglionic = Acetylcholine
3. General Effect: Resting/Digesting
• Active when body is at rest
• Blood shunted toward internal organs
• Long term response
• Conserves energy
• Regular heartbeat, breathing rate, digestion, etc.

Examples of Effects on specific Sympathetic Parasympathetic

organs
Increase Heart Rate Decrease Heart Rate
Smooth Muscle of Bronchioles Dilate Constrict
Urinary Bladder Relax/fill Contract/expel
Digestive Activity Decrease Increase
Sweat Glands Increase No effect
Arrector Pili M. Increase Neutral
Pupil of Eye Dilate Constrict
Lecture 20: Visual & Auditory System

Visual System
I. Anatomy of the Eye
1. Orbit Eye Socket
• Composed of bones: Frontal, Maxillary & Zygomatic
• Also, tremendous amount of fat protects the eyeball
2. Associated Structures
a. Eyebrow/eyelashes/eyelid
• Brow/Lashes ‒ protects eye from dust & foreign objects
• Lid ‒ protects eye from foreign object
- Keeps eyeball moist
- Contains a small amount of cartilage
b. Conjunctiva/Conjunctivitis
• Infection/inflammation of the conjunctiva
• Pink Eye
c. Lacrimal gland
• Location: upper lateral corner of the orbit
• Secretes tears which bathe the eye as they flow from the upper lateral regions inferiorly
towards the inferior medial portion
• Controlled by: CN VII Facial N.
d. Nasolacrimal Duct
• Location: passes from medial corner of the orbit & lateral nose to the nasal cavity
• That s why ‒ when we cry we often get a runny nose
e. Extrinsic Muscles of the Eye
• These skeletal muscles allow for superior, inferior, medial & lateral rotational movement of
eyeball.
• All under voluntary control: CN III, IV, VI
3. 3 Major Layers of the Eye
1. Outermost Layer
a. Sclera
• Tough outermost layer of CT called the white of eye
• Continuous with Dura (Extrinsic muscles attach here)
• Protects the sensitive inner structures & gives shape to eyeball
b. Cornea
• Transparent anterior portion
• Covers iris, pupil & anterior chamber
• Avascular: oxygen diffuses from vessels in sclera
2. Middle or Vascular Layer
a. Choroid ‒ contains blood vessels supplying interior of eyeball.
b. Ciliary body ‒ contains muscles which change shape of the lens
c. Iris ‒ colored/pigmented t(contains SMOOTH muscle) that regulates the size of the pupil
to protect retina from strong light
3. Innermost Layer: Retina ‒ composed of 10 layers
a. Pigmented layer ‒ outer later that is BLACK in color so it absorbs light rays
b. Nine nervous layers = 3 layers involved in the conduction of an image
• Rods (dim light) & cones (color)
• Bipolar cells
• Ganglionic cells

Visual Response - Light is converted to an electrical impulse in the retina and then is transmitted to
occipital lobe of brain.

4. Optic Nerve
 • Extends from posterior side of the eye
• Transmits impulse to the visual pathway
• Composed of axons from ganglion cells

Fovea Centralis & Optic Disc

1. Fovea Centralis ‒ area of most acute vision/sharpest vision
2. Optic Disc: called Blind Spot
• This is where optic nerve enters with blood vessels
• There are no cells of the retina at the blind spot

Visual Pathway

Retina ® Optic Nerve ® Optic Chiasm ® Thalamus ® Optic Radiations ® Occipital Cortex (Visual Cortex)

4. Lens
Changes shape to help bend light rays & bring them into sharp focus on the retina.
This adaptability is Accommodation
• Crystal clear/transparent, contains elastic CT
• Composed of protein
• If protein amount increases; lens becomes cloudy

5. Cavities & Chambers

1. Anterior Cavity (anterior to the lens) is composed of two chambers
a. Anterior
b. Posterior
Aqueous Humor:
• A clear liquid produced by the ciliary body
• Continually produced
Note: if not drained off through channels there is an increase in pressure causing blindness:
Glaucoma
2. Posterior Cavity ‒ posterior to lens
Vitreous chamber containing Vitreous Humor.
• Clear gelatinous (jelly like) substance produced during embryonic development
• Function: maintains pressure & shape of eyeball

6. Blood Supply
• Vessels in choroid layer come in laterally
• Branches of the internal carotid artery enter with the optic nerve. They look like spokes of a
wheel when we observe at the back of the eye.

II. Function
• Refraction & transmission of light waves to photoreceptor cells of retina
• The amount of light & the focus of light must be regulated
• The AUTONOMIC NERVOUS SYSTEM (CN III) controls this with NO CONSIOUS EFFORT
2 ways:
1. Accommodation
a. Changing shape of lens through contraction/ relaxation of the suspensory ligament
b. Focus FAR = lens becomes THIN
c. Focus NEAR = lens becomes THICK
2. Alteration in the size of the pupil
a. Dilation
i. Smooth muscle of the iris that runs radially like spokes of a wheel
b. Constriction
i. Smooth Muscle of the iris that runs in circular direction
Lecture 21: Heart I

A. General Description & Position of the heart

1. Position & Organization
Because the heart is situated obliquely between the lungs, traditional body planes aren t used to
describe its position.
• Rotated 45° to left
• Tilted in a caudal direction
The heart is described as having 3 walls.
1. Anterior Wall
• frontal/upper portion
• Includes the right atrium & both ventricles
2. Inferior Wall
• Portion that resets on diaphragm
• bottom , includes both right & left ventricles
3. Posterolateral Wall
• Largest portion of the left ventricle
• The largest muscular wall (in depth & size)

Base: broad superior region where major vessels enter and exit the heart (mainly posterior left atrium)
Apex: The blunt cone-shaped end at the inferolateral aspect of the heart. (T4 level (nipple), mainly tip of
left ventricle)

The organ is divided into 4 internal chambers: 2 atria (superior) & two ventricles (inferior)

B. Protective Covering of the Heart

The heart and the roots of the great vessels are enclosed in a double-walled sac referred to as the
Pericardium.

It is composed of two parts:

A. Fibrous Pericardium
• Outer Sac
• Tough dense connective tissue
• Attaches heart to the diaphragm & base of the vessels
B. Serous Pericardium: inner layer composed of 2 portions:
a. Partial pericardium
• outer serous layer attached to fibrous pericardium
b. Visceral pericardium
• Inner serous layer attached to the heart surface: like the skin of an apple
• Also called epicardium

In between these two serous layers there is the pericardial cavity:

• This space contains serous fluid.
• Thin layer of watery fluid lubricates membrane
• Purpose is to decrease friction btw the layers of the pericardium as the heart beats (contracts &
relaxes)

Clinical consideration: Pericarditis refers to an inflammation or infection of the pericardium.

C. External Anatomy
Various grooves or depressions can be observed on the surface of the heart.
1. Atrioventricular sulcus
• Separates atria from ventricles
• Contains right & left coronary arteries & circumflex artery
 • Arteries are imbedded in fat pad
2. Anterior & posterior interventricular sulci
• Separate right & left ventricles
• Contains interventricular arteries (anterior & posterior)
• Arteries are imbedded in fat pads

D. Internal Anatomy: Layers of the Heart Wall

The wall of the heart is composed of 3 distinct layers:
1. Epicardium (visceral pericardium)
• Outermost layer composed of fibrous CT
• Fat & coronary blood vessels are found in sulci of this layer
2. Myocardium
• Middle layer composed of cardiac muscle that has special conduction capabilities
3. Endocardium
• Innermost layer
• Composed of simple squamous epithelium
• (continuous w. endothelial lining in blood vessels)
• Heart Valves are also covered w/in endocardium

E. Blood Vessels that Enter & Exit the Heart

Four vessels carry blood into the heart:
1. Superior Vena Cava: carries deoxygenated blood returned to right atrium from upper body & head
2. Inferior Vena Cava: carries deoxygenated blood which is returned to right atrium from lower body
3. Coronary sinus: contains venous blood returning from the heart s coronary circulation (enters
posterior right atrium)
4. Pulmonary Veins: only set of oxygen rich veins in adult body
• 4 pulmonary veins: 2 from Rt. Lung, 2 from Lt. lung
• Transport oxygenated blood from lungs to the posterior left atrium

Transport Blood out of the Heart:

1. Pulmonary Trunk
• Divides into right & left pulmonary arteries
• Transport deoxygenated blood from right ventricles to the lungs
2. Aorta
• Transport oxygenated blood form left ventricles to body.

F. Chambers of the Heart

The heart has two superior receiving chambers:
• Right Atrium: oxygen poor blood from body
• Left atrium: Oxygen rich blood from lungs
• Atria are separated by interatrial septum.

The heart has two inferior pumping chambers:

• Right ventricle: oxygen poor blood to be sent to the lungs.
• Left ventricle: delivers oxygen rich blood to the body.
• Ventricles are separated by interventricular septum

G. Specializations of the Chambers

1. Trabeculae carnae: muscular ridges that project from inner surface of ventricle to prevent suction that
would occur w/ a flat surface membrane.
2. Valve: As Gates which open & close due to pressure gradient ensuring blood flows only in 1
direction.
a. Atrioventricular (AV): (all covered by endothelium)
 • Tricuspid valve (right AV valve): has 3 cusps. blood passes from RA through this valve to
RV
• Bicuspid valve (left AC valve or mitral valve): has 2 cusps; blood passes from LA through
this valve to the LV.

Structures in the ventricles that help stabilize the valves & prevent backflow & inversion:
1. Papillary muscles:
• Finger-like projections from the wall of the heart
• Prevents valve inversion (prolapse)
• Stabilizes the valve
2. Chordae tendineae
• Tendinous cords which attach papillary muscles to cusps of valves.
• Look like strings on a guitar

b. Semilunar valve (SLV): three cups like valves covered in endothelium which open & close
according to pressure gradients
• Pulmonary SLV: blood passes from RV through this valve on its way to the lungs
• Aortic SLV: blood passes from LV through this valve on its way to the body

Clinical consideration:
Blood may pass from the right atrium into the left atrium in through an opening in this septum called
foramen ovale. At birth foramen ovale closes & becomes fossa ovale visible in the interatrial septum.
Cyanosis ‒ low oxygen levels in the blood cause the lips, fingers & toes to look blue (cyanotic).
Lecture 22: Heart II

A. Layers of the Heart Wall

The wall of the heart is composed of 3 distinct layers:
1. Epicardium (visceral pericardium)
• Outermost layer
• Composed of fibrous CT
2. Myocardium
• Middle layer composed of cardiac muscle
3. Endocardium ‒ innermost layer, lines the heart chambers
• Composed of simple squamous epithelium
• Various grooves or sulci can be observed on the surface of the heart. Blood vessels of the
coronary circulation are located in these.

B. Coronary Circulation
Right & left coronary arteries are the first branches off the aorta.

Right coronary artery: divides into two branches

1. Marginal: supplies myocardium of the inferior wall of both ventricles
2. Posterior interventricular (PCA): travels in sulcus on posterior side to supply posterior wall of both
ventricles.

Left coronary artery: divides into two branches

1. Anterior interventricular/ left anterior descending (LAD): supplies interventricular septum & anterior
wall of both ventricles
2. Circumflex: supplies left atrium & posterior ‒ lateral left ventricle

Venus circulation: three main veins (great, small and middle) drain blood into the coronary sinus which
empties into the right atrium.

Clinical consideration:
Myocardial infarction: an insufficient supply of blood and oxygen to death of cardiac tissue. This can occur
when a thrombus (fixed blood clot) or an embolus (moving blood clot) blocks one of the major coronary
vessels. Cardiac muscle cannot regenerate and therefore dead tissue will be replaced by scar tissue. Inability
to conduct & contract.

Pathology of Atherosclerosis: Atherosclerosis leads to ischemic heart disease & myocardial infarction.

C. Conducting system: Intrinsic & Extrinsic control

Primary intrinsic regulating system stimulates the cardiac muscle fibers to contract without the need for
any direct stimulus from the nervous system. Composed of specialized conducting cells.

Secondary extrinsic regulating system alters the heart rate in response to the body s immediate needs.
Composed of components of the autonomic nervous system.

A. Intrinsic conduction system components are the:

1. Sinoatrial node (sa node) ‒ pace maker of the heart
• Collection of specialized conducting cells located in wall of the right atrium
• Initiates heart beat
2. Atrioventricular node (AV node)
• Receives impulse from SA node
• Sends impulse to the bundle of His.
3. Atrioventricular bundle of His
• tract or collection of conduction fibers located in the interventricular septum
 • Transmits impulse to purkinje fibers
4. Purkinje fibers
• Located in walls of the ventricles
• Conduct impulse to myocardium
• Results in ventricular contraction
B. Extrinsic control through AND pathways: Responsible for altering heart rate to meet needs of the
body.
1. Sympathetic stimulation
• Release of norepinephrine
• Acts on SA node
• Increases HR & strength of contraction
2. Parasympathetic stimulation
• Inhibitory (vagus CN X)
• Release of acetylcholine
• Decreases HR

D. Cardiac cycle
Refers to a complete heartbeat. Sequence of one contraction and relaxation of the heart chambers.
SA node initiates each cycle.
Occurs approximately 70 times per minute.
Approximately 5 L of blood is pumped by the heart every minute.

As the atria contract, simultaneously they force blood into both ventricles.

Systole = contraction of cardiac muscle

• Ventricles contract
• AV valves close and blood is ejected from the heart
• Blood in the right ventricle exits through the pulmonary arteries while blood in the left ventricle leaves
through the aorta

Diastole = relaxation of cardiac muscle

• Ventricles relax
• Semilunar valves close & AV valves close
• Blood has filled the atria which are awaiting the signal from the SA node to begin the next cardiac
cycle.
- Note as atria contract simultaneously, they force blood into both ventricles
- Note as ventricles contract simultaneously they force blood through the semilunar valves out of
the heart

Ventricular Diastole = Tri & bicuspid valves open

Ventricular systole = semilunar valves open.

- These events occur in both the atria & ventricles.

E. Heart Sounds
Auscultation ‒ act of listening to sounds with the use of a stethoscope. Sounds made by the vibrations that
occur as the valves close. lubb-dubb ‒ one heart beat
• 1st heart sound: lubb ‒ closure of AV valves during ventricular contraction
• 2nd heart sound: dub ‒ closure of semilunar valves during ventricular relaxation

Valves are located deep to the sternum.

These areas are referred to as the four auscultatory areas:
1. Aortic area
• Aortic semilunar valve
 • 2nd intercostal space, right space
2. Pulmonic area
• Pulmonic semilunar valve
• 2nd intercostal space, left side
3. Tricuspid area
• Right Av valve
• 5th intercostal space
• To the right of the sternum
4. Bicuspid area
• Left av valve
• 5th intercostal space
• To the left of sternum, near apex of heart
Lecture 23: Blood Vessels I

I. Function
This blood vessels of the body form an extensive tubular network.
This functions as the major transport system for:
1. Gases: oxygen from the lungs and carbon dioxide from cells
2. Nutrients: (carbohydrates, lipids and amino acids) from digestive tract to cells
3. Waste products: from cells to kidneys and skin for excretion
4. Hormones: of the endocrine system to cells & tissue

II. General Structure

Dynamic structures that pulsate, constrict and dilate.
Structure of each blood vessel dictates its function.

Terminology:
Lumen = the opening/internal of the blood vessels tubular structure
• They are tubular structures that possess a lumen (opening).
Tunics = multilayered walls of the blood vessel
• They are surrounded by a wall composed of tunics (coats/layers)

III. Composition of Blood Vessel Walls

1. Tunica externa: superficial layer
• Composed of: CT (collagen)
• Function: protect vessel & help anchor it to other structures
Note: why is the tunica externa of an artery much thicker than that of a vein? Blood in the
arteries is under much greater pressure.
2. Tunica media:
• Composed of: circularly arranged smooth muscle
• Function: regulates diameter of blood vessels & size of lumen ‒ amount of blood flow & blood
pressure
- Vasodilation: muscle relaxes to increase the diameter of vessel/lumen
- Vasoconstriction: muscle contracts to decrease the diameter of vessel/lumen
3. Tunica intima: innermost layer in direct contact with blood in lumen
Also called Endothelium.
• Composed of: simple squamous epithelium
• Function:
- This very thin layer allows for passage of nutrients & waste products to & from the blood
& tissues at the capillary level.
- Also produces a number of substances required for blood coagulation & other vascular
function.

IV. Cardiovascular System

Is a CLOSED system that transports blood through two separate circuits:
1. Pulmonary circuit
• Transports blood from the heart to lungs, allows for exchange of O2 & CO2 and returns blood to
the heart.

The heart sends blood out into the:

2. Systemic circuit
• Transports blood throughout the body to all other organs for nutrient, gas, waste exchange.
• Blood vessels are classified according to their structural and functional characteristics.
V. Types of Blood Vessels
1. Arteries
a. Have all 3 tunics
b. Carry blood away from heart & channel blood to arterioles plus elastic fibers are present
along w/ smooth muscle in their tunica media allowing them to expand & recoil.
c. Blood is under HIGHEST velocity & pressure.
d. Largest arteries possess: vaso vasorum vessels of the vessels supply THICK blood vessel wall

2. Arterioles
a. Have all 3 tunics
b. Function: they regulate the amount of blood flow to tissues based on the tissue s energy
needs, through changes in the smooth muscle in their tunica media.
c. Unique structure: Precapillary sphincter of arteriole
d. Unique Structure: Precapillary sphincter of arteriole
• Composed of smooth muscle
• Located @ junction of an arteriole & capillary bed
• It will contract or relax to control the amount of blood entering a capillary bed.
e. The diameter of Arterioles is regulated 2 ways: regulates 2 ways:
1. Local factors (ex. Nitric oxide, O2 & CO2 levels)
These levels in the tissues signal the smooth muscles to contract or relax, thus regulating
how much blood enters a capillary bed.
1. Local factors (ex. Nitric oxide, O2 & CO2 level)
• These levels in the tissues signal the smooth muscles to contract or relax,
thus regulating how much blood enters a capillary bed
2. Sympathetic Nervous System
• Acts on the smooth muscle in the tunica media of arterioles.
• An increase in sympathetic activity causes widespread VASOCONSTRICTION of the
tunica media in most arterioles ® decrease blood flow (especially in abdominal cavity)
• Sympathetic do increase blood flow to skeletal muscles &. The heart through vasodilation
of vascular smooth muscle

3. Capillaries: Diameter 8‒10 µm (diameter of RBC 7-8 µm) ® must travel single file
• An increase in sympathetic activity causes widespread VASOCONSTRICTION
of the tunica media in most arterioles ® decrease Blood flow (especially in
abdominal cavity)
• Sympathetic do increase blood flow to skeletal muscles & the heart through
vasodilation of vascular smooth muscle

4. Capillaries: Diameter 8-10 µm (diameter of RBC 7-8 µm)

A. Velocity & pressure of blood flow is LOW
B. Cross-sectional area is HIGHEST
• Composed of: only tunica intima (Endothelium). Recall that simple squamous epithelium ‒
VERY THIN!
 Note: Capillaries level are capillaries level most favorable level for exchange of water, gases, nutrients
and waste products.
product. Why? Thinnest walls, most permeable, large surface area, low velocity & pressure.

Types of Capillaries
A. Continuous: Most common. most common
- Endothelium held together by tight junctions forming a complete, continuous
lining
- Substance can only pass through the tiny clefts: limited exchange
• Endothelium held together by tight junctions forming complete, continuous lining.
• Substances can only pass through the tiny clefts: limited exchange.
• Located primarily in muscle, CT, nervous system
B. Fenestrated
• Permit rapid exchange of fluids & small solutes
• Perforated endothelial cells appears like Swiss-Cheese
- Found in filtration site of kidney, intestines and endocrine glands.
• Found in filtration site of kidney
C. Sinusoidal
• Permit the exchange of larger proteins & cells
- Large gaps of discontinuous basement membrane allow for the most exchange
of fluid & solutes of all capillaries.
• Large gaps of discontinuous basement membrane allow for the most exchange or
fluid & solutes of all capillaries.
• Found in RED BONE MARROW, LIVER & SPLEEN.

5. Venules: collect blood from CAPPILARIES & transport it to veins

a. Composed of:
6. Venules
• Collect blood from capillaries and transport it to veins
• Composed of:
o 3 tunics (very thin)
o Less smooth muscle than arterioles.

7. Veins: brings blood to the heart: right atrium

a. Composed of:
• Have a large lumen & thin walls
• Composed of 3 tunics ‒ have fewer elastic & muscle fibers than arteries
• Veins of lower limbs have valves to prevent backflow of blood
Clinical consideration: Varicose Veins
Dilated veins due to poor valves &/or weakened vessel wall.
8. Veins
• Has large lumen & thin walls
• Composed of 3 tunics ‒ have fewer elastic & muscular than arteries.
• Veins of lower limb have valves to prevent backflow of blood.

Clinical consideration: Varicose veins ‒ dilated veins due to poor valves &/or weakened vessel wall.

Distribution of blood in body:

Described as HIGHLY COMPLIANT (easily stretch/expand) allowing them to hold more blood, so they act
as a Blood reservoir : contain 60% of body s total blood!!
Venoconstriction ‒ constriction of smooth muscle with an increase in sympathetic nerve innervation helps
to redistribute blood to needed sites.
Distribution of Blood in the Body
• Veins are described as HIGHLY COMPLIANT (easily stretch/expand) allowing them to hold more blood,
so they act as a Blood reservoir (contain 60% of the body s total blood).
• Venoconstriction ‒ constriction of smooth muscle with an increase in sympathetic nerve innervation
helps to redistribute blood to needed sites.
 Lecture 24: Blood Vessels II

I. Pulmonary Circuit
Consists of the portion of the circulatory system which is responsible for the transport of blood to the
lungs for the exchange of oxygen and carbon dioxide and the return of the blood to the systemic circuit
which transports it throughout the body. It consists of:

1. Pulmonary Ventricle 5. Pulmonary Veins (return

(receives blood from RA) blood from lungs)

2. Pulmonary trunk 4. Lungs, exchange of

O2 & CO2
6. Left Atrium
3. Pulmonary Arteries

Portal system:
Consists of 2 sets of capillary beds that blood must travel before returning to general circulation.
This means there are 2 sites for exchange of substances.

Capillary bed #1 enters a vein ‒ then passes through

Capillary bed #2 ‒ to another vein… then onto the heart!

There are 3 portal systems in the body:

1. Hepatic Portal System ‒ Intestines to liver
2. Hypophyseal Portal System ‒ Hypothalamus to Pituitary
3. Kidney portal system ‒ Glomerulus Peritubular Capillaries

A. Hepatic Portal Circulation

Blood enters the liver from 2 sources:
1. Hepatic Artery
• 25% of blood supply is + O2
1. Hepatic artery
• 25% of blood supply is + O2
• This is a branch of the celiac trunk
2. Portal Vein
2. Portal vein
• Supplies 75% of blood supply

This vein is formed by the union of 3 veins that drain the small and large intestine & the spleen:
This vein is formed by the union of three veins that drain the small and large intestine & spleen:
1. Superior mesenteric vein
2. Inferior mesenteric vein
3. Splenic vein
Blood is drained from the liver by the hepatic vein & next enters the inferior vena cava.

II. Special Considerations:

A. Arterio ‒ Venous (AV) shunts
The AV shunt provides a mechanism by which the volume of blood entering a capillary bed can e precisely
regulated. It allows for the delivery of increased amounts of blood to those tissues which require an
immediate additional supply of oxygen & nutrients.
In conjunction with this it enables blood to bypass capillary beds supplying tissues which do not need this
rich blood supply at that particular moment. This accomplished by sympathetic control of the smoot
muscle of the precapillary sphincter of arterioles.
B. Collateral Circulation
Connections btw adjacent capillary beds exist in selected regions of the body. This is especially
true of areas surrounding the joints of the extremities.
A result of this anastomoses (connection) a blockage of one artery supplying an area may not
be as serious since adjacent vessels will maintain an uninterrupted blood supply to the tissue at
that site.
Lecture 25: Lymphatic System

Lymphatic System
Composed of lymphatic vessels & tissue, lymph nodes, spleen, thymus, tonsils and GALT (Gut Associated
Lymphatic Tissues ‒ Peyer s

Composed of: Lymphatic Vessels & Tissue, Lymph nodes, spleen, thymus, tonsils & GALT (Gut Associated
Lymphatic Tissues ‒ Peyer s Patches in the intestine)

I. Lymph: Clear, watery fluid

Tissue fluid which comes from extracellular (interstitial space)
1. Composition:
a. Plasma
b. Plasma proteins
c. Lipids
d. Lymphocytes
e. Miscellaneous debris (bacteria, malignant cells)
2. Function
• Assists cardiovascular system in the return of excess tissue fluid to the circulation
• Immune Defense
Clinical application: Edema: problems with lymphatic drainage.
Accumulation of fluid in extracellular (interstitial) space resulting in swelling

II. Lymphatic vessels

1. Location
a. Widely distributed throughtout the body
b. Run alongside the blood vessels within the loose connective tissue
2. Structural characteristics
a. Lymphatic capillaries
• Begin as blind-ended tubes, small, thin-walled
• VERY PERMEABLE!!
b. Medium-Large Lymphatic Vessels
1. Thicker walls
2. Smooth muscle fibers surround vessel
3. Have valves ‒ permit fluid to flow in one direction only
c. Lymphatic ducts
1. Largest lymphatic vessels
2. Thicker walls, valves
1. Right lymphatic duct
2. Thoracic duct
d. Lacteals
1. Located in intestine
2. Transport products of fat digestion

III. Lymph Nodes

1. Function
a. Filtration of lymph ‒ removal of foreign particles
b. Production of lymphocytes
1. T-cells ‒ destroy foreign material
2. B-cells ‒ produce antibodies
2. Structure & Contents
a. Enclosed in fibrous capsule
b. Afferent vessels ‒ take filtered lymph away from node
c. Efferent vessels - take filtered lymph away from node
 d. Reticular fibers ‒ form a meshwork that traps small particles, debris, cells
e. Macrophages ‒ engulf and digest debris
f. Aggregation of T-cells
g. Germinal centers ‒ area where B-lymphocytes develop and becomes plasma cells
which produce antibodies
Clinical consideration: Lymphadenitis ‒ swollen glands ; normal response to infection
lymphadenopathy ‒ accumulation of malignant cells in lymph node
3. Transport of Lymph/specific path
Tissue Fluid (intercellular spaces) ® lymphatic capillaries ® Large lymphatic vessels ®
Lymphatic ducts ® Venous system

Right lymphatic duct ‒ drains upper right quadrant head, thorax, upper limb
Thoracic duct ‒ Both lower extremities abdomen, left thorax, left head and neck
Both drain into the subclavian veins

Factors affecting Lymphatic Flow back to heart

• Rhythmic contraction of skeletal muscle ‒ help push fluid along
• Negative pressure in thorax ‒ helps draw fluid up through thoracic duct
• Valves ‒ prevent the backflow of lymph

IV. Associated Lymphoid Organs

1. Spleen
a. Location
• Upper left quadrant
• Posterolateral to the stomach
• Level of the 9th-11th ribs
b. Structure & Contents
1. Red pulp ‒ consists of blood flowing through a meshwork of fibers
2. White pulp ‒ clusters of lymphoid tissue
3. Reticular fibers ‒ meshwork of fibers, traps debris passing through so
macrophages can engulf it
4. Sinusoids ‒ irregular passageways through which blood passes
c. Function of Spleen
1. Production of blood cells
• Fetal life ‒ all cell types
• Adult ‒ usually only lymphocytes
2. Storage
• Platelets
• WBC & RBC
• Iron
3. Filtration
• Filters blood
• Destroys & disposes of old RBCs
4. Immune function
• Production of lymphocytes & antibodies
Clinical consideration: The spleen also acts as a reservoir since it stores a great deal of
blood. In the case of hemorrhage, it contracts and releases stored blood cells and
platelets. How does this happen?
(ANS Sympathetic release of norepinephrine. Fight or Flight response )

When the spleen becomes enlarged there is the risk of rupture. This can occur in
infection (mononucleosis) and malignancy (leukemia).

2. Thymus
 a. Bi-lobed mass of lymphoid tissue
b. Located beneath the sternum
c. During prenatal & postnatal development it is responsible for the production of T-
lymphocytes
NOTE: it begins to degenerate at puberty and not functional in the adult.

3. Tonsils
a. Description: Clusters of lymphoid tissue
b. Location: just deep to the mucous membrane lining the upper pharynx (actually form
a discontinuous ring)
c. Specific Location of the Tonsils
1. Lingual tonsils
• Located on posterior 1/3 of tongue
2. Pharyngeal tonsils adenoids
• Located on roof of posterior wall of the nasopharynx
3. Palatine tonsil the tonsils
• Extend into soft palate on each side of oropharynx
Lecture 26: Blood I

1. Functions of Blood
a. Transport system
• Oxygen from lungs to cells of the body
• Carbon dioxide from cells to lungs
• Nutrients from digestive tract to cells
• Waste products from cells to kidneys and sweat glands
• Enzymes & hormones to various cells
b. Protection
• White blood cells help combat infection (phagocytosis of microorganisms & production of
antibodies)
• Prevention of body fluid/blood loss by clotting mechanism
c. Regulation
• Body temperature (water it contains provides means for heat dissipation)
• Volume of body water
• pH (by way of buffer system)
2. Composition of Blood
a. Plasma/serum (55%) = Liquid portion
1. Liquid portion of blood
2. Contains Major Plasma Proteins
a. Albumin ‒ very large, has many functions
• Transport protein
• Blood pressure regulation
• Affects osmotic pressure
b. Fibrinogen
• Necessary for blood clotting
c. Globulins
• Transport of lipids & antibody formation
3. Ions (electrolytes) e.g., sodium, potassium, chloride
4. Compounds such as glucose, urea etc.
b. Cellular Elements (45%)
1. Erythrocytes (red blood cells)
2. Leukocytes (white blood cells)
3. Thrombocytes (platelets)

Cell Description Function Lifespan

Erythrocytes (RBC) • Biconcave shape
• No nucleus (no mitosis)
• Stains reddish-pink
• Contain hemoglobin
WBC: Neutrophil • Segmented nucleus
(granulocyte) • Polymorphonucleated (aka
PMN, Seg)
• Granules: contain enzymes
WBC: Eosinophil • Bi-lobed nucleus
• Lg Pink granules
WBC: Basophil • Lobed nucleus
• Dark granules
WBC: Monocyte • Largest, variably-shaped
nucleus
• Transport of Oxygen & 120 days
Carbon Dioxide
• Phagocyosis of bacteria, A few
debris, etc., increased in hours
bacterial infections
• Fights parasitic infections &
allergies
• Contains histamine
• Affects vascular permeability
• Increase in number in a type
of leukemia
• Phagocytosis
 • Blue cytoplasm • Moves into the tissues &
becomes a macrophage
WBC: Lymphocyte • Non-granulocytes • Immune defense Hours to
• Blue cytoplasm • Fights viral infection years
• Round nucleus • Increased in viral infections
• Subtypes: T cells (cell-
mediated defense) & B cells
(antibody production)
Thrombocytes (platelets) • Small, granular fragments • Blood clotting
• Actually portion of cytoplasm
of a Megkaryocyte which
resides in the bone marrow

Hemopoiesis (Blood Cell Formation)

A. Location
• During the stages of embryonic & fetal development blood cells are formed in various areas (organs).
Included among these are the yolk sac, liver, spleen, thymus, lymph nodes & bone marrow.
• In the adult, blood cells are formed in the red bone marroe of ther sternum, ribs, vertebrae, pelvis,
head of the humerus & femur and in the lymphoid tissue/organs (lymph nodes & spleen, tonsils).
B. Bone Marrow ‒ located in the spaces or cavities within long & flat bones
• Red marrow ‒ hemopoietic (blood forming)
• Yellow marrow ‒ contains a large number of fat cells
• At birth all of our bone marrow is red
• With age the blood forming activity lessens & the red marrow is replaced by yellow marrow
• In the adult only approximately 50% of our bone marrow is red marrow
C. Development of Blood Cells
• Cells called pleuriopotential stem cells give rise to all the various blood cells.
• Their offspring undergo mitotic activity producing more blood cells & also go on to develop special
characteristic as they become mature blood cells
• When these cells become mature, they leave the bone marrow & enter the circulation (peripheral blood)
to replace the cells which have died or have been lost (e.g., due to hemorrhage).
• Hormones such as erythropoietin which is produced in the kidney influence the rate of production of
these cells.

Specific points to note about Blood Cell maturation include:

1. The loss of the nucleus in red cell as it matures. Also realize that the hemoglobin content of this cell
progressively increases.
2. The appearance of granules in the maturing granulocytes and the gradual segmentation of their nuclei.
3. Note the megakaryocyte. It remains in the marrow however fragments of its cytoplasm (platelets) enter
the peripheral blood.

Hematologists & medical technologists look for changes or abnormal appearance of these cells to
diagnosis disease.
Lecture 27: Blood II

Blood Grouping: ABO system

1. Antigen (Agglutinogen)
a. A protein found on the surface of erythrocytes. The type of antigen present is genetically
determined
• A
• B
• AB
Note: No O antigen; O means non A non B
b. Antibody (Agglutinin)
• Present in plasma
• Attacks the corresponding antigen
• Example: Anti-A antibody will combine with the A antigen causing a clumping of the cells
which have this antigen on their surface
IMPORTANT NOTE:
- Your serum/plasma does NOT contain the antibody that corresponds to the antigen on your
RBC since this would cause your RBCs to agglutinate! (clump)
- So, if you are Type A, you only have Anti B antibodies

Blood Groups
Blood Group Antigen on RBC Antibodies in Plasma Can be transfused with
A A Anti-B A&O Universal Donor = O
B B Anti-A B&O Universal Recipient =
AB A&B None A, B, AB & O AB
O None Anti-A & Anti-B O

Blood Transfusion
• Generally, when a blood transfusion is needed, packed RBCs are transferred from a Donor into
the Recipient
• To ensure compatibility, a small amount of blood from the Donor is cross-matched with a sample
from the Recipient
• If the blood is not compatible, the antibodies in the recipient s plasma will agglutinate (clump) the
newly transfused donor RBCs.
• This aggulation results in the destruction of the RBCs as well as a series of serious side effects
(transfusion reaction).
• Therefore when deciding what blood type can safely be transfused into a patient, always consider
whether the
 a. Donor RBC antigen will be attacked by the antibodies in the Recipient s plasma.
(incompatible)
• Or another way of saying this is that the patient must not have an antibody that will agglutinate
the RBCs they are receiving from the donor.

Rh System
• Similar to ABO system
• Most individuals possess the Rh antigen and are referred to as being Rh positive
• Rh negative individuals may develop antibodies against the Rh antigen if exposed to that antigen

Hemolytic Disease of the Newborn

• These antibodies may cross the placenta during pregnancy. An Rh-positive fetus carried by a
sensitized Rh negative mother may be at risk.

Hemostasis
• Refers to the stoppage of bleeding when blood vessels are damaged or ruptured.
• This involves the sequential activation of many different components

3 basic mechanisms operate to prevent blood loss

1. Constriction of Blood Vessels
• Smooth muscle in vessel walls contracts. This causes vasocontraction resulting in slowing
down blood loss.
• How does this happen? Response of the ANS Sympathetic release of Norepinephrine causes
contraction of smooth muscle in the tunica media.
2. Platelet plug formation
• Platelets accumulate and become sticky
• They adhere to each other and to collagen fibers, thus forming a plug.
3. Coagulation ‒ Formation of the Fibrin Clot
• Clotting factors in plasma work together in a complex process that results in the formation of stable
clot
• Example: Thrombin & Fibrinogen
• In addition, Calcium & Vitamin K are essential for this process to occur.
Fibrinolysis ‒ Break down of clots
Thrombus ‒ fixed blood clot
Embolus ‒ thrombus which has moved
Fibrinolytic system ‒ responsible for the breakdown of clots
Plasmin is the major enzyme that breaks down fibrin clots

Medicinal Anticoagulant Therapy:

Oral anticoagulants:
• Vit K antagonists EX: coumadin/warfarin
• Heparin: anti thrombin ‒ which breaks down clots
• Aspirin: inhibits platelet aggregation
• TPA ‒ Tissue Plasminogen Activator: Acts a Clot Buster to break down clots