Chapter 1: Blood – Summary notes

A. Human Blood

Blood type is a system to classify blood based on the differences of the surface antigens on the red
blood cells.

The two most common blood typing in human are the ABO system and Rh system.

ABO System:
- classified based on the antigen A and antigen B on the red blood cells.
Blood Type A = Has antigen A on RBC & antibody B in the blood plasma.
Blood Type B = Has antigen B on RBC & antibody A in the blood plasma.
Blood Type AB = Has both antigen A and antigen B on RBC & neither antibody A nor
antibody B in the blood plasma.
Blood Type O = Has neither antigen A nor antigen B on RBC but has both antibody A
and antibody B in the blood plasma.

Rh systems:
- classified based on the presence of Rh(D) antigen or Rh factor on the red blood cells.
Rh(D) pos or Rh + : Has antigen D/antigen Rh on the RBC
Rh(D) neg or Rh - : Has no antigen D/antigen Rh on the RBC

Examples:
B pos or B+ means blood type B and positive for the Rh factor.
O neg or O- means blood type O and negative for the Rh factor.
B. Blood Transfusion

Blood Transfusion: The administration of blood directly into the bloodstream of another person.
Transfusion Reaction: Any adverse effect of a blood transfusion.
Transfusion reaction includes agglutination and hemolysis .
Agglutination : Clumping together of red blood cells
Hemolysis : Bursting of red blood cells

Blood Compatibility
Persons with blood type A can receive blood from type A and O.
Persons with blood type B can receive blood from type B and O.
Persons with blood type AB can receive blood from type A, B, AB and O.
Persons with blood type O can receive blood from type O only.

Blood Incompatibility
Blood transfusion with incorrectly matched blood type can be fatal.
For example, when a person with blood type A receives blood from type B, the B antibodies of the
recipient will attack the B antigens from the donated blood. Transfusion reaction will occur.
The antigen-antibody reaction will cause agglutination or hemolysis of red blood cells. The clumps
may block blood vessels and cause organ damage or even death. The hemoglobin released by
damaged red blood cells can block the kidney and lead to kidney failure.

Can a person with Rh-negative receive blood from Rh-positive?

Persons who are Rh-positive can receive both Rh-positive and Rh-negative bloods.
Persons who are Rh-negative can receive Rh-negative blood only. However, he can still
receive Rh-positive blood, but only once.
When a person with Rh-negative blood receives Rh-positive blood for the first time, no transfusion
reaction will occur. It is because initially his body has no Rh antibodies, and when exposed to Rh-
positive blood, he will start to produce Rh antibodies, but, it takes several months for the production
of Rh antibodies.
When he receives Rh-positive blood for the second time, his Rh antibodies which are produced after
the first exposure to the Rh-positive blood will attack the Rh antigens from the second Rh-positive
blood, causing transfusion reaction to occur.

Effect of Rh factor on Pregnancy

If an Rh-negative woman marries an Rh-positive man, there is a chance to have an Rh-positive baby.
During pregnancy or childbirth, the fetal Rh-positive blood may leak into the mother's blood stream.
If this happens, her body will produce Rh antibodies to attack the Rh-positive blood in the fetus.
There is no effect on the first baby because it takes several months to produce the Rh antibodies.
However, if she becomes pregnant with a second Rh-positive baby, the Rh antibodies produced
during the first pregnancy will enter the fetal blood stream to cause fetal red blood cells to swell and
burst.
This disease is called hemolytic disease of the newborn (HDN), characterized by reduced numbers of
mature red blood cells and elevated blood levels of bilirubin.
For prevention, the Rh-negative mother will be given an injection of Rh antibodies (RhoGAM)
starting from her first pregnancy.
The injected Rh antibodies will quickly destroy any of the fetal Rh-positive blood entered into the
mother’s body before she begins to produce her own Rh antibodies.
C. Blood Disorders

I. Anemia
Reduction in the oxygen-carrying capacity of blood.
Causes: low levels of hemoglobin, low numbers of red blood cells, abnormal hemoglobin, heavy
menstrual flow in women
Symptoms: pale skin, headaches, fatigue, dizziness, difficulty in breathing.

Types of anemia
Iron-deficiency anemia: insufficient iron results in fewer hemoglobin molecules in red blood cells.
Aplastic anemia: bone marrow does not produce enough stem cells.
Hemorrhagic anemia: extreme blood loss during injuries, bleeding ulcers, malaria, etc.
Pernicious anemia: deficiency of vitamin B12 absorbed by the digestive tracts.
Sickle-cell anemia: red blood cells become sickle-shaped when oxygen concentration is low. An
inherited disorder.

II. Leukemia
A type of blood cancer.
Uncontrolled proliferation of abnormal immature white blood cells in the bone marrow.
Types: acute or chronic
Causes: mutation of white blood cells, viral infections, exposure to radiation or harmful chemicals,
genetic factor.
Symptoms: tissues bruise easily, bones become tender, headaches, enlarged lymph nodes.
Treatments: radiotherapy, chemotherapy, transplants of bone marrow.

Happy Reading…
Chapter 2 - Cardiovascular System – summary notes

A. Structure/Anatomy of Human Heart

• Pericardium – a thick membranous sac surrounding the heart that secretes lubricating fluid.
Pericardium consists of fibrous pericardium and serous pericardium (parietal pericardium
and visceral/epicardium)

The wall of heart consists of 3 layers:

• Epicardium - outermost (visceral) layer of the heart often infiltrated with fat.
• Myocardium – major portion of the heart which consists of cardiac muscle.
• Endocardium – inner lining of the heart which consists of connective tissue and endothelial
tissue.

The heart has 4 chambers: left atrium, right atrium, left ventricle and right ventricle. Atria are
receiving chambers while ventricles are discharging chambers.

• Septum separates the heart into left and right side so that there is no mixing of oxygen-rich
(‘oxygenated’) blood and oxygen-poor (‘deoxygenated’) blood.

The heart has 4 valves: 2 atrioventricular valves (tricuspid valve and bicuspid valve) and 2
semilunar valves (pulmonary semilunar valve and aortic semilunar valve).

• Tricuspid valve – has 3 flaps, lies between right atrium and right ventricle. It allows oxygen
poor blood to flow from the right atrium into right ventricle and prevents backflow of blood
when ventricles contract.
• Bicuspid valve (mitral valve) – has 2 flaps, lies between left atrium and left ventricle. It
allows oxygen rich blood to flow from the left atrium into left ventricle and prevents
backflow of blood when ventricles contract.
• Pulmonary semilunar valve – located at the base of pulmonary trunk. It allows oxygen poor
blood to flow from the right ventricle into pulmonary trunk and prevents backflow of blood
when ventricles relax.
• Aortic semilunar valve – located at the base of aorta. It allows oxygen rich blood to flow
from the left ventricle into aorta and prevents backflow of blood when ventricles relax.

• Chordae tendineae – strong fibrous strings. It supports the atrioventricular valves and
prevent them from inverting when ventricles contract.

• Coronary artery – blood vessels found on the surface of the heart. It arises from the base of
aorta. It carries oxygen and nutrients to the heart muscle.

• Cardiac vein – blood vessels found on the surface of the heart. It joins to the right atrium. It
carries carbon dioxide and wastes away from heart muscle.
B. Heart Physiology

I. Cardiac Cycle
◼ Each heartbeat is called a cardiac cycle.
◼ All events associated with blood flow through heart during one complete heartbeat.
◼ When the heart beats, first the two atria contract at the same time; then the two ventricles contract at the
same time. Then, all chambers relax.
◼ Systole : contraction of heart muscle
◼ Diastole : relaxation of heart muscle.
◼ The heart contracts or beats about 70 times a minute and each heartbeat lasts about 0.85 second.
◼ Normal adult rate (at rest): 60 – 80 beats per minute.

Process:
1. Late diastole: all chambers relax, filling with blood.
2. Atrial systole: atria contract, add 20% more blood to ventricles.
3. Isovolumic ventricular contraction: closes AV valves ("lub"), builds pressure.
4. Ventricular ejection: pushes open semi lunar valves, blood forced out.
5. Ventricular relaxation: aortic back flow slams semi lunar valves shut ("dup") ; AV valves open refilling
starts – back to start of cycle.

II. Intrinsic Control of Heartbeat / Conduction System / Nodal System of the Heart

- SA node or pacemaker, initiates the heartbeat and causes the atria to contract on average every
0.85 seconds.
- When impulses reach the AV node, there is a slight delay (0.1s) that allows the atriato finish their
contraction.
- The signal for the ventricles to contract travels from the AV node through atrioventricular bundle
(bundle of His) and the two bundle branches before reaching the smaller Purkinje fibers.
- The AV bundle, its branches, and the Purkinje fibers consist of specialized cardiac muscle fibers
that efficiently cause the ventricles to contract.
C. Blood Circulations
I. Blood Circulation in the heart

• Oxygen poor blood from the body flows through superior and inferior vena cava into the
right atrium, then flows through the tricuspid valve into the right ventricle.
• When the ventricles contracts, atrioventricular valves close and the blood flows through the
pulmonary semilunar valve into the pulmonary trunk, then pulmonary arteries to the lungs.
• In the lung unloading of carbon dioxide and loading of oxygen occur.
• Oxygen rich blood from the lungs flows through pulmonary veins into the left atrium, then
flows through the bicuspid valve into the left ventricle.
• When the ventricles contracts, atrioventricular valves close and the blood flows through the
aortic semilunar valve into the aorta to all the body.
• In the cell of all the body unloading of oxygen and loading of carbon dioxide occur.

II. Pulmonary Circuit & Systemic Circuit

• Pulmonary Circuit – Oxygen poor blood from the right ventricle pumps into pulmonary
trunks, then pulmonary arteries to the capillary beds of lungs. Gaseous exchange occurs in
the lungs (unloading of carbon dioxide and loading of oxygen). Oxygen rich blood flows
through the pulmonary veins into the left atrium.

• Systemic Circuit – Oxygen rich blood from the left ventricle pumps into aorta, arteries and
capillary beds of all body tissues. Gaseous exchange occurs in the body tissues (unloading of
oxygen and loading of carbon dioxide). Oxygen poor blood flows through the veins, then
vena cavae into the right atrium.

III. Blood Vessels: Artery, Capillary & Veins

Aorta  Arteries  Arterioles  Capillaries  Venules  Veins  Vena Cava

- Artery carries blood away from the heart whereas vein carries blood to the heart.
- All arteries carry oxygen rich blood except pulmonary artery.
- All veins carry oxygen poor blood except pulmonary vein.
D. Cardiac Output

Cardiac Output: The amount of blood pumped out by one side of the heart in 1 min.
- Cardiac Output (CO) is the product of the heart rate (HR) and the Stroke Volume (SV)
CO = HR x SV
- Cardiac output will increase when SV increases or HR increases or both.

Example:
If the normal resting values for heart rate is 75 beats per minute and stroke volume is 70 ml per beat,
the average cardiac output is:
CO = HR x SV
= 75 x 70
= 5250 ml/min

Stroke Volume: The volume of blood pumped out by a ventricle in each heartbeat.
- SV depends on venous return (amount of blood entering the heart and distending the ventricles).
- The higher the volume of venous return, the higher the stroke volume.
- The higher the speed of venous returns, the higher the stroke volume.
Exercise will increase venous return because it results in an increased heart rate and force.
Severe blood loss or extremely rapid heart rate will decrease stroke volume.

Factors affecting Heart Rate

1. Neural factor
- Sympathetic division of the autonomic nervous system increases heart rate by increasing the SA
and AV nodal activity.
- Parasympathetic division of the autonomic nervous system decreases heart rate by decreasing
the SA and AV nodal activity.
2. Hormonal factor
- Ephinephrine and thyroxine increase heart rate.
3. Electrolytes / Ions
- Low Ca2+ depress the heart, high Ca2+ causes prolonged contraction of the heart.
- Deficit of K+ causes the heart to beat feebly and abnormal heart rhythms.
4. Age
- Resting heart rate is fastest in the fetus (140-160 beats/min) and gradually decreases
throughout life.
5. Gender
- Female (72-80 beats/min) has faster heart rate that male (64-72 beats/min).
6. Temperature
- Heat increases heart rate by increasing the metabolic rate of heart cells.
- Cold decreases heart rate by decreasing the metabolic rate of heart cells.
7. Exercise
- Exercise increase heart rate through the sympathetic division of the autonomic nervous system.
E. Blood Pressure

Blood pressure: the pressure of blood against the wall of a blood vessel.
- Systolic pressure: the highest arterial pressure. It occurs when the heart/ventricle contracts.
- Diastolic pressure: the lowest arterial pressure. It occurs when the heart/ventricle relaxes.
- Normal resting blood pressure: 120 mmHg over 80 mmHg
or 120/80 mmHg
- 120mmHg is the systolic pressure while 80mmHg is the diastolic pressure

Factors affecting Blood Pressure

1. Peripheral resistance: Amount of friction encountered by the blood as it flows through the blood
vessels.
- Vasoconstriction, blood volume & blood viscosity will increase peripheral resistance, thus
increasing the blood pressure.
2. Neural factor
- Parasympathetic division of the autonomic nervous system has little or no effect.
- Sympathetic division of the autonomic nervous system will increase the blood pressure through
vasoconstriction.
3. Renal factor
- When blood pressure increases beyond normal, the kidney allows more water to leave the body
in the urine, thus decreasing the blood pressure.
- When blood pressure decreases, the kidney will retain body water, thus increasing the blood
pressure.
4. Temperature
- Cold temperature increases blood pressure through vasoconstriction
- Warm temperature decreases blood pressure through vasodilation.
5. Chemicals
- Nicotine increases blood pressure by causing vasoconstriction.
- Alcohol and histamine decreases blood pressure by causing vasodilation.
- Epinephrine increase blood pressure.
6. Diets
- Diet low in salt, saturated fats and cholesterol help to prevent high blood pressure.

The End & Happy Reading

Chapter 3 – Lymphatic System – summary notes

3.1 Functions of Lymphatic System

Lymphatic system consists of lymphatic vessels, and lymphoid tissues & organs.
1. Lymphatic vessels transport fluids that have escaped from the blood vascular system
back to the blood.
2. Transports absorbed fats from intestines to blood.
3. Lymphoid tissues & organs house phagocytic cells and lymphocytes for body defense
and resistance to disease.

3.2 Formation of Lymph

• Blood pressure in the arterial end of blood capillary pushes fluid (water & small molecules
such as sugars, salts, oxygen, urea) through the capillary wall, forming the interstitial fluid.
• Blood cells and proteins are too large to pass through the capillary wall, which remain in the
capillaries, causing an increase in the blood osmolarity.
• The resulting osmotic gradient pulls water into the blood capillary by osmosis near the
venous end.
• About 85% of the fluid that leaves the blood at the arterial end of blood capillary re-enters
from the interstitial fluid at the venous end, and the remaining 15% of the fluid enters the
lymphatic capillary forming the lymph.

Comparison of blood, interstitial fluid, and blood.

Blood Interstitial Fluid Lymph
Red blood cells Present Absent Absent
White blood cells Present Absent Present
Protein Present Absent Absent
Lipid Present Absent Present
3.3 Lymphatic Pathway

• Lymphatic vessels: one-way system, ‘pumpless’, lymph flows toward the heart, thin-walled,
larger vessels have valves.
• Lymph is transported from the lymph capillaries →larger lymphatic vessels → lymphatic
duct →blood vessel near the heart.

There are 2 lymphatic ducts:

1. Right lymphatic duct: drains the lymph from the right arm and the right side of the head and
thorax into the right subclavian vein of the blood system.
2. Thoracic duct: drains the lymph from the rest of the body into the left subclavian vein of the
blood system.
3.4 Lymphoid Tissues & Organs

1. Lymph Node

• Protects the body by removing foreign material such as bacteria and tumor cells from the
lymphatic system
• Protects the body by producing lymphocytes that function in the immune response.

Lymph node varies in shape and size, mostly are kidney-shaped and less than 1 inch long.

Its cortex contains lymphocytes & its medulla houses the phagocytic macrophages.

Lymph enters the convex side of a lymph node through afferent lymphatic vessels and exits via
efferent lymphatic vessels.

There is more afferent lymphatic vessel than efferent lymphatic vessels.

The flow of lymph through the lymph node is very slow which allows time for the lymphocytes and
macrophages to perform their protective function.
2. Spleen

• Filters and cleanses blood of bacteria, viruses & other debris.

• Destroys worn-out red blood cells and return some of their breakdown products to the liver.
• Act as a blood reservoir
• In fetus, the spleen is an important hematopoietic (blood cell-forming) site, but only
lymphocytes are produced in adult.

3. Thymus

• Produces hormone thymosin to program lymphocytes.

• Maturation site for T lymphocyte.

4. Tonsils

• To trap and remove any bacteria or other foreign pathogens entering the throat.

5. Peyer’s patches

• To capture and destroy bacteria, thus preventing them from penetrating the intestinal wall.

Happy Reading….
Chapter 4 –Immune System – summary notes

A) Immunodeficiency

• A medical condition in which your body does not have the normal ability to resist infection.
• Congenital or acquired condition that impairs the function of immune cells or production of
certain molecules (phagocytes or complement system)
Eg: SCID and AIDS

I. SCID (Severe Combined Immunodeficiency) = bubble baby disease

• Genetic defects that produce a marked deficit of B and T cells.
• abnormalities in interleukin receptors.
• Children afflicted have little or no protection against disease-causing organisms.
• Fatal if untreated, usually treatment from bone marrow transplants.
• Victims are extremely vulnerable to infectious diseases
David Vetter, become famous for living in a sterile environment.

David Phillip Vetter (September 21, 1971 – February 22, 1984. He died in 1984, at the age of 12.

Extra reading: [David Phillip Vetter (September 21, 1971 – February 22, 1984. He died in 1984, at the age of 12.
Their first son, David Joseph Vetter III, was also born with SCID and died at 7 months of age. Vetter's parents
were advised by physicians that any future male children they might conceive would have a 50% chance of
inheriting the disease. At the time, the only management available for children born with SCID was isolation in
a sterile environment until a successful bone marrow transplant could be performed.
A special sterilized cocoon bed was prepared for Vetter at his birth. Immediately after being removed from his
mother's womb, Vetter entered the plastic germ-free environment that would be his home for most of his life.
Water, air, food, diapers and clothes were sterilized before entering the sterile chamber. Items were placed in a
chamber filled with ethylene oxide gas for four hours at 140 degrees Fahrenheit (60˚C), and then aerated for a
period of one to seven days before being placed in the sterile chamber.
Vetter later received a bone marrow transplant from his sister, Katherine. A few months after the transplant,
Vetter became ill with infectious mononucleosis. He died 15 days later on February 22, 1984, from Burkitt's
lymphoma at age 12. The autopsy revealed that the donor Katherine's bone marrow contained traces of a
dormant virus, Epstein-Barr, which had been undetectable in the pre-transplant screening.]

II. AIDS (Acquired Immune Deficiency Syndrome)

• AIDS is caused by HIV (Human Immunodeficiency Virus)
• HIV targets helper T cells by attaching to CD4 receptors.
• HIV is commonly transmitted through sexual contact or contaminated hypodermic needles.
• Infected mothers can pass the virus to their children during pregnancy, labor and delivery,
or when breast-feeding.
• HIV can be transmitted through blood, semen, breast milk & vaginal secretion, but NOT
urine, feces, saliva, perspiration, tears, or nasal secretions unless there is blood in these
fluids.
Development of AIDS
Phase I:
• lasts from a few weeks to a few years after initial exposure to the virus.
• Has flulike symptoms of swollen lymph nodes, chills & fever, fatigue, and body aches.
• T cell population may decline briefly, then rebound as more cells and antibodies are
produced in the body to fight against the virus.
• The person having these antibodies is said to be “HIV- positive”, but he or she is not having
the disease AIDS yet.
• The antibodies do not destroy the virus entirely because many of the virus remain inside
cells, where antibodies and immune cells cannot reach them.

Phase II:
• Can occur for 6 months or > 10 years before progress to phase III.
• The virus begins to do its damage, wiping out more and more of the helper T cells.
• The person becomes more vulnerable to opportunistic infections.
• May have persistent or recurrent flulike symptoms.

Phase III:
• When the number of helper T cells <200/mm3 of blood and has an opportunistic infection or
the type of cancer associated with HIV infection, the person is said to have AIDS.
• Eg. of cancers associated with AIDS: pneumonia, meningitis, tuberculosis, encephalitis,
Kaposi’s sarcoma, non-Hodgkin’s lymphoma, etc.

Kaposi sarcoma: foot & eyelid:

B) Autoimmune disease
• The immune system loses its ability to distinguish friend from foe, i.e., to tolerate self-
antigens, while still recognizing and attacking foreign antigens.
• The body will produce antibodies (autoantibodies) and sensitized T cells that attack and
damage its own tissues.
• Autoimmune disease is more common in female than in male.
• At the moment, there are no cures for autoimmune diseases.

Examples of Autoimmune Diseases:

1. Multiple sclerosis (MS)
2. Myasthenia gravis
3. Graves’ disease
4. Juvenile (type I) diabetes mellitus
5. Systemic lupus erythematosus (SLE)
6. Glomerulonephritis
7. Rheumatoid arthritis (RA)

1. Multiple sclerosis
• The most common autoimmune disorder affecting the central nervous system.
• The disease usually begins between the ages of 20 and 50 and is twice as common in women
as in men.
• It destroys the white matter (myelin sheaths) of the brain and spinal cord.
• The three main characteristics of MS are the formation of lesions in the central nervous
system (also called plaques), inflammation, and the destruction of myelin sheaths of
neurons.

2. Myasthenia gravis
• The hallmark of myasthenia gravis is fatigability.
• It impairs communication between nerves and skeletal muscles.
• Muscles become progressively weaker during periods of activity and improve after periods
of rest. Muscles that control eye and eyelid movement, facial expressions, chewing, talking,
and swallowing are especially susceptible.

3. Graves' disease
• An immune system disorder that results in the overproduction of thyroid hormone
(hyperthyroidism).
• Thyroid gland produces excessive amounts of thyroxine.
• Usually, there is protrusion of the eyeballs.
• It is more common among women and before the age of 40.
4. Juvenile (type I) diabetes mellitus
• It destroys pancreatic beta cells, resulting in deficient production of insulin.
• The subsequent lack of insulin leads to increased blood and urine glucose.
• The classical symptoms are polyuria (frequent urination), polydipsia (increased thirst),
polyphagia (increased hunger) and weight loss.

5. Lupus erythematosus or Lupus

• Our immune system attacks and causes inflamed connective tissue.
• It can affect the skin, joints, kidneys, heart, lungs, brain, and other organs.
• Occur mainly in females between the age of 10 - 50.
• Lupus often starts as a red skin rash on the face or head. Other symptoms include fever,
fatigue, joint pain, and weight loss.
• Inflammation can lead to osteoarthritis, pericarditis, or pleurisy (inflammation of the lining
in lungs).

6. Glomerulonephritis
• A severe impairment of kidney function.
• Characterized by inflammation of the glomeruli or small blood vessels in the kidneys.
• Glomerulonephritis signs & symptoms may include:
➢ red blood cells in urine (hematuria)
➢ Foamy urine due to excess protein (proteinuria)
➢ High blood pressure (hypertension)
➢ Fluid retention (edema) with swelling evident in face, hands, feet and abdomen
➢ Fatigue from anemia or kidney failure

7. Rheumatoid arthritis (RA)

• Our immune system attacks and causes inflamed synovial membrane that lines certain joints.
• Fingers, wrists, toes or other joints become painful and stiff.
• Without treatment, synovial fluid accumulates and joints swell. Neutrophils, lymphocytes
and other inflammatory cells migrate into the joint. Eventually the synovial membrane
thickens, scar tissue forms, and the bones of the joints may fuse.
• No one knows what causes rheumatoid arthritis. Genes, environment, and hormones might
contribute.
• Treatments include pain-relieving medications and drugs that neutralize chemicals in the
inflammatory response; mild exercise and physical therapy to improve the range of motion;
and surgery to replace damaged joints with artificial joints.
Condition or event that may trigger self-attack:
• Foreign antigen resemble self-antigen
• Antibodies made against the foreign antigen can cross-react with self
antigen
• Eg: Age-old disease rheumatic fever, antibodies produced against
streptococcal infection react with heart antigens causing lasting damage to
heart muscle and valves, and also joints and kidney.
• New self-antigen appear:
• Gene mutation
• Changes in structure of self-antigen
• Novel self-antigen released by trauma.

C) Hypersensitivities / Allergies
• Allergy: an inappropriate response of the immune system to an allergen.
• Allergen: any substance that causes an allergic reaction.

How an allergic reaction (immediate hypersensitivity) develops:

1. Exposure to an allergen causes B cells to produce specific IgE antibodies.
2. The IgE antibodies bind to mast cells, sensitizing the cell to future exposures to the same
allergen.
3. The next exposure to the allergen causes the mast cell to release histamine.
4. Histamine causes a localized or systemic inflammatory response.

• Some allergens, such as poison ivy, affect only the areas exposed to the allergen → localized
response.
• Allergens, such as food allergens, bee sting venom are carried by blood to the mast cells
throughout the body and affect several organ systems, eg. respiratory, digestive and
circulatory system → systemic response.
• Anaphylactic shock is a severe systemic allergic reaction that include difficulty breathing
(caused by constricted airways), severe stomach cramps (muscle contractions), swelling
throughout the body (increased capillary permeability), and circulatory collapse with a life-
threatening fall in blood pressure (dilated arterioles).
• Epinephrine, a hormone is used to dilates the airway and constricts peripheral blood vessels,
to prevent the shock.

Immediate hypersensitivity:
• Responds within seconds to the allergen.
• Triggered by the release of histamine when IgE antibodies bind to mast cells.
• Treatment: antihistamines drugs, hormone epinephrine, allergy shot that contains IgG
antibodies that bind with the allergen and block its attachment to IgE antibodies.

Delayed hypersensitivity:
• Responds in 1-3 days after contact with the allergen.
• Mediated mainly by delayed hypersensitivity T cells and cytotoxic T cells.
• Triggered by lymphokines released by the activated T cells.
• Treatment: Corticosteroid drugs.

Happy Reading….
Chapter 5: Urinary System – summary notes
General functions of kidney:
1. Regulate concentration of wastes
2. Regulate concentration of electrolytes
3. Regulate volume of blood plasma
4. Regulate pH of blood plasma
5. Eliminate metabolic toxins
6. Produce hormone erythropoietin.
7. Produce urine.

*3 types of metabolic toxin/wastes : 1. Urea – by product of amino acid metabolism.

2. Creatinine – breakdown of creatine phosphate.
3. uric acid – breakdown of nucleotides.

External Anatomy / Structure of Kidney

Functions of
1. ureter – transports urine from kidney to urinary bladder.
2. urinary bladder – stores urine until excretion.
3. urethra – transports urine from urinary bladder to body surface

Internal Anatomy / Structure of Kidney

Blood vessels in kidney:

Renal artery  Interlobar arteries Arcuate arteries  Interlobular arteries  Afferent arterioles
 Glomerulus  Efferent arterioles  Peritubular capillaries  Interlobular veins  Arcuate
veins  Interlobar veins  Renal vein
Anatomy / Structure of Nephron

*Urine formation:
Three stages of urine formation: 1. Glomerular filtration
2. Tubular reabsorption
3. Tubular secretion

Glomerular Filtration
• Occurs between glomerulus and Bowman’s capsule.
• Water and small molecules such as nutrients, salts, nitrogenous wastes move from the
glomerulus into the Bowman’s capsule.
• Filterable blood components: water, nitrogenous wastes, nutrients, salts.
• Non-filterable blood components: blood cells, platelets, plasma proteins.
Factors/adaptions facilitate the glomerular filtration:
– 1. hydrostatic pressure set up by having smaller diameter of efferent arteriole than
that of the afferent arteriole.
– 2. having squamous epithelial cells and podocytes on the wall of Bowman’s capsule.
• The non-filterable components leave the glomerulus by way of the efferent arteriole.
• The filterable components will form the glomerular filtrate and flows into the proximal
convoluted tubules.
Tubular Reabsorption
• Occurs mainly at proximal convoluted tubule.
• Water, nutrients, required salts are passively and actively reabsorbed from the tubule into
the blood capillary.
• When Na+ are actively reabsorbed, Cl- follow passively, and water moves passively from the
tubule into the blood.
• Nutrients such as glucose and amino acids return to the blood through selective process.
• Reabsorbed filtrate components: most water, nutrients, required salts.
• Non-reabsorbed filtrate components: some water, nitrogenous wastes, excess salts.
Factors/adaptions facilitate the tubular reabsorption:
• The cuboidal epithelial cells lining the wall of PCT which have microvilli to increase the
surface area for tubular reabsorption and a lot of mitochondria to supply the energy for
active transport.
• The substances that are not reabsorbed become the tubular fluid which enters the loop of
Henle.

Tubular Secretion
• Occurs mainly at distal convoluted tubule.
• Substances are removed from blood and added to the tubular fluid.
• Hydrogen ions, creatinine, and drugs such as penicillin are removed by active transport from
blood into the DCT.
Factors/adaptions facilitate the tubular reabsorption:
– The cuboidal epithelial cells lining the wall of DCT with a lot of mitochondria to
supply the energy for active transport.

In conclusion….
.….. urine contains substances that have undergone glomerular filtration but have not been
reabsorbed, and substances that have undergone tubular secretion.
Countercurrent Multiplier System

1. The loop of Henle and collecting duct act as countercurrent multipliers to create osmotic gradients
that facilitate transport processes.
2. The gradients are maintained by vasa recta capillaries.
3. The osmotic concentration of urine depends on the permeability of the distal tubule and
collecting duct which can be regulated by hormone.
If permeable  concentrated urine.
If impermeable  dilute urine.

4. In the descending loop of Henle:

- The descending loop of Henle is permeable to water, but not very permeable to salt
(NaCl).
- Water is drawn out of the filtrate (tubular fluid) and into the interstitial space where it is
quickly picked up by capillaries.
- As it descends, the filtrate becomes more concentrated.

5. In the ascending loop of Henle:

- Salt (NaCl) is actively pumped into the interstitial fluid.
- As more salt is removed by the ascending limb, the saltier the interstitial fluid.
- The ascending loop of Henle is permeable to salt (NaCl), but impermeable to water.

6. High concentration of urea and NaCl outside the nephron deep in the kidneys helps
concentrate urine in the collecting duct.
GLOMERULAR FILTRATION RATE (GFR)

GFR = the volume of fluid filtered from glomerular capillaries into the Bowman's capsule per unit
time (per min).

Glomerular filtration rate (GFR) depends on the net filtration pressure. The higher the net filtration
pressure, the higher the glomerular filtration rate.

Net filtration pressure:

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