GENERAL ANATOMY and PHYSIOLOGY

Andrea Q. Carigma, M.D.

Before we start, here are the few things you have to keep in mind:

• The more recent Dentistry Licensure exams involving anatomy and physiology (CLUSTER 1)
have evolved from basic objective questions to questions that involve biochemical basis of
physiology and anatomy questions that are reflected in the practice of medicine. However,
the old question types still exist.
• As much as this realization is unnerving, there are ways by which we can make it easier:
MNEMONICS – which I will be teaching you.
• Each mnemonic will be placed in a text box (for easier reference – REMEMBER THEM. They
help. Really.) Also, examiners seem to love EXCEPTION QUESTIONS so please take note of
the exceptions noted here in the lecture. Remember them.
So, are you ready?
GAME!
BACK TO BASICS.

First off, ANATOMICAL PLANES:

1. SAGITTAL – divides the body into RIGHT AND LEFT halves.
** by the way, if the question goes “… divides the body into EQUAL right and left halves?” Go
for MIDSAGITTAL instead.
 2. CORONAL – divides the body into ANTERIOR AND POSTERIOR HALVES. Also known as
FRONTAL PLANE.
3. HORIZONTAL – also known as TRANSVERSE. This plane divides the body into SUPERIOR AND
INFERIOR HALVES.

THE TRUNK

• Composed of the THORAX and the ABDOMEN.

• The cavities of the trunk are lined by two layers of SEROUS MEMBRANE (SEROSA). One lines
the wall (PARIETAL SEROSA) and one lines the organs (VISCERAL SEROSA)
o PERICARDIUM – lines the cavity occupied by the heart.
o PLEURA – lines the cavity occupied by the lungs.
o PERITONEUM – lines the abdominal cavity.
 C-E-A
8-10-12
Phrenic nerve, vagus nerve, azygos vein & thoracic duct.

C-E-A
8-10-12
Phrenic nerve, vagus nerve, azygos vein & thoracic duct.

To make you remember that:

C – CAVAL – is at T8 level. Structure that passes through: vena cava and phrenic nerve.
E – ESOPHAGEAL – is at T10 level. is at T8 level. Structure that passes through: esophagus
and vagus nerves.
A – AORTIC - is at T12 level. Structure that passes through: aorta, azygos vein and thoracic
duct.

Again:

C-E-A
8-10-12
The thorax and the abdomen
Phrenic are divided
nerve, vagus by the skeletal
nerve, azygos muscleduct.
vein & thoracic called the DIAPHRAGM.
The
The diaphragm ismnemonic for theTHREE
noted to have OPENINGS OF THE DIAPHRAGM.
OPENINGS that allow for the passage of important structures.
A usual question asked in the boards: the DIVISIONS OF THE ABDOMINAL CAVITY, and the structures
that occupy them.
There are two ways that the abdominal cavity is divided

• BY FOUR QUADRANTS, or
• BY NINE REGIONS
THE SKELETAL SYSTEM

There are 206 BONES in the adult skeletal system (>300 bones in a newborn infant). These bones
are either categorized as AXIAL or APPENDICULAR skeleton.

** A COMMON MISTAKE BY MANY STUDENTS: CLAVICLE, SCAPULA and PELVIS are often mistaken
as part of the axial skeleton. NO. They are APPENDICULAR. Appendicular bones are bones of the
appendages/ limbs and the clavicle, scapula and pelvis are parts of the limbs.
THE SKULL
The skull is composed of the cranium (encases the brain) and the facial bones.

THESE ARE THE THINGS THAT YOU MUST (MUST, I MEAN MUST) REMEMBER ABOUT THE SKULL:

• FONTANELLES
o Anterior fontanelle – BREGMA; diamond in shape. Closes at 1.5 years
o Posterior fontanelle – LAMBDA; triangular. Closes at 1 year.
• THE PTERION
o the region where the frontal, parietal, temporal, and sphenoid bones join together.
o Thinnest aspect of the lateral side of the skull.
o Beneath the pterion: MIDDLE MENINGEAL VESSELS

• BONY ORBIT
o The anterior margin is composed. ONLY of three bones: FRONTAL, ZYGOMATIC and
the MAXILLA. The nasal bone is NOT a part of it.
o The entire bony orbit is composed of SEVEN BONES:

• THE VOMER is the bone of the nasal septum that divides the nasal cavity.

• THE OSSICLES (found in the middle ear)

o Malleus: The malleus is attached to the eardrum. It has a handle that attaches to the
inner surface of the eardrum, and a head that is suspended from the wall of the
tympanic cavity.
o Incus: The incus is connected to the malleus on the side closer to the eardrum, and
to the stapes on the side closer to the inner ear.
o Stapes: The stapes has an arch and a footplate. This footplate is held by a ringlike
piece of tissue in an opening called the oval window, which is the entrance into the
inner ear.
 o Stapedius and Tensor tympani: The stapedius is the muscle of the inner ear that
inserts on the stapes. The tensor tympani is the inner ear muscle that insert on the
malleus.

• CRANIAL FOSSA
o The cranial fossa is composed of THREE BONES:
▪ ANTERIOR CRANIAL FOSSA
▪ MIDDLE CRANIAL FOSSA
▪ POSTERIOR CRANIAL FOSSA

There are openings in the cranial fossa for the passage of the cranial nerves.
 o

USING YOUR FINGERS, RECITE THE OPENINGS FOR EACH OF THE CRANIAL NERVES.

1 – CRIBRIFORM PLATE
2 – OPTIC CANAL
3 – SUPERIOR
4 – ORBITAL
5 – FIS-
6 – SURE (to make you remember that CN III, IV, V1, VI all pass through the superior orbital fissure)
7–I
8 – AM (to make you remember that CN VII and VIII both pass through the IAM – Internal acoustic meatus)
9 – JUG
10 – JUG
11 – JUG (to make you remember that CN IX, X, XI all pass through the jugular foramen)
12 – hypoglossal canal

REPEAT UNTIL YOU MEMORIZE IT. THIS IS ALWAYS ASKED IN THE BOARDS.
THE PARANASAL SINUSES

o
o TAKE NOTE: ALL OF THE PARANASAL SINUSES DRAIN INTO THE MIDDLE MEATUS OF
THE NOSE. EXCEPT FOR THE SPHENOIDAL SINUS which drains into the ethmoidal
sinus (sphenoethmoidal recess)

ETHMOID BONE vs SPHENOID BONE

• ETHMOID BONE
o Forms the floor of the anterior cranial fossa
o Important features: ETHMOID-CRI-CRI
▪ Crista galli – anchors the falx cerebri (extension of the dura mater found
between the cerebral hemispheres)
▪ Cribriform plate – where the olfactory nerve passes through.
• SPHENOID BONE
o Shaped like bat wings
o PLEASE MEMORIZE THE FORAMENA OF THE SPHENOID BONE – AS WELL AS WHERE
THEY ARE FOUND:
THE VERTEBRA

• The vertebra is composed of 26 bones

o CERVICAL - 7
o THORACIC - 12
o LUMBAR - 5
o SACRUM - 1 (five bones fused together)
o COCCYX – 1 (four bones fused together)
• The bones are easily distinguished by the shape of the vertebral body:

• For the cervical vertebra, the typical cervical vertebra has a bifid spine and foramen
transversarium (for the passage of the vertebral artery) except for the atypical vertebrae:

o Atypical cervical vertebra:

▪ ATLAS – no body
▪ AXIS – has a dens
▪ C7 – no bifid spine; has the longest spinous process

THE RIBS

• There are 12 pairs of ribs (one for each of the thoracic vertebra).
• The ribs are classified as
o TRUE RIB – ribs 1-7; directly attached to the sternum
o FALSE RIB – ribs 8-10; attached to the sternum through the 7th rib.
o FLOATING RIB – ribs 11-12; no anterior attachment.
THE STERNUM

• The sternum has three parts:

1. MANUBRIUM – possesses a notch on the superior margin called the JUGULAR
NOTCH.
2. CORPUS – body. The manubrium and the body are attached at the joint called the
STERNAL ANGLE (sternal angle of Louis/ transverse ridge). The sternal angle is the
anatomic landmark for the bifurcation of the trachea (which is called the CARINA).
3. XIPHOID PROCESS

THE PELVIS

• TWO pelvic bones (NOT SIX. Or three.)

• The pelvis is the fusion of THREE fused PARTS:
o ILIUM
▪ Most superior; has FOUR spines
o ISCHIUM
▪ Most posterior and inferior; has only ONE spine, the ISCHIAL SPINE that
divides the pelvis into having GREATER AND LESSER SCIATIC NOTCHES.
o PUBIS
▪ The most anterior; the pubis of the two pelvic bones meet anteriorly at the
SYMPHYSIS PUBIS.

• The ACETABULUM is the circular depression on the lateral aspect of the pelvis where the
three parts meet.

• MALE vs. FEMALE PELVIS

• The true pelvis is the cylindrical space between the pelvic inlet and the pelvic outlet.
• The pelvic inlet, also termed as the pelvic brim, is bounded by the following:
o Superior border of the symphysis pubis
o Iliopectineal line
o Sacral promontory
 • The levator ani muscle that forms the floor of the pelvis is composed of the following muscles
o iliococcygeus muscle
o pubococcygeus muscle
o puborectalis muscle

JOINTS

• In the older terminology, joints are called

o Synathrosis: Immovable; now referred to as FIBROUS JOINT
▪ Suture
▪ Gomphosis
▪ syndesmosis
o Amphiarthrosis: minimal movement; now referred to as CARTILAGENOUS JOINT
▪ Synchondrosis
▪ symphysis
o Diarthrosis: Freely movable; now referred to as SYNOVIAL JOINT
▪ SYNOVIAL JOINTS INCLUDE:
MUSCULAR SYSTEM

This segment discusses the SKELETAL MUSCLES (muscles attached to bones. Cardiac muscles and
smooth muscle will be discussed in their respective system discussion.)
TERMS TO REMEMBER

• ORIGIN
o The point that moves the least
• INSERTION
• BELLY
o The part of the muscle between the origin and insertion
• TENDON – connective tissue that attaches the muscle to the bone
• APONEUROSIS – wide fibrous sheet that surrounds the muscle
• MOTOR UNIT – composed of a muscle and the nerve that innervates the muscle fibers

• SARCOMERE – the basic functional unit of the skeletal muscle.

o The sarcomere is marked by one Z line and another. (i.e., the boundary of the
sarcomere: Z to Z)
o Parts of the sarcomere:
▪ Myofilaments
• ACTIN
o Thin filament; one of the two contractile filaments
o Remember: acTHIN
• MYOSIN
o Thicker filament; one of the two contractile filaments
• TITIN
o Responsible for the elasticity of muscles
▪ Z LINE – The actin filaments are attached to the Z line.
▪ M LINE - The myosin filaments are attached to the M line.
▪ A BAND – dark band; where myosin filaments are found
▪ I BAND – light band; where actin filaments are found.
** The alternating A bands and I bands give skeletal muscles the striated
(striped) appearance)
• ENDOMYSIUM vs. PERIMYSIUM vs. EPIMYSIUM
o A muscle fiber is a cell. Each fiber is surrounded by ENDOMYSIUM.
o A bundle of fibers is called a FASCICLE. Each fiber is surrounded by PERIMYSIUM.
o A bundle of fasicles is called a BELLY. Each fiber is surrounded by EPIMYSIUM.
 • Classification of muscles based on ACTION:
o Prime mover:
▪ A muscle is a prime mover when it is the chief muscle or member of a chief
group of muscles responsible for a particular movement.
o Antagonist:
▪ Any muscle that opposes the action of the prime mover is an antagonist.
o Fixator:
▪ A fixator contracts isometrically (i.e., contraction increases the tone but does
not in itself produce movement) to stabilize the origin of the prime mover so
that it can act efficiently.
o Synergist:
▪ In many locations in the body, the prime mover muscle crosses several joints
before it reaches the joint at which its main action takes place. To prevent
unwanted movements in an intermediate joint, groups of muscles called
synergists contract and stabilize the intermediate joints.

** HELPFUL THINGS IN STUDYING THE SKELETAL MUSCLE SYSTEM:

• REMEMBER THE EXCEPTIONS:

• The names of the muscle reflect the action (especially for the muscles of facial expression)
• Questions on origin and insertion are rare. Focus on action.
• Know where the muscle is located. It helps in remembering the action.
Look:
• ANTERIOR COMPARTMENT MUSCLES OF THE ARM ARE ALL FLEXORS OF THE UPPER
ARM JOINTS.
• POSTERIOR COMPARTMENT MUSCLES OF THE ARM ARE ALL EXTENSORS OF THE
UPPER ARM JOINTS.

This is the same for the hip joint and the ankle:
• ANTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL FLEXORS OF THE HIPS.
• POSTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL EXTENSORS OF THE
HIPS.
• ANTERIOR COMPARTMENT MUSCLE OF THE LOWER LEGS LEADS TO DORSIFLEXION.
• POSTERIOR COMPARTMENT MUSCLES OF THE LOWER LEGS LEAD TO PLANTAR
FLEXION.

However, please remember that it is different for the knee

• ANTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL EXTENSORS OF THE
KNEE.
• POSTERIOR COMPARTMENT MUSCLES OF THE ARM ARE ALL FLEXORS OF THE KNEE.
 • ANTERIOR COMPARTMENT MUSCLES OF THE ARM ARE ALL FLEXORS OF THE
UPPER ARM JOINTS.
• POSTERIOR COMPARTMENT MUSCLES OF THE ARM ARE ALL EXTENSORS OF THE
UPPER ARM JOINTS.

This is the same for the hip joint and the ankle:
• ANTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL FLEXORS OF THE
HIPS.
• POSTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL EXTENSORS OF THE
HIPS.
• ANTERIOR COMPARTMENT MUSCLE OF THE LOWER LEGS LEADS TO
DORSIFLEXION.
• POSTERIOR COMPARTMENT MUSCLES OF THE LOWER LEGS LEAD TO PLANTAR
FLEXION.

However, please remember that it is different for the knee

• ANTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL EXTENSORS OF THE
KNEE.
• POSTERIOR COMPARTMENT MUSCLES OF THE LEGS ARE ALL FLEXORS OF THE
KNEE

• STUDY THE FOLLOWING TABLES.

• Focus on the EXCEPTIONS (on action, nerve supply)
MEMORIZE THE ORIGIN AND INSERTION OF THE MUSCLES OF MASTICATION!
ROTATOR CUFF MUSCLES:

S-I-t-S
Supraspinatus

Infraspinatus

Teres minor

Subscapularis
PHYSIOLOGY OF MUSCLE CONTRACTION
The sequence of events that result in the contraction of an individual muscle fiber begins with a
signal—the neurotransmitter, ACETYLCHOLINE—from the motor neuron innervating that fiber. The local
membrane of the fiber will depolarize as positively charged sodium ions (Na+) enter, triggering an
action potential that spreads to the rest of the membrane will depolarize, including the T-tubules. This
triggers the release of calcium ions (Ca++) from storage in the sarcoplasmic reticulum (SR). The Ca++
then initiates contraction, which is sustained by ATP. As long as Ca++ ions remain in the sarcoplasm
to bind to troponin, which keeps the actin-binding sites “unshielded,” and as long as ATP is available
to drive the cross-bridge cycling and the pulling of actin strands by myosin, the muscle fiber will
continue to shorten to an anatomical limit.
TROPONIN the binding protein in the actin filament that binds calcium.
** In smooth muscles, calcium binds to CALMODULIN (not troponin).
TROPOMYOSIN the protein in the actin filament that covers/ shields the binding site of actin for
myosin.
NERVOUS SYSTEM

The nervous system has two divisions. The central nervous system (CNS) consists of the brain and
spinal cord. The peripheral nervous system (PNS) consists of cranial nerves and spinal nerves. The
PNS includes the autonomic nervous system (ANS) and the somatic nervous system.
CELL TYPES OF THE NERVOUS SYSTEM
Nerve cells are called neurons. These are cells that can transmit impulses (neurotransmitters) for
control functions. Whatever their specific functions, all neurons have the same physical parts. The
cell body contains the nucleus and is essential for the continued life of the neuron. Dendrites are
processes that transmit impulses toward the cell body. The one axon of a neuron transmits impulses
away from the cell body.
Neuroglia
Neuroglia or glial cells support the neurons in the nervous system.
Astrocytes play a role in creating the blood-brain barrier, which allows certain substances to
selectively pass from the capillary system. They are also responsible for reactive scar
formation in the brain.
In the peripheral nervous system, axons and dendrites are wrapped in specialized cells called
Schwann cells. During embryonic development, Schwann cells grow to surround the neuron
processes, enclosing them in several layers of Schwann cell membrane. These layers are the
myelin sheath; myelin is a phospholipid that electrically insulates neurons from one another.
Without the myelin sheath, neurons would short-circuit, just as electrical wires would if they
were not insulated.
The spaces between adjacent Schwann cells, or segments of the myelin sheath, are called
nodes of Ranvier (neurofibril nodes). In every 4-5 mm of the axon, there is a node of Ranvier.
These nodes are the parts of the neuron cell membrane that depolarize when an electrical
impulse is transmitted. The nuclei and cytoplasm of the Schwann cells are wrapped around
the outside of the myelin sheath and are called the neurolemma, which becomes very
important if nerves are damaged.
In the central nervous system, the myelin sheaths are formed by oligodendrocytes, one of the
neuroglia, the specialized cells found only in the brain and spinal cord. Because no Schwann
cells are present, however, there is no neurolemma, and regeneration of neurons does not
occur. This is why severing of the spinal cord, for example, results in permanent loss of
function.
Ependymal cells are neuroglia that line the fluid filled spaces of the brain called ventricles.
Another kind of neuroglia are microglia, which are constantly moving, phagocytizing cellular
debris, damaged cells, and pathogens.
THE PHYSIOLOGY OF NEURONS
The events of an electrical nerve impulse are the same as those of the electrical impulse generated in
muscle fiber. Stated simply, a neuron not carrying an impulse is in a state of polarization, with Na ions
more abundant outside the cell, and K ions and negative ions more abundant inside the cell. The
neuron has a positive charge on the outside of the cell membrane and a relative negative charge
inside.
A stimulus (such as a neurotransmitter) makes the membrane very permeable to Na ions, which rush
into the cell. This brings about depolarization, wherein the cell membrane charge (mV) becomes more
positive. The outside now has a negative charge, and the inside has a positive charge. As soon as
depolarization takes place, the neuron membrane becomes very permeable to K ions, which rush out
of the cell. This restores the positive charge outside and the negative charge inside, and is called
repolarization. (The term action potential refers to depolarization followed by repolarization.) Then the
sodium and potassium pumps return Na ions outside and K ions inside, and the neuron is ready to
respond to another stimulus and transmit another impulse. An action potential in response to a
stimulus takes place very rapidly and is measured in milliseconds.
An individual neuron is capable of transmitting hundreds of action potentials (impulses) each second.
Transmission of electrical impulses is very rapid. The presence of an insulating myelin sheath
increases the velocity of impulses, since only the nodes of Ranvier depolarize. This is called saltatory
conduction. Many of our neurons are capable of transmitting impulses at a speed of many meters per
second. Imagine a person 6 feet (about 2 meters) tall who stubs his toe; sensory impulses travel from
the toe to the brain in less than a second (crossing a few synapses along the way). You can see how
the nervous system can communicate so rapidly with all parts of the body, and why it is such an
important regulatory system.
Types of nerve conduction
• Continuous conduction
– Seen in non-myelinated fibers.
– Depolarization of each adjacent area of plasma membrane
• Saltatory conduction
– Seen in myelinated fibers
– Current flows only at nodes ; the nerve impulse leaps through nodes
– Faster travel of impulse
Nerve fiber classification

**PLEASE MEMORIZE THIS. This will come in handy not only in physiology but also in anesthesiology.
Neurotransmission
After the generation of the action potential, the neurons undergo EXOCYTOSIS wherein a chemical
signal (neurotransmitter) is released from the cell.
Each neurotransmitter serves a specific function. The major excitatory neurotransmitter is
GLUTAMATE. The major inhibitory neurotransmitter is GAMMA-AMINO BUTYRIC ACID (GABA).

** Please take note of the amino acid precursors of the neurotransmitters:

THE BRAIN
he brain is composed of 3 main structural divisions: the cerebrum, the brainstem, and the
cerebellum. At the base of the brain is the brainstem, which extends from the upper cervical spinal
cord to the diencephalon of the cerebrum. The brainstem is divided into the medulla, pons, and
midbrain. Posterior to the brainstem lies the cerebellum.

The cerebrum is the largest component of the brain. It is divided into right and left hemispheres. The
corpus callosum is the collection of white matter fibers that joins these hemispheres.
Each of the cerebral hemispheres is further divided into 4 lobes: the frontal lobe, the parietal lobe,
the temporal lobe, and the occipital lobe. The medial temporal lobe structures are considered by
some to be part of the so-called limbic lobe.
The frontal lobe is distinguished from the parietal lobe posteriorly by the central sulcus (Rolandic
fissure). The frontal lobe and parietal lobes are divided inferiorly from the temporal lobe by the
lateral sulcus (Sylvian fissure). The parietal lobe is distinguished from the occipital lobe by the
parieto-occipital sulcus on the medial surface.
**Please take note of the areas of the cerebral cortex and their specific functions.
REMEMBER THE LOBE WHERE THEY ARE FOUND:
The cerebrum is further divided into the telencephalon and diencephalon. The telencephalon
consists of the cortex, the subcortical fibers, and the basal nuclei. The diencephalon mainly consists
of the thalamus and hypothalamus.
The cerebellum consists of 2 hemispheres, connected by a midline structure called the vermis.
Whereas the cerebrum has gyrus, the cerebellum has convolutions called FOLIA.
Evolutionarily, the brainstem is the most ancient part of the brain. Structurally, it can be divided into
the medulla oblongata, pons, and midbrain.

CEREBROSPINAL FLUID
The brain is bathed in cerebrospinal fluid (CSF), which is continuously produced and absorbed. The
ventricles are CSF-containing cavities within the brain. The structures that produce CSF are
contained within the ventricles and are called the choroid plexuses. CSF is produced at a rate of
about 450 mL/day, although at any given time about 150 mL can be found within the CSF spaces.
Thus, the volume of CSF in most adults is turned over about 3 times per day.
The brain has 4 ventricles – fluid filled spaces in the brain. Within the cerebral hemispheres are the
lateral ventricles, which are connected to each other and to the third ventricle through a pathway
called the interventricular foramen (of Monro). The third ventricle lies in the midline, separating
deeper brain structures such as the left and right thalami. The third ventricle communicates with the
fourth ventricle through the cerebral aqueduct (of Sylvius), which is a long narrow tube.

From the fourth ventricle, CSF flows into the subarachnoid space around both the brain and the
spinal cord. From the subarachnoid space, CSF is then absorbed into the venous system. Arachnoid
granulations or villi are structures projecting into the superior sagittal sinus that release CSF back
into the venous system.
**Hydrocephalus is a condition in which production of CSF is disproportionate to absorption. This is
most commonly caused by impaired absorption resulting from obstruction of the CSF circulatory
pathways, in which case it is termed obstructive hydrocephalus. This also occurs when the
absorption of CSF is impaired, in which case it is termed communicating hydrocephalus. Rarely is
hydrocephalus caused by increased CSF production.
MENINGES
The brain (as well as the spinal cord) is covered by meninges. The meninges consist of 3 tissue layers
that cover the brain and spinal cord: the pia, arachnoid, and the dura mater. The pia along with the
arachnoid are referred to as the leptomeninges, whereas the dura is referred to as the pachymeninx.
The innermost of the 3 layers is the pia mater, which tightly covers the brain itself, conforming to its
grooves and folds. This layer is rich with blood vessels that descend into the brain.
Outside the pia mater, which tightly contours the brain, is the arachnoid mater. The arachnoid mater
is a thin web like layer. Between the pia mater and the arachnoid mater is a space called the
subarachnoid space, which contains cerebrospinal fluid (CSF). This space is where the major arteries
supplying blood to the brain lie. If a blood vessel ruptures in this space, it can cause a subarachnoid
hemorrhage.
The outermost meningeal layer is the dura mater, which lines the interior of the skull. The dura mater
is composed of 2 individual layers, the meningeal dura and the periosteal dura. For the most part,
these layers are fused; venous sinuses can be found in areas of separation. The tentorium cerebelli
is a dura mater fold that separates the cerebellum from the cerebrum. The falx cerebri is a fold that
separates the left and right cerebral hemispheres.

THE CRANIAL NERVES

There are 12 pairs of cranial nerves that function mainly to convey motor signals to and sensory
information from the head and neck. The lower cranial nerves have somewhat more complex visceral
functions that are not strictly limited to the head and neck. The cranial nerves are as follows:

I: The olfactory nerve relays information from the nerves of the olfactory epithelium to mesial
temporal lobe and frontal lobe structures
II: The optic nerve relays visual information from the retina; the right and left optic nerves then join at
the optic chiasm, where they give rise to the optic tracts, which convey visual information to the
thalamus and brainstem and, ultimately, the visual cortex; optic gliomas can arise from the optic
nerve
III: The oculomotor nerve is principally involved in the control of eye movements through its
innervation of the superior rectus, the medial rectus, the inferior rectus, and the inferior oblique
muscles
V: The trochlear nerve innervates the superior oblique muscle and is purely a motor nerve
V: The trigeminal nerve is both a motor and sensory nerve and has 3 divisions, V1 (the ophthalmic
division), V2 (the maxillary division), and V3 (the mandibular division); it is involved in conveying
sensory information from the face and also in controlling the muscles of mastication; vascular
compression of the branches of the trigeminal nerve near its entry into the brainstem has been
associated with some types of facial pain, including trigeminal neuralgia
VI: The abducens nerve innervates the lateral rectus nerve, allowing lateral eye movements
VII: The facial nerve is principally involved in innervation of the muscles of facial expression and also
plays a role in tearing, salivation, and taste; Bell's palsy is a relatively common facial nerve palsy
VIII: The vestibulocochlear nerve is a purely sensory nerve that conveys auditory information from the
cochlea to the brainstem via the cochlear branch; the vestibular branch conveys proprioceptive
information about head position and movement from the inner ear to the brainstem; acoustic
neuromas are typically benign tumors that can arise from the vestibular portion of this nerve
IX: The glossopharyngeal nerve is involved in taste and salivation, as well as sensation in the
oropharynx; the afferent limb of the gag reflex is mediated by the glossopharyngeal nerve
X: The vagus nerve conveys visceral sensation to the brainstem and also controls some visceral
functions, such as heart rate and gastrointestinal motility
XI: The accessory nerve has contributions from a spinal component and innervates neck muscles
involved in head turning (STERNCOCLEIDOMASTOID MUSCLE and TRAPEZIUS MUSCLE).
XII: The hypoglossal nerve is a motor nerve that innervates muscles of the tongue (EXCEPT FOR THE
PALATOGLOSSUS MUSCLE)
THE SPINAL CORD
The spinal cord is located inside the vertebral canal, which is formed by the foramina of 7 cervical,
12 thoracic, 5 lumbar, and 5 sacral vertebrae, which together form the spine. The spinal cord
extends from the foramen magnum down to the level of the first and second lumbar vertebrae (at
birth, down to second and third lumbar vertebrae)
The conus medullaris is the cone-shaped termination of the caudal cord. The pia mater continues
caudally as the filum terminale through the dural sac and attaches to the coccyx. The coccyx has only
1 spinal segment. The cauda equina (Latin for horse tail) is the collection of lumbar and sacral spinal
nerve roots that travel caudally prior to exiting at their respective intervertebral foramina. The cord
ends at vertebral levels L1-L2.

THE SPINAL NERVES

Humans have 31 pairs of spinal nerves, each roughly corresponding to a segment of the vertebral
column: eight cervical spinal nerve pairs (C1–C8), 12 thoracic pairs (T1–T12), five lumbar pairs (L1–
L5), five sacral pairs (S1–S5), and one coccygeal pair. The spinal nerves (together with the cranial
nerves) are part of the peripheral nervous system (PNS).
Each spinal nerve is formed by the combination of nerve fibers from the dorsal and ventral roots of
the spinal cord. The dorsal roots carry afferent sensory axons, while the ventral roots carry efferent
motor axons.
The spinal nerve emerges from the spinal column through an opening (intervertebral foramen)
between adjacent vertebrae.
This is true for all spinal nerves except for the first spinal nerve pair, which emerges between the
occipital bone and the atlas (the first vertebra). Thus the cervical nerves are numbered by the
vertebra below, except C8, which exists below C7 and above T1.
The thoracic, lumbar, and sacral nerves are then numbered by the vertebra above. In the case of a
lumbarized S1 vertebra (i.e., L6) or a sacralized L5 vertebra, the nerves are typically still counted to
L5 and the next nerve is S1.
REMEMBER: ALL SPINAL NERVES ARE MIXED NERVES (both sensory and motor)
A nerve plexus is a branching network of intersecting nerves

PLEASE MEMORIZE THE COMPONENTS OF THE VARIOUS SPINAL NERVE PLEXUSES:

THE AUTONOMIC NERVOUS SYSTEM
The autonomic nervous system is the part of the nervous system that supplies the internal organs,
including the blood vessels, stomach, intestine, liver, kidneys, bladder, genitals, lungs, pupils, heart,
and sweat, salivary, and digestive glands.
The autonomic nervous system has two main divisions:

• Sympathetic
• Parasympathetic
After the autonomic nervous system receives information about the body and external environment, it
responds by stimulating body processes, usually through the sympathetic division, or inhibiting them,
usually through the parasympathetic division.
An autonomic nerve pathway involves two nerve cells. One cell is located in the brain stem or spinal
cord. It is connected by nerve fibers to the other cell, which is located in a cluster of nerve cells (called
an autonomic ganglion). Nerve fibers from these ganglia connect with internal organs. Most of the
ganglia for the sympathetic division are located just outside the spinal cord on both sides of it. The
ganglia for the parasympathetic division are located near or in the organs they connect with.
The presynaptic/ preganglionic neurons for both the sympathetic and parasympathetic neurons store
and release ACETYLCHOLINE. The two systems differ in the neurotransmitter in the postsynaptic/
postganglionic neuron. NOREPINEPHRINE is released by the sympathetic post-synaptic neuron,
whereas ACETYLCHOLINE is released by the parasympathetic post-synaptic neuron.
The difference in neurotransmitters explains why the two systems have different effects on organs.
(please see the table of responses below).
The two divisions balance each other out dan-in, day-out to maintain the necessary functions of the
organ systems.
The neurotransmitters of the ANS and the circulating catecholamines bind to specific receptors on the
cell membranes of the effector tissue. All adrenergic receptors and muscarinic receptors are coupled
to G proteins which are also embedded within the plasma membrane. Receptor stimulation causes
activation of the G protein and the formation of an intracellular chemical, the second messenger. (The
neurotransmitter molecule, which cannot enter the cell itself, is the first messenger.) The function of
the intracellular second messenger molecules is to elicit tissue-specific biochemical events within the
cell which alter the cell's activity.
CHOLINERGIC TRANSMISSION
Acetylcholine binds to 2 types of cholinergic receptors. Nicotinic receptors are found on the cell bodies
of all postganglionic neurons, both sympathetic and parasympathetic, which receive the acetylcholine
released by the presynaptic neuron. Acetylcholine released from the preganglionic neurons binds to
these nicotinic receptors and causes a rapid increase in the cellular permeability to Na+ ions and Ca++
ions. The resulting influx of these 2 cations causes depolarization and excitation of the postganglionic
neurons the ANS pathways.
Muscarinic receptors are found on the cell membranes of the effector tissues and are linked to G
proteins and second messenger systems which carry out the intracellular effects. Acetylcholine
released from all parasympathetic postganglionic neurons and some sympathetic postganglionic
neurons traveling to sweat glands binds to these receptors. Muscarinic receptors may be either
inhibitory or excitatory, depending on the tissue upon which they are found.

ADRENERGIC TRANSMISSION
There are 2 classes of adrenergic receptors for norepinephrine and epinephrine, alpha (α) and beta
(β). Furthermore, there are at least 2 subtypes of receptors in each class: α1, α2, β1 and β2. All of
these receptors are linked to G proteins and second messenger systems which carry out the
intracellular effects.
Alpha receptors are the more abundant of the adrenergic receptors. Of the 2 subtypes, α1 receptors
are more widely distributed on the effector tissues. Alpha one receptor stimulation leads to an increase
in intracellular calcium. As a result, these receptors tend to be excitatory. For example, stimulation of
α1 receptors causes contraction of vascular smooth muscle resulting in vasoconstriction and
increased glandular secretion by way of exocytosis.
Compared to α1 receptors, α2 receptors have only moderate distribution on the effector tissues. Alpha
2 receptor stimulation causes a decrease in cAMP and, therefore, inhibitory effects such as smooth
muscle relaxation and decreased glandular secretion.
Stimulation of each type of β receptor leads to an increase in intracellular cAMP. Whether this results
in an excitatory or an inhibitory response depends upon the specific cell type. As with α receptors, β
receptors are also unevenly distributed with β2 receptors, the more common subtype on the effector
tissues. Beta 2 receptors tend to be inhibitory. For example, β2 receptor stimulation causes relaxation
of vascular smooth muscle and airway smooth muscle resulting in vasodilation and bronchodilation,
respectively. Beta 2 receptors have a significantly greater affinity for epinephrine than for
norepinephrine. Furthermore, terminations of sympathetic pathways are not found near these
receptors. Therefore, β2 receptors are stimulated only indirectly by circulating epinephrine instead of
by direct sympathetic nervous activity.
Beta 1 receptors are the primary adrenergic receptor on the heart (a small percentage of the
adrenergic receptors on the myocardium are β2). Both subtypes of β receptors on the heart are
excitatory and stimulation leads to an increase in cardiac activity. Beta 1 receptors are also found on
certain cells in the kidney. Epinephrine and norepinephrine have equal affinity for β1 receptors.
Beta three (β3) receptors are found primarily in adipose tissue. Stimulation of these receptors, which
have a stronger affinity for norepinephrine, causes lipolysis.
CARDIOVASCULAR SYSTEM

The circulatory system comprises the cardiovascular system that transports blood, and the lymphatic
system that distributes lymph throughout the body. The circulatory system, which is a network of blood
vessels that transports nutrients in the form of amino acids, electrolytes, lymph (fluid containing white
blood cells), hormones, and oxygenated blood to tissues or organs in the human body. This maintains
homeostasis, the immune system, and stabilizes body temperature and pH levels.

The human cardiovascular network is a closed loop system that enables the transport of oxygenated
blood to the tissues and organs of the human body and the de-oxygenated blood to the respiratory
organs. The heart pumps approximately 5 L of blood through the cardiovascular network to vital organs
of the human body, providing nutrients and oxygen that are needed, and then transporting the waste
products and harmful chemicals away from them.

THE HEART

The heart is located in the thoracic cavity between the lungs. This area is called the mediastinum. The
base of the cone-shaped heart is uppermost, behind the sternum, and the great vessels enter or leave
here. The apex (tip) of the heart points downward and is just above the diaphragm to the left of the
midline (APEX BEAT is located in the 5th left intercostal space, midclavicular line).

The heart is enclosed in the pericardial membranes, of which there are three layers. The outermost is
the fibrous pericardium, a loose fitting sac of strong fibrous connective tissue that extends inferiorly
over the diaphragm and superiorly over the bases of the large vessels that enter and leave the heart.
The serous pericardium is a folded membrane; the fold gives it two layers, parietal and visceral. Lining
the fibrous pericardium is the parietal pericardium. On the surface of the heart muscle is the visceral
pericardium, often called the epicardium.

The heart comprises the right ventricle and left atrium, separated by a partition septum. Each half
consists of two chambers; a thin-walled atrium and a thick-walled ventricle. The atria receive blood
from the veins, while the ventricles pump blood out of the heart and through the circulatory system.
The walls of the four chambers of the heart are made of cardiac muscle called the myocardium. The
chambers are lined with endocardium, simple squamous epithelium that also covers the valves of the
heart and continues into the vessels as their lining.

RIGHT ATRIUM
• Openings (4) found in the right atrium.
o superior vena cava carries blood from the upper body
o inferior vena cava carries blood from the lower body
o coronary sinus drains blood used by the heart itself
o atrioventricular orifice (guarded by the TRICUSPID VALVE)
• The endocardium of the right atrium is lined by muscular ridges called musculi pectinati
(pectinate muscles)

LEFT ATRIUM
• Openings (5) found in the right atrium.
o 4 pulmonary veins
o atrioventricular orifice (guarded by the MITRAL VALVE aka the BICUSPID VALVE)
• The endocardium of the left atrium is SMOOTH. It has NO muscular ridges.
RIGHT and LEFT VENTRICLES
The endocardium of the ventricles possesses ridges, trabeculae carnae. Projecting into the lower part
of the ventricles are columns of myocardium called papillary muscles. Strands of fibrous connective
tissue, the chordae tendineae, extend from the papillary muscles to the flaps of the tricuspid valve.
When the right ventricle contracts, the papillary muscles also contract and pull on the chordae
tendineae to prevent inversion of the tricuspid valve.

The walls of the left ventricle are thicker than those of the right ventricle, which enables the left
ventricle to contract more forcefully. The left ventricle pumps blood to the body through the aorta, the
largest artery of the body.

BLOOD FLOW THROUGH THE HEART

The right atrium is the upper right chamber of the heart collecting de-oxygenated blood from the vena
cava, and then passes it via the tricuspid valves. This goes into the right ventricle for pumping into the
lungs through the pulmonary valve and via the pulmonary artery for oxygenation. The oxygenated blood
returns via the pulmonary vein into the left atrium, which then pumps the blood into the left ventricle
through the mitral valve. The left ventricle is the strongest chamber of the heart that supplies the
oxygenated blood to the rest of the human body via the aorta after passing through the aortic valves.
The valves: tricuspid pulmonary, mitral and aortic valves of the heart ensure that blood flows in the
circulatory system effectively without reversing its direction in the circuit.
CARDIAC CYCLE
The cardiac cycle is the sequence of events in one heartbeat. In its simplest form, the cardiac cycle is
the simultaneous contraction of the two atria, followed a fraction of a second later by the simultaneous
contraction of the two ventricles. Systole is another term for contraction. The term for relaxation is
diastole. You are probably familiar with these terms as they apply to blood pressure readings. If we
apply them to the cardiac cycle, we can say that atrial systole is followed by ventricular systole. There
is, however, a significant difference between the movement of blood from the atria to the ventricles
and the movement of blood from the ventricles to the arteries.

Following their contraction, the atria relax and the ventricles begin to contract. Ventricular contraction
forces blood against the flaps of the right and left AV valves and closes them; the force of blood also
opens the aortic and pulmonary semilunar valves. As the ventricles continue to contract, they pump
blood into the arteries. Notice that blood that enters the arteries must all be pumped. The ventricles
then relax, and at the same time blood continues to flow into the atria, and the cycle begins again.
CONDUCTION SYSTEM OF THE HEART
The conduction system is the electrical supply of the heart. The cardiac cycle is a sequence of
mechanical events that is regulated by the electrical activity of the myocardium. Cardiac muscle cells
have the ability to contract spontaneously; that is, nerve impulses are not required to cause
contraction. The heart generates its own beat, and the electrical impulses follow a very specific route
throughout the myocardium.

The natural pacemaker of the heart is the sinoatrial (SA) node, a specialized group of cardiac muscle
cells located in the wall of the right atrium just below the opening of the superior vena cava. The SA
node is considered specialized because it has the most rapid rate of contraction, that is, it depolarizes
more rapidly than any other part of the myocardium (60 to 80 times per minute). As you may recall,
depolarization is the rapid entry of Na ions and the reversal of charges on either side of the cell
membrane. The cells of the SA node are more permeable to Na ions than are other cardiac muscle
cells. Therefore, they depolarize more rapidly, then contract and initiate each heartbeat. From the SA
node, impulses for contraction travel to the atrioventricular (AV) node, located in the lower interatrial
septum. The transmission of impulses from the SA node to the AV node and to the rest of the atrial
myocardium brings about atrial systole.
The electrical impulse now continues to the only pathway from the atria to the ventricles, the
atrioventricular bundle (AV bundle), also called the bundle of His. The AV bundle is within the upper
interventricular septum; it receives impulses from the AV node and transmits them to the right and left
bundle branches. From the bundle branches, impulses travel along Purkinje fibers to the rest of the
ventricular myocardium and bring about ventricular systole.
THE CARDIAC ACTION POTENTIAL
The electrical impulses that travel through the conduction system are the ACTION POTENTIAL.
Action potential: electrical stimulation created by a sequence of ion fluxes through
specialized channels in the membrane (sarcolemma) of cardiomyocytes that leads to cardiac
contraction.
The action potential in typical cardiomyocytes is composed of 5 phases (0-4), beginning and ending
with phase 4.

Phase 4: The resting phase

• The resting potential in a cardiomyocyte is −90 mV due to a constant outward leak of

K+ through inward rectifier channels.
• Na+ and Ca2+ channels are closed at resting membrane potential.

Phase 0: Depolarization

• An action potential triggered in a neighboring cardiomyocyte or pacemaker cell

causes the transmembrane potential (TMP) to rise above −90 mV.
• Fast Na+ channels start to open one by one and Na+ leaks into the cell, further raising
the TMP.
• TMP approaches −70mV, the threshold potential in cardiomyocytes, i.e. the point at
which enough fast Na+ channels have opened to generate a self-sustaining inward
Na+ current.

Phase 1: Early repolarization

• TMP is now slightly positive.

• Some K+ channels open briefly and an outward flow of K+ returns the TMP to
approximately 0 mV.

Phase 2: The plateau phase

• L-type Ca2+ channels are open and there is a small, constant inward current of Ca 2+.
This becomes significant in the excitation-contraction coupling process described below.
• K+ leaks out down its concentration gradient through delayed rectifier K+ channels.
• These two countercurrents are electrically balanced, and the TMP is maintained at
a plateau just below 0 mV throughout phase 2.

Phase 3: Repolarization

• Ca2+ channels are gradually inactivated.

• Persistent outflow of K+, now exceeding Ca2+ inflow, brings TMP back towards resting
potential of −90 mV to prepare the cell for a new cycle of depolarization.
• Normal transmembrane ionic concentration gradients are restored by returning
Na and Ca2+ ions to the extracellular environment, and K+ ions to the cell interior. The
+

pumps involved include the sarcolemmal Na+-Ca2+ exchanger, Ca2+-ATPase and Na+-K+-
ATPase.
THE 12-L ECG
The electrocardiography is a measurement of the electrical impulses generated by the heart.
This is the typical appearance of the ECG tracing. It has characteristic waveforms: P, Q, R, S, T waves.
Each of these waves correspond to the generation of action potentials in various areas of the heart.
Notice the appearance of the ECG tracing being a summary of ALL the generated action potentials.

P WAVE = ATRIAL DEPOLAROZATION

QRS COMPLEX = VENTRICULAR DEPOLARIZATION
T WAVE = VENTRICULAR REPOLARIZATION
HEART SOUNDS

The third heart sound (S3) is a low-frequency, brief vibration occurring in early diastole at the end of
the rapid diastolic filling period of the right or left ventricle. Synonymous terms include: ventricular
gallop, early diastolic gallop, ventricular filling sound, and protodiastolic gallop. Children and adults
up to age 35 to 40 may have a normal third heart sound.

The fourth heart sound is a low-pitched sound coincident with late diastolic filling of the ventricle due
to atrial contraction. It thus occurs shortly before the first heart sound.

A pathologic fourth heart sound usually indicates reduced ventricular compliance. Commonly, this
results from conditions that can lead to ventricular hypertrophy. A left-sided fourth heart sound is
frequently present in patients with systemic hypertension, aortic stenosis, or hypertrophic
cardiomyopathv. A left ventricular fourth heart sound is common also in patients with coronary heart
disease.
CARDIAC OUTPUT
Cardiac output is the amount of blood pumped by a ventricle in 1 minute.
A certain level of cardiac output is needed at all times to transport oxygen to tissues and to remove
waste products. During exercise, cardiac output must increase to meet the body’s need for more
oxygen. We will return to exercise after first considering resting cardiac output. To calculate cardiac
output, we must know the pulse rate and how much blood is pumped per beat.

Stroke volume is the term for the amount of blood pumped by a ventricle per beat; an average resting
stroke volume is 60 to 80 mL per beat.

A simple formula then enables us to determine cardiac output:

Cardiac output = stroke volume X pulse (heart rate)

Let us put into this formula an average resting stroke volume, 70 mL, and an average resting
pulse, 70 beats per minute (bpm):
Cardiac output = 70 mL X 70 bpm
Cardiac output = 4900 mL per minute (approximately 5 liters)

Starling’s law of the heart, which states that the more the cardiac muscle fibers are stretched, the
more forcefully they contract. During exercise, more blood returns to the heart; this is called venous
return. Increased venous return stretches the myocardium of the ventricles, which contract more
forcefully and pump more blood, thereby increasing stroke volume.
REGULATION OF HEART RATE
Although the heart generates and maintains its own beat, the rate of contraction can be changed to
adapt to different situations. The nervous system can and does bring about necessary changes in
heart rate as well as in force of contraction.

The medulla of the brain contains the two cardiac centers, the accelerator center and the inhibitory
center. These centers send impulses to the heart along autonomic nerves. Recall that the autonomic
nervous system has two divisions: sympathetic and parasympathetic. Sympathetic impulses from the
accelerator center along sympathetic nerves increase heart rate and force of contraction during
exercise and stressful situations. Parasympathetic impulses from the inhibitory center along the vagus
nerves decrease the heart rate.

Baroreceptors and chemoreceptors are located in the carotid arteries and aortic arch. Baroreceptors
in the carotid sinuses and aortic sinus detect changes in blood pressure. Chemoreceptors in the
carotid bodies and aortic body detect changes in the oxygen content of the blood. The sensory nerves
for the carotid receptors are the glossopharyngeal (9th cranial) nerves; the sensory nerves for the
aortic arch receptors are the vagus (10th cranial) nerves.

ARTERIES vs. VEINS

ARTERIES (resistance vessels)

Arteries carry blood from the heart to capillaries; smaller arteries are called arterioles.

If we look at an artery in cross-section, we find three layers (or tunics) of tissues, each with different
functions. The innermost layer, the tunica intima, is the only part of a vessel that is in contact with
blood. It is made of simple squamous epithelium called endothelium. This lining is the same type of
tissue that forms the endocardium, the lining of the chambers of the heart. As you might guess, its
function is also the same: Its extreme smoothness prevents abnormal blood clotting. The endothelium
of vessels, however, also produces nitric oxide (NO), which is a vasodilator. The tunica media, or middle
layer, is made of smooth muscle and elastic connective tissue. Both of these tissues are involved in
the maintenance of normal blood pressure, especially diastolic blood pressure when the heart is
relaxed. The smooth muscle is the tissue affected by the vasodilator NO; relaxation of this muscle
tissue brings about dilation of the vessel. Smooth muscle also has a nerve supply; sympathetic nerve
impulses bring about vasoconstriction. Fibrous connective tissue forms the outer layer, the tunica
externa. This tissue is very strong, which is important to prevent the rupture or bursting of the larger
arteries that carry blood under high pressure

VEINS (capacitance vessels)

Veins carry blood from capillaries back to the heart; the smaller veins are called venules. The same
three tissue layers are present in veins as in the walls of arteries, but there are some differences when
compared to the arterial layers. The inner layer of veins is smooth endothelium, but at intervals this
lining is folded to form valves. Valves prevent backflow of blood and are most numerous in veins of
the legs, where blood must often return to the heart against the force of gravity. The middle layer of
veins is a thin layer of smooth muscle. It is thin because veins do not regulate blood pressure and
blood flow into capillaries as arteries do. Veins can constrict extensively, however, and this function
becomes very important in certain situations such as severe hemorrhage. The outer layer of veins is
also thin; not as much fibrous connective tissue is necessary because blood pressure in veins is very
low.

An anastomosis is a connection, or joining, of vessels, that is, artery to artery or vein to vein. The
general purpose of these connections is to provide alternate pathways for the flow of blood if one
vessel becomes obstructed.
Capillaries carry blood from arterioles to venules. Their walls are only one cell in thickness; capillaries
are actually the extension of the endothelium, the simple squamous lining, of arteries and veins. Some
tissues do not have capillaries; these are the epidermis, cartilage, and the lens and cornea of the eye.
FETAL CIRCULATION

The fetus is connected to the placenta by the umbilical cord, which contains two umbilical arteries and
one umbilical vein. The umbilical arteries are branches of the fetal internal iliac arteries; they carry
blood from the fetus to the placenta. In the placenta, carbon dioxide and waste products in the fetal
blood enter maternal circulation, and oxygen and nutrients from the mother’s blood enter fetal
circulation. The umbilical vein carries this oxygenated blood from the placenta to the fetus. Within the
body of the fetus, the umbilical vein branches: One branch takes some blood to the fetal liver, but
most of the blood passes through the ductus venosus to the inferior vena cava, to the right atrium.

The other modifications of fetal circulation concern the fetal heart and large arteries (also shown in
Because the fetal lungs are deflated and do not provide for gas exchange, blood is shunted away from
the lungs and to the body:
The foramen ovale is an opening in the interatrial septum that permits some blood to flow from the
right atrium to the left atrium, not, as usual, to the right ventricle. The blood that does enter the right
ventricle is pumped into the pulmonary artery. The ductus arteriosus is a short vessel that diverts most
of the blood in the pulmonary artery to the aorta, to the body. Both the foramen ovale and the ductus
arteriosus permit blood to bypass the fetal lungs.

Just after birth, the baby breathes and expands its lungs, which pulls more blood into the pulmonary
circulation. More blood then returns to the left atrium, and a flap on the left side of the foramen ovale
is closed. The ductus arteriosus constricts, probably in response to the higher oxygen content of the
blood, and pulmonary circulation becomes fully functional within a few days. After birth, when the
umbilical cord is cut, the remnants of these fetal vessels constrict and become nonfunctional.

BLOOD PRESSURE REGULATION

Blood pressure can be adjusted by producing changes in the following variables:

• Cardiac output that can be altered by changing stroke volume or heart rate.
• Resistance to blood flow in the blood vessels is most often altered by changing the diameter
of the vessels (vasodilation or vasoconstriction).
 • Changes in blood viscosity (its ability to flow) or in the length of the blood vessels (which
increases with weight gain) can also alter resistance to blood flow.

The cardiovascular center in the medulla oblongata receives information about the state of the body
through the following sources:

• Baroreceptors are sensory neurons that monitor arterial blood pressure. Major baroreceptors
are located in the carotid sinus (an enlarged area of the carotid artery just above its separation
from the aorta), the aortic arch, and the right atrium.

• Chemoreceptors are sensory neurons that monitor levels of CO 2 and O 2. These neurons alert
the cardiovascular center when levels of O 2 drop or levels of CO 2 rise (which result in a drop
in pH). Chemoreceptors are found in carotid bodies and aortic bodies located near the carotid
sinus and aortic arch.

Higher brain regions, such as the cerebral cortex, hypothalamus, and limbic system, signal the
cardiovascular center when conditions (stress, fight‐or‐flight response, hot or cold temperature)
require adjustments to the blood pressure.

The kidneys provide a hormonal mechanism for the regulation of blood pressure by managing blood
volume:

The renin‐angiotensin‐aldosterone system of the kidneys regulates blood volume. In response

to rising blood pressure, the juxtaglomerular cells in the kidneys secrete renin into the blood.

Renin converts the plasma protein angiotensinogen to angiotensin I, which in turn is converted
to angiotensin II by ACE (angiotensin converting enzyme) from the lungs. Angiotensin II
activates two mechanisms that raise blood pressure:
• Angiotensin II constricts blood vessels throughout the body (raising blood pressure
by increasing resistance to blood flow). Constricted blood vessels reduce the
amount of blood delivered to the kidneys, which decreases the kidneys' potential
to excrete water (raising blood pressure by increasing blood volume).
 • Angiotensin II stimulates the adrenal cortex to secrete aldosterone, a hormone that
reduces urine output by increasing retention of H 2O and Na + by the kidneys
(raising blood pressure by increasing blood volume).

Various substances influence blood pressure. Some important examples follow:

• Epinephrine and norepinephrine, hormones secreted by the adrenal medulla, raise blood
pressure by increasing heart rate and the contractility of the heart muscles and by causing
vasoconstriction of arteries and veins. These hormones are secreted as part of the fight‐or‐
flight response.
• Antidiuretic hormone (ADH), a hormone produced by the hypothalamus and released by the
posterior pituitary, raises blood pressure by stimulating the kidneys to retain H 2O (raising
blood pressure by increasing blood volume).
• Atrial natriuretic peptide (ANP), a hormone secreted by the atria of the heart, lowers blood
pressure by causing vasodilation and by stimulating the kidneys to excrete more water and
Na+ (lowering blood pressure by reducing blood volume).
• Nitric oxide (NO), secreted by endothelial cells, causes vasodilation.
RESPIRATORY SYSTEM

The respiratory system, functionally, can be separated in two zones;

• conducting zones (nose to bronchioles) form a passageway of the inhaled gases

• respiratory zone (alveolar duct to alveoli) where the gas exchange takes place.
Anatomically, respiratory tract is divided into:

• upper respiratory tract (organ outside thorax - nose, pharynx and larynx)
• lower respiratory tract (organ within thorax - trachea, bronchi, bronchioles, alveolar duct and
alveoli).

UPPER RESPIRATORY TRACT

NASAL CAVITY
Nose and nasal cavity are divided into two halves by the nasal septum. The lateral wall of the
nose consists of three turbinates or conchae (superior, middle and inferior).
PHARYNX
The pharynx is a tube-like passage that connects the posterior nasal and oral cavities to the
larynx and esophagus.

1. OROPHARYNX
- soft palate to epiglottis
- two sets of TONSILS (the tonsils remove pathogens that enter the pharynx)
a. Palatine
b. Lingual
 2. NASOPHARYNX
- located superior and posterior to the soft palate.
- contains the PHARYNGEAL TONSILS and TUBAL TONSILS
3. LARYNGOPHARYNX
- inferior to the epiglottis and posterior to the larynx.
- this division opens into the esophagus and larynx.

LARYNX
The LARYNX (voice box) lies superior to the trachea. It is composed of NINE CARTILAGES -
three unpaired (epiglottis, thyroid and cricoid cartilage) and three paired (arytenoid,
cuneiform and corniculate
• The EPIGLOTTIS is a spade shade cartilage that is important during swallowing. It tips
inferiorly to seal off the glottis and prevents food from entering the trachea.
• The THYROID CARTILAGE is shaped like a shield when viewed from the anterior surface.
This is the ADAM’S APPLE.
• On the postero-inferior side of the thyroid cartilage, the CRICOID CARTILAGE extends
superiorly to where the thyroid cartilage would be. This cartilage is sometimes called the
SIGNET RING CARTILAGE.
• The ARYTENOID CARTILAGES is below the epiglottis at the entrance to the GLOTTIS. They
are located superior to the cricoid cartilage in the posterior part of the larynx, with the
base of the arytenoid cartilages articulating on either side with the posterior aspect of
the upper border of the cricoid lamina. The anterior angle of the base of the arytenoid
cartilage is elongated to form a vocal process for attachment of the vocal ligament, while
the lateral angle is elongated to form a muscular process for attachment of the posterior
and lateral cricoarytenoid muscles. The arytenoid cartilages anchor the vocal cords.
• The CORNICULATE CARTILAGES are 2 small, conical cartilages that articulate with the
apices of the arytenoid cartilages, serving to extend them posteriorly and medially. They
are located in the posterior parts of the aryepiglottic folds of mucous membrane.
• The CUNEIFORM CARTILAGES are 2 small, club-shaped cartilages that lie anterior to the
corniculate cartilages in the aryepiglottic folds. They form small, whitish elevations on the
surface of the mucous membrane just anterior of the arytenoid cartilages.
The GLOTTIS is a passageway into the trachea. The thyroid cartilage forms the walls of the
glottis. The arytenoid cartilage extends inferiorly into the glottis.
The true vocal cords are located inferiorly inside the glottis. As air passes over the vocal
cords they flutter, producing sound from the vibration. Pitch can be changed by tightening or
loosening the cords. There are folds covering part of the epiglottis called FALSE VOCAL
CORDS.
TRACHEA
The trachea is a hollow conduit for gases and bronchial secretions. It extends from the level of C6
(cricoid cartilage) to the carina, approximately located at the level of T4–T5.
The trachea has 16 to 22 horseshoe bands (c-shaped) of cartilages. The posterior tracheal wall lacks
cartilage and is supported by the trachealis muscle.
The trachea divides at carina into the right and left main bronchus. The right main stem bronchus
has a more direct downward course, is shorter than the left and begins to ramify earlier than the left
main bronchus. This leads to higher chances of foreign body aspiration towards the right lung.
BRONCHI
It is a complex system that transports gases from the trachea down to the acini, the gas exchange
units of the lung. It is partitioned into 23 generations of dichotomous branching, extending from
trachea (generation 0) to the last order of terminal bronchioles (generation 23).

• At each generation, each airway is being divided into two smaller daughter airways.
• At each generation, the number of branchings increase
• At each generation, the surface area increases

Broncho-pulmonary segment may be defined as an area of distribution of any bronchus. Each lobar
bronchi divides into segmental bronchi (tertiary bronchi), which supply the broncho-pulmonary
segment of each lobe. Technically, there are ten broncho-pulmonary segments in each lung, but in
left lung, some of these segments fuse and there are as few as eight broncho-pulmonary segments.
The bronchi continue to divide into smaller and smaller bronchi up to 23 generations of divisions
from main bronchus. As bronchi become smaller, their structure changes:
 • Cartilaginous ring becomes irregular and then disappear. When bronchi lose all cartilaginous
support, the airway is then referred as bronchioles
• The epithelium changes from pseudostratified columnar to columnar to cuboidal in the
terminal bronchioles
• There are no cilia and mucous producing cells (Goblet cells) in bronchioles; however,
surfactant producing cells (Clara cells) become present.
• The amount of smooth muscle in the tube wall increases as the airway becomes smaller.

ALVEOLI
An alveolus is an anatomical structure that has the form of a hollow cavity and is found in the lung
parenchyma.
The pulmonary alveoli are the terminal ends of the respiratory tree that outcrop from either alveolar
sacs or alveolar ducts; both are sites of gas exchange.
The alveolar membrane is the gas-exchange surface. Carbon-dioxide-rich blood is pumped from the
rest of the body into the alveolar blood vessels where, through diffusion, it releases its carbon
dioxide and absorbs oxygen.
The alveoli consist of an epithelial layer and an extracellular matrix surrounded by capillaries. In
some alveolar walls there are pores between alveoli called pores of Kohn.

PHYSIOLOGY OF BREATHING
Movement of inspired gas into and exhaled gas out of lung is called as ventilation.
Breathing is a muscular event:
Respiration refers to gas exchange. As air reaches the alveoli, oxygen diffuses into the capillaries,
and carbon dioxide is unloaded into the alveoli.
External respiration: aka gas exchange where oxygen is exchanged with carbon dioxide.
Internal respiration: gas exchange between blood and tissue cells
HEMOGLOBIN
Hemoglobin develops in cells in the bone marrow that become red blood cells.
Each hemoglobin molecule is made up of four heme groups surrounding a globin group, forming a
tetrahedral structure.
Heme, a pigment molecule, is composed of a ring-like organic compound known as a porphyrin to
which an iron atom is attached. It is the iron atom that binds oxygen as the blood travels between
the lungs and the tissues. There are four iron atoms in each molecule of hemoglobin, which
accordingly can bind four atoms of oxygen. Globin consists of two linked pairs of polypeptide chains.
Hemoglobin S is a variant form of hemoglobin that is present in persons who have sickle cell
anemia, a severe hereditary form of anemia in which the cells become crescent-shaped
when oxygen is lacking. The abnormal sickle-shaped cells die prematurely and may become
lodged in small blood vessels, potentially obstructing the microcirculation and leading to
tissue damage. The sickling trait is found mainly in people of African descent
OXYGEN HEMOGLOBIN DISSOCIATION CURVE
The normal oxyhemoglobin dissociation curve (OHDC), shown here by the solid blue line, indicates that
when the partial pressure of arterial oxygen (PaO2) is 40 mm Hg, oxygen saturation of hemoglobin
(SaO2) is 75%. At the tissue or capillary level, a PaO2 of 40 mm Hg is normal. At this point, about 25%
of the oxygen carried on hemoglobin from the tissues to the lungs has been unloaded and used at the
tissue level.
Conditions that alter hemoglobin’s affinity for oxygen can shift the OHDC to the right or left:
• A shift to the right (dotted purple line)
decreases hemoglobin’s affinity for oxygen
for a given PaO2 value, and the SaO2 value
decreases below normal. Hemoglobin
releases oxygen to the tissues more readily
in an effort to keep tissues well-oxygenated
(because oxygen demand is higher than
normal). Causes of a shift to the right
include increased body temperature,
acidosis, exercise, and elevated 2,3-
diphosphoglycerate (2,3-DPG) or partial
pressure of arterial carbon dioxide ( PaCO2)
levels.
• A shift to the left (dotted green line)
increases hemoglobin’s affinity for oxygen.
It can result from increased blood pH,
decreased body temperature, or reduced
2,3-DPG or PaCO2 levels. In a leftward shift,
less oxygen is released to the tissues but
more oxygen is bound to hemoglobin in the
lungs; the SaO2 value is higher than normal
for a given PaO2 value.
VOLUMES are single measurements:
• Tidal volume (TV): volume of air in normal breathing ( approx. 500 ml)
• Inspiratory reserve volume (IRV): amount of air that can be taken in forcibly over the tidal
volume
• Expiratory reserve volume (ERV): amount of air that can be forcibly exhaled after a tidal
expiration (1200 mL)
• Residual volume (RV): volume of air remaining in the lungs even after strenuous expiration
(approx. 1200 mL)
CAPACITIES are combinations of volumes
• Inspiratory capacity (IC): sum of TV + IRV (3500 mL)
• Functional residual capacity (FRC): sum of ERV + RV (2400 mL)
• Vital capacity (VC): total amount of exchangeable air; VC = TV + IRV + ERV (4800 mL)
• Total Lung Capacity (TLC): sum of all the volumes (~6000mL)
GASTROINTESTINAL SYSTEM

The two divisions of the digestive system are the alimentary tube and the accessory organs.
The alimentary tube extends from the mouth to the anus. It consists of the oral cavity, pharynx,
esophagus, stomach, small intestine, and large intestine. Digestion takes place within the oral cavity,
stomach, and small intestine; most absorption of nutrients takes place in the small intestine.
Undigestible material, primarily cellulose, is eliminated by the large intestine (also called the colon).
The accessory organs of digestion are the teeth, tongue, salivary glands, liver, gallbladder, and
pancreas. Digestion does not take place within these organs, but each contributes something to the
digestive process.

ORAL CAVITY
Food enters the oral cavity (or buccal cavity) by way of the mouth. The boundaries of the oral cavity are
the hard and soft palates superiorly; the cheeks laterally; and the floor of the mouth inferiorly. Within
the oral cavity are the teeth and tongue and the openings of the ducts of the salivary glands.
SALIVARY GLANDS
The digestive secretion in the oral cavity is saliva, produced by three pairs of salivary glands.
The parotid glands are just below and in front of the ears. The submandibular (also called
submaxillary) glands are at the posterior corners of the mandible, and the sublingual glands
are below the floor of the mouth.
 Each gland has at least one duct that takes saliva to the oral cavity. Secretion of saliva is
continuous, but the amount varies in different situations. The presence of food (or anything
else) in the mouth increases saliva secretion. This is a parasympathetic response mediated by
the facial and glossopharyngeal nerves. The sight or smell of food also increases secretion of
saliva. Sympathetic stimulation in stress situations decreases secretion, making the mouth dry
and swallowing difficult. Saliva is mostly water, which is important to dissolve food for tasting
and to moisten food for swallowing. The digestive enzyme in saliva is salivary amylase, which
breaks down starch molecules to shorter chains of glucose molecules, or to maltose, a
disaccharide. Most of us, however, do not chew our food long enough for the action of salivary
amylase to be truly effective. As you will see, another amylase from the pancreas is also
available to digest starch.
PHARYNX
The oropharynx and laryngopharynx are food passageways connecting the oral cavity to the
esophagus. No digestion takes place in the pharynx. Its only related function is swallowing, the
mechanical movement of food. When the bolus of food is pushed backward by the tongue, the
constrictor muscles of the pharynx contract as part of the swallowing reflex. The reflex center for
swallowing is in the medulla, which coordinates the many actions that take place: constriction of the
pharynx, cessation of breathing, elevation of the soft palate to block the nasopharynx, elevation of the
larynx and closure of the epiglottis, and peristalsis of the esophagus.

ESOPHAGUS
The esophagus is a muscular tube that takes food from the pharynx to the stomach; no digestion
takes place here. Peristalsis of the esophagus propels food in one direction and ensures that food
gets to the stomach even if the body is horizontal or upside down. At the junction with the stomach,
the lumen (cavity) of the esophagus is surrounded by the lower esophageal sphincter (LES or cardiac
sphincter), a circular smooth muscle. The LES relaxes to permit food to enter the stomach, then
contracts to prevent the backup of stomach contents.

• 10 in long
• Composed of skeletal and smooth muscles
• Mainly found in the thoracic region
• Pierces the diaphragm at T10
• Has no true anatomic sphincter – however, a
physiologic sphincter exists (contraction of the
circular muscles)
• Has 3 constrictions - where it begins (C6); where it
Crosses the left bronchus (T4-T5); where it ends –
(T10)
STOMACH
The stomach is located in the upper left quadrant of the abdominal cavity, to the left of the liver and
in front of the spleen. Capacity: 0.8-1.5 L (max). Although part of the alimentary tube, the stomach is
not a tube, but rather a sac that extends from the esophagus to the small intestine. Because it is a
sac, the stomach is a reservoir for food, so that digestion proceeds gradually and we do not have to
eat constantly. Both mechanical and chemical digestion take place in the stomach.
The cardiac orifice is the opening of the esophagus, and the fundus is the portion above the level of
this opening. The body of the stomach is the large central portion, bounded laterally by the greater
curvature and medially by the lesser curvature. The pylorus is adjacent to the duodenum of the small
intestine, and the pyloric sphincter surrounds the junction of the two organs. The fundus and body are
mainly storage areas, whereas most digestion takes place in the pylorus.
When the stomach is empty, the mucosa appears wrinkled or folded. These folds are called rugae;
they flatten out as the stomach is filled and permit expansion of the lining without tearing it. The gastric
pits are the glands of the stomach and consist of several types of cells; their collective secretions are
called gastric juice.
Mucous cells secrete mucus, which coats the stomach lining and helps prevent erosion by the
gastric juice.
Chief cells secrete pepsinogen, an inactive form of the enzyme pepsin.
 Parietal cells produce hydrochloric acid (HCl); these cells have enzymes called proton pumps,
which secrete H+ ions into the stomach cavity. The H+ ions unite with Cl– ions that have
diffused from the parietal cells to form HCl in the lumen of the stomach. HCl converts
pepsinogen to pepsin, which then begins the digestion of proteins to polypeptides, and also
gives gastric juice its pH of 1 to 2. This very acidic pH is necessary for pepsin to function and
also kills most microorganisms that enter the stomach. The parietal cells also secrete intrinsic
factor, which is necessary for the absorption of vitamin B12.
Enteroendocrine cells called G cells secrete the hormone gastrin.
Enterochromaffin-like (ECL) cells produce histamine (which stimulates the parietal cells to
produce acid).

The external muscle layer of the stomach

consists of three layers of smooth muscle:
circular, longitudinal, and oblique layers. These
three layers are innervated by the myenteric
plexuses of the enteric nervous system.
Stimulatory impulses are carried from the CNS
by the vagus nerves (10th cranial) and provide
for very efficient mechanical digestion to
change food into a thick liquid called chyme.
SMALL INTESTINES

The small intestine is about 1 inch (2.5 cm) in diameter and approximately 20 feet (6 m) long and
extends from the stomach to the cecum of the large intestine.

• Duodenum – 10 in
• Jejunum – 8 ft
• Ileum – 12 ft
The duodenum is the first 10 inches (25 cm) of the small intestine. The common bile duct enters the
duodenum at the ampulla of Vater (or hepatopancreatic ampulla). The jejunum is about 8 feet long,
and the ileum is about 11 feet in length. Digestion is completed in the small intestine, and the end
products of digestion are absorbed into the blood and lymph.
The mucosa has simple columnar epithelium that includes cells with microvilli and goblet cells that
secrete mucus. Grossly, the mucosa of the small intestines are thrown into folds called plica circulares
(circular folds). Microscopically, the mucosa has finger-like projections calld villi. Enteroendocrine cells
secrete the hormones of the small intestine.
Lymph nodules called Peyer’s patches are especially abundant in the ileum to destroy absorbed
pathogens.
The external muscle layer has the typical circular and longitudinal smooth muscle layers that mix the
chyme with digestive secretions and propel the chyme toward the colon.
Stimulatory impulses to the enteric nerves of these muscle layers are carried by the vagus nerves. The
waves of peristalsis, however, can take place without stimulation by the central nervous system; the
enteric nervous system can function independently and promote normal peristalsis. There are three
sources of digestive secretions that function within the small intestine: the liver, the pancreas, and the
small intestine itself.
LARGE INTESTINES
The large intestine, also called the colon, extends from the ileum of the small intestine to the anus,
the terminal opening.
The cecum is the first portion, and at its junction with the ileum is the ileocecal valve, which is not a
sphincter but serves the same purpose. After undigested food (which is now mostly cellulose) and
water pass from the ileum into the cecum, closure of the ileocecal valve prevents the backflow of
fecal material.
Attached to the cecum is the appendix, a small, dead-end tube with abundant lymphatic tissue. The
appendix seems to be a vestigial organ, that is, one whose size and function seem to be reduced.
Although there is abundant lymphatic tissue in the wall of the appendix, the possibility that the
appendix is concerned with immunity is not known with certainty. Appendicitis refers to inflammation
of the appendix,bwhich may occur if fecal material becomes impacted within it.
The remainder of the colon consists of the ascending, transverse, and descending colon, which
encircle the small intestine; the sigmoid colon, which turns medially and downward; the rectum; and
the anal canal.
The rectum is about 6 inches long, and the anal canal is the last inch of the colon that surrounds the
anus. Clinically, however, the terminal end of the colon is usually referred to as the rectum.
No digestion takes place in the colon. The only secretion of the colonic mucosa is mucus, which
lubricates the passage of fecal material.
The longitudinal smooth muscle layer of the colon is in three bands called taeniae coli. The rest of
the colon is “gathered” to fit these bands. This gives the colon a puckered appearance; the puckers
or pockets are called haustra, which provide for more surface area within the colon. The functions of
the colon are the absorption of water, minerals, and vitamins and the elimination of undigestible
material.
Stretch receptors in the smooth muscle layer of the rectum generate sensory impulses that travel to
the sacral spinal cord. The returning motor impulses cause the smooth muscle of the rectum to
contract.
Surrounding the anus is the internal anal sphincter (involuntary), which is made of smooth muscle.
As part of the reflex, this sphincter relaxes, permitting defecation to take place. The external anal
sphincter (voluntary) is made of skeletal muscle and surrounds the internal anal sphincter. If
defecation must be delayed, the external sphincter may be voluntarily contracted to close the anus.
The awareness of the need to defecate passes as the stretch receptors of the rectum adapt. These
receptors will be stimulated again when the next wave of peristalsis reaches the rectum
The liver consists of two large lobes, right and left, and fills the upper right and center of the abdominal
cavity, just below the diaphragm. The structural unit of the liver is the liver lobule, a roughly hexagonal
column of liver cells (hepatocytes). Between adjacent lobules are branches of the hepatic artery and
portal vein. The capillaries of a lobule are sinusoids, large and very permeable vessels between the
rows of liver cells. The sinusoids receive blood from both the hepatic artery and portal vein, and it is
with this mixture of blood that the liver cells carry out their functions.
In each corner of the lobule, a portal triad is seen. The
portal triad is composed of:

• portal vein
• hepatic arteriole
• bile duct
The hepatic artery brings oxygenated blood, and the
portal vein brings blood from the digestive organs and
spleen. Each lobule has a central vein. The central
veins of all the lobules unite to form the hepatic veins,
which take blood out of the liver to the inferior vena
cava. The cells of the liver have many functions (which
are discussed in a later section), but their only digestive
function is the production of bile. Bile enters the small
bile ducts, called bile canaliculi, on the liver cells, which
unite to form larger ducts and finally merge to form the
hepatic duct, which takes bile out of the liver. The
hepatic duct unites with the cystic duct of the
gallbladder to form the common bile duct, which takes
bile to the duodenum.
BILE
Yellow fluid containing bile salts, glutathione, phospholipids, cholesterol, bilirubin and other organic
anions, proteins, metals, ions, and xenobiotics.
Importance of adequate bile formation:

• Essential for uptake of lipid nutrients from the small intestine

• For protection of the small intestine from oxidative insults
• For excretion of endogenous and xenobiotic compounds.

Bile produced in the liver are collected by the right and left hepatic ducts. Bile then flows into the
common hepatic duct, which joins with the cystic duct from the gallbladder to form the common bile
duct. The common bile duct in turn joins with the pancreatic duct to empty into the duodenum.
Bile can be stored and concentrated in the gallbladder before its release into the duodenum.
Cholecystokinin promotes the contraction of the gall bladder to release bile. Vagal stimulation also
stimulates gall bladder contraction, but to a smaller extent.

OTHER FUNCTIONS OF THE LIVER

The liver is a remarkable organ, and only the brain is capable of a greater variety of functions. The liver
cells (hepatocytes) produce many enzymes that catalyze many different chemical reactions. These
reactions are the functions of the liver.

• Carbohydrate metabolism—As you know, the liver regulates the blood glucose level. Excess
glucose is converted to glycogen (glycogenesis) when blood glucose is high; the hormones
insulin and cortisol facilitate this process. During hypoglycemia or stress situations, glycogen
is converted back to glucose (glycogenolysis) to raise the blood glucose level. Epinephrine and
glucagon are the hormones that facilitate this process.
 The liver also changes other monosaccharides to glucose. Fructose and galactose, for
example, are end products of the digestion of sucrose and lactose. Because most cells,
however, cannot readily use fructose and galactose as energy sources, they are converted by
the liver to glucose, which is easily used by cells.

• Amino acid metabolism—The liver regulates blood levels of amino acids based on tissue needs
for protein synthesis. Of the 20 different amino acids needed for the production of human
proteins, the liver is able to synthesize 12, called the nonessential amino acids. The chemical
process by which this is done is called transamination, the transfer of an amino group (NH2)
from an amino acid present in excess to a free carbon chain that forms a complete, new amino
acid molecule. The other eight amino acids, which the liver cannot synthesize, are called the
essential amino acids. In this case, “essential” means that the amino acids must be supplied
by our food, because the liver cannot manufacture them. Similarly, “non-essential” means that
the amino acids do not have to be supplied in our food because the liver can make them. All
20 amino acids are required in order to make our body proteins. Excess amino acids, those
not needed right away for protein synthesis, cannot be stored.

• Lipid metabolism—The liver forms lipoproteins, which as their name tells us, are molecules of
lipids and proteins, for the transport of fats in the blood to other tissues. The liver also
synthesizes cholesterol and excretes excess cholesterol into bile to be eliminated in feces.
Fatty acids are a potential source of energy, but in order to be used in cell respiration they
must be broken down to smaller molecules. In the process of beta-oxidation, the long carbon
chains of fatty acids are split into two-carbon molecules called acetyl groups, which are simple
carbohydrates. These acetyl groups may be used by the liver cells to produce ATP or may be
combined to form ketones to be transported in the blood to other cells. These other cells then
use the ketones to produce ATP in cell respiration.

• Synthesis of plasma proteins— The liver synthesizes many of the proteins that circulate in the
blood. Albumin, the most abundant plasma protein, helps maintain blood volume by pulling
tissue fluid into capillaries. The clotting factors are also produced by the liver. These, as you
recall, include prothrombin, fibrinogen, and Factor 8, which circulate in the blood until needed
 in the chemical clotting mechanism. The liver also synthesizes alpha and beta globulins, which
are proteins that serve as carriers for other molecules, such as fats, in the blood.

• Formation of bilirubin—This is another familiar function: The liver contains fixed macrophages
that phagocytize old red blood cells (RBCs). Bilirubin is then formed from the heme portion of
the hemoglobin. The liver also removes from the blood the bilirubin formed in the spleen and
red bone marrow and excretes it into bile to be eliminated in feces.

• Phagocytosis by Kupffer cells—The fixed macrophages of the liver are called Kupffer cells (or
stellate reticuloendothelial cells). Besides destroying old RBCs, Kupffer cells phagocytize
pathogens or other foreign material that circulate through the liver. Many of the bacteria that
get to the liver come from the colon. These bacteria are part of the normal flora of the colon
but would be very harmful elsewhere in the body. The bacteria that enter the blood with the
water absorbed by the colon are carried to the liver by way of portal circulation. The Kupffer
cells in the liver phagocytize and destroy these bacteria, removing them from the blood before
the blood returns to the heart.

• Storage—The liver stores the fat-soluble vitamins A, D, E, and K, and the water-soluble vitamin
B12. Up to a 6- to 12-month supply of vitamins A and D may be stored, and beef or chicken
liver is an excellent dietary source of these vitamins. Also stored by the liver are the minerals
iron and copper.
PANCREAS

The pancreas is located in the upper left abdominal quadrant between the curve of the duodenum and
the spleen and is about 6 inches (15 cm) in length. The pancreas is both an exocrine and endocrine
organ.
The exocrine glands of the pancreas are called acini (singular: acinus). They produce enzymes that are
involved in the digestion of all three types of complex food molecules. The pancreatic enzyme amylase
digests starch to maltose. You may recall that this is the “backup” enzyme for salivary amylase, though
pancreatic amylase is responsible for most digestion of starch. Lipase converts emulsified fats to fatty
acids and glycerol. The emulsifying or fat-separating action of bile salts increases the surface area of
fats so that lipase works effectively. Trypsinogen is an inactive enzyme that is changed to active trypsin
in the duodenum. Trypsin digests polypeptides to shorter chains of amino acids.
The pancreatic enzyme juice is carried by small ducts that unite to form larger ducts, then finally the
main pancreatic duct. An accessory duct may also be present. The main pancreatic duct emerges from
the medial side of the pancreas and joins the common bile duct to the duodenum. The pancreas also
produces a bicarbonate juice (containing sodium bicarbonate), which is alkaline.
Secretion of pancreatic juice is stimulated by the hormones secretin and cholecystokinin, which are
produced by the duodenal mucosa when chyme enters the small intestine. Secretin stimulates the
production of bicarbonate juice by the pancreas, and cholecystokinin stimulates the secretion of the
pancreatic enzymes.

Summary of the gastrointestinal secretions and their functions:

INTRAPERITONEAL vs. RETROPERITONEAL STRUCTURES

The abdominal viscera can be divided anatomically by their relationship to the peritoneum. There are
two main groups: intraperitoneal and retroperitoneal organs.
Intraperitoneal organs are enveloped by visceral peritoneum, which covers the organ both anteriorly
and posteriorly. Examples include the stomach, liver and spleen.
Retroperitoneal organs are not associated with visceral peritoneum; they are only covered in parietal
peritoneum, and that peritoneum only covers their anterior surface.
ENDOCRINE SYSTEM

INTRODUCTION

An endocrine gland is a tissue that produces

chemical substances called hormones. These
hormones are released into the circulating blood
and influence the function of cells at another
location in the body. The endocrine system is
essential for cell-to-cell communication for the
maintenance of the following functions:

• Food seeking & satiety

• Metabolism & caloric economy
• Growth & Differentiation
• Reproduction
• Homeostasis
• Response to environmental change
• Arousal, defense, flight & secluding
behaviors

The important endocrine glands include the

following:
◼ Pituitary gland
◼ Thyroid gland
◼ Parathyroid glands
◼ Pancreas
◼ Adrenal gland
◼ Ovary/ testes
HORMONES

The hormones that are produced by the endocrine glands mediate the activity of the endocrine system. They
exert their effects by binding to specific receptors in the cells of the target organ.

Hormones may either be:

• PEPTIDE HORMONES or
• LIPOPHILIC (STEROID) HORMONES

PEPTIDE HORMONES

The peptide hormones are water soluble. They have no specific transport mechanism (that is, they are not
bound to plasma proteins while they are transported in the bloodstream). These hormones act by binding to
receptors on the cell membrane surface and they need 2nd messengers to exert their action.

LIPOPHILIC (STEROID) HORMONES

The precursor is cholesterol (for most steroid hormones) or 7-dehydrocholesterol (for Vit D metabolites). These
precursors undergo a series of enzymatic transformations to form the final products.

Examples of steroid hormones include:

• The reproductive hormones - estrogen, testosterone, progesterone
• The hormones produced by the adrenal cortex – aldosterone, cortisol and dehydropiandrosterone

Steroid hormones are transported into the bloodstream bound to plasma proteins (e.g. estrogen and
testosterone are bound to SHBG (sex hormone binding globulin)

Since these hormones are lipophilic, they easily diffuse across the cell membrane and they exert their effects
by binding to receptors that are found in the cytoplasm or the nucleus.
HYPOTHALAMIC-PITUITARY HORMONES
The pituitary gland is also called the hypophysis. It lies in the sella turcica, a bony cavity at the base of the
brain. The pituitary gland is connected to the hypothalamus, from which it receives neuroendocrine control
(whether stimulatory or inhibitory).

The pituitary is divided into the:

 ANTERIOR PITUITARY (adenohypophysis)
▪ GROWTH HORMONE (GH)
✓ Promotes somatic growth (protein formation, cell multiplication and
differentiation)
▪ ADRENOCORTICOTROPIC HORMONE (ACTH)
✓ Regulates the production of adrenocortical hormones
▪ THYROTROPIN/ THYROID STIMULATING HORMONE (TSH)
✓ Modulates thyroid hormone production in the thyroid gland
▪ PROLACTIN (PRL)
✓ Promotes development of the mammary glands for lactation
▪ FOLLICLE STIMULATING HORMONE (FSH)
✓ Promotes development of oocyte/ spermatocyte
▪ LUTEINIZING HORMONE (LH)
✓ Promotes estrogen/ testosterone production
 The hormones of the anterior pituitary gland. (figure above)

 POSTERIOR PITUITARY (neurohypophysis)

▪ ANTI-DIURETIC HORMONE
✓ Also known as vasopressin
✓ Regulates water reabsorption in the collecting tubules (and the distal parts
of the distal convoluted tubules) of the kidneys
✓ produce vasoconstriction (hence the name “vasopressin”)
▪ OXYTOCIN
✓ Uterine smooth muscle contraction
✓ Milk letdown

The production of hormones by the pituitary gland is regulated by the HYPOTHALAMUS. Shown below is the
organization of the HYPOTHALAMIC-PITUITARY GLAND-TARGET ORGAN (HPO) AXIS. Hypothalamic hormones
(usually named “releasing hormones”) promote production, or they may inhibit production (e.g. Dopamine’s
effect on prolactin production)

GROWTH HORMONE

Growth hormone (GH) is important in the attainment of the normal adult size. GH plays an important role in
lipid and carbohydrate metabolism as well as muscle and bone development. It is a 191-amino acid peptide
chain. The production of GH is promoted by the hypothalamic GHRH (growth hormone releasing hormone) and
is inhibited by somatostatin which is also produced by the hypothalamus.

GH produces the following effects:

LONGITUDINAL BONE GROWTH (as long as the epiphyseal plates are still open)
MUSCLE MASS BUILD UP (anabolic effect)
LIPOLYSIS (breakdown of stored fats; hence, catabolic effect)
* GH may decrease insulin sensitivity, and this in turn, leads to a compensatory hyperinsulinemia.

The effects of GH are due to the binding of GH with its receptor (which is a JAK-STAT receptor found on the cell
membrane surface). The growth-promoting effects are mediated through an increase in the production of IGF-1
(insulin-like growth factor/ SOMATOMEDIN)

GH has a short half-life (20-25 minutes). When in reaches the liver, it gets cleaved by hepatic enzymes.
Pituitary adenomas occur most commonly in adults. In adults, GH-secreting adenomas cause ACROMEGALY,
which is characterized by abnormal growth of cartilage and bone tissue, and many organs including skin,
muscle, heart, liver, and the gastrointestinal tract.

When a GH-secreting adenoma occurs before the long bone epiphyses close, it leads to the rare condition,
GIGANTISM.

Under normal physiologic conditions, GH production of the pituitary is controlled by SOMATOSTATIN (a hormone
produced by the hypothalamus). Somatostatin inhibits the pituitary production of GH. Somatostatin as a drug
has very limited use BECAUSE OF ITS SHORT HALF-LIFE (1-3 minutes).

PART II. GONADOTROPINS AND HUMAN CHORIONIC GONADOTROPIN

The gonadotrophs (cells in the pituitary gland) produce the gonadotropins FSH and LH.

FSH = FOLLICLE STIMULATING HORMONE

o FSH is responsible for the ovarian follicle development (from the primary oocyte to the mature
Graffian follicle) in the the female. It also participates in the steroidogenesis.
o In the male, it promotes steroidogenesis
LH = LUTEINIZING HORMONE
o promotes estrogen and progesterone production
o promotes androgen production in the Theca and Leydig cells.

HUMAN CHORIOGONADOTROPIN (HCG) on the other hand is a placental hormone that primarily functions to
maintain estrogen and progesterone production necessary for pregnancy.

Gonadotropin-releasing hormone (GnRH) is secreted by neurons in the hypothalamus.

It is a decapeptide (10 amino acid) hormone that binds to G protein-coupled receptors on the plasma
membranes of gonadotroph cells of the pituitary gland. Pulsatile GnRH secretion is required to stimulate the
gonadotroph cell to produce and release LH and FSH.

Sustained nonpulsatile administration of GnRH or GnRH analogs inhibits the release of FSH and LH by the
pituitary in both women and men, resulting in hypogonadism.

PART V. PROLACTIN AND THE DOPAMINE AGONISTS

Prolactin is a 198-amino-acid peptide hormone produced in the anterior pituitary. Prolactin is the principal
hormone responsible for lactation. Milk production is stimulated by prolactin when appropriate circulating
levels of estrogens, progestins, corticosteroids, and insulin are present.

The pituitary production of prolactin is regulated by DOPAMINE that is released from the hypothalamus.

Prolactin is elevated as a result of prolactin-secreting adenomas. Hyperprolactinemia produces a syndrome of

amenorrhea and galactorrhea in women, and loss of libido and infertility in men.

Adenomas that secrete excess prolactin usually retain the sensitivity to inhibition by dopamine exhibited by the
normal pituitary.
PART VI. THE POSTERIOR PITUITARY HORMONES – OXYTOCIN AND VASOPRESSIN

The posterior pituitary produces TWO HORMONES:

OXYTOCIN and ANTI-DIURETIC HORMONE (aka VASOPRESSIN)

OXYTOCIN is a 9-amino-acid peptide that participates in labor and delivery and elicits milk ejection in lactating
women. Pharmacologic concentrations of oxytocin powerfully stimulate uterine contraction. It is administered
intravenously at regulated rate.

Oxytocin acts through G protein-coupled receptors and the phosphoinositide-calcium second-messenger

system to contract uterine smooth muscle. Oxytocin also stimulates the release of prostaglandins and
leukotrienes that augment uterine contraction.

Oxytocin is used to

o induce labor for conditions requiring early vaginal delivery such as incompatibility problems,
maternal diabetes, preeclampsia, or ruptured membranes.
o used to augment abnormal labor that is protracted or displays an arrest disorder.
o Oxytocin has several uses in the immediate postpartum period, including the control of uterine
hemorrhage after vaginal or cesarean delivery.

VASOPRESSIN is a peptide hormone released by the posterior pituitary in response to rising plasma tonicity or
falling blood pressure. A deficiency of this hormone results in diabetes insipidus.

Vasopressin is a nonapeptide with a 6-amino-acid ring and a 3-amino-acid side chain. Vasopressin is
administered by intravenous or intramuscular injection. The half-life of circulating vasopressin is approximately
15 minutes.

Vasopressin activates two subtypes of G protein-coupled receptors.

V1 receptors are found on vascular smooth muscle cells and mediate vasoconstriction.
V2 receptors are found on renal tubule cells and reduce diuresis through increased water permeability
and water resorption in the collecting tubules.

THYROID HORMONES AND ANTI-THYROID DRUGS

The normal thyroid gland secretes sufficient amounts of the thyroid hormones—triiodothyronine (T3) and
tetraiodothyronine (T4, thyroxine)—to normalize growth and development, body temperature, and energy levels.

T3 = 3 iodine molecules present in the hormone

T4 = 4 iodine molecules present in the hormone

Aside from T3 and T4, the thyroid also produces CALCITONIN – a hormone necessary for regulation of calcium
metabolism. Calcitonin is produced by the parafollicular cells of the thyroid gland.

The cells of the thyroid gland are arranged in FOLLICLES filled with a secretory substance called COLLOID and
lined with cuboidal epithelial cells that secrete into the interior of the follicles. (the apical surface of the cells
face the colloid. The basal surface of the cell are in close apposition with the blood vessels. See the figure
below)
The major constituent of colloid is the large glycoprotein
THYROGLOBULIN, which contains the thyroid hormones
within its molecule. Once the secretion has entered the
follicles, it must be absorbed back through the follicular
epithelium into the blood before it can function in the
body.

THYROID HORMONE SYNTHESIS

For T3 and T4 to be produced, it is crucial that there is

adequate IODIDE intake. Iodide, ingested from food,
water, or medication, is rapidly absorbed. The thyroid
gland removes about 75 mcg a day from this pool for
hormone synthesis, and the balance is excreted in the
urine.

THERE ARE FOUR IMPORTANT STEPS IN THYROID HORMONE SYNTHESIS:

E – ENTRY
P – PEROXIDATION
O – ORGANIFICATION
C – COUPLING

STEP NO. 1: ENTRY

The first step is the transport of iodide into the thyroid gland by an intrinsic follicle cell basement membrane
protein called the sodium/iodide symporter (NIS).
STEP NO. 2: PEROXIDATION (iodide to iodine conversion)
At the apical cell membrane, iodide is oxidized by thyroidal peroxidase to iodine.

STEP NO. 3: ORGANIFICATION – The formation of MIT and DIT

After the formation of the elemental iodine, it rapidly iodinates tyrosine residues within the thyroglobulin
molecule to form monoiodotyrosine (MIT) and diiodotyrosine (DIT).

STEP NO. 4: COUPLING

Two molecules of DIT combine within the thyroglobulin molecule to form L-thyroxine (T4 ).
2+2=4
One molecule of MIT and one molecule of DIT combine to form T3.
1+2=3

Thyroxine, T3, MIT, and DIT are released from thyroglobulin by exocytosis and proteolysis of thyroglobulin at the
apical colloid border. T3 and T4 are then released into the blood stream. The MIT and the DIT may be used for
another synthesis of thyroid hormones.
CONTROL OF THYROID PRODUCTION
Hypothalamic cells secrete thyrotropin-releasing hormone (TRH). TRH is secreted into capillaries of the
pituitary portal venous system, and in the pituitary gland, TRH stimulates the synthesis and release of
thyrotropin (thyroid-stimulating hormone; TSH). TSH in turn stimulates an adenylyl cyclase–mediated
mechanism in the thyroid cell to increase the synthesis and release of T4 and T3. These thyroid hormones act
in a negative feedback fashion in the pituitary to block the action of TSH and in the hypothalamus to inhibit the
synthesis and secretion of TRH.

TRANSPORT OF THYROID HORMONES

T4 and T3 in plasma are reversibly bound to protein, primarily thyroxine-binding globulin (TBG). Protein bound
thyroid hormone is inactive. Only the free hormone will exert an effect.

METABOLISM OF THYROID HORMONES

The primary pathway for the peripheral metabolism of thyroxine is deiodination.

DEIODINATION OF T4 PRODUCES T3.

4–1=3

The product may either be T3 (active) and rT3 (inactive).

The thyroid hormones are very crucial for central nervous system (CNS) function, cardiovascular function and
metabolism. T3 and T4 exert their effect by entering the cell and binding to nuclear receptors. The activation of
the receptor leads to alteration of gene transcription and translation.
T4 and T3 can enter the cell BUT ONLY T3 IS CAPABLE OF BINDING TO THE THYROID HORMONE RECEPTOR IN
THE NUCLEUS.
ADRENOCORTICOSTEROIDS
INTRODUCTION

The adrenal glands are two triangular masses on the superior poles of the kidneys.
The adrenal gland parenchyma is divided into the superficial CORTEX and the deeper MEDULLA. The hormones
of the cortex are LIPOPHILIC/ STEROIDAL, i.e. they are all derived from CHOLESTEROL.

CORTEX
o Mineralocorticoid: ALDOSTERONE
o Bind to its receptor and promotes SODIUM
REABSORPTION IN THE COLLECTING TUBULE and
the distal part of the distal convoluted tubule.
o Produced by the Zona glomerulosa
o RENIN-ANGIOTENSIN-ALDOSTERONE SYNTHESIS
o The production of aldosterone by the adrenals is
under the influence of angiotensin, i.e.
angiotensin promotes aldosterone production.

o Glucocorticoid: CORTISOL
o Increases serum glucose
o Immune modulating effects
▪ decreases WBC
▪ Inhibits PHOSPHOLIPASE A2
o Promotes fetal lung surfactant

o Sex Hormone: DEHYDROEPIANDROSTERONE

MEDULLA
o Epinephrine

Here are the few important things that I want you to remember
• THE ADRENOCORICOSTEROIDS (All the hormones produced by the adrenal cortex – aldosterone,
cortisol and dehydroepiandrosterone) are DERIVATIVES OF CHOLESTEROL.

• The adrenocorticosteroids are STRUCTURALLY RELATED. THEREFORE, THERE IS A CHANCE THAT ONE
HORMONE WILL ACTIVATE A RECEPTOR FOR ANOTHER – by virtue of the structure activity relationship
(Lock-and-key mechanism between receptors and ligands). Example: Cortisol may activate the
aldosterone receptor and cause sodium reabsorption in the kidneys.

• Enzymes that mediate hydroxylation reactions (these are actually CYP enzymes) are responsible for
the production of the adrenocorticosteroid hormones. Any agent that may impair enzyme activity will
impair hormone production.
ADRENAL CORTEX HORMONES

1. CORTISOL
▪ Also known as COMPOUND F/ HYDROCORTISONE
▪ The production of cortisol is promoted by the ACTH (adrenocorticotropic hormone) in the
pituitary. Cortisol is released by CIRCADIAN RHYTHM (because ACTH is highest in the early
morning and after meals.)
 ▪ Cortisol when released into the bloodstream is BOUND TO PLASMA PROTEIN- CORTISOL
BINDING PROTEIN (CBG) and to a small extent ALBUMIN.
▪ It has a short half life (60-90 minutes). Most of the cortisol produced are metabolised by the
LIVER.

▪ EFFECTS OF CORTISOL
i. Gluconeogenesis and glycogen synthesis (in the fasting state)
Inhibition of glucose uptake by the muscles/ muscle catabolism (breakdown)
Increased lipolysis
THE SUMMATIVE EFFECT: INCREASED SERUM GLUCOSE

ii. Thinning of the skin

iii. OSTEOPOROSIS
This is due to increased osteoclast activity (bone resorption.

iv. DECREASED FUNCTION AND DISTRIBUTION OF THE LEUKOCYTES (WBC)

DECREASED CHEMOKINE AND CYTOKINE PRODUCTION
INHIBITION OF PHOSPHOLIPASE A2 (the enzyme that converts cholesterol to
arachidonic acid – the source of prostaglandins)
THESE ARE ACTUALLY THE MECHANISMS OF ACTION OF CORTISOL AND
DRUGS RELATED TO CORTISOL AS ANTI-INFLAMMATORY DRUGS.

v. INCREASED RBC AND PLATELET COUNT.

vi. In the central nervous system: INSOMNIA, DEPRESSION

vii. INCREASED INCIDENCE OF GASTRIC MUCOSAL ULCER.

viii. INCREASED PRODUCTION OF FETAL LUNG SURFACTANT

MECHANISM OF ACTION

Glucocorticoids (S) exert their effect by entering the cell by passive diffusion (since they are very lipid
soluble). Once inside the cell, (S) is joined by a chaperone molecule (HSP – Heat shock protein) until it
meets the receptor (R). Before binding with the (R), (S) will dissociate from the HSP. The activation of
the receptor leads to alteration of DNA transcription and translation leading to the response to
glucocorticoids.

Dexamathasone Suppression Test is used for the diagnosis of Cushing's syndrome. As a screening
test, 1 mg dexamethasone is given orally at 11 PM, and a plasma sample is obtained the following
morning. In normal individuals, the morning cortisol concentration is usually less than 3 mcg/dL,
whereas in Cushing's syndrome the level is usually greater than 5 mcg/dL.
To distinguish between hypercortisolism due to anxiety, depression, and alcoholism (pseudo-Cushing
syndrome) and bona fide Cushing's syndrome, a combined test is carried out, consisting of
dexamethasone (0.5 mg orally every 6 hours for 2 days) followed by a standard corticotropin-releasing
hormone (CRH) test (1 mg/kg given as a bolus intravenous infusion 2 hours after the last dose of
dexamethasone).
 2. ALDOSTERONE
▪ The major MINERALOCORTICOID produced in the zona glomerulosa of the cortex
▪ The production of aldosterone is mildly affected by ACTH. Its regulation depends on
ANGIOTENSIN that is produced by the RAAS (Renin-angiotensin-aldosterone system)
▪ Promotes SODIUM REABSORPTION IN THE COLLECTING TUBULE and the distal part of the
DISTAL CONVOLUTED TUBULE.

▪ The half-life of aldosterone is 15-20 minutes. It is excreted renally.

▪ Mineralocorticoids act by binding to the mineralocorticoid receptor in the cytoplasm of target
cells, especially principal cells of the distal convoluted and collecting tubules of the kidney.
The drug-receptor complex activates a series of events similar to those described above for
the glucocorticoids.

3. DEHYDROEPIANDROSTERONE
▪ A weak androgen
▪ Converted peripherally to more potent androgens or to estrogens and interaction with
androgen and estrogen receptors, respectively

THE GONADAL HORMONES

THE HPO AXIS OF REPRODUCTION

Gonadotropin-releasing hormone (GnRH) in pulses with the appropriate amplitude, which stimulates the
release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
At the beginning of each cycle, a variable number of follicles (vesicular follicles), each containing an ovum,
begin to enlarge in response to FSH. After 5 or 6 days, one follicle, called the dominant follicle, begins to
develop more rapidly. The outer theca and inner granulosa cells of this follicle multiply and, under the influence
of LH, synthesize and release ESTROGEN at an increasing rate. (as you will see in the diagram below)

The estrogen secretion reaches a peak just before midcycle, and the granulosa cells begin to secrete
PROGESTERONE. These changes stimulate the brief surge in LH and FSH release that precedes and causes
OVULATION. This surge is thought to be a positive feedback of estrogen to LH production by the pituitary.
When the follicle ruptures, the ovum is released into the abdominal cavity near the opening of the uterine tube.

The endometrium, in the presence of estrogen, becomes thicker. Progesterone maintains the stability of the
endometrium. In the event of fertilization, the zygote formed by the union of the sperm and the egg cell will
implant in this thickened endometrium.

Following the above events, the cavity of the ruptured follicle fills with blood (corpus hemorrhagicum), and the
luteinized theca and granulosa cells proliferate and replace the blood to form the CORPUS LUTEUM. The cells
of this structure produce estrogens and progesterone for the remainder of the cycle, or longer if pregnancy
occurs.

If pregnancy does not occur, the corpus luteum begins to degenerate and ceases hormone production,
eventually becoming a corpus albicans. The endometrium, which proliferated during the follicular phase and
developed its glandular function during the luteal phase, is shed in the process of menstruation in the absence
of the hormones that support the endometrium.
FEMALE HORMONES: ESTROGEN AND PROGESTERONE
The Estrogens
The major estrogens produced by women are estradiol (estradiol-17B, E2), estrone (E1), and estriol (E3)
When released into the circulation, ESTRADIOL binds strongly to an alpha2 globulin (sex hormone-binding
globulin [SHBG]) and with lower affinity to albumin. Bound estrogen is relatively unavailable for diffusion into
cells, and it is the free fraction that is physiologically active.

ESTRADIOL IS THE MOST ACTIVE AMONG THE THREE ESTROGENS. Estrone and estriol have low affinity for the
estrogen receptor. Estradiol is converted by the liver and other tissues to estrone and estriol

FUNCTION OF THE ESTROGENS

▪ Estrogens are required for the normal sexual maturation and growth of the female.
o Stimulation of the development of the vagina, uterus, and uterine tubes as well as the
secondary sex characteristics.
o Stimulation of the stromal development and ductal growth in the breast and are responsible
for the accelerated growth phase and the closing of the epiphyses of the long bones that
occur at puberty.
o growth of axillary and pubic hair and alter the distribution of body fat to produce typical
female body contours.

▪ Estrogen plays an important role in the development of the endometrial lining.

o When estrogen production is properly coordinated with the production of progesterone during
the normal human menstrual cycle, regular periodic bleeding and shedding of the
endometrial lining occur.

▪ Estrogen decrease the rate of resorption of bone by promoting the apoptosis of osteoclasts and by
antagonizing the osteoclastogenic and pro-osteoclastic effects of parathyroid hormone and
interleukin-6.
o THIS IS WHY POST MENOPAUSAL WOMEN ARE AT RISK FOR FRACTURES.

▪ Estrogens increase in the high-density lipoproteins (HDL), a slight reduction in the low-density
lipoproteins (LDL), and a reduction in total plasma cholesterol levels. Plasma triglyceride levels are
increased.
o THISIS WHY WOMEN HAVE A LESSER INCIDENCE OF CARDIOVASCULAR DISEASES (MI AND
STROKE) COMPARED TO MEN. The estrogens are protective by promoting lipid balance.

MECHANISM OF ACTION.

Estrogen works similarly like the other lipophilic hormones. Estrogen (S) exerts it effect by entering the cell by
passive diffusion (since they are very lipid soluble). Once inside the cell, (S) is joined by a chaperone molecule
(HSP – Heat shock protein) until it meets the receptor (R). Before binding with the (R), (S) will dissociate from
the HSP. The activation of the receptor leads to alteration of DNA transcription and translation.

The Progestins
Natural Progestins: Progesterone
Progesterone is the most important progestin in humans. In addition to having important hormonal effects, it
serves as a precursor to the estrogens, androgens, and adrenocortical steroids. It is synthesized in the ovary,
testis, and adrenal from circulating cholesterol. Large amounts are also synthesized and released by the
placenta during pregnancy.

In the ovary, progesterone is produced primarily by the corpus luteum.

The mechanism of action of progesterone—described in more detail above—is similar to that of other steroid
hormones. Progestins enter the cell and bind to progesterone receptors that are distributed between the
nucleus and the cytoplasm. The ligand-receptor complex binds to a progesterone response element (PRE) to
activate gene transcription.

EFFECTS OF THE PROGESTINS

▪ Progesterone increases basal insulin levels and the insulin response to glucose.
▪ Progesterone can compete with aldosterone for the mineralocorticoid receptor of the renal tubule,
causing a decrease in Na+ reabsorption.
▪ promotes glycogen storage, stimulates lipoprotein lipase activity and seems to favor fat deposition
▪ Progesterone is responsible for the alveolobular development of the secretory apparatus in the breast.
It also participates in the preovulatory LH surge and causes the maturation and secretory changes in
the endometrium that are seen following ovulation

MALE HORMONES: ANDROGENS

In humans, the most important androgen secreted by the testis is TESTOSTERONE. About 95% is produced by
the Leydig cells and only 5% by the adrenals.

About 65% of circulating testosterone is bound to sex hormone-binding globulin. SHBG is increased in plasma
by estrogen, by thyroid hormone, and in patients with cirrhosis of the liver. of the remaining testosterone is
bound to albumin.

In many target tissues, testosterone is converted to dihydrotestosterone by 5-alpha-reductase. In these

tissues, dihydrotestosterone is the major active androgen. Again, TESTOSTERONE MAY BE CONVERTED TO
ESTROGEN. The conversion of testosterone to estradiol by P450 aromatase also occurs in some tissues,
including adipose tissue, liver, and the hypothalamus, where it may be of importance in regulating gonadal
function.
FFECTS OF TESTOSTERONE
GENITALS penile and scrotal growth.

SKIN appearance of pubic, axillary, and beard hair.

sebaceous glands become more active
skin tends to become thicker and oilier

LARYNX larynx grows and the vocal cords become thicker, leading to a lower-
pitched voice.

BONES Skeletal growth is stimulated and epiphysial closure accelerated

stimulating and maintaining sexual function in men

MUSCLES increase lean body mass

BLOOD reduction of hormone binding and other carrier proteins and increased
liver synthesis of clotting factors, triglyceride lipase, 1-antitrypsin,
haptoglobin, and sialic acid

OTHERS stimulate renal erythropoietin secretion and decrease HDL levels

PANCREATIC HORMONES
The pancreas is a retroperitoneal organ located in the epigastric area of the abdomen. It is both an endocrine
and exocrine gland. The pancreas plays an important role in lipid and carbohydrate digestion (production of
amylase and lipase) and bicarbonate production into the small intestine for digestion.

ENDOCRINE FUNCTION OF THE PANCREAS

The endocrine pancreas in the adult human consists of approximately 1 million islets of Langerhans
interspersed throughout the pancreatic gland. Within the islets, at least four hormone-producing cells are
present.

CELL TYPE % HORMONES PRODUCED

Alpha (A) cell 20 Glucagon, proglucagon

Beta (B) cell 75 Insulin, C-peptide, proinsulin, amylin

Delta (D) cell 3–5 Somatostatin

G cell 1 Gastrin

F cell (PP cell)1 1 Pancreatic polypeptide (PP)

DIABETES MELLITUS

Diabetes mellitus is defined as an elevated blood glucose associated with absent or inadequate pancreatic
insulin secretion, with or without concurrent impairment of insulin action.

The disease states underlying the diagnosis of diabetes mellitus are now classified into four categories:

Type 1, insulin-dependent diabetes

• selective beta cell (B cell) destruction and severe or absolute insulin deficiency
• Interruption of the insulin replacement therapy can be life-threatening and can result in
diabetic ketoacidosis or death.
o Diabetic ketoacidosis is caused by insufficient or absent insulin and results from
excess release of fatty acids and subsequent formation of toxic levels of ketoacids.
Type 2, non–insulin-dependent diabetes
• characterized by tissue resistance to the action of insulin combined with a relative deficiency
in insulin secretion
• Dehydration in untreated and poorly controlled individuals with type 2 diabetes can lead to a
life-threatening condition called nonketotic hyperosmolar coma.
o In this condition, the blood glucose may rise to 6–20 times the normal range and an
altered mental state develops or the person loses consciousness. Urgent medical
care and rehydration is required.
Type 3, other
Type 4, gestational diabetes mellitus
INSULIN
• contains 51 amino acids arranged in two chains (A and B) linked by disulfide bridges
• Proinsulin, a long single-chain protein molecule, is processed within the Golgi apparatus of beta cells
and packaged into granules, where it is hydrolyzed into insulin and a residual connecting segment
called C-peptide by removal of four amino acids.
• Insulin is released from pancreatic beta cells at a low basal rate and at a much higher stimulated rate
in response to a variety of stimuli (post-prandial insulin production)
o glucose
o other sugars (eg, mannose)
o certain amino acids (eg, leucine, arginine)

** Inhibitory signals include somatostatin, leptin, and chronically elevated glucose and fatty
acid levels.

• INSULIN RELEASE

CLOSURE OF
INCREASED INCREASED ATP- CELL EXOCYTOSIS
GLUCOSE ATP DEPENDENT DEPOLARIZA- OF INSULIN
LEVELS PRODUCTION POTASSIUM TION FROM THE
CHANNELS BETA CELL
The liver and kidney are the two main organs that remove insulin from the circulation.

After insulin has entered the circulation, it diffuses into tissues, where it is bound by specialized receptors that
are found on the membranes of most tissues. The biologic responses promoted by these insulin-receptor
complexes have been identified in the primary target tissues, ie, liver, muscle, and adipose tissue.

Insulin exerts its effect by binding to the insulin receptor on the cell membrane surface. This receptor contains
TYROSINE KINASE. Activation of this receptor leads to phosphorylation reactions that would eventually
TRANSLOCATE THE GLUCOSE TRANSPORTER (GLUT) on to the cell membrane surface.

Simply putting it, INSULIN WOULD BRING GLUCOSE INTO THE CELL. Without insulin, the glucose present in the
blood circulation will remain in the blood, therefore, you get HYPERGLYCEMIA.

• Patients are diagnosed to have diabetes mellitus if hyperglycemia exists chronically (by testing for
fasting blood glucose (FBG), random blood glucose (RBG) and oral glucose tolerance test (OGTT).

The table below summarizes the effect of insulin (as well as glucagon)
GLUCAGON

Glucagon is synthesized in the alpha cells of the pancreatic islets of Langerhans. Glucagon is a peptide—
identical in all mammals—consisting of a single chain of 29 amino acid.

It binds to specific Gs protein-coupled receptors on liver cells to exert its action.

Glucagon INCREASES SERUM GLUCOSE by promoting glycogenolysis, gluconeogenesis and ketogenesis in the
liver.

Glucagon also has a potent inotropic and chronotropic effect on the heart. It can also produce profound
relaxation of the intestine.

URINARY SYSTEM

The urinary system consists of two kidneys, two ureters, the urinary bladder, and the urethra. The
formation of urine is the function of the kidneys, and the rest of the system is responsible for
eliminating the urine.
As the kidneys form urine to excrete these
waste products, they also accomplish several
other important functions:
1. Regulation of the volume of blood by
excretion or conservation of water
2. Regulation of the electrolyte content of the
blood by the excretion or conservation of
minerals
3. Regulation of the acid–base balance of the
blood by excretion or conservation of ions such
as H ions or HCO3 ions
4. Regulation of all of the above in tissue fluid
The process of urine formation, therefore, helps
maintain the normal composition, volume, and
pH of both blood and tissue fluid by removing
those substances that would upset the normal
constancy and balance of these extracellular
fluids.
The two kidneys are located in the upper abdominal cavity on either side of the vertebral column,
behind the peritoneum (retroperitoneal). The upper portions of the kidneys rest on the lower surface
of the diaphragm and are enclosed and protected by the lower rib cage. The kidneys are embedded
in adipose tissue that acts as a cushion and is in turn covered by a fibrous connective tissue
membrane called the renal fascia, which helps hold the kidneys in place
Each kidney has an indentation called the hilus on its medial side. At the hilus, the renal artery
enters the kidney, and the renal vein and ureter emerge. The renal artery is a branch of the
abdominal aorta, and the renal vein returns blood to the inferior vena cava. The ureter carries urine
from the kidney to the urinary bladder.
INTERNAL STRUCTURE OF THE KIDNEY

In a coronal or frontal section of the kidney, three

areas can be distinguished. The lateral and
middle areas are tissue layers, and the medial
area at the hilus is a cavity.
The outer tissue layer is called the renal cortex; it
is made of renal corpuscles and convoluted
tubules. These are parts of the nephron and are
described in the next section.
The inner tissue layer is the renal medulla, which
is made of loops of Henle and collecting tubules
(also parts of the nephron). The renal medulla
consists of wedge-shaped pieces called renal
pyramids. The tip of each pyramid is its apex or
papilla.
The third area is the renal pelvis; this is not a layer
of tissues, but rather a cavity formed by the
expansion of the ureter within the kidney at the
hilus. Funnel-shaped extensions of the renal
pelvis, called calyces (singular: calyx), enclose the
papillae of the renal pyramids. Urine flows from
the renal pyramids into the calyces, then to the
renal pelvis and out into the ureter.

THE NEPHRON
The nephron is the structural and functional unit of the kidney. Each kidney contains approximately 1
million nephrons. It is in the nephrons, with their associated blood vessels, that urine is formed. Each
nephron has two major portions: a renal corpuscle and a renal tubule.
Renal Corpuscle

A renal corpuscle consists of a glomerulus surrounded by a Bowman’s capsule.

 The glomerulus is a capillary network that arises from an afferent arteriole and empties into
an efferent arteriole. The diameter of the efferent arteriole is smaller than that of the afferent
arteriole, which helps maintain a fairly high blood pressure in the glomerulus.
Bowman’s capsule (or glomerular capsule) is the expanded end of a renal tubule; it encloses
the glomerulus. The inner layer of Bowman’s capsule is made of podocytes; the name means
“foot cells,” and the “feet” of the podocytes are on the surface of the glomerular capillaries.
The arrangement of podocytes creates pores, spaces between adjacent “feet,” which make
this layer very permeable. The outer layer of Bowman’s capsule has no pores and is not
permeable. The space between the inner and outer layers of Bowman’s capsule contains
renal filtrate, the fluid that is formed from the blood in the glomerulus and will eventually
become urine.
Renal Tubule
The renal tubule continues from Bowman’s capsule and consists of the following parts: proximal
convoluted tubule (in the renal cortex), loop of Henle (or loop of the nephron, in the renal medulla),
and distal convoluted tubule (in the renal cortex).
The distal convoluted tubules from several nephrons empty into a collecting tubule. Several
collecting tubules then unite to form a papillary duct that empties urine into a calyx of the renal
pelvis. Notice how thin the walls of the tubule are, and also the microvilli in the proximal convoluted
tubule. These anatomic characteristics provide for efficient exchanges of materials, as you will see.
All parts of the renal tubule are surrounded by peritubular capillaries, which arise from the efferent
arteriole. The peritubular capillaries will receive the materials reabsorbed by the renal tubules; this is
described in the section on urine formation.
BLOOD VESSELS OF THE KIDNEY
Renal artery enters kidney at hilus and
branches into interlobar arteries which run
between pyramids.
1. Interlobar arteries bifurcate at the
cortico- medullary junction to form arcuate
arteries which run between the cortex and the
base of the pyramids.
2. Arcuate arteries give rise to
interlobular arteries which run radially in
cortex between medullary rays
3. Interlobular arteries give rise to
afferent arterioles
4. Afferent arterioles give rise to
glomerular capillaries.
5. Glomerular capillaries coalesce into
efferent arterioles draining individual renal
corpuscles.
6. The efferent arterioles are of smaller
diameter that their afferent counterparts and
maintain filtration pressure.
FORMATION OF URINE
The formation of urine involves three major processes. The first is glomerular filtration, which takes
place in the renal corpuscles. The second and third are tubular reabsorption and tubular secretion,
which take place in the renal tubules.
(1) GLOMERULAR FILTRATION You may recall that filtration is the process in which blood
pressure forces plasma and dissolved material out of capillaries.

In glomerular filtration, blood pressure forces plasma, dissolved substances, and small
proteins out of the glomeruli and into Bowman’s capsules. This fluid is no longer plasma
but is called renal filtrate. The blood pressure in the glomeruli, compared with that in
other capillaries, is relatively high, about 60 mmHg. The pressure in Bowman’s capsule is
very low, and its inner, podocyte layer is very permeable, so that approximately 20% to
25% of the blood that enters glomeruli becomes renal filtrate in Bowman’s capsules.

The blood cells and larger proteins are too large to be forced out of the glomeruli, so they
remain in the blood. Waste products are dissolved in blood plasma, so they pass into the
renal filtrate. Useful materials such as nutrients and minerals are also dissolved in
plasma and are also present in renal filtrate. Filtration is not selective with respect to
usefulness; it is selective only with respect to size. Therefore, renal filtrate is very much
like blood plasma, except that there is far less protein and no blood cells are present.

The glomerular filtration rate (GFR) is the amount of renal filtrate formed by the kidneys
in 1 minute, and averages 100 to 125 mL per minute.

(2) TUBULAR REABSORPTION Tubular reabsorption takes place from the renal tubules into
the peritubular capillaries. In a 24-hour period, the kidneys form 150 to 180 liters of
filtrate, and normal urinary output in that time is 1 to 2 liters. Therefore, it becomes
apparent that most of the renal filtrate does not become urine. Approximately 99% of the
filtrate is reabsorbed back into the blood in the peritubular capillaries. Only about 1% of
the filtrate will enter the renal pelvis as urine.

Most reabsorption and secretion (about 65%) take place in the proximal convoluted
tubules, whose cells have microvilli that greatly increase their surface area. The distal
convoluted tubules and collecting tubules are also important sites for the reabsorption of
water

(3) TUBULAR SECRETION This mechanism also changes the composition of urine. In tubular
secretion, substances are actively secreted from the blood in the peritubular capillaries
into the filtrate in the renal tubules. Waste products, such as ammonia and some
creatinine, and the metabolic products of medications may be secreted into the
filtrate to be eliminated in urine. Hydrogen ions (H) may be secreted by the tubule cells to
help maintain the normal pH of blood.
JUXTAGLOMERULAR APPARATUS
Juxtaglomerular Apparatus or Complex is a specialized region of a nephron where the afferent
arteriole and Distal Convoluted Tubule (DCT) come in direct contact with each other. Juxtaglomeruar
Apparatus (JGA) consists of:
1) Juxtaglomerular cells (modified smooth muscle
cells) of afferent arteriole including renin containing
(synthesizes and stores renin) and sympathetically
innervated granulated cells which function as
mechanoreceptors to sense blood pressure.
2) Macula densa cells (Na+ sensors) of Distal
Convoluted Tubule (DCT) which function as
chemoreceptors to sense changes in the solute
concentration and flow rate of filtrate.
3) Juxtaglomerular/Extraglomerular mesangial cells
(Lacis cells) forming connections via actin and
microtubules which allow for selective
vasoconstriction/vasodilation of the renal afferent
and efferent arterioles with mesangial cell
contraction.

Functions of Juxtaglomerlar Apparatus (JGA):

• Local transmission of Tubuloglomerular Feedback (TGF) at its own nephron via angiotensin II
(AT II)
• Systemic production of Angiotensin II (AT II) as part of Renin-Angiotensin-Aldosterone System
(RAAS)

TAMM-HORSFALL PROTEIN
Tamm-Horsfall protein (THP) is exclusively produced by renal tubular cells of the distal loop of Henle
and is the most abundant urinary protein in mammals.
• THP is a potent immunoregulatory molecule that induces specific THP-directed cell-mediated
immunity.
• antimicrobial molecule combating urinary tract infection (UTI).
ACID BASE BALANCE

ELIMINATION OF URINE
The ureters, urinary bladder, and urethra do not change the composition or amount of urine, but are
responsible for the periodic elimination of urine.
URETERS
Each ureter extends from the hilus of a kidney to the lower, posterior side of the urinary bladder. Like
the kidneys, the ureters are retroperitoneal, that is, behind the peritoneum of the dorsal abdominal
cavity. The smooth muscle in the wall of the ureter contracts in peristaltic waves to propel urine
toward the urinary bladder. As the bladder fills, it expands and compresses the lower ends of the
ureters to prevent backflow of urine.
URINARY BLADDER
The urinary bladder is a muscular sac below the
peritoneum and behind the pubic bones. In
women, the bladder is inferior to the uterus; in
men, the bladder is superior to the prostate
gland.
The bladder is a reservoir for accumulating urine,
and it contracts to eliminate urine. The mucosa
of the bladder is transitional epithelium, which
permits expansion without tearing the lining.
When the bladder is empty, the mucosa appears
wrinkled; these folds are rugae, which also
permit expansion. On the floor of the bladder is a
triangular area called the trigone, which has no rugae and does not expand. The points of the
triangle are the openings of the two ureters and that of the urethra. The smooth muscle layer in the
wall of the bladder is called the detrusor muscle. It is a muscle in the form of a sphere; when it
contracts it becomes a smaller sphere, and its volume diminishes. Around the opening of the urethra
the muscle fibers of the detrusor form the internal urethral sphincter (or sphincter of the bladder),
which is involuntary.
URETHRA
The urethra carries urine from the bladder to the exterior. The external urethral sphincter is made of
the surrounding skeletal muscle of the pelvic floor, and is under voluntary control.
In women, the urethra is 1 to 1.5 inches (2.5 to 4 cm) long and is anterior to the vagina.
In men, the urethra is 7 to 8 inches (17 to 20 cm) long. The first part just outside the bladder is
called the prostatic urethra because it is surrounded by the prostate gland. The next inch is the
membranous urethra, around which is the external urethral sphincter. The longest portion is the
cavernous urethra (or spongy or penile urethra), which passes through the cavernous (or erectile)
tissue of the penis. The male urethra carries semen as well as urine.
THE URINATION REFLEX
Urination may also be called micturition or voiding. This reflex is a spinal cord reflex over which
voluntary control may be exerted. The stimulus for the reflex is stretching of the detrusor muscle of
the bladder.
The bladder can hold as much as 800 mL of urine, or even more, but the reflex is activated long
before the maximum is reached.
When urine volume reaches 200 to 400 mL, the stretching is sufficient to generate sensory impulses
that travel to the sacral spinal cord. Motor impulses return along parasympathetic nerves to the
detrusor muscle, causing contraction. At the same time, the internal urethral sphincter relaxes. If the
external urethral sphincter is voluntarily relaxed, urine flows into the urethra, and the bladder is
emptied.

REPRODUCTIVE SYSTEM

Male Reproductive Organs

• Primary sex organs:
• Testes (testicles)
• Produce the “gametes” or spermatozoa
• Secondary sex organs:
• Sperm transport ducts: epididymides, ductus/vas deferentia, ejaculatory ducts, &
urethra
• Accessory glands: seminal vesicles, prostate gland & bulbourethral glands
• Copulatory organ: penis
• Scrotum
• Epididymis: where spermatozoa undergo final maturation
• Ductus deferens (Vas deferens): tube between epididymis & ejaculatory duct
• “Spermatic cord” encases the ductus deferens as well as testicular artery &
vein
• Penetrates into the pelvic cavity via “inguinal canal”
• Spermatic cord: Vas deferens + nerve + blood and lymphatic vessels + cremaster
• Ejaculatory duct: connection between ductus deferens & seminal vesicle
• Seminal vesicles: secrete fructose-rich fluid to aid in spermatozoa viability
• Prostate gland: glandular tissue encased by smooth muscle; Secretes alkaline buffer to
neutralize vaginal acids (enhance spermatozoa viability)
• Bulbourethral glands (Cowper’s glands): superficial to the pelvic diaphragm; Secrete mucus-
rich solution to neutralize urethra & lubricate penis prior to coitus
• Penis - copulatory organ

• Proximal region = root

• Middle shaft = body
• Distal region = glans penis
• Body = three large tubes of tissue
• Corpora cavernosa penis: paired dorsal tubes with large arterial blood flow;
Normally “gated” by the sympathetic nervous system
• Corpus spongiosum penis: single tube that encases the spongy urethra
• Glans penis = expanded distal end of the corpora spongiosum penis
• Prepuce is very loosely attached to corpora spongiosum penis
Female Reproductive Organs

• Primary sex organ = ovary/ovaries

• Gametes (follicles) are not produce, they were formed during fetal development
• Secrete androgen hormones (estrogen) for secondary sex organ development & sex
organ maturation
• Secondary sex organs
• Required for fertilization
• Vagina, uterine/fallopian tubes, uterus & mammary glands

OVARIES
• The cortex contains many oocytes in
various stages of development
• The medulla is a connective tissue rich
in blood vessels
• The ovaries are covered by the tunica
albuginea and the germinal epithelium
FALLOPIAN TUBES
• Tubes originating at the uterus and ending near the ovaries
• At the ovarian end, the fimbrae must catch ova & direct into the tubular apparatus
• Fimbrae located distal to the uterus, in “infundibulum” region of the uterine tube
apparatus
• Uterine tube structure:
• Inner mucosa
• Middle muscularis (circular & longitudinal muscle same as intestinal tract)
• Outer serosa = visceral peritoneum
UTERUS
• Fundus = region where uterine tubes enter
• Body = main region
• Cervix = entrance to vagina (similar in shape to ileocecal valve)
• Uterine cavity has distinct regions
• Cervical canal = tube in cervix region
• Isthmus (“internal os”) of uterus = line between cervical canal & uterine
cavity
• Uterine osteum (“os”) = Outermost portion of cervical canal
 • Uterine Wall = 3 functional layers (metria):
• Perimetrium = visceral peritoneum
• Myometrium = 3 layers of smooth muscle (like the stomach)
• Endometrium = stratum functionale (sloughed off during menses) & stratum basale

EXTERNAL GENITILIA = VULVA

HOMOLOGOUS STRUCTURES: MALE vs FEMALE