CHAPTER III

REVIEW OF ANATOMY AND PHYSIOLOGY

A. Hematologic System

Blood is the only fluid tissue in the body. Though it seems to be a thick, homogeneous liquid, it actually
has both solid and liquid components. Blood transports everything that must be carried from one place to another
within the body – nutrients, hormones, wastes, and body heat – through blood vessels throughout the body and
serves as a vehicle for distributing body heat and aiding in homeostasis. It is composed of a nonliving fluid matrix
(plasma) and formed elements. Normal adult blood volume is 5 to 6 liters. Dissolved in the plasma are the gases,
nutrients, proteins, salts, and so on. The plasma composition changes as body cells remove or add substances to it,
but homeostatic mechanisms act to keep it relatively constant. The formed elements of blood, which makes up about
45 percent of whole blood, includes erythrocytes (RBCs), Leukocytes (WBCs), and platelets. When bacteria,
viruses, or other foreign substances invade the body, WBCs increase in number and fight them in various ways.
Stoppage of blood loss from an injured blood vessel involves three steps: vascular spasms, platelet plug formation,
and blood clot formation. Abnormal bleeding may reflect a deficit of platelets (thrombocytopenia), genetic factors
(hemophilia), or inability of the liver to make clotting factors. There is a continuous interchange of fluid between
blood and tissues. Some fluid enters the lymphatics before eventually returning to the blood stream. The two main
forces operating pressure gradients to control fluid movement are hydrostatic pressure, which encourages the
passage of fluid through the capillary wall, and protein osmotic pressure, which encourages the retention of fluid in
the capillaries to maintain osmotic equilibrium. At the arterial end the blood pressure is greater than the osmotic
pressure and fluid is forced out of the capillary. The reverse is then true at the venous end and fluid is attracted into
the vessel.

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B. Lymphatic and Immune System
The lymphatic system is a series of vessels, ducts,
and trunks that remove interstitial fluid from the tissues and
return it the blood. The lymphatics are also used to transport
dietary lipids and cells of the immune system. Cells of the
immune system all come from the hematopoietic system of
the bone marrow. Primary lymphoid organs, the bone
marrow and thymus gland, are the locations where
lymphocytes of the adaptive immune system proliferate and
mature. Secondary lymphoid organs are site in which
mature lymphocytes congregate to mount immune
responses. Many immune system cells use the lymphatic
and circulatory systems for transport throughout the body to
search for and then protect against pathogens.
Innate immune responses are critical to the early
control of infections. Whereas barrier defenses are the
body’s first line of physical defense against pathogens,
innate immune responses are the first line of physiological
defense. Innate responses occur rapidly, but with less
specificity and effectiveness than the adaptive immune
response. Innate responses can be caused by a variety of
cells, mediators, and antibacterial proteins such as
complement. Within the first few days of an infection, another series of antibacterial proteins are induced, each with
activities against certain bacteria, including opsonization of certain species. Additionally, interferons are induced
that protect cells from viruses in their vicinity. Finally, the innate immune response does not stop when the adaptive
immune response is developed. In fact, both can cooperate and one can influence the other in their responses against
pathogens.
T cells recognize antigens with
their antigen receptor, a complex of two
protein chains on their surface. They do not
recognize self-antigens, however, but only
processed antigen presented on their
surfaces in a binding groove of a major
histocompatibility complex molecule. T
cells develop in the thymus, where they
learn to use self-MHC molecules to
recognize only foreign antigens, thus
making them tolerant to self-antigens.
There are several functional types of T
lymphocytes, the major ones being helper,
regulatory, and cytotoxic T cells.
B cells, which develop within the
bone marrow, are responsible for making
five different classes of antibodies, each with its own functions. B cells have their own mechanisms for tolerance,
but in peripheral tolerance, the B cells that leave the bone marrow remain inactive due to T cell tolerance. Some B
cells do not need T cell cytokines to make antibody, and they bypass this need by the crosslinking of their surface
immunoglobulin by repeated carbohydrate residues found in the cell walls of many bacterial species. Others require
T cells to become activated.
Early childhood is a time when the body develops much of its immunological memory that protects it from
diseases in adulthood. The components of the immune response that have the maximum effectiveness against a
pathogen are often associated with the class of pathogen involved. Bacteria and fungi are especially susceptible to
damage by complement proteins, whereas viruses are taken care of by interferons and cytotoxic T cells. Worms are

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attacked by eosinophils. Pathogens have shown the ability, however, to evade the body’s immune responses, some
leading to chronic infections or even death. The immune system and pathogens are in a slow, evolutionary race to
see who stays on top. Modern medicine, hopefully, will keep the results skewed in humans’ favor.
C. Cardiovascular System
The heart resides within the pericardial sac and is
located in the mediastinal space within the thoracic cavity.
The pericardial sac consists of two fused layers: an outer
fibrous capsule and an inner parietal pericardium lined with
a serous membrane. Between the pericardial sac and the
heart is the pericardial cavity, which is filled with
lubricating serous fluid. The walls of the heart are
composed of an outer epicardium, a thick myocardium, and
an inner lining layer of endocardium. The human heart
consists of a pair of atria, which receive blood and pump it
into a pair of ventricles, which pump blood into the vessels.
The right atrium receives systemic blood relatively low in
oxygen and pumps it into the right ventricle, which pumps
it into the pulmonary circuit. Exchange of oxygen and
carbon dioxide occurs in the lungs, and blood high in oxygen returns to the left atrium, which pumps blood into the
left ventricle, which in turn pumps blood into the aorta and the remainder of the systemic circuit. The septa are the
partitions that separate the chambers of the heart. They include the interatrial septum, the interventricular septum,
and the atrioventricular septum. Two of these openings are guarded by the atrioventricular valves, the right tricuspid
valve and the left mitral valve, which prevent the backflow of blood. Each is attached to chordae tendineae that
extend to the papillary muscles, which are extensions of the myocardium, to prevent the valves from being blown
back into the atria. The pulmonary valve is located at the base of
the pulmonary trunk, and the left semilunar valve is located at the
base of the aorta. The right and left coronary arteries are the first to
branch off the aorta and arise from two of the three sinuses located
near the base of the aorta and are generally located in the sulci.
Cardiac veins parallel the small cardiac arteries and generally drain
into the coronary sinus.

The heart is regulated by both neural and endocrine control,

yet it is capable of initiating its own action potential followed by
muscular contraction. The conductive cells within the heart
establish the heart rate and transmit it through the myocardium.
The contractile cells contract and propel the blood. The normal
path of transmission for the conductive cells is the sinoatrial (SA)
node, internodal pathways, atrioventricular (AV) node,
atrioventricular (AV) bundle of His, bundle branches, and Purkinje
fibers. The action potential for the conductive cells consists of a
prepotential phase with a slow influx of Na+ followed by a rapid
influx of Ca2+ and outflux of K+. Contractile cells have an action
potential with an extended plateau phase that results in an extended
refractory period to allow complete contraction for the heart to
pump blood effectively. Recognizable points on the ECG include
the P wave that corresponds to atrial depolarization, the QRS
complex that corresponds to ventricular depolarization, and the T
wave that corresponds to ventricular repolarization.
The cardiac cycle comprises a complete relaxation and
contraction of both the atria and ventricles, and lasts approximately
0.8 seconds. Beginning with all chambers in diastole, blood flows
passively from the veins into the atria and past the atrioventricular
valves into the ventricles. The atria begin to contract (atrial

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 systole), following depolarization of the
atria, and pump blood into the ventricles.
The ventricles begin to contract
(ventricular systole), raising pressure
within the ventricles. When ventricular
pressure rises above the pressure in the
atria, blood flows toward the atria,
producing the first heart sound, S1 or lub.
As pressure in the ventricles rises above
two major arteries, blood pushes open the
two semilunar valves and moves into the
pulmonary trunk and aorta in the
ventricular ejection phase. Following
ventricular repolarization, the ventricles
begin to relax (ventricular diastole), and
pressure within the ventricles drops. As
ventricular pressure drops, there is a tendency for blood to flow back into the atria from the major arteries,
producing the dicrotic notch in the ECG and closing the two semilunar valves. The second heart sound, S2 or dub,
occurs when the semilunar valves close. When the pressure falls below that of the atria, blood moves from the atria
into the ventricles, opening the atrioventricular valves and marking one complete heart cycle. The valves prevent
backflow of blood. Failure of the valves to operate properly produces turbulent blood flow within the heart; the
resulting heart murmur can often be heard with a stethoscope.
Many factors affect HR and SV, and together, they contribute to cardiac function. HR is largely determined
and regulated by autonomic stimulation and hormones. There are several feedback loops that contribute to
maintaining homeostasis dependent upon activity levels, such as the atrial reflex, which is determined by venous
return. SV is regulated by autonomic
innervation and hormones, but also by
filling time and venous return. Venous
return is determined by activity of the
skeletal muscles, blood volume, and
changes in peripheral circulation. Venous
return determines preload and the atrial
reflex. Filling time directly related to HR
also determines preload. Preload then
impacts both EDV and ESV. Autonomic
innervation and hormones largely regulate
contractility. Contractility impacts EDV as
does afterload. CO is the product of HR
multiplied by SV. SV is the difference
between EDV and ESV.
D. Urinary System
Consist of two kidneys, the primary excretory organs. Each kidney’s waste products are carried by a ureter
to a single urinary bladder. The waste is emptied from the urinary bladder the urethra. The kidney’s each filter a
large volume of blood. Waste from the blood are collected and form urine. Urine consists of (1) excess water, (2)
excess ions, (3) metabolic wastes, including the protein by-product urea, (4) toxic substances. The kidneys can
suffer extensive damage and still maintain homeostasis. As long as about one-third of one kidney remain functional,
survival is possible. However, is the functional ability of the kidney’s fails completely, death will result unless the
person receive medical treatment. The major function of the urinary system is excretion, which controls the
composition and volume of the body fluids. The kidneys also have many other important metabolic activities. The
kidney function include:
a. Excretion. The kidneys remove waste product from the blood. Most of the waste products are metabolic
by a product of metabolism other waste products are substance absorbed by the intestine. Many waste products are

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toxic. Organs such as the skin, liver, lungs, and intestines eliminates some of these wastes products. However, id the
kidneys fail to function, these organ cannot remove sufficient waste to maintain homeostasis
b. Regulation of blood volume and pressure. The kidneys play a major role in controlling the extracellular
fluid volume in the body. The kidneys can produce either large volume of dilute urine or a small volume of
concentrated urine, depending on the hydration of the level of the body. Through urine production, the kidneys
regulate blood volume and blood pressure,
c. Regulation of the concentration of solute in the blood. The kidneys help regulate the concentration of the
major molecules and ions.
d. Regulation of extracellular fluid pH. The kidneys excrete variable amount of H+ to help regulate
extracellular fluid pH.
e. Regulation of red blood cells synthesis. The kidneys secrete a hormone, erythropoietin, which regulates
the synthesis of red blood cells in bone marrow
f. Regulation of Vitamin D synthesis. The kidneys play and important role in controlling blood levels of
Ca2+ by regulating the synthesis of vitamin D.

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