Human Histology - MLS212 - Module 5

MODULE IN
HUMAN HISTOLOGY
MLS 212
Department of Medical Laboratory Science
SCHOOL OF NATURAL SCIENCES

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MLS 212
COURSE LEARNING OUTCOMES

At the end of the module, you should
be able to:
• discuss the basic characteristics of
cells and tissues and relate these to
their function
• discuss the inter-relatedness of the
different organ-systems at the
cellular-tissue in their embryologic
development and on their
dependence on each other in the
maintenance of homeostasis
• discuss clinical conditions by
tracing their pathophysiology
arising from altered histophysiology
• demonstrate critical thinking in all
aspects of the course
• apply research skills in
HUMAN HISTOLOGY understanding health trends and
developments in the field of human
histology
• apply proper cognitive and
affective domains in the
performance of assigned tasks
• display professional and ethical
netiquette as they participate in
OBL and CBL tasks
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COURSE INTRODUCTION
Dear future Registered Medical Technologist,
“Learning must continue”, that is the battle cry of our education secretary Ms. Leonor Briones.
Making a stand, this 79-year-old strong willed, visionary secretary said that learners cannot be
deprived of their basic right to education, not even by a deadly virus. These are not empty
words for someone who at 4 years old, learned to read and write on banana leaves during
the last World War.
The challenge to learning presented by the COVID 19 pandemic is not unique. Ms Briones did
not learn on her own, she had a determined mother-teacher, and she was a student, a blank
canvas open and ready to learn in the middle of screaming war planes and exploding
ordnance.
We are surrounded by technology. We are better equipped to meet the challenge of the
times. This course, Histology as a branch of anatomy will deal with parts and functions of the
human body. Human Anatomy in your first year was mostly gross, Histology on the other hand
is microscopic. In other words, you will rediscover the human body on the microscopic scale.
This will provide opportunities to understand histophysiology as well. Understanding how the
body works at the cellular level offers a better perspective that provides competency and
knowledge to the Medical Laboratory Science student in navigating the intricacies of
pathology, the study of diseases. The course includes both theory and laboratory practice
using histology atlases. The lecture portion will follow the traditional and logical sequence of
cells to tissues to organs. Within, the sequence will be a description/ discussion of the different
cells and tissues with their corresponding functions and some clinical correlations.
The destination awaits, let your discovery driven journey bear the good fruits of you labor.
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MODULE 5 – Absorption and Excretion
This module will provide you with the cellular and tissue components that make up the
respiratory, digestive, and urinary system organs. It will put emphasis on the histophysiology of the
mentioned systems that distinctively operate at the cellular level. It will describe organ-system roles in
maintaining homeostasis in addition, whenever applicable, pathophysiology of clinical conditions will
be discussed in a cause and effect manner.
MODULE SELF MONITORING FORM
To help you keep track of your module tasks, you are provided below with a self-monitoring
form. Take the time to tick on the “Yes” box for each activity that you finish and be reminded about
pending activities that you are yet to do. Remember that your success in achieving the module
objectives depends entirely on how conscientious you are of your own progress.
Done?
ACTIVITIES
YES NO
Read the Module Introduction, Module Contents, and Module Objectives
Do Lecture Activity 5.1.1 Review of Respiratory Physiology
Read Lecture Activity 5.1.2 The Respiratory tree
Do Lecture Activity 5.1.3 Pathophysiology
Do Lecture Activity 5.2.1 Fact or Fiction
Do Lecture Activity 5.2.2 Read
Do Lecture Activity 5.3.1 Getting it together
Do Lecture Activity 5.3.2 Read
Do Lecture Activity 5.3.3 Concentrating and Diluting capacity of the

Kidney
Do Lecture Activity 5.3.4 RAAS
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MODULE CONTENTS
Module Introduction ........................................................................................................................ 4
Module Self-Monitoring Form .......................................................................................................... 4
Module Contents .............................................................................................................................. 5
Module Objectives ........................................................................................................................... 5
Engage: Role of the respiratory system in homeostasis
Lecture Activity 5.1.1 ……………………………………………………………………………………… 6
Explain: Read
Elaborate: Pathophysiology
Unit 5.2 – Digestive System
Engage: Fact or Fiction
Explain: Read
Lecture Activity 5.2.2………………………………………………………………………………………. 17
Explore: Getting it together
Explain: Read
Elaborate: Concentrating and Diluting Capacity of the Kidney
Evaluate:
Lecture Activity 5.3.4……………………………………………………………………………………..... 62
References ………………………………………………………………………………………………….. 63
MODULE OBJECTIVES:
After you are done reading and doing the tasks in this module, you are expected to be able to:
1. Describe the basic tissue structure of the respiratory, digestive and urinary systems
2. Discuss tissue-organ dynamics in homeostasis
3. Discuss clinical conditions that arise from an altered structure/function of a tissue-organ
component
This module is divided into three (3) lecture units

Lecture Unit 5.1 – Respiratory system
Unit Objectives:
1. Describe the respiratory tree according to its functional divisions
2. Describe the cell-tissue structural and functional units of the respiratory tree
3. Discuss the homeostatic role of the respiratory system
4. Discuss clinical conditions associated with specific components of the respiratory tree
5. Discuss relevance of the system to the COVID 19 pandemic
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Lecture Unit 5.2- Digestive system
Objectives:
1. To describe the digestive tract and its accessory glands
2. Describe the cell-tissue components of the system and relate them to their functions
3. Describe the homeostatic role of the digestive system
4. Discuss clinical conditions associated with specific components of the digestive system
Lecture Unit 5.3– Urinary system

1. To describe the structural and functional components of the urinary system
2. Describe the histology of the nephron and relate each part in the process of urine formation
3. Describe homeostatic role of the urinary system
4. Discuss clinical conditions associated with specific components of the urinary system
RESPIRATORY SYSTEM
UNIT 1
Lecture activity 5.1.1 Role of the respiratory system in homeostasis
Wearing a mask during the COVID 19 pandemic is both protective and preventive. Together
with social distancing and hand washing they form the groundwork of public health advisories on
infection spread and control. These advisories although universal in application may not be practical
in certain situations. Have you tried exercising while wearing a mask?
1.Provide an explanation on the physiologic effects and the risks associated with wearing a
mask while doing light to moderate exercise as compared to doing heavy exercise like running
or aerobic Zumba.
2. List at least 3 activities to avoid injury during these activities.
3. Comment or give insights or rejoinders to at least 2 of your classmate’s answers
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Lecture Activity 5.1.2
UNIT 5.1 – Read

Introduction
The respiratory system is the site where respiratory gasses

oxygen and carbon dioxide are exchanged. If you review your
anatomy and physiology, the 4 main functions of the respiratory system are, 1. Pulmonary ventilation-
the work of breathing, inhale, and exhale that bring air into and out of the lungs 2. External respiration-
exchange of gasses between the alveoli and the pulmonary capillaries. 3. Internal respiration-
exchange of gasses between the peripheral circulation and the interstitial spaces and cells. 4.
Respiratory gas transport- the forms by which oxygen and carbon dioxide are transported to and from
the pulmonary and the peripheral circulation.
The system is divided anatomically into the upper and lower respiratory tracts, the boundary
being at the glottis, the opening of the trachea. Functionally the system has 2 components:
1. Conducting portion which consist of the nasal cavities, nasopharynx, larynx, trachea,
bronchi, bronchioles, and terminal bronchioles. Functions to warm, moisten and filter the air
before it reaches the respiratory components where gas exchange occurs
A. Nasal Cavity:
1. Nares- nostrils that are lined by thin skin that open into the vestibule
2. Vestibule- first portion of the nasal cavity, where epithelial lining becomes non
keratinized.
• Posteriorly, epithelial lining is respiratory epithelium (pseudostratified ciliated
columnar epithelium with goblet cells)
• Vibrissae- contained in the vestibule composed of thick, short hairs which filter
large particles from inspired air
• Lamina propria is richly vascularized (many venous plexuses) and contains
seromucous glands. (Epistaxis- nose bleed occurs when these superficial
venous plexuses are damaged like in excessive blowing of the nose or by nose
picking)
3. Olfactory epithelium (fugure5.1)
• Located at the roof of the nasal cavity on either side of the nasal septum and
on the superior nasal conchae
• Epithelium- tall pseudostratified columnar epithelium consisting of olfactory
cells, supporting (sustentacular) cells and basal cells
• Its lamina propria contains many veins and unmyelinated nerves and houses
the Bowman’s glands
• Olfactory cells- are bipolar neurons with a bulbous apical projection (olfactory
vesicle) from which several modified cilia extend
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• Olfactory cilia- long non motile cilia that extend over the surface of the
olfactory epithelium, they act as receptors of odor
• Supporting (Sustentacular cells)-possess nuclei that are more apically
located, have many microvilli and a prominent terminal web of
filaments
• Basal cells- rest on basal lamina but do not extend to the surface, they
are believed to be regenerative for all the three cell types
• Bowmans glands- produce thin watery secretion that is released onto
the olfactory epithelial surface via narrow ducts. Odorants (the stimuli
for the sense of smell) dissolve in this watery material are detected by
the sensory receptors, olfactory cilia. The secretion also flushes the
epithelial surface, preparing receptors to receive new odorous stimuli.
B. Nasopharynx:
1. Posterior communication of the nasal cavities, becomes continuous with the
oropharynx at the level of the soft palate
2. Lined with respiratory epithelium and below this up to the laryngopharynx is stratified
squamous epithelium
3. Lamina propria, located beneath the epithelium contains mucous and serous glands
as well as an abundance of lymphoid tissue (pharyngeal tonsil), when inflamed it is
called an adenoid.
C. Larynx: connects pharynx with the trachea
(Look back icon: Go to laboratory activity on the system at hand to gain more information
about the item)
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Figure 5.1: a. Schematic illustration of the olfactory epithelium. b. microscopic section M-mucosa, C-Cilia, S-
Supporting cells, ON-Olfactory nerve, B-basal cells, LP- lamina propria (Mescher, 2018)
D. Trachea and extrapulmonary (primary) bronchi

1. C shaped hyaline cartilages are supplied with dense fibroelastic connective tissues in
between them which permit elongation of the trachea during inhalation
2. Cells of the respiratory epithelium on the mucosa
• Ciliated cells: long, actively motile cilia that beat toward the mouth
• Move inhaled particulate matter trapped in the mucus toward to oropharynx
thus protecting the delicate lung tissue form damage
• Also possess microvilli
• Mature Goblet cells- contain large secretory granules containing mucinogen
droplets which are secreted onto the epithelial surface to trap inhaled particles
• Small mucous granule cells
• Sometimes called brush cells because of their many uniform microvilli
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• Actively divide and replace desquamated cells
• Represent goblet cells after they have secreted their
mucinogen
• Diffuse neuroendocrine cells (DNES cells)
• AKA small granule cells, amine precursor uptake and
decarboxylation (APUD) cells, or enteroendocrine cells
• Synthesize different polypeptide hormones and
serotonin which exert a local effect on nearby cells and
structures (paracrine regulation). The peptide hormones may
also enter the blood and have and endocrine effect (tropic)
on distant cells and structures.
Figure 5.2 Ellectron micrograph of
• Short basal cells- rest on basal lamina but do not
intrapulmonary bronchus (XS)
extend to the lumen (pseudostratified)
(E)respiratory membrane with goblet
• Divide and replace other cell types
cells; beneath epithelium in the lamina
propria of loose fibroelastic 3. Submucosa is a connective tissue layer containing
connective tissue are bundles of many seromucous glands
smooth muscle cells(SM) wrapped in 4. Adventitia contains C shaped hyaline cartilages and
spiralling arrangement around the forms the outermost layer of the trachea
lumen. (C)are irregular plates of E. Intrapulmonary bronchi (secondary bronchi)/ Lobar
cartilage, (G) seromucous glands and bronchi (figure 5.2)
(L)Lymphoid tissues, (A) Alveoli (x75) 1. Arise from subdivisions of primary bronchi
(Gartner,2015) 2. Divide many times and give rise to segmental bronchi
3. Their wall contains irregular cartilage plates
4. Lined by respiratory epithelium
5. Spiraling smooth muscle bundles separate lamina propria from submucosa which
contain submucous glands
F. Primary and terminal bronchioles lack glands in the submucosa and their walls contain
smooth muscles rather than cartilage plates
1. Primary bronchioles
• 1mm or less
• Epithelium: ciliated columnar with goblet cells in the larger airways to ciliated
cuboidal with Clara cells in the smaller passages
• Divide to form several terminal bronchioles after entering pulmonary lobules
2. Terminal bronchioles
• Most distal part of the conducting zone
• Less than 0.5mm diameter
• Simple cuboidal epithelial lining containing Clara cells
• Functions of Clara cells
• Divide and some differentiate into ciliated cells
• Secrete glycosaminoglycans
• Metabolize airborne toxins, a process carried out by cytochrome p450
enzymes in their abundant smooth endoplasmic reticulum (SER)
• Increased toxic stress stimulates division to become alveolar cells
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CLINICAL CORRELATION:
ASTHMA- marked by widespread contraction of smooth muscles in the bronchioles
causing a decrease in their diameter
• Associated with extremely difficult expiration of air, accumulation of mucus in the
passageways and infiltration of inflammatory cells
• Often treated with drugs that stimulate sympathetic activity- cause smooth muscle
relaxation leasing to dilation of passageways and corticosteroids which are anti-
inflammatory
• Taste receptors that respond to bitter tastes when stimulated by a bitter taste cause the
bronchiolar smooth muscles to relax causing them to dilate up to 90% of their normal
volume. (potential for aerosolized drug delivery that can be used to stimulate these
receptors)
2. Respiratory portion- includes the respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli,
all in the lung. The exchange of gasses takes place in this portion of the respiratory system.
A. Respiratory bronchioles (figure 5.3)
• Transition point between conducting and respiratory zone
• Lined with simple cuboidal containing mostly Clara cells and some ciliated cells
except in area interrupted by alveoli
• Distally the lining abruptly changes to simple squamous epithelium
B. Alveolar ducts (figure 5.3)
• Linear passageways continuous with respiratory bronchioles
• Wall consist of adjacent alveoli, which are separated from one another by an
interalveolar septum
• Most distal portion of the respiratory system- contains smooth muscle cells that rim the
opening of adjacent alveoli (appear as knobs on histological section)
• Lined by type II pneumocytes and highly attenuated simple squamous epithelium of
type I pneumocytes.
C. Alveolar sacs (figure 5.3)
• Expanded outpouchings of numerous alveoli at the distal ends of the alveolar ducts
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Figure 5.3 Respiratory portion, Inset: respiratory membrane (Gartner, 2015)
D. Alveoli (figure 5.3)

• Pouchlike evaginations about 200um in diameter in the walls of the respiratory
bronchioles, alveolar ducts and in alveolar sacs
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• Respiratory membrane/ blood gas barrier (figure 5.2): thin walls across which oxygen
and carbon dioxide diffuses between air and the blood.
• Separated form each other by interalveolar septa that contain one or more alveolar
pores (pores of Kohn). These pores permit equalization of pressure between alveoli
• Rimmed by elastic fibers at their openings (except in alveolar ducts where they are
rimmed by smooth muscle cells) and are supported by reticular fibers in their walls
• Lined by type I pneumocytes and type II pneumocytes
Alveolar cells
• Type I pneumocytes (type I alveolar cells)

• Cover 95% of the alveolar surface and form part of the respiratory membrane
• Extremely thin cytoplasm (less than 80mm thick)
• Form tight junctions with adjacent cells
• Has phagocytic capabilities
• Unable to divide
• Type II pneumocytes (type II alveolar cells, great alveolar cells, granular
pneumocytes, septal cells) (figure 5.3)
• Cuboidal, found near septal intersections
• Bulge into alveolus, free surface contains microvilli
• Capable of division and regeneration into both types of pneumocytes
• Form tight junctions with adjacent cells
• Synthesize pulmonary surfactant which is stored in cytoplasmic lamellar bodies
• Surfactant- phospholipids and at least 4 proteins. Forms tubular myelin
(a network configuration) when it is first released from lamellar bodies; it
then spreads to produce a monomolecular film over the surface of the
alveolar surface, forming a lower aqueous phase and a superficial lipid
phase
• Function- Pulmonary surfactant. Reduces the surface tension of the
alveolar surface, permitting the alveoli to expand easily during
inspiration and preventing alveolar collapse during expiration
• Alveolar macrophages (alveolar phagocytes; dust cells) (figure 5.3)
• Principal mononuclear phagocytes of the alveolar surface
• Remove inhaled dust, bacteria and other particulate matter trapped in
the pulmonary surfactant
• Migrate to bronchioles after filling with debris and carried to the upper
airways- at the oropharynx, they are either swallowed or expectorated
• May also exit by migrating to the interstitium and leave via lymphatic
vessels.
E. Interalveolar septum:
• Wall or partition between 2 adjacent alveoli
• Outer surface- extremely thin simple squamous epithelium lining the alveoli
• Contains elastic and reticular fibers in its thicker regions
• Houses continuous capillaries in its central (interior) region
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• Contain the blood gas barrier (respiratory membrane) (figure 5.4) which separates
the alveolar air space from the capillary lumen
• Thinnest layers are 0.2um or less with the following layers
• Type I pneumocytes and a layer of surfactant lining the alveolar
airspace
• Fused basal lamina of type I pneumocytes and capillary endothelial
cells
• Endothelium of continuous capillaries within the interalveolar septum
• Thicker regions measure as much as 0.5um across and has an interstitial area
between the two unfused basal laminae
• Function- permits the diffusion of gases between the alveolar space and the
blood. Oxygen passes from alveolus into the capillary and carbon dioxide from
capillary blood into the alveolus.
Figure 5.4: blood gas barrier
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Hyaline membrane disease: Infant Respiratory distress syndrome- observed in premature
infants (<28 weeks gestational age) who lack adequate amounts of pulmonary
surfactant
• Characterized by labored breathing due to alveoli that are difficult to expand.
The lack of surfactant causes high alveolar surface tension causing a higher
tendency for alveolar collapse.
• If detected before birth, hyaline membrane disease can often be prevented by
prolonging pregnancy and sometimes by administering glucocorticoids to the
expectant mother a few days prior to delivery to help induce the synthesis of
surfactant.
Emphysema- results from destruction of alveolar walls and formation of cyst like sacs, reducing
the surface area available fo r gas exchange
• It is marked by decreased elasticity of the lung s, which are unable to recoil
adequately during expiration. In time, the lungs expand and enlarge the
thoracic cavity (barrel chest).
• associated with exposure to cigarette smoke and other substances that inhibit
a1-antitrypsin, a protein that normally protects the lungs from the action of
elastase produced by alveolar macrophages.
• It can be a hereditary condition resulting from a defective a1 -antitrypsin. In such
cases, gene therapy with recombinant a1 -antitrypsin is being used in an effort to
correct the problem, and it has recently been successful in boosting the
availability of this protective protein.
Lecture Activity 5.1.3 Pathophysiology
The lack of evidence-based data is one of the reasons for the apparent lack of a unified global
strategy in handling the present COVID 19 pandemics. Hussain (2020), echoed a proposed
pathophysiology of SARS-CoV2 binding to ACE2 with high affinity as a virus receptor to infect humans
through spike glycoproteins on the surface of its membrane. Armed with this premise, create a concept
map of SARS-CoV2 pneumonia. Start by describing the viral impact on the cells of the respiratory
system. Justify GIT manifestations and why the hypertensive elderly patient is particularly considered at
greater risk for mortality.
Click the link below for a guide on how to make a concept map
https://youtu.be/RqDkcOFMzL0
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Consider the scoring rubric below:
9-10 6-8 3-5 0-2

All relevant cause More than half of Less than half of Few relevant
and effect the relevant cause the cause and cause and
interactions are and effect effect interactions effect
CONTENT
included and interactions are are included and interactions are
correct included and correct included and
correct correct
Understanding of Understanding of Understanding of Poor
cause and effect cause and effect cause and effect understanding
interactions are interactions are interactions are of cause and
clearly clearly clearly effect
LOGIC AND
demonstrated by demonstrated by demonstrated but interactions with
UNDERSTANDING
correct links and correct links but with some errors ( significant errors
descriptive words some descriptive eg. Incorrect links
words are and descriptive
inappropriate words)
Concept map is Concept map is Concept map is Concept map is
neat, clear and neat, clear and neat, clear and untidy with links
legible and has legible and has legible but with difficult to follow
PRESENTATION easy to follow easy to follow links, some links that are
links, no spelling has some spelling difficult to folow,
errors errors has some spelling
errors
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DIGESTIVE SYSTEM
UNIT 5.2
Lecture Activity 5.2.1 Fact or Fiction
Over time, you Have received and learned information that has given you some measure of
valid competence in certain subjects and a perception of competence in others. There are so many
reasons why certain fallacies are perceived as hard and fast facts. Information on health is particularly
riddled with fallacies masquerading as facts, some are deliberate while most are simply received
(sometimes, just overheard) passed on and then embraced ‘hook line and sinker’ without much
thought or the rigors of proper validation. The challenge is to distinguish which is fact and which is fiction
based on sound knowledge. Test your anatomic and physiologic acumen with the phrases below and
explain beside each why it is fact or why it is fiction.
1. The stomach is the main site of food digestion.

2. The stomach produces a new layer of mucus every 2 weeks to protect itself, while it produces
half a gallon of HCl each day.
3. Doing vigorous exercise just after a full meal causes acute appendicitis
4. Eating spicy food can cause hemorrhoids.
5. Drinking coffee or tea or smoking after a heavy meal causes digestion to work more
effectively.
Lecture activity 5.2.2
UNIT 5.2: Read

Introduction
The digestive system is divided into an alimentary tract and

accessory organs of digestion. The alimentary tract is a continuous passage that starts with the mouth
and end in the anus. Water and food pass through this passage and by mechanical and chemical
mechanisms- digestion and absorption of the food products take place. Accessory organs of the
system are made up of the salivary glands, liver and the pancreas. These glands give significant
contributions to the process of chemical digestion by producing enzymes, buffers, emulsifiers and
lubricants delivered to the alimentary tract via a system of ducts.
1. Oral cavity and Alimentary tract:
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A. Oral cavity- internal part of the mouth that function for ingestion, mastication, and
lubrication in preparation for deglutition. It has 2 divisions Oral vestibule, it is the space
between inner lips, cheeks, and front surface of the teeth. Oral cavity it is the space between
the upper and lower dental arches, extending from the inner surface of the teeth to the
oropharynx
• Oral Mucosa
• Lining mucosa- covered by non-keratinized stratified squamous epithelium
with 2 distinct layers, stratum basale and stratum spinosum only.
• Lines the inner oral surfaces of the lips, cheeks, soft palate, inferior
surface of the tongue and the floor of the mouth.
• Less exposed to abrasion than the masticatory mucosa
• Provides a barrier against the invasion of pathogens and toxic
chemicals
• Contains receptors for sensations and serves immunological functions
through diffuse lymphoid tissues, epithelium contains transient antigen
presenting cells.
• Also provides lubrication and buffering by minor glands in the
submucosal layer
• Connective tissue layers
• Lamina propria- thin layer of loose connective tissue with many
elastic fibers and a few collagen fibers
• Submucosa – thick layer of connective tissue which contains
minor salivary glands and is attached to the underlying muscle.
Continuously secrete saliva to keep the mucosa wet
• Masticatory mucosa
• keratinized stratified squamous epithelium
• Exposed to significant abrasion due to high compression and friction
during chewing
• It has stratum basale, spinosum, granulosum and corneum.
• Lamina propria is thick with a dense network of collagen fibers and a
few elastic fibers
• No submucosa and is directly and rigidly attached to the underlying
bone
• Injection into this area is difficult and painful due to sensitive periosteum
• Covers the oral surfaces of the gingiva and the hard palate
• Specialized mucosa
• Covers the anterior 2/3rds of the tongue
• Consists of keratinized and non-keratinized squamous epithelium and
numerous papillae
• Filiform, fungiform, circumvallate and foliate papillae- most will
have taste buds except for filiform papillae
• Main function is to mix food during chewing
• Lamina propria is attached to underlying skeletal muscle
• Lips- well developed core of striated muscles makes the structure highly mobile for
ingestion, speech, and other forms of communication.
• 3 different covered surfaces of the lips (figure 5.2.1)
• Internal mucous surface- lining mucosa with many minor salivary glands
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Figure 5.2.1 Lip
Low-magnification micrograph of a lip section showing one side covered by typical oral mucosa (OM), the
opposite side covered by skin (S) containing hair follicles (F) and associated glands. Between the oral
portion of the lips and normal skin is the vermilion zone (V), where epidermis is very thin, lightly
keratinized, and transparent to blood in the rich microvasculature of the underlying connective tissue.
Because this region lacks the glands for oil and sweat, it is prone to excessive dryness and chapping in cold,
dry weather. Internally, the lips contain much striated muscle (M) and many minor salivary glands (G). X10.
H&E. (Mescher, 2016)
Vermilion zone- thin keratinized squamous stratified squamous

•
epithelium that is in the transition zone between oral mucosa and skin.
• Lacks salivary or sweat glands
• Kept moist with saliva from the tongue
• Underlying connective tissue is very rich in both sensory
innervation and capillaries which impart the pink color to this
region
• Outer surface- thin skin with epidermal and dermal layers, sweat glands
and many hair follicles and sebaceous glands
• Teeth- (figure 5.2.2) there are 32 permanent teeth arranged in 2 bilaterally symmetric
arches in the maxillary and mandibular bones
• Twenty of the permanent teeth are preceded by primary teeth (deciduous or
milk teeth) the others are permanent molars with no deciduous precursors
• Crown- part of the tooth that is exposed above the gingiva
• Neck- constricted part at the gum.
• Roots- one or two of them that fit firmly into the bony sockets in jaws called
dental alveoli
• Enamel- extremely hard acellular covering of the crown
- Hardest component of the human body
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-
96% hydroxyapatite crystals, 2-3%
organic material, very few proteins and
no collagen
- Fluoride in incorporated or adsorbed by
hydroxy apatite crystals
- Enamel containing fluoroapatite are mor
resistant to acidic dissolution caused by
microorganisms, hence added to
toothpaste and water supplies.
• Cementum- covering of the roots. Meets the enamel
at the neck
• Dentin- calcified bulk of the tooth that surrounds an
internal pulp cavity
• Dental pulp-highly vascular and well innervated
Consists largely of loose, mesenchymal connective tissue
with much ground substance, thin collagen fibers,
Figure 5.2.2 The molar
fibroblasts, and mesenchymal stem cells
• Root canal- part of the pulp cavity that narrows in each root for the blood
vessels lymphatics and nerves of the pulp cavity
• Periodontium- structures responsible for keeping the teeth in the maxillary and
mandibular bones. It includes the:
• cementum
• Periodontal ligaments- fibrous connective tissue bundles of collagen
fibers (Sharpey fibers) inserted into the cementum and the alveolar
bone
• Alveolar bone with the associated gingiva
B. Esophagus- muscular tube about 25cm long in adults. It transports swallowed material from
pharynx to the stomach
• The most muscular portion of the digestive tract
• Esophageal glands in the submucosa lubricate and protect the mucosa and
esophageal cardiac glands near the stomach secrete additional mucus.
• Swallowing- begins with voluntary muscle action but finishes with involuntary peristalsis
• Skeletal muscle exclusively makes up the upper third of the esophagus
• Skeletal muscle and smooth muscle make up the middle third
• Smooth muscle exclusively makes up the lower third
• Distal 1-2cm is peritoneal in location covered by serosa, the rest is covered by
adventitia
C. Stomach- greatly dilated segment of the digestive tract
• Functions:
• Continuation of carbohydrate digestion initiated by amylase of saliva
• Add an acidic fluid to the ingested and mix its contents into a viscous mass
called chyme by the churning activity of the muscularis
• Begin the digestion of triglyceride by a secreted lipase
• Promote initial digestion of proteins with the enzyme pepsin
• Four regions of the stomach
• Cardia- narrow transitional zone, 1.5-3cm wide between the esophagus and
the stomach
• Primarily involved with mucus production histologically similar to the
pylorus
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Pylorus- funnel shaped region that opens into the small intestine
•
• Primarily involved with mucus production histologically similar to the
cardia
• Fundus and Body- identical in microscopic structure
• Sites of gastric glands releasing acidic gastric juice
• Rugae- large, longitudinally directed folds of the mucosa and
submucosa of the empty stomach
• Flatten when stomach fills with food
• Gastric glands (figure 5.2.3; 5.2.4)
• Simple branched tubular glands in the lamina propria of the cardia, fundus,
and pylorus.
• Each gland consists of an isthmus, which connects the gland to the base of a
gastric pit; a neck; and a base.
• Cells of the fundic glands
• Parietal (oxyntic) cells
• These are pyramidal cells concentrated in the upper half ofthe
gland.
• They secrete hydrochloric acid (HCl) and gastric intrinsic factor.
The latter is necessary for absorption of vitamin B12 in the ileum.
• They possess a unique intracellular tubulovesicular system, many
mitochondria, and secretory intracellular canaliculi (deep
invaginations of the apical plasma membrane) lined by microvilli
• When the parietal cells are stimulated to secrete HCl, the number
and length of microvilli increase and the complexity of the
tubulovesicular system decreases (suggesting that
tubulovesicular membranes are incorporated into the
intracellular canaliculi, thus lengthening the microvilli)
• Chief (zymogenic) cells
• pyramidal cells residing in the lower half of the gland.
• secrete pepsinogen (a precursor of the enzyme pepsin) and the
precursors of two other enzymes, rennin and lipase.
• display an abundance of basal rough endoplasmic reticulum
(RER), a supranuclear Golgi complex, and many apical zymogen
(secretory) granules.
• Mucous neck cells
• located in the neck of the gland (and may be able to divide).
• possess short microvilli, apical mucous granules, a prominent
5.2.3 Gastric Gland (Mescher, Golgi complex, numerous mitochondria, and some basal RER.
2016) • produce soluble mucus
• Diffuse neuroendocrine system (DNES) cells
• also referred to as enteroendocrine cells or as APUD cells (amine
precursor uptake and decarboxylation cells).
• two major categories, open and closed.
• Open category has short processes that reach the lumen;
they are believed to be chemosensory, and they test the
luminal content to release specific substances based on
the circumstances.
21
•Closed category does not have processes that reach the
lumen and, therefore, they are "closed off" from the
luminal content.
• Include more than a dozen types of cells that house many small
hormone containing granules, usually concentrated in the basal
cytoplasm.
• Each enteroendocrine cell is believed to secrete only one
hormone
• Possess an abundance of mitochondria and RER and a
moderately well-developed Golgi complex.
Figure 5.2.4 Gastric Glands
• Gastric juice- contains water, HCl, mucus, pepsin, lipase, rennin, and electrolytes. It is
very acidic (pH 2.0) and facilitates the activation of pepsinogen to pepsin, which
catalyzes the partial hydrolysis of proteins.
• Regulation of gastric secretion is effected by neural activity (vagus nerve) and
by several hormones.
• Gastrin and histamine, released by enteroendocrine cells in the gastric
and duodenal mucosa, together with acetylcholine released by
parasympathetic nerve fibers of the vagus nerve, stimulate HCI
secretion.
• Somatostatin, produced by enteroendocrine cells of the pylorus and
duodenum, inhibits the release of gastrin and thus indirectly inhibits HCI
secretion.
• Urogastrone (also known as human epidermal growth factor),
produced by Brunner glands of the duodenum, and gastric inhibitory
peptide along with prostaglandins, produced by enteroendocrine cells
in the small intestine, directly inhibit HCI secretion.
22
Gastroesophageal reflux disease (GERD)- digestive disorder characterized by an
incompetent inferior esophageal sphincter.
• Manifest as heartburn or reflux esophagitis
• Lubricating mucus produced by the esophagus offers little protection against the
acid that rises/ reflux from the stomach due to the incompetent sphincter
• Untreated GERD can produce metaplastic changes in the stratified squamous
epithelium of the esophageal mucosa called Barrett esophagus
Pernicious anemia- Parietal cells in the stomach secrete Intrinsic factor.
• Gastric acidity is Important in activating Intrinsic factor so that it avidly binds with Vit
B12 as it passes through the stomach.
• The Intrinsic factor-Vit B12 complex is important so that absorption will take place in
the terminal ileum
• Vitamin B12 is a cofactor required for DNA synthesis affecting proper erythrocyte
maturation
• Low levels of Vit B12 can reduce proliferation of erythroblast producing large
immature nonfunctional erythrocyte precursors called megaloblast (Megaloblastic
anemia)
• Damaged parietal cells may be due various reasons, it may be to gastric mucosal
atrophy in the elderly or due to autoimmunity
D. Small intestine (figure 5.2.5)

• The small intestine is approximately 7 m long and has three regions: the duodenum
(proximal), jejunum (middle), and ileum (distal).
• Function.
• Secretes several hormones
• Continues and completes the digestion of foodstuffs and absorbs the resulting
metabolites.
• Luminal surface modifications- The luminal surface of the small intestine possesses
plicae circulares, intestinal villi, and microvilli, which collectively increase the luminal
surface area by a factor of 400 to 600
• Plicae circulares (valves of Kerckring) are permanent spiral folds of the
mucosa and submucosa that are present in the distal half of the duodenum,
the entire jejunum, and the proximal half of the ileum.
• Plicae circulares increase the surface area twofold to threefold.
• Intestinal villi are permanent evaginations that possess, in their connective
tissue core (lamina propria), numerous plasma cells and lymphocytes,
fibroblasts, mast cells, smooth muscle cells, capillary loops, and a single lacteal
(blindended lymphatic capillary). Villi increase the surface area 1 0-fold.
23
• Microvilli of the apical surface of the epithelial cells of each villus possess actin
filaments that interact with myosin filaments in the terminal web. Microvilli
increase the surface area about 20-fold.
Table 5.2.1 Selected Hormones Secreted by Cells of the Alimentary Tract (Gartner,2015)
• Mucosa of the small intestine

• The epithelium of the mucosa of the small intestine is simple columnar. It is
composed of goblet cells, surface absorptive cells, and some DNES cells that
are of both types open and closed
• Goblet cells
• are unicellular glands that produce mucinogen, which
accumulates in membrane bounded granules, distending the
apical region (theca) of the cell. After being released,
mucinogen becomes hydrated and is thus converted to mucin,
a thick, viscous substance that acts as a protective coating of
the epithelial lining of the lumen; mucin, when mixed with luminal
contents is known as mucus.
• increase in number from the duodenum to the ileum.
• Surface absorptive cells
24
• tall columnar cells with numerous mitochondria, smooth
endoplasmic reticulum (SER) and RER, and a Golgi complex.
• Possess a layer of closely packed microvilli (striated
border) on their free apical surface.
• Glycocalyx, which overlies the microvilli and binds various
enzymes, including disaccharidases and dipeptidases.
• Well-developed tight junctions and zonula adherens.
• DNES cells produce and secrete gastrin, cholecystokinin, gastric
inhibitory peptide, and several other hormones (Table 5.2.1).
• Some of the open DNES cells possess the three genes for G
protein-linked taste receptors like those of the taste buds located
on the tongue.
• the taste cells of the gastrointestinal tract communicate with the
islets of Langerhans, signaling the beta cells to release insulin
once sweet taste is detected in the lumen.
• Lamina propria
• Contains lacteals (blind-ended lymphatic vessels) and capillary loops.
• (crypts) of Lieberkühn. occupies the cores of the villi and the interstices
between the numerous glands
• Paneth cell located at the base of the crypts of Lieberkühn, are
pyramidal cells that secrete the antibacterial enzyme lysozyme
stored in large, apical, membrane bounded secretory granules.
• Also release other antibacterial agents, defensins and
tumor necrosis factor a and display extensive RER
(basally),
• These agents have the capability of killing bacteria as well
as certain protozoa.
• Regenerative cell ls, located in the basal half of the crypts of
Lieberkühn, are thin, tall, columnar stem cells that divide to
replace themselves and the other types of epithelial cells.
• Intermediate cells make up the bulk of the epithelial lining of the
crypts of Lieberkühn. These cells have regenerative properties;
they are derived from regenerative cells but have not as yet
committed themselves to a certain cell line.
• Lymphoid nodules are usually small and solitary and are located in the
lamina propria of the duodenum and jejunum.
• Peyer patches form large contiguous aggregates, which
frequently extend through the muscularis mucosae into
the submucosa.
• increase in size and number in the ileum,
• M (microfold) cells are highly specialized, have an unusual
shape, and lie in the epithelium over lymphoid nodules
and Peyer patches.
• They are derived from undifferentiated cells of the
crypts of Lieberkühn.
• They sample antigens as well as bacteria, viruses,
and parasitic microorganisms. The endocytosed
particles are conveyed via transcytosis to
25
macrophages and lymphocytes that lie in the
infoldings of the basal plasmalemma of M cells.
• These macrophages and the B and T lymphocytes
are located in the lamina propria.
• Activated B lymphocytes respond to antigenic challenge
by forming more B cells, which enter the lymph and blood
circulation, then home back to their original locations,
where they populate the lamina propria and differentiate
into immunoglobulin A (IgA) producing plasma cells.
• Plasma cells manufacture monomeric immunoglobulin A
(lgA).
• Muscularis mucosae is composed of an inner circular and an outer longitudinal layer
of smooth muscle.
• Submucosa consists of fibroelastic connective tissue containing blood and lymphatic
vessels, nerve fibers, and Meissner plexus.
• Brunner glands which are present only in the duodenum. These glands
produce:
• alkaline fluid which protects the duodenal epithelium from the
acidic chyme
• urogastrone (Table 5.2.1) a polypeptide hormone (human
epidermal growth factor) that enhances epithelial cell division
and inhibits gastric HCl production.
• Muscularis externa is composed of two layers of smooth muscle: an inner circular and
an outer longitudinal layer. The inner layer participates in the formation of the
ileocecal sphincter. Auerbach (myenteric) plexus is housed between the two layers.
• External layer
• Serosa covers all the jejunum and ileum and part of the duodenum.
• Adventitia covers the remainder of the duodenum.
E. Large intestine (figure 5.2.6)

• consists of the cecum, colon (ascending, transverse, descending, and sigmoid
colon), rectum, anal canal, and appendix.
• Contains some digestive enzymes received from the small intestine.
• Houses bacteria that produce vitamin 812 and vitamin K; the former is necessary for
hemopoiesis and the latter for coagulation.
• Produces abundant mucus, which lubricates its lining and facilitates the passage and
elimination of feces.
• Function.
• Absorption of electrolytes, fluids, and gases.
• Dead bacteria and indigestible remnants of the ingested material are
compacted into feces.
• Cecum and colon
• Mucosa lacks villi and possesses no specialized folds.
• The epithelium of the mucosa of the cecum and colon is simple
columnar with numerous goblet cells, surface absorptive cells, and
occasional DNES cells.
• Lamina propria is like the small intestine, possessing lymphoid nodules, blood
and lymph vessels, and closely packed crypts Lieberkühn, which lack Paneth
cells.
26
Fibroblasts at the base of the crypts of Lieberkühn of the lamina propria
•
undergo mitotic division and travel alongside of the epithelial
components of the intestinal crypt, and as they reach the vicinity of the
opening of the crypt, differentiate into cells with characteristics of
macrophages. It is believed that these newly differentiated cells assist
the monocyte-derived macrophages in their protective functions.
• Lymphoid elements, members of the gut-associated lymphoid tissues
(GALT),
• Interestingly, lymphoid drainage occurs rarely, if ever, from the
lamina propria; thereby, the absence of lymphatic vessels
greatly limits the capability of metastasis of malignant tumors
from the mucosa of the colon.
• Muscularis mucosae consists of an inner circular and outer longitudinal layer of
smooth muscle cells.
• Submucosa of the cecum and colon is composed of fibroelastic connective tissue. It
contains blood and lymphatic vessels, nerves, and Meissner (submucosal) plexus.
• Muscularis externa of the cecum and colon is composed of an inner circular and a
modified outer longitudinal layer of smooth muscle.
• The outer layer is gathered into three flat, longitudinal ribbons of smooth muscle
that form the teniae coli.
• When continuously contracted, the teniae coli form sacculations of the wall
known as haustra coli.
• Auerbach (myenteric) plexus is housed between the two layers of smooth
muscle.
• External layer of the cecum and colon
• Adventitia covers the ascending and descending portions of the colon.
• Serosa covers the cecum and the remainder of the colon.
• Appendices epiploicae Fat-filled outpocketings of the serosa are
characteristic of the transverse and sigmoid colon.
• Lumen of the large intestine houses trillions of microbes, approximately lO times the
number of cells in the entire human body.
• These microorganisms form a part of the body's microbiome, whose
physiological balance has shown to reflect the health of the individual
harboring them.
• Three groups of intestinal flora, known as enterotypes that predominate in the
human population, and each individual possesses a predominance of one of
these enterotypes. How these enterotypes develop and what their significance
is are not yet understood.
• Rectum is like the colon but contains fewer and deeper crypts of Lieberkühn
• Anal canal is the constricted continuation of the rectum.
• Anal columns (or rectal columns of Morgagni longitudinal folds of the anal
mucosa, which join each other to form anal valves.
• Anal sinuses regions between adjacent valves are known as.
• Epithelium of the anal canal
• Simple columnar changing to simple cuboidal proximal to the anal
valves.
• Changes to stratified squamous nonkeratinized distal to the anal valves.
• Changes to stratified squamous keratinized (epidermis) at the anus
27
Lamina propria is composed of fibroelastic connective tissue and contains
•
sebaceous glands, circumanal glands, hair follicles, and large veins.
• Muscularis mucosae consists of an inner circular and an outer longitudinal layer
of smooth muscle, both of which terminate at the anal valves.
• Submucosa is composed of dense, irregular fibroelastic connective tissue that
houses large veins.
• Muscularis externa is composed of an inner circular and an outer longitudinal
layer of smooth muscle.
• inner circular layer forms the internal anal sphincter.
• Adventitia attaches the anus to surrounding structures.
• External anal sphincter is composed of skeletal muscle, whose superficial and
deep layers invest the anal canal.
• Exhibits continuous tonus, thus maintaining a closed anal orifice.
• The degree of tonus is under voluntary control, so the retention or
evacuation of feces normally can be controlled at will.
F. Appendix a short, tubular extension of the blind terminus of the cecum.
• It has a narrow, stellate, or irregularly shaped lumen that often contains debris.
• The wall is thickened by large aggregates of lymphoid nodules in the mucosa and
even in the submucosa (in middle-aged and older individuals).
• Mucosa of the appendix
• Epithelium is simple columnar and contains surface columnar cells and goblet
cells.
• Lamina propria displays numerous lymphoid nodules (capped by M cells) and
lymphoid cells.
• does not form villi but possesses shallow crypts of Lieberkiihn with some goblet
cells, surface columnar cells, regenerative cells, occasional Paneth cells, and
numerous DNES cells, especially deep in the crypts.
• Muscularis mucosae is composed of an inner circular and outer longitudinal
layer of smooth muscle.
• Submucosa fibroelastic connective tissue containing confluent lymphoid
nodules and associated cell populations.
• Muscularis externa of the appendix is composed of an inner circular and an
outer longitudinal layer of smooth muscle.
• Serosa surrounds the appendix.
2. Digestion and absorption
A. Carbohydrates
• Salivary and pancreatic amylases hydrolyze carbohydrates to disaccharides and
polysaccharides. This process begins in the oral cavity, continues in the stomach, and
is completed in the small intestine.
• Disaccharidases present in the glycocalyx of the brush border of surface absorptive
cells cleave disaccharides into monosaccharides, principally into glucose, fructose,
and galactose.
• Monosaccharides are actively conveyed by transporters coupled to Na+ and
located at the microvillar bases into surface absorptive cells and then discharged by
the use of additional transporters at the base of the cells into the lamina propria,
where they enter the circulation to be transported to the liver via the hepatic portal
vein system.
28
B. Proteins
• Pepsin in the lumen of the stomach partially hydrolyzes proteins, forming a mixture of
highmolecular-weight polypeptides. Pepsin activity is greatest at low pH.
• Pancreatic proteases within the lumen of the small intestine hydrolyze the
polypeptides received from the stomach into very short polypeptides (composed of
no more than three or four amino acids) and dipeptides.
• Dipeptides are cleaved into amino acids by dipeptidases present in the glycocalyx
of the brush border of surface absorptive cells. Short polypeptides and amino acids
are conveyed by transporters located at the base of the microvilli into surface
absorptive cells. Amino acids and short polypeptides are discharged into the lamina
propria by various transporters located at the base of the surface absorptive cells,
where they enter the circulation to be transported to the liver via the hepatic portal
vein system.
C. Fats are degraded by pancreatic lipase into monoglycerides, free fatty acids, and glycerol
in the lumen of the small intestine (figure 5.2.7)
• Absorption of lipid digestion products occurs primarily in the duodenum and upper
jejunum.
• Bile salts act on the free fatty acids and monoglycerides, forming water-soluble
micelles.
• Micelles and glycerol then enter the surface absorptive cells.
• Formation of chyle
• Triglycerides are resynthesized from mono glycerides and free fatty acids within
the SER.
• Chylomicrons are formed in the Golgi complex by the complexing of the
resynthesized triglycerides with proteins. Chylomicrons are transported to the
lateral cell membrane and released by exocytosis; after crossing the basal
lamina, they enter lacteals in the lamina propria to contribute to the formation
of chyle.
• Chyle enters the submucosal lymphatic plexus by contraction of smooth
muscle cells in the intestinal villi.
• Chyle travels via larger and larger lymph vessels into the largest lymph vessel,
known as the thoracic duct, which empties into the junction of the left
subclavian vein with the left internal jugular vein to enter into the systemic
circulation at the left side of the heart.
• Short-chain fatty acids of less than 10 to 12 carbon atoms are not re-esterified but
leave the surface absorptive cells directly and enter blood vessels of the lamina
propria to be transported to the liver via the hepatic portal vein system.
D. Water and electrolytes are absorbed by surface absorptive cells of both the small and the
large intestine, whereas gases are absorbed mostly in the large intestine.
29
Figure 5.2.5 Absorptive surface of the small intestine.
(a) The mucosa and submucosa are the inner two of the gut’s four concentric layers. (b) They
form circular folds or plicae circulares, which increase the absorptive area. (c) They are lined
by a dense covering of fingerlike projections called villi. Internally each villus contains lamina
propria connective tissue with microvasculature and lymphatics called lacteals.
(d) Villi are covered with a simple columnar epithelium composed of absorptive enterocytes
and goblet cells. X70. H&E. (e) At the apical cell membrane of each enterocyte are located
dense microvilli, which serve to increase greatly the absorptive surface of the cell. X18,000.
TEM. (Mescher, 2016)
30
Figure 5.2.6 Large intestine.
As shown at the top, the large intestine consists of the cecum; the ascending,
transverse, descending, and sigmoid regions of the colon; and the rectum. (a)
Anterior view of the large intestine with the proximal end exposed shows the
ileocecal valve at its attachment to the ileum, along with the sac called the
cecum and its extension, the appendix. The mucosa has only shallow plicae
and no villi. The muscularis has two layers, but the outer longitudinal layer
consists only of three distinct bundles of muscle fibers called teniae coli that
produce the haustra in the colon wall. The serosa of the colon is continuous
with that of the supporting mesenteries and displays a series of suspended
masses of adipose tissue called omental appendages.
(b) At the distal end of the rectum, the anal canal, the mucosa, and
submucosa are highly vascularized, with venous sinuses, and are folded as a
series of longitudinal folds called anal columns (of Morgagni) with intervening
anal sinuses. Fecal material accumulates in the rectum is eliminated by
muscular contraction, including action of an internal anal sphincter continuous
with the circular layer of the muscularis and an external sphincter of striated
(voluntary) muscle. (Mescher, 2016)
31
Figure 5.2.7 Lipid absorption and processing by enterocytes.
(a) TEM shows that enterocytes involved in lipid absorption accumulate many small lipid droplets in
vesicles of the smooth ER (SER). These vesicles fuse near the nucleus, forming larger globules that are
moved laterally and cross the cell membrane to the extracellular space (arrows) for eventual
uptake by lymphatic capillaries (lacteals) in the lamina propria. X3000.
(b) Diagram showing lipid processing by enterocytes. Ingested fats are emulsified by bile acids to
form a suspension of lipid droplets from which lipids are digested by lipases to produce glycerol,
fatty acids, and monoglycerides. ① The products of hydrolysis diffuse passively across the microvilli
membranes and are collected in the cisternae of the smooth ER, where they are resynthesized as
triglycerides. ②Processed through the RER and Golgi, these triglycerides are surrounded by a thin
layer of proteins and packaged in vesicles containing chylomicrons (0.2-1 µm in diameter) of lipid
complexed with protein ③. Chylomicrons are transferred to the lateral cell membrane, secreted by
exocytosis, and flow into the extracellular space in the direction of the lamina propria, where most
enter the lymph in lacteals ④.
(Mescher, 2016)
32
3. Accessory Glands of the digestive system
A. Major Salivary glands
• 3 paired exocrine glands (figure 5.2.7)
• Parotid,
• Submandibular
• Sublingual
• Function: Synthesize and secrete salivary amylase, lysozyme, lactoferrin and secretory
component
• Secretory component - a portion of the lgA dimer receptor molecule located
on the basal plasma membrane of the secretory cell
• facilitates the transfer of the IgA dimer into the early endosome of the
secretory cell. This portion of the receptor molecule remains bound to
the IgA dimers, immunoglobulins that are produced by plasma cells in
the connective tissue, forming a complex that resists enzymatic
digestion in the saliva but can still perform its immune function.
• Serous secretory cells of major salivary glands also secrete histidine-rich,
proline-rich, and cysteine-rich proteins. The cells of the striated ducts of these
glands also release an enzyme kallikrein both into the lumen as well as into the
connective tissue. In the lumen kallikrein begins the digestion of proline- and
cysteine-rich proteins, whereas in the connective tissue kallikrein enters the
bloodstream, where it converts kininogens into the vasodilator and bronchial
smooth muscle contractant bradykinin.
• Lysozyme and lactoferrin are antimicrobial agents that control the bacterial
flora of the oral cavity.
• Amylase begins the digestion of carbohydrates in the oral cavity.
• Structure; (figure 5.2.8)
• The major salivary glands are compound tubuloacinar (tubuloalveolar) glands.
They are further classified as serous, mucous, or mixed (both serous and
mucous), depending on the type of secretory acini they contain.
• These glands are surrounded by a capsule of dense irregular collagenous
connective tissue with septa that subdivide each gland into lobes and lobules.
• Neurovascular elements serving these glands are conveyed to the acinar cells
within the connective tissue septa.
• Salivary gland acini
• Salivary gland acini consist of pyramidal serous or mucous cells
arranged around a central lumen that connects with an intercalated
duct. Mucous acini may be overlaid with a crescent-shaped collection
of serous cells called serous demilunes. Iit has been suggested that
serous demilunes are fixation artifacts- In spite of this finding they will be
treated as if they were actual structures.
• Acini of salivary glands possess myoepithelial cells that share the basal
lamina of the acinar cells. The acinus and its associated intercalated
and striated ducts form the salivon, the functional unit of a salivary
gland.
33
Figure 16–1 Major salivary glands.
About 90% of saliva is produced by three bilateral pairs of salivary glands: the parotid,
submandibular, and sublingual glands. Locations and relative sizes of these glands
are shown here diagrammatically. These glands plus microscopic minor salivary
glands throughout the oral mucosa produce 0.75-1.50 L of saliva daily. (Mescher,2016)
•They release a primary secretion that resembles extracellular fluid. This

secretion is modified in the ducts to produce the final secretion.
• Salivary glands are classified according to their types of acini.
• Parotid glands consist of serous acini and are classified as serous.
• Sublingual glands consist mostly of mucous acini capped with
serous demilunes. They are classified as mixed.
• Submandibular glands consist of both serous and mucous acini
(some also have serous demilunes). They are classified as mixed.
• Salivary gland ducts (figure 5.2.8)
• Intercalated ducts originate in the acini and join to form striated ducts.
They may deliver bicarbonate ions into the primary secretion.
• Striated (intralobular) ducts
• Lined by ion-transporting cells that remove sodium and chloride
ions from the luminal fluid (via a sodium pump) and actively
pump potassium and bicarbonate ions into it, thus transforming
the initial saliva (primary saliva) produced by the acinar cells into
secondary saliva, which leaves the striated duct and eventually
enters the oral cavity.
• Striated ducts converge in each lobule to form intralobular ducts
that merge with each other to form interlobular (excretory)
ducts, which run in the connective tissue septa. These ducts drain
34
into the main duct of each gland, which empties into the oral
cavity.
• Saliva
• A hypotonic solution produced at the rate of about 1 L per day.
• Function
• Saliva lubricates and cleanses the oral cavity by means of its water and
glycoprotein content.
• Controls bacterial flora by the action of thiocyanate, lysozyme,
lactoferrin, and IgA, as well as by its cleansing action.
• Initiates digestion of carbohydrates by the action of salivary amylase.
• Acts as a solvent for substances that stimulate the taste buds.
• Assists in the process of deglutition (swallowing).
Figure 5.2.8 Epithelial components of a submandibular gland lobule.
The secretory portions are composed of pyramidal serous (violet) and mucous
(tan) cells. Serous cells are typical protein-secreting cells, with rounded nuclei,
accumulation of rough ER in the basal third, and an apex filled with protein-rich
secretory granules. The nuclei of mucous cells, flattened with condensed
chromatin, are located near the bases of the cells. The short intercalated ducts
are lined with cuboidal epithelium. The striated ducts are composed of
columnar cells with characteristics of ion-transporting cells: basal membrane
invaginations with mitochondrial accumulations. Myoepithelial cells are shown
around the serous acini.
35
1. The flow of saliva is important not only for the easy swallowing of masticated food but
also as a vehicle that facilitates the sensation of taste and the initiation of digestion as well
as for the maintenance of proper oral health. Individuals who had radiation treatment for
cancers of the head and/o r neck and those who are being treated with chemotherapy
frequently have xerostomia, dry mouth, because of reduced salivary gland function.
Frequently, these patients have to use artificial saliva to maintain a moist oral environment.
Usually, subsequent to the cessation of radiation therapy or chemotherapy, salivary gland
function returns to normal.
2. Sjogren syndrome is believed to be an autoimmune disease whose symptoms are
xerostomia, dry eyes, and generally dry mucous membranes. Although there is no cure for
this painful and potentially debilitating disorder, eyedrops, the frequent intake of fluids,
and/or the use of artificial saliva relieve some of the symptoms.
3. Salivary calculus is a calcification that is formed usually in the parotid gland. It may
block the flow of saliva th rough the parotid duct. Occasionally, th e blockage results in the
backflow of saliva, with a concomitant painful swelling of the parotid gland. Frequently, a
simple massage of th e parotid duct can dislodge the stone; otherwise a surgical approach
may be necessa ry.
4. Mumps, a viral infection, usually affects children 5 to 15 years of age but may affect
adults as well. It is usually relatively benign in children, although it may ca use considerable
pain because of th e swelling of the salivary glands. In adult ma les the virus may also cause
swelling of the testes, and in addition to the considerable pain, it may result in sterility if both
testes are involved. In others the pancreas may also become involved, causing pancreatitis
with its attendant symptoms of abdominal pain and mild-to-severe nausea and vomiting.
Fortunately, the symptoms subside with in a week and there are no residual complications.
In a few adults, less than 1 0% of the cases, the mumps virus may also cause
meningoencephalitis that resolves itself in a week or so, but in a very small number of cases,
serious, lifelong complications may result, including deafness and facial paralysis.
B. Pancreas: The pancreas has a slender connective tissue capsule. This gland produces
digestive enzymes in its exocrine portion and several hormones in its endocrine portion (islets
of Langerhans). Blood flow into the pancreas is arranged in such a fashion that the acini
receive arterial blood from vessels dedicated to these structures and the islets of Langerhans
also receive blood dedicated to the islets. Additionally, acini also receive venous blood
drained from the islets of Langerhans, so that hormones, such as somatostatin, released by
those islet cells can reach the acinar cells immediately after release.
• Exocrine pancreas- serous compound tubuloacinar gland.
• Pancreatic acinar cells (figure 5.2.8; figure 5.2.9)
• Pancreatic acinar cells are pyramidal serous cells arranged around a
central lumen.
36
They possess a round basal nucleus, abundant rough endoplasmic
•
reticulum (RER), an extensive Golgi complex, numerous mitochondria,
and many free ribosomes.
• Zymogen (secretory) granules are membrane bound and densely
packed in the apical region of pancreatic acinar cells. They contain
enzymes and pro enzymes packaged in the Golgi complex.
• Basal plasmalemma has receptors for cholecystokinin and
acetylcholine.
• Pancreatic ducts (figure 5.2.8; figure 5.2.9)
• The initial intra-acinar portion of the intercalated ducts is formed by
centroacinar cells, which are low cuboidal with a pale cytoplasm.
• From the initial portion, the intercalated ducts converge into a small
number of intralobular ducts, which in turn empty into large interlobular
ducts that empty into the main (or accessory) pancreatic duct.
• The main pancreatic duct fuses with the common bile duct, forming the
ampulla of Vater, which delivers secretions of the exocrine pancreas
and the contents of the gallbladder into the duodenum at the major
duodenal papilla.
Figure 5.2.8 Pancreas and duodenum.
(a) The main regions of the pancreas are shown in relation to the two pancreatic ducts and the
duodenum. (Mescher,2016)
(b) Micrographs show a pancreatic islet and several pancreatic acini. X75 and X200. H&E. 37
Figure 5.2.9 Pancreatic acini.
(The diagram shows the arrangement of cells more

clearly. Under the influence of secretin, the centroacinar
and intercalated duct cells secrete a copious HCO3−-rich
fluid that hydrates, flushes, and alkalinizes the enzymatic
secretion of the acini. (Mescher, 2016)
• Exocrine pancreatic secretions

• Enzyme-poor alkaline fluid
• Enzyme-poor alkaline fluid is released in large quantities by
intercalated duct cells stimulated by secretin in conjunction with
acetylcholine.
• Function. It probably neutralizes the acidic chyme as it
enters the duodenum.
• Digestive enzymes Synthesized and stored in the pancreatic
acinar cells.
• Their release is stimulated by cholecystokinin (previously
known as pancreozymin) and costimulated by
acetylcholine released by postganglionic
parasympathetic fibers.
• Digestive enzymes are secreted as enzymes or
proenzymes that must be activated in the intestinal
lumen.
• Enzymes include pancreatic amylase, pancreatic lipases,
ribonuclease, and deoxyribonuclease; proenzymes
38
include trypsinogen, chymotrypsinogen,
procarboxypeptidase, and pro elastase.
• In order to protect themselves from the digestive enzyme
trypsin, these cells manufacture trypsin inhibitor so that
trypsinogen cannot be converted to trypsin within the
cytosol.
• Islets of Langerhans (endocrine pancreas) (Table 5.2.2)
• Islets of Langerhans are richly vascularized spherical clusters (100-200 11m in
diameter) of endocrine cells surrounded by a fine network of reticular fibers.
They are scattered among the acini of the exocrine pancreas in an apparently
random fashion.
• Islet cells (Table 5.2.2)
• Islet cells are of several types that can be differentiated from each
other only by immunocytochemistry or by the use of special stains.
• They produce several polypeptide hormones, but each cell type
produces only one hormone.
• Islet hormones
• Glucagon is produced by α-cells and acts to elevate the blood glucose
level.
• Insulin is produced by β-cells and acts to decrease the blood glucose
level.
• Mechanism of insulin release. Increased blood glucose levels
cause glucose to bind to transmembrane proteins (glucose
transporter protein 2 [GLUT-2]) of β-cells, which induces these
cells to release their stored insulin and, if necessary, synthesize
more insulin.
• This uptake of glucose occurs in a manner that does not
require the presence of insulin.
• Mechanism of insulin action. Insulin causes the transport of
glucose and amino acids into hepatocytes, fat cells, cardiac
muscle cells, and skeletal muscle cells.
• It does so by binding to the extracellular moiety of
transmembrane insulin receptors of these cells, which
triggers a response from the intracellular component that
includes the placing of glucose transporter protein 4
(GLUT-4) on the cell membranes of fat cells and skeletal
muscle and cardiac muscle cells, and glucose enters
these cells by way of GLUT-4. Unlike in the case of GLUT-2,
this uptake of glucose occurs in a manner that requires the
presence of insulin.
• Somatostatin and vasoactive intestinal peptide are produced by δ-cells
and δ1 -cells (D cells and D1 cells), respectively.
• Somatostatin inhibits the release of hormones by nearby
secretory cells; it also inhibits the release of pancreatic enzymes
and hydrochloric acid (HCl) production by parietal cells in the
39
stomach and reduces the motility of the gastrointestinal tract
and gallbladder by decreasing the contraction of their smooth
muscles.
• Vasoactive intestinal peptide induces glycogenolysis in the liver
and adjusts gut motility and secretion of ions and water.
• Gastrin, produced by G cells, stimulates (in conjunction with histamine
and acetylcholine) gastric HCl secretion.
• Pancreatic polypeptide, produced by PP (pancreatic polypeptide-
producing) cells, inhibits release of exocrine pancreatic secretions and
the release of bile from the gallbladder.
• Ghrelin, produced by Epsilon (ε) cells, produces the feeling of hunger.
Table 5.2.2 Comparison of Secretory Cells in Islets of Langerhans (Gartner,2015)
40
1. lnsulinomas -Individuals who have low blood glucose and high blood insulin levels may
be suffering from insulinoma, a tumor of the β-cells of the islets of Langerhans. lnsulinomas
are benign in 90% of the cases, and the condition is usually resolved by surgical excision
of the tumor.
2. Type 1 (insulin-dependent) diabetes mellitus (lDDM)
• IDDM results from a low level of plasma insulin.
• Characterized by polyphagia (in satiable hunger), polydipsia (unquenchable
thirst), and polyuria (excessive urination).
• It usually has a sudden onset before 20 years of age and is distinguished by
damage to and destruction of β- cells of the islets of Langerhans. Because of its
early onset, IDDM is also known as juvenile-onset diabetes mellitus.
• It is treated with a combination of insulin therapy and diet.
3. Type 2 (non-insulin-dependent) diabetes mellitus (NIDDM)
• NIDDM does not result from low levels of plasma insulin and is insulin resistant, which
is a major factor in its pathogenesis. The resistance to insulin is due to decreased
binding of insulin to its plasmalemma receptors and to defects in post receptor
insulin action.
• It commonly occurs in overweight individuals older than 40 years.
• It is usually controlled by diet.
• Older individuals with type 2 diabetes often present with memory problems
probably because amyloid-j3-derived diffusible ligands (ADDLs) bind to the
presynaptic membranes of the axons of certain neurons that are responsible for
memory storage.
• This condition prevents the replenishment of insulin receptors of these axons, even
though the receptors, synthesized in the soma, are available in the soma's
cytoplasm. Apparently, the receptors are prevented from being transferred from
the cytosol of the soma to the axoplasm of the axon. This makes these neurons
insulin resistant and unable to regulate their glucose metabolism, and in turn, these
neurons cannot function normally, and the patient has memory loss and Alzheimer
disease-associated dementia. Some researchers suggest this to be type 3
diabetes. Despite our understanding that the brain is not insulin dependent, that is
different from being insulin responsive, a study by Gray (2014) explains the
physiology of insulin receptors in the brain.
4. Pancreatic cancer is a malignant neoplasm, and most patients die within 6 months to 1
year after diagnosis.
• Most of the cases are adenocarcinomas in the h e a d o f the pancreas. Its
incidence is three to fo ur times greater in male patients than in female patients.
Although its symptoms include anorexia, flatulence, fatty stool if the bile duct is
obstructed, sudden loss of weight, weakness, back pain, and jaundice, exploratory
biopsy is commonly re quired for a definitive diagnosis.
5. Blood glucose level in a fasting, nondiabetic individual should be between 80 and 110
mg per 1 00 ml (4.4 to 6.1 mmol per L) of blood.
• If the glucose levels rise above that level, the βcells release insulin. If the blood
glucose levels fall below that level, the a- cells release glucagon. Additional
control mechanisms include the neurotransmitters released by the cells of the
autonomic nervous system, namely: sympathetic fibers increase glucagon
secretion and inhibit insulin secretion, whereas parasympathetic fibers increase
both insulin and glucagon secretions in order to maintain a balanced homeostasis. 41
C. Liver composed of a single type of parenchymal cell, the hepatocyte.
• It is the largest gland in the body, weighing as much as 1.5 kg.
• It is surrounded by a dense, irregular collagenous connective tissue known as Glisson
capsule, which gives rise to septa that subdivide the liver into its four lobes (right, left,
caudate, and quadrate lobes) and its enormous number of lobules.
• Function. The liver produces bile and plasma proteins and has a myriad of other
functions.
• Liver lobules (figure 5.2.10)

• The classic liver lobule is a hexagonal mass of tissue primarily composed of
plates of hepatocytes (liver cel ls), which radiate from the region of the central
vein toward the periphery (figure 5.2.10).
• Portal areas (portal canals or portal triads) regions of the connective
tissue between lobules that contain branches of the portal vein, hepatic
artery, lymph vessel, and bile duct.
• They are present at alternate corners of a classic liver lobule.
• Each portal area is surrounded by the limiting plate, a cylindrical plate
of modified hepatocytes. A narrow space, known as the space of Moll,
separates the limiting plate from the connective tissue elements of the
portal area.
Figure 5.2.10. A portion of the classic liver lobule showing the area served by one
portal triad. (Gartner,2015)
• Liver sinusoids
• Sinusoidal capillaries that arise at the periphery of a lobule and
run between adjacent plates of hepatocytes.
42
• They receive blood from the vessels in the portal areas and
deliver it to the central vein.
• They are lined by sinusoidal lining cells (endothelial cells) that
have large discontinuities between them, display fenestrations,
and lack basal laminae.
• The lining of the sinusoid also contains phagocytic cells (Kupffer
cells) derived from monocytes; these cells are interspersed
among the sinusoidal lining cells but form no junctions with them.
Kupffer cells remove debris, old erythrocytes, and cellular
fragments from the bloodstream.
• Space of Disse
• Subendothelial space between hepatocytes and the cells lining
the sinusoids.
• It contains the short microvilli of hepatocytes, reticular fibers
(which maintain the architecture of the sinusoids), and
occasional nonmyelinated nerve fibers.
• Contains stellate-shaped fat-storing cells (Ito cells, also known as
perisinusoidal stellate cells), which preferentially store vitamin A.
However, when the liver is compromised, hepatocytes release
tumor growth factor J3, and in response, these fat-storing cells
can divide, change their phenotype, and begin to synthesize
collagen, leading to fibrosis and, if necessary, differentiate into
myofibroblasts to control blood flow into the sinusoids.
• Function The space of Disse functions in the exchange of material
between the bloodstream and hepatocytes. Hepatocytes do
not directly contact the bloodstream
• Portal lobule
• a triangular region with three apices that are neighboring central
veins and a center in a portal area (figure 5.2.11).
• It contains portions of three adjacent classic liver lobules.
• The portal lobule is defined in terms of bile flow. In this concept of
liver lobulation, the bile duct is in the center of the lobule.
• Hepatic acinus of Rappaport
• diamond-shaped region encompassing triangular sections of
two adjacent classic liver lobules (with apices that are the central
veins) and is divided by the common distributing vessels (figure
5.2.11).
• This concept of liver lobulation is defined in terms of blood flow
from the distributing vessels in a single portal area. This concept
was established to explain the histologic appearance of
pathologic changes that occur in liver disease.
• The hepatic acinus of Rappaport can be divided into three zones
on the basis of the proximity of the hepatocytes to the incoming
blood.
43
Figure 5.2.11. The defining characteristics of the classic liver lobule,
porta l lobule, and liver hepatic aci nus of Rappaport. Observe the
zonulation within the acinus of Rappaport. (Gartner,2015)
• Blood, bile, and lymph flow (figure 5.2.10)

• Blood flow into the liver is derived from two sources and is directed from the
portal triads at the periphery of each classic liver lobule toward the central
vein.
• The hepatic artery brings oxygen-rich blood from the abdominal aorta
and supplies 20% to 30% ofthe liver's blood.
• The portal vein brings nutrient-rich blood from the alimentary canal and
spleen; it supplies 70% to 80% ofthe liver's blood.
• Blood flow out of the liver occurs via the hepatic vein, formed by the union of
numerous sublobular veins, which collect blood from the central veins (figure
5.2.10).
• Bile flow is directed toward the periphery of the classic liver lobule (in
the opposite direction of blood flow). Bile is carried in a system of ducts
that culminate in the left and right hepatic ducts, which leave the liver
and carry bile to the gallbladder. a. Bile canaliculi
• Bile canaliculi (5.2.12)
• are expanded intercellular spaces between adjacent
hepatocytes that form tiny canals for the initial flow of bile.
• They receive the liver's exocrine secretion (bile) and carry
it to the canals of Hering (bile ductules) at the very
44
periphery of classic liver lobules. The canals of Hering are
composed of both modified hepatocytes and low
cuboidal cholangiocytes (duct cells).
• Cholangiocytes of the canals of Hering or cells that
resemble cholangiocytes and reside as cells of the canals
of Hering can act as regenerative cells both of the liver as
well as of bile ductules and bile ducts. It has been
demonstrated that even if 50% of the liver is excised, it can
regenerate to its previous size of 1.5 kg. b. Bile ducts
• Bile ducts are located in the portal areas and are composed of
a single layer of cuboidal shaped cholangiocytes.
• The apical surface of each cholangiocyte faces the
lumen of the bile duct and displays numerous short
microvilli as well as a single, long primary cilium that
monitors bile flow and bile composition within the bile
duct.
• They receive bile from the canals of Hering.
• They enlarge and fuse to form the hepatic ducts,
composed of a stratified epithelium of cholangiocytes,
which leave the liver at the porta hepatis
• Lymph in the liver collects in the space of Moll and is drained from there
by branches of the lymph vessels located in the portal areas. As these
lymph vessels coalesce, they increase in size and eventually form one
or two larger lymph vessels that join the thoracic duct to return the lymph
into the blood vascular system at the junction of the left subclavian and
left internal jugular veins.
• Hepatocytes
• Hepatocytes are large polyhedral cells (20-30 flm in diameter) that possess
abundant RER and smooth endoplasmic reticulum (SER); numerous
mitochondria, lysosomes, and peroxisomes; several Golgi complexes; and
many lipid droplets and glycogen deposits.
• They usually contain one round central nucleus; about 25% of the cells are
binucleated. Occasionally, nuclei are polyploid.
• Their average lifespan is approximately 5 months. tahir99-VRG & vip.persianss.ir
• Hepatocyte surfaces:
• Hepatocyte surfaces facing the space of Disse possess microvilli, which
by increasing the surface area facilitate the transfer of materials (e.g.,
endocrine secretions into the blood and nutrients into the hepatocytes)
between the hepatocytes and the blood.
• Abutting surfaces of adjacent hepatocytes
• frequently delineate bile canaliculi, small, tunnel-like expansions
of the intercellular space.
• The bile canaliculi are sealed off from the remaining intercellular
space by occluding junctions located on each side of each
canaliculus.
45
• possess microvilli that extend into the bile canaliculus.
• also have gap junctions.
• Hepatic functions carried out by hepatocytes
• Exocrine secretion involves the production and release of 600 to 1,200 mL of
bile per day. Bile is a fluid composed of bilirubin glucuronide (bile pigment),
bile acids (bile salts), cholesterol, lecithin, phospholipids, ions, IgA, and water.
Hydrophobic bilirubin, a breakdown product of hemoglobin, is converted into
water-soluble bilirubin glucuronide (a nontoxic compound) in the SER of the
hepatocytes.
• Endocrine secretion involves the production and release of several plasma
proteins (e.g., prothrombin, fibrinogen, albumin, factor III, and lipoproteins) and
urea. Hepatocytes can also manufacture and release nonessential amino
acids.
• Metabolites are stored in the form of glycogen (stored glucose) and
triglycerides (stored lipid).
• Gluconeogenesis is the conversion of amino acids and lipids into glucose, a
complex process catalyzed by a series of enzymes.
• Detoxification entails the inactivation of various substances, such as drugs,
noxious chemicals, and toxins, by enzymes, such as the microsomal mixed-
function oxidase system, that catalyze the oxidation, methylation, or
conjugation of such substances. These reactions usually occur in the SER or in
peroxisomes, as in the case of alcohol.
• lgA transfer involves the uptake of IgA across the space of Disse and its release
into bile canaliculi. IgA is transported through the hepatobiliary duct system to
the intestine, where it serves an immunologic protective function. This process
is referred to as the enterohepatic circulation.
• Hepatic functions carried out by cells other than hepatocytes
• Ito cells store vitamin A.
• Kupffer cells phagocytose unwanted materials.
Figure 5.2.12 Bile ductules.

Near the periphery of each hepatic lobule, many bile canaliculi join with the much larger bile canals of
Hering, which are lined by cuboidal epithelial cells called cholangiocytes. These canals soon join the bile
ductules in the portal areas and drain into the biliary tree. 46
D. Gallbladder
• communicates with the common hepatic duct via the cystic duct, which originates
at the neck of the gallbladder.
• It has a muscular wall whose contraction, stimulated by cholecystokinin (possibly in
conjunction with acetylcholine), forces bile from its lumen into the duodenum.
• The wall has four layers:
• The mucosa is composed of a simple columnar epithelium and a richly
vascularized lamina propria. When the gallbladder is empty, the mucosa
displays highly convoluted folds (Figure 17 .5). 2.
• The muscle layer is composed of a thin, oblique layer of smooth muscle cel ls.
• The connective tissue layer consists of dense irregular collagenous connective
tissue and houses nerves and blood vessels.
• The serosa covers most of the gallbladder, but adventitia is present where the
organ is attached to the liver.
• Function
• The gallbladder concentrates, stores, and releases bile.
• It removes approximately 90% of the bile's water content by the
manipulation of the subepithelial connective tissue electrolyte levels. It
does so by actively removing sodium, chloride, and bicarbonate ions
from the epithelial cells using energy-requiring pumps in the epithelial
cell's basal plasmalemma, which, in turn, causes water to leave the cell,
passively, via aquaporin l and aquaporin 8 channels. To equilibrate the
osmotic differences between the bile in the lumen of the gallbladder
and the epithelial cells lining the lumen, water moves from the bile into
the epithelial cells because of the processes just described.
1. Hepatitis is an inflammation of th e liver, usually due to a viral infection but occasionally
due to toxic materials.
a. Viral hepatitis A (infectious hepatitis) is c a used by hepatitis A virus, which is frequently
transmitted by the fecal-oral route. It has a short incubation period (2-6 weeks), and is
usually not fata l but may cause jaundice.
b. Viral hepatitis B (serum hepatitis) is c a used by hepatitis B virus, which is transmitted by
blood and its derivatives.
i. It has a long incubation period (6 weeks to 5 months).
ii. Its clinical symptoms are like those associated with viral hepatitis A, but with more
serious consequences, including cirrhosis, jaundice, and death.
c. Viral hepatitis C is caused by hepatitis C virus and is responsible for most transfusion
related cases of hepatitis. It is also associated with hepatocellular carcinoma.
2. Jaundice (icterus)
a. Jaundice is characterized by excess bilirubin in the blood and deposition of bile pigment
in the skin and sclera of the eyes, resulting in a yellowish appearance.
b. It m ay be hereditary or caused by pathologic conditions, such as excessive destruction
of red blood cells (hemolytic jaundice), liver dysfunction, and obstruction of the biliary
passages (obstructive jaundice).
47
1. Gallstones (biliary calculi)
a. Gallstones are concretions, usually of fused crystals of cholesterol, which form in the
gallbladder or bile duct.
b. Accumulation of gallstones may lead to th e blockage of the cystic duct, which prevents
emptying of the gallbladder.
c. Gallstones may have to be surgically removed if less-invasive methods fail to dissolve or
pulverize them.
2. Inflammation of the gallbladder, whether chronic or acute, usually due to the presence of
gallstones, obstructing the access to the cystic duct, is known as cholecystitis.
• Chronic cholecystitis is frequently the result of multiple bouts of acute cystitis.
• The acute form of the condition is quite painful, and the pain is experienced in the upper
right quadrant of the abdomen and may be so severe as to induce nausea and vomiting.
Frequently, the condition is treated by surgical removal of the gallbladder.
48
URINARY SYSTEM
UNIT 3
Lecture Activity 5.3.1 Getting it together
The respiratory system is capable of absorbing oxygen and excreting carbon dioxide. The
digestive system absorbs nutrients from the diet and excrete indigestible material including wastes.
Likewise, the urinary system is capable of absorbing and excreting water and electrolytes according
to the needs of the body. These functions may appear to be distinct and separate from each other,
but the systems are so organized that they are interdependent on each other and together contribute
to the welfare of the body by keeping it in balance or in a state of homeostasis. Create a concept
map that illustrates the physiology of acid base balance that unites the three systems (Respiratory,
Digestive and Urinary systems) together.
9-10 6-8 3-5 0-2

CONTENT
correct correct
LOGIC AND
UNDERSTANDING
errors
49
Lecture Activity 5.3.2 Read
UNIT 5.3 Urinary System

Introduction
The Urinary system is the major excretory system of

the body. Other organs are also capable of excretory
functions but once the kidney fails, the other excretory
systems cannot compensate to bring the body back into homeostasis. The kidneys can suffer extensive
damage and still maintain homeostasis. If a third of the kidney function is intact survival is possible.
However, if, the functional ability of the kidneys fail completely, death will result unless the person
receives medical treatment.
The urinary system consists of two kidneys and two ureters that lead to a single urinary bladder,
and a single urethra that continues form the bladder to the exterior of the body. They are large bean
shaped organs located retroperitoneally adjacent to the posterior body wall. The concave medial
border of the kidney is the hilum, which contains three large structures, the renal artery, renal vein and
funnel shaped renal pelvis that becomes the ureter. Surrounding these structures is loose connective
tissue and a fat filled space called the renal sinus.
The functional unit of the kidney is the uriniferous tubules. It consists of the nephron and collecting
duct into which empty the filtered contents of the nephron. Millions of nephrons are present in each
kidney cortex, the nephron in turn is subdivided into two components, a renal corpuscle and renal
tubules.
1. Function:
• Regulation of the balance between water and electrolytes (inorganic ions) and the
acid base balance
• Excretion of metabolic wastes along with excess water and electrolytes in urine
• Excretion of many bioactive substances, including many drugs
• Regulation of arterial blood pressure by secretion of renin
• Secretion of erythropoietin, a glycoprotein growth factor that stimulates erythrocyte
production in red marrow when blood oxygen level is low
• Conversion of the steroid prohormone vitamin D, initially produced in the epidermis to
the active form- calcitriol
• Gluconeogenesis during starvation or periods of prolonged fasting, making glucose
from amino acids to supplement this process int eh liver
A. Kidneys
• Hilum- concave medial border where nerves enter, ureter exits and blood and lymph
vessels enter and exit- lateral border is convex covered by a thin fibrous capsule
50
• Renal pelvis- upper expanded end of the ureter which divides into :
• Major calyces- there are about 2-3 of them which form smaller branches,
• Minor calyces- smaller branches of the Major calyces
• Renal cortex- outer darker region with many corpuscle and cross section of tubules
• Renal medulla-inner layer consisting of 8-12 conical structures called renal pyramids
which are separated by extensions the cortex called renal columns.
• Renal lobe- each pyramid plus the cortical tissue at its base and along its sides
• Renal lobule- consist of the central medullary ray and the closely associated cortical
tissue on either side of it, extending as far as in interlobular artery. Its many nephrons
drain into the collecting tubules of the medullary ray
• Medullary rays- striations extending from the medulla into the cortex
• Renal papilla- tip of the renal papilla that projects into a minor calyx that collects urine
formed by tubules in the pyramid
• The renal interstitium- connective tissue compartment of the kidney. It is scanty in the
cortex, occupying less than 10% of the cortical volume, and somewhat greater in the
medulla, occupying about 20% of the medullary volume.
• Consists primarily of fibroblasts and mononuclear cells (probably
macrophages).
• In the medulla, it consists of two additional cell types:
• Pericytes are located along the blood vessels that supply the loops of
Henle.
• Interstitial cells have long processes that extend toward (and perhaps
encircle) capillaries and tubules in the medulla. These cells manufacture
medullipin I, a vasodepressor hormone that is converted to medullipin
II in the liver. Medullipin II is a vasodilator that acts to reduce blood
pressure.
B. Nephron (Table 5.3.1) consist of a renal corpuscle, proximal tubule (composed of the
proximal convoluted tubule and the pars recta of the proximal tubule), thin descending limb
of Henle loop, Henle loop, thin ascending limb of Henle loop, and distal tubule (composed
of the pars recta of the distal tubule, the very short macula densa, and the distal convoluted
tubule). Unfortunately for the student, the pars recta of the proximal tubule is also known as
the descending thick limb of Henle loop, and the pars recta of the distal tubule is also known
as the ascending thick limb of Henle loop.
• Classification. Nephrons can be classified according to location of the renal
corpuscle:
• Cortical- near the capsule,
• Mid-cortical- between the other two.
• juxtamedullary- near the corticomedullary junction
51
Table 5.3.1 Important Structural and Functional Characteristics of the Uriniferous Tubule
• Juxtamedullary nephrons possess longer loops of Henle than do
cortical or mid-cortical nephrons and are responsible for
establishing the interstitial concentration gradient in the medulla.
52
Even though only about 15% of all nephrons are juxtamedullary
nephrons
• A renal corpuscle (figure 5.3.1) consists of the glomerulus and Bowman capsule and
is the structure in which the filtration of blood occurs.
• Bowman capsule
• The parietal layer is the simple squamous epithelium that lines the outer
wall of the Bowman capsule.
• The visceral layer (glomerular epithelium) is the modified simple
squamous epithelium composed of podocytes that lines the inner wall
of the Bowman capsule and envelops the glomerular capillaries.
• Bowman space (also known as capsular space or urinary space) is the
narrow chalice shaped cavity between the visceral and parietal layers
into which the ultrafiltrate passes.
• The vascular pole is the site on Bowman capsule where the afferent
glomerular arteriole enters and the efferent glomerular arteriole leaves
the glomerulus.
• The urinary pole is the site on Bowman capsule where the capsular
space becomes continuous with the lumen of the proximal convoluted
tubule.
• Podocytes are highly modified epithelial cells that form the visceral layer of
Bowman capsule and synthesize glomerular endothelial growth factor, a
signaling molecule that facilitates the formation and maintenance of the
glomerular endothelial cells.
• Podocytes have complex shapes and possess several primary processes
that give rise to many secondary processes called pedicels.
• Pedicels
• Pedicels embrace the glomerular capillaries and
interdigitate with pedicels arising from other primary
processes.
• Their surfaces facing Bowman space are coated with
podocalyxin, a protein that is thought to assist in
maintaining their organization and shape.
• Pedicels possess α2β1integrin molecules that cause them
to adhere to the basal lamina.
• Filtration slits are elongated spaces about 40 nm in width
between adjacent pedicels. A filtration slit diaphragm bridges
each filtration slit and is the principal structure that is the barrier
responsible for the filtration of proteins.
• Each slit diaphragm is composed of the extracellular
portion of the transmembrane protein nephrin of one
pedicel that contacts the extracellular portion of nephrin
from the adjacent pedicel.
53
• The renal glomerulus is the tuft of capillaries that extends into
the Bowman capsule.
• Glomerular endothelial cells (figure 5.3.2)
• form the inner layer of the capillary walls.
• have a thin cytoplasm that is thicker around the
nucleus, where most organelles are located.
• possess large fenestrae (60-90 nm in diameter) but
lack the thin diaphragms that typically span the
openings in other fenestrated capillaries.
• The basal lamina is between the podocytes and the
glomerular endothelial cells and is manufactured by both
cell populations. It is unusually thick (0.15-0.5 um) and
contains three distinct zones:
• The lamina rara externa, an electron-lucent zone
adjacent to the podocyte epithelium.
• The lamina densa, a thicker, electron-dense
Figure 5.3.1 Renal Corpuscle intermediate zone of amorphous material.
(Gartner, 2015) • The lamina rara interna, an electron-lucent zone
adjacent to the capillary endothelium.
• The mesangium is the interstitial tissue between glomerular
capillaries. It is composed of mesangial cells and an
amorphous extracellular matrix elaborated by these cells.
• Mesangial cells
• phagocytose large protein molecules and
debris, which may accumulate during
filtration or in certain disease states.
• can also contract, thereby decreasing the
surface area available for filtration.
• possess receptors for angiotensin II and atrial
natriuretic peptide.
• manufacture platelet-derived growth
factor, endothelins, inteleukin-1, and
prostaglandin E2 •
• Renal filtration barrier (figure 5.3.2)

• Structure. The renal filtration barrier is composed
of the fenestrated endothelium of the glomerular
5.3.2 Filtratiion Barrier (Gartner,
capillaries, the basal lamina (laminae rarae and lamina
2015)
densa), and the filtration slit diaphragm bridging the
filtration slits between adjacent pedicels filtration slit
diaphragm
• Function. The renal filtration barrier permits passage of
water, ions, and small molecules from the bloodstream
54
into the capsular space but prevents passage of large
and/or most negatively charged proteins, thus forming an
ultrafiltrate of blood plasma in the Bowman space.
• The laminae rarae contain heparan sulfate, a
polyanionic glycosaminoglycan that assists in
restricting the passage of negatively charged
proteins into the Bowman space.
• The lamina densa contains type IV collagen
(composed of a3, a4, and a5 chains rather than
the a1 and a.z chains present in most other lamina
densa), perlacan, lam in in, entactin, and agrin. The
negative charges of some of these
macromolecules and the filtration slit diaphragm
act as a selective macromolecular filter,
preventing the passage of large protein molecules
(molecular weight greater than 69,000 Da) into the
Bowman space
Glomerulonephritis 1. type of nephritis characterized by inflammation of the glomeruli.
2. It is sometimes marked by proliferation of podocytes, endothelial cells, and mesangial
cells in the glomerular tuft; infiltration of leukocytes is also common.
3. often occurs secondary to a streptococcal infection elsewhere in the body, which is
thought to result in deposition of immune complexes in the glomerular basal lamina. The
immune complexes damage th e glomerular basal lamina and markedly reduce its filtering
ability.
4. It may also result from immune or autoimmune disorders.
5. It is associated with production of urine-containing blood (hematuria), protein
(proteinuria), or both; in severe cases, decreased urine output (oliguria) is common.
6. It occurs in acute, subacute, a n d chronic form. The chronic form, in which the destruction
of glomeruli continues, leads eventually to renal failure and death.
Chronic Renal Failure
1. Chronic renal failure can res lt from a variety of diseases (e.g., diabetes mellitus,
hypertension, atherosclerosis) in which blood flow to the kidneys is reduced, causing a
decrease in glomerular filtration and tubular ischemia.
2. It is associated with pathological changes (hyalinization) in the glomeruli and atrophy of
the tubules, which impair virtually all aspects of renal function.
3. It is marked by acidosis and hyperkalemia because the acid-base balance cannot be
maintained, and by uremia because of t e inability to eliminate metabolic wastes.
4. If untreated, chronic renal failure leads to neurological problems, coma, and death
55
• Proximal convoluted tubule (figure 5.3.3)
• The proximal convoluted tubule is lined by a single layer of irregularly shaped
(cuboidal to columnar) epithelial cells that have microvilli forming a prominent
brush border. These cells exhibit the following structures:
• Apical canaliculi, vesicles, and vacuoles (endocytic complex), which
function in protein absorption.
• Prominent interdigitations along their lateral borders, which interlock
adjacent cells with one another.
• Numerous mitochondria compartmentalized in the basal region by
extensive infoldings of the basal plasma membrane, which supply
energy for the active transport of Na + out of the tubule.
• Apically situated occluding junctions that block the paracellular
pathway. And the apical cell membrane has glucose transporters,
Na+K+ -ATPase pump, and an apically positioned tubulovesicular
system designed to endocytose small proteins and peptides that
escaped into the ultrafiltrate.
• Basolateral cell membrane possesses Na +K+ -ATPase pump, and,
additionally, the basal cell membrane has glucose and amino acid
transporters.
• Each cell also possesses a primary cilium that functions in monitoring the
flow and composition of the ultrafiltrate.
• Function
• The proximal convoluted tubule drains the Bowman space at the
urinary pole of the renal corpuscle.
• It resorbs from the glomerular filtrate all of the glucose, amino
acids, and small proteins and 60% to 80% of the sodium chloride
and water and returns it into the peri tubular capillary system to
be distributed from there into the remainder of the body.
• It exchanges H+ in the interstitium for HC03- in the filtrate.
• It secretes organic acids (e.g., creatinine) and bases and certain
foreign substances into the filtrate.
• Loop of Henle (figure 5.3.3)
• Descending thick limb of the Henle loop
• The descending limb of the Henle loop is also known as the
straight portion (pars recta) of the proximal tubule.
• It is lined by a simple cuboidal epithelium that has a prominent
brush border and is similar to that lining the proximal convoluted
tubule.
• Its function is to resorb, exchange, and secrete in a manner
similar to that of the proximal convoluted tubule.
• Thin limb of the Henle loop
• The thin limb of the Henle loop is composed of a descending
segment, a loop, and an ascending segment, all of which are
lined by simple squamous epithelial cells possessing a few short
microvilli. The nuclei of these cells bulge into the lumen.
56
• In juxtamedullary nephrons, the thin limb can be divided into
three distinct portions on the basis of the four different types of
simple squamous epithelial cells that form it, their organelle
content, the depth of their tight junctions, and their permeability
to water.
• Cells of the descending thin limb possess many aquaporin
l channels and, therefore, this segment is very permeable
to water as well as being somewhat permeable to ions
such as sodium and chloride.
• Henle loop itself is similar to the ascending thin limb and is
mostly impermeable to water.
• The ascending thin limb is almost completely
impermeable to water but possesses many sodium and
chloride channels, which permit these ions to enter the
cell from the lumen of the tubule and exit the cell into the
renal interstitium. Additionally, urea enters the lumen of
the ascending thin limb.
• Ascending thick limb of the Henle loop
• The ascending thick limb of the Henle loop is also known
as the straight portion (pars recta) of the distal tubule.
• It is lined by cuboidal epithelial cells that possess only a
few microvilli, an apical nucleus, and mitochondria
compartmentalized within basal plasma membrane
infoldings. These cells manufacture and release a
glycoprotein known as uromodulin (Tamm-Horsfall
glycoprotein) that reduces the ability of the kidney to form
kidney stones and in some fashion reduces the possibility
of urinary tract infections. Moreover, uromodulin also
modulates the mechanism of urine concentration.
• It establishes a gradient of osmolarity in the medulla (see
Section V).
• The ascending thick limb returns to the renal corpuscle of
origin, where it is in close association with the afferent and
efferent glomerular arterioles. In this region, the wall of the
tubule is modified, forming the macula densa, which is
part of the juxtaglomerular apparatus (JG apparatus).
• JG apparatus (juxtaglomerular apparatus) is located at the vascular pole of
the renal corpuscle.
• Components of the JG apparatus
• JG cells (juxtaglomerular cells)
• are modified smooth muscle cells that exhibit some
characteristics of protein secreting cells.
• are located primarily in the wall of the afferent arteriole,
but a few may also be present in the wall of the efferent
arteriole.
57
synthesize renin (a proteolytic enzyme) and store it in
•
secretory granules.
• Macula densa cells
• are tall, narrow, closely packed epithelial cells of the
distal tubule.
• have elongated, closely packed nuclei that appear as a
dense spot (macula densa) by light microscopy.
• may monitor the osmolarity and volume of the fluid in the
distal tubule and transmit this information to JG cells via
the gap junctions between the two cell types. When the
sodium concentration or the volume of the ultrafiltrate is
reduced, the macula densa cells direct the JG cells to
release their renin.
• Extraglomerular mesangial cells
• are also known as polkissen (pole cushion) or lacis cells.
• lie between the afferent and efferent glomerular
arterioles, but their functions are not understood.
• Function. The JG apparatus maintains blood pressure by the following
mechanism:
• Stimuli:A decrease in extracellular fluid volume (perhaps
detected by the macula densa as decreased ultrafiltrate
volume), a decrease in blood pressure at the afferent glomerular
arteriole, or a decrease in sodium concentration of the
ultrafiltrate stimulates JG cells to release renin into the
bloodstream.
• Renin acts on angiotensinogen (a large protein manufactured
by hepatocytes of the liver) in the plasma. Renin cleaves the first
10 amino acids from angiotensinogen, converting it to the
decapeptide angiotensin I. In capillaries of the lung and
elsewhere, angiotensin-converting enzyme cleaves two amino
acids from angiotensin I, converting it to angiotensin II, a potent
vasoconstrictor that stimulates release of aldosterone in the
adrenal cortex and the release of antidiuretic hormone (ADH) by
the neurohypophysis.
• Aldosterone stimulates the epithelial cells of the distal convoluted
tubule to remove Na + and cr. Water follows the ions, thereby
increasing the fluid volume in the extracellular compartment,
which leads to an increase in blood pressure.
• ADH causes the epithelial cells (mainly the principal cells) of the
collecting tubule to add aquaporin 2 (AOP-2) channels (as well
as AQP-3 and AQP-4 channels) to their cell membrane and thus
become permeable to water, releasing H20 into the renal
interstitium. As with the aldosterone mechanism discussed
above, the increased extracellular fluid volume leads to
elevation of the blood pressure.
58
• Distal convoluted tubule (figure 5.3.3)
• The distal convoluted tubule is continuous with the macula densa and
is similar histologically to the ascending thick limb of the Henle loop. b.
• It is much shorter and has a wider lumen than the proximal convoluted
tubule and lacks a brush border.
• Function. The distal convoluted tubule resorbs Na+ from the filtrate and
actively transports it into the renal interstitium; this process is stimulated
by aldosterone. It also transfers K+, NH4 +, and H+ into the filtrate from
the interstitium.
• Connecting tubule (figure 5.3.3) is a short segment between the distal
convoluted tubule and the collecting tubule into which it drains. It is lined by
the following two types of epithelial cells:
• Principal cells have many infoldings of the basal plasma membrane.
These cells remove Na+ from the filtrate and secrete K+ into it. b.
• Intercalated cells have many apical vesicles and mitochondria. These
cells remove K+ from the filtrate and secrete H+ into it.
• Collecting tubules (figure 5.3.3) have an embryological origin different from
that of nephrons. They have segments in both the cortex and the medulla and
converge to form larger and larger tubules.
• Cortical collecting tubules are located primarily within medullary rays,
although a few are interspersed among the convoluted tubules in the
cortex (cortical labyrinth). They are lined by a simple epithelium
containing two types of cuboidal cells. Principal (light) cells possess a
round central nucleus and a single primary cilium. It is these cells that
are responsible for the ability of the collecting tubules to concentrate
urine.
• Intercalated (dark) cells are less numerous than principal cells and
possess microplicae (folds) on their apical surface and numerous apical
cytoplasmic vesicles. There are two types of intercalated cells:
• a-interca lated cells that have the ability to release H + ions into
the tubular lumen and reabsorb HCO3, thus acidifying urine via
H+ and H+/K+ exchanger
• possess hydrogen pumps
• β-intercalated cells that have the ability to release HC03- ions
into the tubular lumen and reabsorb acid, thus causing the urine
to be more alkaline. a-Intercalated cells,
• HC03- pumps to fulfill their function.
• Medullary collecting tubules. In the outer medulla, medullary collecting tubules
are similar in structure to cortical collecting tubules and contain both principal
and intercalated cells in their lining epithelium. In the inner medulla, the
collecting tubules are lined only by principal cells.
• Papillary collecting tubules (ducts of Bellini)
• Papillary collecting tubules are large collecting tubules (200-300 Jlm in
diameter) formed from converging smaller tubules.
59
• They are lined by a simple epithelium composed of columnar cells that
have a single primary cilium.
• They empty at the area cribrosa, a region at the apex of each renal
pyramid that has 10 to 25 openings through which the urine exits into a
minor calyx
Figure 5.3.3 A uriniferous tubule showing its major structural and functional
features and its vascular associations. ADH, antidiuretic hormone (Gartner,2015)
C. The excretory passages include the minor and major calyces and the renal pelvis, located
within each kidney, and the ureters, urinary bladder, and urethra, located outside the
kidneys.
• These structures generally possess a three-layer wall composed of a mucosa of
transitional epithelium (except in the urethra) lying on a lamina propria of connective
tissue, a muscularis (smooth muscle), and an adventitia.
• Ureter
• conveys urine from the renal pelvis of each kidney to the urinary bladder.
• transitional epithelium that is thicker and contains more cell layers than that of
the renal calyces.
• possesses a two-layer muscularis (an inner longitudinal and outer circular layer
of smooth muscle) in its upper two-thirds. The lowest third possesses an
additional outer longitudinal layer of smooth muscle.
60
•contracts its muscle layers, producing peristaltic waves that propel the urine,
so that it enters the bladder in spurts.
• Urinary bladder.
• transitional epithelium with a morphology that differs in the relaxed (empty)
and distended states,
• thin lamina propria of fibroelastic connective tissue, and a three-layer
muscularis.
• Epithelium of the relaxed bladder
• is five to six cell layers thick and has rounded superficial dome-shaped
cells that bulge into the lumen.
• These cells contain unique plaques (having a highly ordered
substructure) in their thick luminal plasma membrane and flattened
elliptical vesicles in their cytoplasm.
• Epithelium of the distended bladder
• The epithelium of the distended bladder is only three to four cell layers
thick.
• has squamous superficial cells.
• much thinner and has a larger luminal surface than the relaxed bladder,
this results from insertion of the elliptical vesicles into the luminal plasma
membrane of the surface cells.
Lecture Activity 5.3.3 Concentrating and Diluting Capacity of the kidney
The color of your urine is a crude but a good measure of the body’s’ level of hydration. Have
you noticed the color of urine appearing dark yellow during times of poor water intake? Have you
noticed, the color of urine turning a very pale straw when forcing fluids?
1. Make a concept map of fluid homeostasis for dehydration and overhydration

2. Create the concept map at the level of the nephron
3. Include hormonal influence on the physiologic mechanism
61
9-10 6-8 3-5 0-2

CONTENT
correct correct
LOGIC AND
UNDERSTANDING
errors
Lecture Activity 5.3.4 Renin Angiotensin Aldosterone System (RAAS)
Make a flow chart to illustrate the activity of the RAAS in regulating blood pressure.
62
References
Cui, D., Natfel, J., Lynch,J., Yang, G., Daley, W., Haines, D., & Fratkin, J. (2011). Atlas of histology with
functional and clinical correlations. Philadelphia, PA: Lippincott Williams & Wilkins
Eroschenko, V., (2013). Difiore’s atlas of histology with functional correlations. Philadelphia, PA:
Lippincott Williams & WIlkins
Gartner, L.,& Hiatt, J., (2015). Cell biology and histology (7thed.). Baltimore, MD: Lippincott Williams&
Wilkins
Gray, S. M., Meijer, R. I., & Barrett, E. J. (2014). Insulin regulates brain function, but how does it get
there? Diabetes, 63(12), 3992–3997. https://doi.org/10.2337/db14-0340
Hussain, A., Kaler, J., Tabrez, E., Tabrez, S., & Tabrez, S. (2020). Novel COVID-19: A Comprehensive
Review of Transmission, Manifestation, and Pathogenesis. Cureus, 12(5), e8184.
https://doi.org/10.7759/cureus.8184
Mescher, A. (2016). Junquiera’s basic histology: text and atlas (14thed.). New York: McGraw-Hill
Education
Patwari, R. (2017,October 9).Making concept maps [Video]. You Tube: https://youtu.be/RqDkcOFMzL0
63

Human Histology - MLS212 - Module 5

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MODULE IN

Department of Medical Laboratory Science

SCHOOL OF NATURAL SCIENCES

COURSE LEARNING OUTCOMES

MODULE SELF MONITORING FORM

Read the Module Introduction, Module Contents, and Module Objectives

Do Lecture Activity 5.1.1 Review of Respiratory Physiology

Read Lecture Activity 5.1.2 The Respiratory tree

Do Lecture Activity 5.1.3 Pathophysiology

Do Lecture Activity 5.2.1 Fact or Fiction

Do Lecture Activity 5.2.2 Read

Do Lecture Activity 5.3.1 Getting it together

Do Lecture Activity 5.3.2 Read

Do Lecture Activity 5.3.3 Concentrating and Diluting capacity of the

Do Lecture Activity 5.3.4 RAAS

This module is divided into three (3) lecture units

Lecture Unit 5.3– Urinary system

Lecture activity 5.1.1 Role of the respiratory system in homeostasis

2. List at least 3 activities to avoid injury during these activities.

3. Comment or give insights or rejoinders to at least 2 of your classmate’s answers

UNIT 5.1 – Read

The respiratory system is the site where respiratory gasses

D. Trachea and extrapulmonary (primary) bronchi

D. Alveoli (figure 5.3)

• Type I pneumocytes (type I alveolar cells)

Figure 5.4: blood gas barrier

Lecture Activity 5.1.3 Pathophysiology

9-10 6-8 3-5 0-2

Lecture Activity 5.2.1 Fact or Fiction

1. The stomach is the main site of food digestion.

Lecture activity 5.2.2

UNIT 5.2: Read

The digestive system is divided into an alimentary tract and

1. Oral cavity and Alimentary tract:

Vermilion zone- thin keratinized squamous stratified squamous

Figure 5.2.4 Gastric Glands

D. Small intestine (figure 5.2.5)

• Mucosa of the small intestine

E. Large intestine (figure 5.2.6)

•They release a primary secretion that resembles extracellular fluid. This

Figure 5.2.8 Epithelial components of a submandibular gland lobule.

Figure 5.2.8 Pancreas and duodenum.

(The diagram shows the arrangement of cells more

• Exocrine pancreatic secretions

Table 5.2.2 Comparison of Secretory Cells in Islets of Langerhans (Gartner,2015)

• Liver lobules (figure 5.2.10)

• Blood, bile, and lymph flow (figure 5.2.10)

Figure 5.2.12 Bile ductules.

Lecture Activity 5.3.1 Getting it together

Consider the scoring rubric below:

9-10 6-8 3-5 0-2

UNIT 5.3 Urinary System

The Urinary system is the major excretory system of

• Renal filtration barrier (figure 5.3.2)

Lecture Activity 5.3.3 Concentrating and Diluting Capacity of the kidney

1. Make a concept map of fluid homeostasis for dehydration and overhydration

9-10 6-8 3-5 0-2

Lecture Activity 5.3.4 Renin Angiotensin Aldosterone System (RAAS)

Patwari, R. (2017,October 9).Making concept maps [Video]. You Tube: https://youtu.be/RqDkcOFMzL0

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