You are on page 1of 372

Nursing Review of

Anatomy and Physiology
Review for Philippine Nursing
Licensure Examination
Outline of Selected Topics in
Anatomy and Physiology
 The Cell
 Integumentary
 Musculoskeletal
 Nervous
 Endocrine
 Cardiovascular and Hematologic
 Gastrointestinal
 Urinary/Fluids and Electrolytes
 Reproductive
The Cell

Basic Structural and
Functional Unit of the body
Functions of the Cell
1. Basic unit of life
2. Protection and support
3. Movement
4. Communication
5. Cell metabolism and energy release
6. Inheritance
The Cell

Composed of the
Cytoplasm, Cell Membrane,
the organelles, the nucleus
and the inclusions
The Cell
 Thecytoplasm is the viscous,
translucent, watery material where the
organelles are located
The Cell
 TheCell membrane is a semi-
permeable membrane that serves as
the boundary separating the cellular
structures from the external
The cell membrane
Selectively permeable
Bi-lipid layers

Functions to regulate
passage of substances
The cell membrane
 Phagocytosis- cell eating
 Pinocytosis- cell drinking

 Endocytosis- cell engulfment

 Exocytosis- cell excretion
Cell connections

Tight junction= binds adjacent cell together and
form permeability barrier, which regulates
what material crosses
Desmosome= mechanical link that functions to
bind cell to one another
 Hemidesmosomes= anchor the cell to the
basement membrane
Gap junction= small channel that allows
molecules and ions to pass from one
The cellular organelles
 These are the cellular metabolic
units with specific functions to
maintain the life of the cell
 These include the mitochondrion,
endoplasmic reticulum, ribosome,
golgi apparatus, lysosomes,
peroxisomes, cytoskeleton and
The mitochondrion
 The POWERHOUSE of the cell
 Contains enzymes and the complexes
responsible for the production of the
 Also contains mitochondrial DNA
 Metabolic processes occurring in this
organelle include – Kreb’s cycle, beta-
oxidation of fats, urea cycle, heme
 This organelle is maternally inherited
The endoplasmic reticulum
 An extensive network of membrane-
enclosed tubules
 There are two types- Rough and
Smooth endoplasmic reticulum
 Rough endoplasmic reticulum is
covered with ribosomes site of
protein synthesis
 Smooth endoplasmic reticulum has no
ribosome site of lipid synthesis
 Together with the endoplasmic
reticulum is the site of protein
 Maybe found in the cytoplasm and in
the mitochondria
 They may be free or attached to the
endoplasmic reticulum
Golgi Apparatus
 This organelle modifies,
concentrates and packages proteins
 This also packages enzymes into
 Proteins and enzymes usually are
transported from the rough
endoplasmic reticulum to the golgi
The lysosomes
 These are membrane-limited
digestive bodies that contain
enzymes that break down foreign
or damaged materials
 The enzymes digest all materials
brought in by phagocytosis
The peroxisomes
 Similarto lysosomes, these are
membrane-bound sacs containing
oxidases (not found in the
 Oxidases are enzymes capable of
reducing oxygen to hydrogen
The cytoskeleton
A series of tubules and rods that
runs through the cytoplasm
supporting the cellular structures
 This is also responsible for cellular
The centrosomes
This contains the centrioles
short cylinders adjacent to the
nucleus responsible for cellular
The cellular inclusions
 These are non-functional units
made up of chemical substances
 These may or may not be present
in all cells
 Examples are pigments, granules,
and fat globules
Cilia and Flagella
 Ciliaare short, hair-like extensions
that occur in large numbers on the
outer surface of the cell
 Flagella are long projections
formed by centrioles that propel
the cell
The Nucleus
 The central control of the cell
 Controls cell growth, metabolisms and
 Contains DNA

 Contains chromosomes DNA +
proteins appearing as granules in the
non-dividing cell
 Genes segments of chromosomes
Cell Division

 Formation of two daughter cell
from a single parent cell.
d. Mitosis – formation of new cell
necessary for growth and tissue
e. Meosis – formation of sex cell
necessary for the reproduction.
Cellular division
 Two types- Mitosis and Meiosis
 Mitosis- equal division of materials
which yields two exact duplicates of
the original cell
 The diploid number (46) of
chromosomes is maintained
 All of the body cells undergo mitosis
except the gametes or sex cells

 All body cell undergo mitosis except sex
cell. There are two step in mitosis:

e. Genetic material within the cell is
f. Cell divided to form two daughter with
same amount and type of DNA.
The cellular division
 Five steps of cellular division I-P-
 Interphase- inactive or resting
 Prophase-Chromatin coils to form
chromosomes, centrioles begin to
 Metaphase-chromosomes line the
equator, and they split lengthwise
 Anaphase-Chromatids separate and
move to the opposite poles
 Telophase-chromosomes uncoil and
nucleoli reappear
INTERPHASE – time between cell division
during which DNA replicate. DNA strand
separate where old strand joined with new
strand of DNA to form two new DNA
Four stage of Mitosis
2. Prophase – chromatin condensed into chromosome.
Chromosome consist of two chromatin join by
 Centriole move to opposite pole.

 Nucleus and nuclear envelope disappear.

2. Metaphase – chromosome aligned at the center, w/
spindle fiber.
3. Anaphase – chromatin separate to form two sets of
identified chromosome. Chromosome assisted by
spindle fiber.
4. Telophase – chromosome disperse.
 Nuclear membrane and nucleolus
 Cytoplasm divided into two cell.
Differentiation – process by which cell develop
with specialized function.

 Egg and sperm cell formed single cell during
fertilization divided by mitosis to form two cell
then become four cell and so forth which
differentiate, give rise to different cell. E.g.
bone cell, muscle cell
The cellular division
 Meiosis is a reduction division
occurring in the sex cells
 Sex cells have only one pair of
chromosomes (23)haploid
The movement of SOLUTES or
particles in a solution from a
higher concentration to a lower
This is a passive process, no
energy is required
 The movement of solvent or water
from a diluted solution into a
more concentrated solution
through a semi-permeable
 The pressure that draws water
inside the vessel which is more
concentrated is called Osmotic
 Ifa sugar is placed in plain water,
the glucose molecules will
dissolve and distribute in the
 Factors that affect diffusion-
concentration gradient, particle
size, solubility and temperature
Special osmosis

A special type of osmotic
pressure is exerted by the
proteins in the plasma. It
is called ONCOTIC
The movement of both solute
and solvent by hydrostatic
pressure, i.e., from an area of a
higher pressure to an area of a
lower pressure
An example of this process is
urine formation
Hydrostatic pressure
Hydrostatic pressure is the
pressure exerted by the fluid
against the container
Increased hydrostatic pressure is
one mechanism producing
Active transport
 Thisis the movement of solutes
across a membrane from a lower
concentration to a higher
concentration with utilization of
 Example is the Sodium-Potassium
pump, Endocytosis and Exocytosis
 Group of cells with similar structure and

There are four (4) Basic types
4. Epithelial

5. Connective

6. Muscle

7. Nervous
Lining, covering and glandular
tissues of the body
The functions are to protect,
absorb, filtrate and secrete
Epithelial tissues
Simple epithelium
Lined by ONE Layer of cell

Lined by many layers of cells
Epithelial tissues
Simple epithelia
1. Simple squamos- alveoli, BV

2. Simple cuboidal- glands

3. Simple columnar- GI tract

4. Pseudo stratified epithelium-
bronchial lining
Epithelial tissues
Stratified epithelium
1. Stratified Squamos- skin

2. Stratified cuboidal-
reproductive duct
3. Transitional epithelium-
bladder and ureter
Connective tissues
 Bone

 Cartilage

 Muscle

 Blood

 Blood vessels
 Adipose tissue
The Integumentary
 The largest body system
 Includes the skin and
accessory structures like the
hair, nails, and glands
 Function: Protection of body
structures and regulation of
body temperature
The Skin as first line
 The skin seals off the
body from the immediate
 There are three layers of

the skin: Epidermis,
dermis, and hypodermis.
Skin cells
 There are many other cells
aside from the keratinized
squamos cells of the skin.
 Melanocytes produce pigment
 Langerhan’s cells participates
in the immune system.
 Histiocytes are specialized
Skin as temperature
 Abundant nerves, blood
vessels and glands are
within the skin’s deeper
 They aid in temperature
 Blood vessels constrict or
dilate depending on the
Skin functions
 Sweat glands produce sweat
to control temperature by
 The piloerector (arrector pili)
muscles will contract to raise
the hairs to trap the heat
Other skin functions
 Vitamin D synthesis
 7-dehydrocholesterolCholecalciferol
 Route of excretion
 Insensible fluid loss of about 500

 Sweat contains water,

electrolytes, urea and lactic acid
Other skin functions
 Skin and mucus membrane are
the first line defense of the
body in immunity
 Skin has receptors for pain,
cold, pressure and heat.
The Skin layers:
 The outermost layer with
stratified squamos epithelium
 Varies in thickness depending
on the body part
 Thinnest in the eyelids and
thickest in the soles and palms
 The layers are- C-L-G-S-B
 The outermost layer is the
stratum corneum with
 The stratum basale is the layer
which regenerates/replaces
new skin cells
 Melanocytes in the skin
produce melanin
The Skin layers: DERMIS
 The second layer- cutis vera
 Is flexible and elastic
 Two layers- papillary and
 Contains blood vessels,
lymphatic vessels, nerves
and appendages
The Skin layers: DERMIS
 The connective tissues in the
dermis contain
 collagen (gives its strength)
 elastin (gives its flexibility) and
 reticular fibers (connect
collagen and elastin)
The Skin layers:
 This is the subcutaneous
 Not strictly a part of the

 Functions to insulate the

body to conserve heat
 Serves as the energy
storage and mechanical
shock absorber
 With little vascular

supply and scant nerve
The Skin appendages
 Hairs- long shafts composed of
keratin. Expanded lower end is
called hair bulb or root. There
are extensive nerve and blood
supply in the hair bulbs
 Nails-flattened structure of
specialized type of keratinized
surface. The visible part is the
nail body.
Fig. 5.5
 Sebaceous glands-glands
which produces an oily
material called sebum, found
in all body parts except the
palms and soles.
 Sweat glands or sudoriferous
glands- glands which secrete
sweat, found in all body parts
except in the nipples. Two
types exist- Eccrine and
Fig. 5.6
The Musculoskeletal System

 This system consists of the
muscles, tendons, ligaments,
bones, cartilage, joints, and
The Musculoskeletal System

 Functions:
• Locomotion and protection
• blood production in the bone
• heat generation,
• maintenance of posture and
• storage of minerals
The Muscles
Three types of muscles exist
in our body
 Voluntary skeletal muscle

 Involuntary cardiac muscle

 Involuntary visceral

smooth muscle
The Muscles
Muscles are
composed of
muscle fibers
nuclei and
Properties of Muscles
 Electrical excitability
• Ability to contract to certain stimuli
 Contractility
• Ability to contract forcefully when
 Extensibility
• Ability to stretch without being
 Elasticity
• Ability to return to its original
length and shape
Muscle Physiology
 Muscle fibers are enclosed
sheaths- perimysium, epimysium
and endomysium
 Each muscle cell has actin and

myosin filaments arranged in a
 This sarcomere is the basic

structural unit of the muscle
Muscle Physiology
 Muscle contraction occurs as actin
and myosin slide past one another
causing the sarcomeres to shorten
 Calcium ion is released by the
muscle endoplasmic reticulum to
initiate contraction
 ATP is used both for muscle
contraction and muscle relaxation
Fig. 7.5a
Fig. 7.6
Fig. 7.7a
Fig. 7.7b
Muscle Physiology
Muscle contraction can be of two
 1. ISOMETRIC- iso= same,

metric=distance: The length of the
muscle does not change, but the
tension increases
 2. ISOTONIC- iso=same,

tonus=tone: The amount of
muscle tension is constant but the
length of the muscle varies
Muscle Physiology
 Muscle tone= refers to the constant
tension produced by muscles of the
body for long periods of time

FAST-twitch muscles= contract
quickly and fatigue quickly
SLOW-twitch muscles=contract slowly
and are more resistant to fatigue
Muscle Physiology
 Smooth Muscle= is not striated,
contracts more slowly, is
autorhythmic and under
involuntary control

 Cardiac muscle- is striated, is
autorhythmic, and under
involuntary control
 Flexion- decreasing the angle
between two joints
 Extension- increasing the angle
between two joints
 Abduction- movement of the limb
away from the midline
 Adduction- movement of the limb
towards the midline
 Internal rotation- moving the body
part inward towards the midline
 External rotation- moving the body
part outward away from the
 Supination- turning a body part
 Pronation- turning a body part
 Inversion- turning the foot inward
 Eversion- turning the foot
 Retraction- moving a body part
 Protraction- moving a body aprt
Muscles of the face
 1. Frontalis
 2. Orbicularis oculi
 3. orbicularis oris
 4. Buccinator
 5. Zygomaticus

 Facial Nerve innervation
Muscles of Mastication
 1. Masseter
 2. Temporalis
 3. Pterygoid muscles

 Innervated by TRIGEMINAL
Muscles of the neck
 1. Platysma
 2. Sternocleidomastoid
Muscle of the upper limb
 1. Biceps
 2. triceps
 3. deltoid
Muscles of the lower limb
 1. Hamstring muscles
 2. Quadriceps
 3. Gluteal muscles
 4. calf muscles
 These are bands of fibrous
connective tissue that attach muscles
to bones
 These are dense, strong, flexible
bands of fibrous connective tissue
that bind bones to other bones
 Bone is a living growing tissue
made of porous mineralized
 The human skeleton contains 206
 Axial bones are bones on the
midline like the vertebrae, skull,
facial bones, ribs and sternum
 Appendicular bones include the
scapulae, bones of the arms and
Classification of Bones
 Long bones- - These bones have a
shaft and ends. Ex: tibia, humerus,
 Short bones- Small and cubical
shaped- Ex: carpals and tarsals
 Irregular bones- vertebrae, mandible
 Sesamoid bones- bones embedded in
the tendons. Ex:patella
 Flat bones- with spongy bones
inside. Ex: scapulae, ribs, clavicle
Structure of the bone
 Long bones have a diaphysis
( shaft) and epiphysis (ends)
 Bones consist of layers of calcified

matrix occupied by bone cells.
 The outer layer of bone is

composed of dense compact bone
(cortical bone)
 The inner layer is composed of

spongy cancellous bones
Bone Structure
 Blood supply of bones reaches by
way of arterioles in the haversian
canal, through the vessels in the
Volkmann's canal
 Bone formation can be from the
cartilage and from the membrane
Bone Structure
 OSTEOBLAST- bone cell responsible
for bone formation and calcification

 OSTEOCLAST- bone cell responsible
for bone resorption and destruction
Bone Ossification
 Ossification is the formation of
bone by the osteoblasts. This
involves the mineralization of
bones from a cartilage
(endochondral) and from a
membrane (membranous).
Fig. 6.5a
Fig. 6.6
Bone Remodeling
 Bone remodeling involves the
removal of old bones by cells
called osteoclasts and deposition of
new bones by the osteoblasts.
 Bone is the major storage of
 If calcium levels in the blood falls,
it is removed from the bone
Bone repair
 When a bone is broken, blood
vessels are also damaged clot
 2-3 days after injury, blood vessels
and cells invade the blood clot
callus formation
 Osteoblasts enter the callus and
begin to form a spongy bone
 Immobilization of the bone is
required because the delicate new
matrix of bone is easily damaged by
excessive movement
Fig. 6.8
The Skull
 Skeleton of the head
 Made of 21 bones
 Cranial bones
• Frontal
• Parietal
• Temporal
• occipital
The Skull
 Facial bones
• Maxilla
• Mandible
• Zygoma
• Nasal
• Vomer
• Palatine
The paranasal sinuses
 These are air-filled cavities in the
facial bones surrounding the nose
and open into the nasal cavity
 They decrease the weight of the
skull and act as resonator of
 Frontal, maxillary, ethmoid and
The Vertebrae
 Composed of 32-33 bones
 7 cervical
 12 thoracic
 5 lumbar
 5 sacral
 3-4 coccygeal
Functions of the vertebrae
 1. Supports the weight of the
head and trunk
 2. Protects the spinal cord

 3. Allows spinal nerves to exit

the spinal cord
 4. Provides a site for muscle

 5. Permits the movement of the

head and trunk
The Cervical Vertebrae
 7 in number
 C1- atlas

 C2- axis

 C7- cervical prominence

 Atlas and occipital bone=

“yes” motion
 Atlas and Axis=

“no” motion
The Thorax
 Made up of the sternum and ribs
 The sternum has 3 parts
• Manubrium
• Body
• Xiphoid process
• The slight elevation in the sternum
is called the Sternal Angle of Louis.
It identifies the location of the
second rib
The Ribs
 The ribs are 12 pairs
• True ribs= 1-7
• False ribs= 8-10
• Floating ribs=11-12
The shoulder
 The clavicle and scapulae constitute
the shoulder
 The clavicle
• Articulates with the sternum
• Most commonly fracture bone
 The Scapulae
• Attached to the ribs and
vertebrae by muscles only
• Has an acromion process, where
the clavicle attaches
The Upper extremity
 Composed of the following bones
 Humerus

 Ulna

 Radius

 Carpals (wrist bones)

 Metacarpals

 Phalanges
The pelvic girdle
 Composed of
the 3 fused
bones- pubis,
ilium and
 Constitute the
hip bone
The pelvic girdle
 Female pelvis has the following
structure: The pelvic inlet is
large/oval, symphysis is shallow.
obturator foramen is oval or
triangular, sacrum is broader

 The male pelvis has the following:
The pelvic inlet is small/round to
heart-shape, symphysis is deep.
Obturator foramen is round
Fig. 6.32
The Lower extremity bones
Composed of the
 Thigh bones- femur

 The leg bones- Tibia and Fibula

 The ankle- tarsal bones

 The foot- metatarsal bones
 A dense connective tissue that
consists of fibers embedded in a
strong, gel-like substance.
 Cartilage supports and shapes

various structures such as the
ear pinna, intervertebral disks,
ear canal, larynx, etc.
 It serves as cushion and shock

Types of Cartilage
 Fibrous cartilage
• Found in the intervertebral disks
 Hyaline cartilage
• Found in the symphisis, the
thyroid cartilage
 Elastic cartilage
• Found in the ears, the epiglottis
Fig. 6.39a
Fig. 6.39b
Fig. 6.40a
Fig. 6.40b
Fig. 6.40c
 These are point of attachment or
contact between two bones
 Variously classified according to its
movement and flexibility
 Fibrous joints- with fibrous tissue
with little or no movement
 Cartilaginous joints- with cartilage
 Synovial joints- with capsule;
freely movable joints
Synovial joints
 Freely movable joints
 With joint cavity/capsule

 Articular surface

 Synovial membrane

 Synovial fluid
Synovial joints
 Plane joint- intercarpal joint
of wrist
 Hinge joint- elbow and ankle

 Pivot- atlas and axis

 Condyloid- “egg-shape”

metacarpophalengeal joint
Synovial joints
 Saddle joint- joint of the
 Ball and socket- hip joint
 Small synovial fluid sacs
located at friction points
around joints, between
tendons, ligaments and bones
 Act as cushions, decrease

stress on adjacent structure
The Nervous System

•The nervous system
coordinates all body functions,
enabling a person to adapt to
changes in internal and
external environment
•The nervous system is
composed mainly of the nerve
cells (neurons) and supporting
The neuron
•This is the basic
conducting cell of the
nervous system
•Highly specialized but
cannot reproduce itself
•Main parts are the cell
body (soma), the fibers:
axon and dendrites.
The neuron
•The axon is a long process
with myelin sheath. This
conducts impulses away
from the cell body

•The dendrites are short,
thick, diffuse branching
processes that receive
impulses and conduct
them towards the cell
The neuroglia
• The supporting cells
• They supply nutrients to the
neurons and help maintain the
electrical potential
• They also form part of the
blood-brain barrier
The neuroglia
• Oligodendrocytes produce
myelin sheath in the CN
• Schwann cells produce
myelin sheath in the
peripheral NS
The Organization of the
Nervous System
•The nervous system is divided
functionally and structurally
into 2 parts
•1. Central Nervous System- the
Brain and the spinal cord
•2. Peripheral Nervous System-
the cranial nerves and spinal
The Organization of the
nervous System
The Peripheral Nervous System is
further classified into THREE
Functional Divisions
1. The Somatic Nervous System-
controls the skeletal muscles
2. The Autonomic Nervous
System- controls the visceral
3. The Enteric Nervous System-
The Central Nervous System
Composed of the brain
• The brain consists of the gross
structures: cerebrum,
cerebellum, brainstem and the
• Diencephalon- Thalamus.
Hypothalamus and pineal body
• Brainstem- Pons, medulla and
Fig. 8.23
The Cerebrum

• This is the largest part of the
• Consists of right and left
hemisphere connected by the
corpus callosum
• Each cerebral hemisphere is
composed of different lobes-
frontal, temporal, parietal and
The Frontal Lobe of the
• Influences the personality of the
• Also responsible for judgment,
abstract reasoning, social
behavior, language expression
and motor movement.
The Temporal lobe of the
• This part of the cerebrum controls the
hearing, language comprehension,
storage and recall of memories
• The LIMBIC system is deeply located
in the temporal lobe. This controls
the basic drives such as hunger,
anger, emotion and sexual drive.
The Parietal lobe of the
• This is the principal center for
the reception and interpretation
of Sensation
• This part interprets and
integrates the sensory inputs
like touch, temperature and pain
• It interprets size, shape,
distance and texture
The occipital lobe of the
• This functions mainly to interpret
visual stimuli
Speech areas in the
• 1. Wernicke’s area- responsible
for the sensory reception of
• 2.Broca’s Area- responsible for
the motor speech
Fig. 8.28
The Cerebellum
• The second largest brain region
• Has also two hemispheres
• Functions to maintain muscle
tone, coordinate muscle
movement, posture and control
• If this is damaged, muscle tone
decreases and fine motor
movements become very clumsy
The Brainstem

• Lies inferior to the cerebrum
• Continuous with the cerebrum and
the spinal cord
• It is composed of the midbrain, the
pons and the medulla oblongata
• Functions: houses the center for
respiration and cardiovascular
The Midbrain

•This connects with the
•Contains numerous ascending
and descending tracts and
The Pons

•Connects the cerebellum with
the cerebrum
•Houses the respiratory center
and cardiovascular center
•Exit points for cranial nerves 5,
6 and 7
The Medulla oblongata

• The most inferior portion of the
• Serves as the center for
autonomic reflexes to maintain
homeostasis, regulating
respiratory vasomotor and
cardiac functions
• Serves as exit of cranial nerves
The Diencephalon
• The thalamus and the
• The thalamus is the relay station of
all sensory stimuli towards the
• The hypothalamus controls body
temperature, appetite, water
balance, pituitary secretions and
sleep-wake cycle
The Basal ganglia
Brain circulation: The circle
of Willis
The spinal cord
•A long cylindrical structure
extending from the foramen
magnum to the L1 in adult,
L3/L4 in pedia
The spinal cord
•In the cross section of the
spinal cord, we find the GRAY
matter- contains neurons; and
WHITE matter-consists of nerve

•There are 31 pairs of spinal
nerves that exit the spinal cord
The spinal cord

• Each spinal nerve is formed by
the dorsal root (sensory) and the
ventral root (motor)
• Cervical segments= 8 pairs
• Thoracic segments=12 pairs
• Lumbar= 5 pairs
• Sacral=5 pairs
• Coccygeal=1 pair
The Meninges
• These are 3 connective tissue
layers surrounding the brain and
spinal cord.
• 1. DURA MATER- the superficial,
thickest layer. The area above the
dura mater is called epidural space
• 2. ARACHNOID- second layer, thin
and wispy.
• 3. PIA MATER- the deepest layer,
adhered to the brain and spinal
The Meninges
• The space in between the
arachnoid and pia mater is called
the arachnoid space
• This arachnoid space contains the
cerebro-spinal fluid (CSF)
• In this space, blood vessels are
also found
The Ventricles

• These are CSF filled cavities in the
• The lateral ventricle- found in the
• The third ventricle- in the center of
the thalamus and hypothalamus
• The fourth ventricle- located at the
base of the cerebellum

• This is the fluid found inside the
ventricles that bathe the brain and
spinal cord
• Function: provides protective
cushion around the CNS
• Produced by the choroid plexus in
the ventricles
• Absorbed by the arachnoid
Tracing the CSF pathway
Lateral ventricle

Interventricular foramen of Monro

Third ventricle

Cerebral aqueduct of Sylvius

Fourth ventricle

Exits trough the median foramen of Magendie or the lateral
foramen of Luscka

Subarachnoid spaces in the cisterna magna, spinal cord

subarachnoid space of the brain

superior sagittal sinus
The cranial nerves

• Are 12 pairs of nerves that exit
the brain
• Can be classified as
– Sensory
– Motor
– Mixed (sensory and motor)
The Autonomic Nervous
• The part of the peripheral
nervous system that innervates
cardiac muscles, smooth muscles
and glands
Functionally divided into
• Sympathetic Nervous System
• Parasympathetic Nervous
• Originates from the T1-L2/L3
segments of the spinal cord
• Utilized by the body for FLIGHT and
FIGHT response
• Neurotransmitter agents are
Epinephrine and Norepinephrine
(coming from the adrenal gland)
Sympathetic responses
• Increased:
– HR
– RR
– BP
– Visual Acuity (Pupillary Dilation)
– Smooth Muscle tone sphincters
are contracted
– Vasoconstriction
– Metabolism ↑ glucose, ↑ fatty acids
Sympathetic responses

• Decreased
– Peristalsis
– Salivary secretions
• Ejaculation
Parasympathetic system

• The vegetative system
• Feed and Breed responses
• Cranio-sacral location
• Cranial nerves- 3, 7, 9, 10 and
• Neurotransmitter is
Parasympathetic responses
• Increased
– Gastric secretions
– Salivary secretions
– peristalsis
• Pupillary constriction
• Decreased
• Smooth muscle tone sphincters are
• erection
Nerve Physiology
• The nerve cells are excitable
• Any stimulus will change the
membrane potential and cause
an action potential to generate
impulse transmission
• The myelin sheath of the nerve
cell is responsible for the
SALTATORY conduction
increases the nerve transmission
Fig. 8.11
Fig. 8.12
• This is the region where
communication occurs between 2
neurons or between a neuron and
a target cell
• A neurotransmitter is released
from the nerve cell towards the
other cell with receptor
Fig. 8.13
The eye and the visual
• Vision is made possible by the
stimulation of the photoreceptor
cells in the retina
• Receptor cells are the RODS and
• The eye is made up of three layers
– Fibrous layer- sclerae and cornea
– Uvea- choroid and iris and ciliary
Fig. 9.13
The optic nerve

•This is the collection of fibers
from the cells in the retina
•It passes through the
brainstem as the optic chiasm
• it will reach the occipital lobe
for visual interpretation
The Vestibular apparatus

•This is the part of the ear that
helps in equilibrium
•Located in the inner ear
•The saccule and utricle control
LINEAR motion
•The semicircular ducts control
the Angular movement/
The Hearing Apparatus
The Olfactory apparatus
• Consists of the nose and the
olfactory nerve
• Stimulation form the olfactory
nerves will reach the limbic
system of the brain
The Gustatory apparatus

• The receptor for taste are
cells in the tongue group
together called the taste
• They are numerous in the
vallate and fungiform
The Gustatory apparatus
Basic taste modalities
• Sweet- tip of the tongue
• Salty- over the dorsum of the
• Sour- sides of the tongue
• Bitter- back of the tongue
The Endocrine System

This system is made up of
widely distributed organs
whose secretions (called
HORMONES) are poured into
the blood to reach the target
 These are chemical substances
released by the glands into the blood
 Each hormone will go to the target
organ and binds its receptor
Two types exists:
 1. Peptides or protein hormones
 2. Lipid or steroid hormones
The hormonal regulation

There exists an inter-
related regulation between
Pituitary and the endocrine
The hormonal regulation

We call it the Hypothalamic-
pituitary-endocrine axis
The exception are the
pancreas and the parathyroid
The endocrine glands
 The pituitary- anterior and
 The pineal gland
 The thyroid gland
 The parathyroid gland
 The adrenal gland
 The pancreas
 The gonads- testes and ovary
The pituitary gland
: anterior lobe

 Also called Adenohypophysis
 Hormones produced
– Growth hormone
– The stimulating hormones-
– Prolactin
The pituitary gland: posterior lobe

 Also called the neurohypophysis
 This lobe does not secrete hormones but
only stores hormones
– Antidiuretic hormone (vasopressin)
– Oxytocin
The pineal gland

Alsocalled epiphysis cerebri
Secretes melatonin
The thyroid gland

Located in the lower part
of the anterior neck
With two lobes connected
by the isthmus
The thyroid gland

 Secretes thyroxine (T4) and tri-
iodothyronine (T3)
 The T3 is the most active
 Function of T3/T4: Increase
metabolic rate, essential for
normal growth and maturation
The thyroid gland

 Italso secretes CALCITONIN
 This is released in response to an
INCREASED calcium level in the
 Function: decreases bone
resorption and increases calcium
excretion in the kidney to
decrease the calcium levels
The parathyroid glands

2 pairs (4) of yellowish
glands closely related to the
posterior surface of the
thyroid gland
Secretes parathyroid
hormone (PTH)
The parathyroid glands

 Functions of the hormone:
– Increases bone breakdown by
– Increases Vitamin D synthesis
– Increases Calcium level in the blood
– Causes retention of calcium in the
The Adrenal glands

a pair of gland resting on top of each
kidney with 2 layers
– Secretes mineralocorticoids
– Secretes glucocorticoids
– Secretes androgens- sex hormones
– Secretes the cathecolamines-
Epinephrine, and norepinephrine
Fig. 10.17
Fig. 10.18
The Adrenal Cortex
 Mineralocorticoid-

– Increases sodium retention,
water retention secondarily
– Causes excretion of potassium
The Adrenal Cortex
 Glucocorticoids- cortisol
– Increases fat and protein
– Increases glucose synthesis
– Inhibit inflammation and
immune response
The Adrenal Cortex

Adrenal androgens
 Estrogens, androgens and
 Insignificant in males
 Increase female sexual drives,
pubic hair and axillary hair
The pancreas

The endocrine portion of the
pancreas is the ISLETS of
This islet is composed of three
types of cells- alpha, beta and
Fig. 10.19
The pancreas

The Alpha cells secrete
The Beta cells secrete
The delta cells secrete
Pancreatic insulin
Causes Hypoglycemia by two
Glucose breakdown-
Glycogen production-
Pancreatic insulin
Needed by most body cells to
allow Glucose to enter the cell
The brain cells, intestinal cells,
the red blood cells and the
islet cells do not need insulin
for glucose entry
Pancreatic glucagon

Causes increased level of
Glucose by:
Glycogen breakdown-
Glucose production-
The Gonads : Male- Testes

 The testes houses the Interstitial
cells of Leydig which secrete
 Testosterone
 Dehydrotestosterone
 Androsterone
The Androgens

 Aid in spermatogenesis
 Maintain functional reproductive
 Responsible for secondary sex
 Responsible for male sexual
The Gonads: Female- Ovary

 The Follicular cells of the ovarian
follicle secrete ESTROGEN and the
corpus luteum secretes
The estrogen

 Aids in uterine and mammary
gland development
 Maintains the structure of the
external genitalia
 Produces the secondary sexual
characteristics in female
 Maintains normal menstrual cycle
The progesterone

 Together with estrogen, maintains
normal menstruation
 Increases body temperature
 Decreases muscle tone and
 Maintains pregnancy

This system is composed of the heart
and the blood vessels
The main functions of this system are:
 to transport oxygen, hormones and
nutrients to the tissues
 and to transport waste products to
the lungs and kidneys for excretion
The Gross Anatomy of the Heart

The heart is located within the
thorax behind the sternum in
the compartment called
The heart is commonly
described as the size of a
clenched fist
The Gross Anatomy of the Heart

The shape is conical, with a
base and an apex
The base is directed upward
The apex is directed downward
to the left at the level of the 5th
Heart Surface

Right ventricle

Left ventricle
The Heart : Anatomy
 The heart has three layers
 The epicardium
 The myocardium
 The endocardium
 The heart is covered by the pericardium
with a parietal and visceral layers
 The pericardial sac is a potential space in
between the two pericardial layers with a
minimal (15 cc) fluid
Fig. 12.4
The Heart: Anatomy

The heart has four chambers
The right atrium
The right ventricle
The left atrium
The left ventricle
The Heart: Anatomy
 The heart also has four valves that guard
the openings in the chambers
 The tricuspid valve – between the right
atrium and right ventricle
 The mitral or bicuspid valve- between the
left atrium and left ventricle
 The pulmonic valve- between the right
ventricle and the pulmonary trunk
 The aortic valve- between the left ventricle
and the aorta
The Heart: Anatomy

The blood supply of the heart:
The coronary arteries are the blood
There are two main coronary arteries-
the right coronary artery and the left
coronary artery
The venous drainage of the heart is the
coronary sinus; the anterior cardiac vein
and the smallest cardiac vein
Blood Supply
Venous Drainage
 Coronarysinus will collect all the
venous blood from the heart into the
RIGHT atrium

 The anterior cardiac vein drains NOT
into the coronary sinus but DIRECTLY
into the right atrium
Fig. 12.11
The Heart : Physiology

This consists of
The conducting system
The cardiac cycle
The cardiac output and Blood
The preload and afterload
The Starling’s law of the heart
The Heart: Physiology

The conducting system of
the heart is a group of
specialized heart cells that
functions to conduct
electrical impulses
independent of any nerve
The Heart: Physiology

The parts of the conducting
system of the heart are:
The SA (sino-atrial) node
The AV (atrio-ventricualr) node
The Bundle of His with its right
and left bundle
The Purkinje fibers
The Heart: Physiology
The intrinsic conduction system
causes the heart muscle to depolarize
in one direction
The rate of depolarization is around 75
beats per minute
The SA node sets the pace of the
This electrical activity is recorded by
the Electrocardiogram (ECG)
The Heart: Physiology

The cardiac cycle consists of the
contraction phase and the
relaxation phase in each heartbeat
The SYSTOLE is the contraction
The DIASTOLE is the relaxation
The Heart: Physiology
Heart sounds can be auscultated
S1, S2, S3, and S4
S1 is due to the closure of the AV valves
S2 is due to the closure of the semilunar
S3 is due to the rushing of blood through
the AV opening
S4 is due to contraction of the atrium
The Heart: Physiology
The amount of blood the heart pumps
out in each beat is called the STROKE
When this volume is multiplied by the
number of heart beat in a minute (heart
rate), it becomes the CARDIAC
When the Cardiac Output is multiplied
by the Total Peripheral Resistance, it
becomes the BLOOD PRESSURE
The Heart: Physiology

The PRELOAD is the degree of
stretching of the heart muscle when it
is filled-up with blood
The AFTERLOAD is the resistance to
which the heart must pump to eject
the blood
The Heart: Physiology
Starling’sLaw of the Heart states that
the force of contraction is proportional to
the degree of stretching of the cardiac
muscle fibers
As the length of the muscle fiber is
stretched, the contractile force
But when the maximum length has been
reach, any further stretching will impair
the contraction
The Blood vessel: Anatomy

This consists of the artery, vein and
capillary together with the lymphatic
The ARTERY has thicker wall, deeply
located, pulsating, reddish, with
abundant smooth muscles and elastic
tissues that carries oxygenated blood
away from the heart towards the body
The Blood vessel: Anatomy
The VEIN is thin-walled, superficially
located, non-pulsating, bluish vessel
that carries
unoxygenated/deoxygenated blood
towards the heart
Arterioles are small arteries
Venules are small veins
CAPILLARIES are diffuse network of
thin- walled tubules that connect
arterioles and venules together
The Blood vessel: Physiology
The diameter of the arterioles is the main
contributor of the peripheral resistance
In the presence of epinephrine, cold
temperature and irritation, the smooth
muscles of the blood vessels will contract
making the lumen smaller ↑resistance
In the presence of histamine, warm
temperature, the vessels will dilate
↓ resistance
Anatomy &
Terminology Physiology
Chronotropic Refers to a change in heart rate
effect A positive chronotropic effect refers to an
increase in heart rate
A negative chronotropic effect refers to a
decrease in heart rate
Dromotropic Refers to a change in the speed of conduction
effect through the AV junction
A positive dromotropic effect results in an
increase in AV conduction velocity
A negative dromotropic effect results in a
decrease in AV conduction velocity
Inotropic Refers to a change in myocardial contractility
effect A postive inotropic effect results in an increase in
myocardial contractility
A negative inotropic effect results in a decrease
in myocardial contractility
Basic Electrophysiology
Myocardial Cell Types
Kinds of Where Primary Primary
Cardiac Found Function Property
Myocardium Contraction and Contractility
Myocardial cells Relaxation

Electrical Generation and Automaticity
Specialized cells conduction conduction of Conductivity
of the system electrical
electrical impulses
Systemic circulation

The aorta- leaves the left ventricle to
form the ascending aorta, aortic arch,
descending aorta, thoracic aorta and
abdominal aorta
The Vena cava ( superior and inferior)
drains the whole body and returns the
blood to the right atrium
Physiology of circulation

Blood pressure is the measure of
force exerted by blood against the
blood vessel wall
Measured by sphygmomanometer
Normally BP is measured as systolic
pressure and diastolic pressure
Physiology of circulation

Capillary exchange
Most exchange of gas and
substances occur across the wall of
the capillary
Usually, the exchange is due to the
filtration difference and diffusion
BP regulation

 Pons and medulla
 Sympathetic nervous system– Increases
heart rate

 Parasympathetic nervous system (vagus)–
decreases heart rate
BP regulation

Receptors sensitive to stretch located
in the carotid sinuses and aortic arch
↓ stretch reflex increase in heart rate
↑ stretch reflex decrease in heart rate
BP regulation
 Hormonal
 Epinephrine vasoconstriction
increased resistance increased BP
 Angiotensinogen blood
Angiotensin 2
 ADH water reabsorption ↑Blood
volume increased BP
 ANF increase sodium excretion
increased urine decreased blood
volume decreased BP
Fig. 13.22
Fetal circulation
Cardiac assessment
Palpation of the apical pulse and PMI
at the 5th ICS LMCL
Auscultation for the heart sounds
 S1 and S2
Auscultation for the heart valves
 TV
 MV
 PV
 AV
Fig. 13.23
 Blood is a special connective
 Total blood volume is about 5
 Blood is composed of two
1. Formed elements- RBC, WBC,
2. Plasma- the liquid portion
Fig. 11.2
The RED Blood Cell
 Non-nucleated cellular element in
the blood
 Biconcave
 Transports Oxygen loosely bound
to Hemoglobin
 Red pigment is due to hemoglobin
 Lifespan is 120 days
 Reticulocytes are immature RBC
Fig. 11.4
The Leukocytes or WBC

Nucleated, larger than
the RBC
Divided into
Granulocytes and
The Leukocytes or WBC
2. Neutrophils- most abundant
WBC, 60-70%. This is the
first cell to arrive in
 Increased in bacterial
 In females, there is the
presence of the Barr
bodies, the condensed X
 2.Eosinophils- cell type that
is capable of limited
phagocytosis, with granules
containing peroxidase.
– This is increased during
parasitic and allergic reactions
 3.Basophils- a WBC that
is capable of releasing
Histamine, heparin and
serotonin during
anaphylaxis . The rarest
type of WBC.
 1. Lymphocyte- second
most abundant (next to
– Found increased in Viral
infection and chronic infection.
This can be:
– T-lymphocyte
– B-lymphocyte
– T-lymphocyte- mediator of
Cellular Immunity
– B-lymphocyte- mediator of
Humoral immunity because this
cell secretes ANTIBODIES when
transformed into plasma cells.
 2.Monocyte- has kidney-shaped
nucleus, a very large WBC that
stays only for 2-3 days in the
circulation. This becomes the
MACROPHAGE in the tissues.
The Platelets
 Also called thrombocytes
 Smallest formed element,
lifespan is 8-10 days
 Involves in clot formation
 Forms the platelet plug in an
injured vessel
 Releases chemicals that can
cause activation of the clotting
Table. 11.2
The Blood groups
 Blood types are grouped into A, B, AB
and O based on the presence of the
antigen on the surface of the RBC
 If antigen A is present, then the blood is
type A
 If antigen B is present, then the blood is
type B
 If antigen A and antigen B is present,
then the type is AB
 If no antigen is present, then blood type
is O
Fig. 11.11
The Blood groups
 Blood group A has Antibody B,
that can react to blood type B
and AB
 Blood group B has antibody A,
that can react to blood type A
and AB
 Blood group AB has no antibody
 Blood group O has no antigen,
but has Both antibody A and B
Rh group
 Along with the ABO group,
there is an Rh system in the
 The “D” antigen is the most
 A person with “D” antigen is Rh
 A person with no “D” antigen is
Rh (-)