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

Structural and Functional Unit of the body

Functions of the Cell
1. 2. 3. 4. 5. 6.

Basic unit of life Protection and support Movement Communication Cell metabolism and energy release Inheritance

The Cell

of the Cytoplasm, Cell Membrane, the organelles, the nucleus and the inclusions

The Cell
 The

cytoplasm is the viscous, translucent, watery material where the organelles are located

The Cell
 The

Cell membrane is a semipermeable membrane that serves as the boundary separating the cellular structures from the external environment

The cell membrane

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 another

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 centrosomes

The mitochondrion
 The

POWERHOUSE of the cell  Contains enzymes and the complexes responsible for the production of the ATP  Also contains mitochondrial DNA  Metabolic processes occurring in this organelle include – Kreb’s cycle, betaoxidation of fats, urea cycle, heme synthesis  This organelle is maternally inherited

The endoplasmic reticulum
 An

extensive network of membraneenclosed 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 synthesis  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 lysozomes  Proteins and enzymes usually are transported from the rough endoplasmic reticulum to the golgi apparatus

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
 Similar

to lysosomes, these are membrane-bound sacs containing oxidases (not found in the lysosomes)  Oxidases are enzymes capable of reducing oxygen to hydrogen peroxide

The cytoskeleton

series of tubules and rods that runs through the cytoplasm supporting the cellular structures  This is also responsible for cellular movements

The centrosomes

contains the centrioles short cylinders adjacent to the nucleus responsible for cellular division

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
 Cilia

are 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 reproduction  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. Mitosis – formation of new cell necessary for growth and tissue repair. 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: Genetic material within the cell is replicated. Cell divided to form two daughter with same amount and type of DNA.



The cellular division
 Five

steps of cellular division I-PM-A-T  Interphase- inactive or resting state  Prophase-Chromatin coils to form chromosomes, centrioles begin to assemble  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 molecule.

Four stage of Mitosis
Prophase – chromatin condensed into chromosome. Chromosome consist of two chromatin join by centromere.  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 formed.  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 number

Cell Physiology

DIFFUSION The movement of SOLUTES or particles in a solution from a higher concentration to a lower concentration 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 membrane  The pressure that draws water inside the vessel which is more concentrated is called Osmotic pressure

 If

a sugar is placed in plain water, the glucose molecules will dissolve and distribute in the solution  Factors that affect diffusionconcentration gradient, particle size, solubility and temperature

Special osmosis

special type of osmotic pressure is exerted by the proteins in the plasma. It is called ONCOTIC PRESSURE


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

pressure is the pressure exerted by the fluid against the container Increased hydrostatic pressure is one mechanism producing edema

Active transport
 This

is the movement of solutes across a membrane from a lower concentration to a higher concentration with utilization of energy  Example is the Sodium-Potassium pump, Endocytosis and Exocytosis


Group of cells with similar structure and function

There are four (4) Basic types 4. Epithelial 5. Connective 6. Muscle 7. Nervous

Epithelium Lining, covering and glandular tissues of the body The functions are to protect, absorb, filtrate and secrete substances

Epithelial tissues

epithelium Lined by ONE Layer of cell

epithelium Lined by many layers of cells

Epithelial tissues

epithelia 1. Simple squamos- alveoli, BV 2. Simple cuboidal- glands 3. Simple columnar- GI tract 4. Pseudo stratified epitheliumbronchial lining

Epithelial tissues

epithelium 1. Stratified Squamos- skin 2. Stratified cuboidalreproductive duct 3. Transitional epitheliumbladder and ureter

Connective tissues
 Bone  Cartilage  Muscle  Blood  Blood

vessels  Adipose tissue

The Integumentary System
 

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 protection
The skin seals off the body from the immediate environment  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 melanin. Langerhan’s cells participates in the immune system. Histiocytes are specialized macrophages

Skin as temperature regulator
Abundant nerves, blood vessels and glands are within the skin’s deeper layer  They aid in temperature regulation  Blood vessels constrict or dilate depending on the temperature

Skin functions

Sweat glands produce sweat to control temperature by evaporation The piloerector (arrector pili) muscles will contract to raise the hairs to trap the heat

Other skin functions

Vitamin D synthesis

7-dehydrocholesterolCholecalciferol (D3)

Route of excretion  Insensible fluid loss of about 500 ml/day  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: EPIDERMIS

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 keratin 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 reticular 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: Hypodermis
This is the subcutaneous tissue  Not strictly a part of the skin  Functions to insulate the body to conserve heat

Serves as the energy storage and mechanical shock absorber  With little vascular supply and scant nerve supply

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 bursae

The Musculoskeletal System

• Locomotion and protection • blood production in the bone marrow • 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 having numerous nuclei and striations

Properties of Muscles

Electrical excitability • Ability to contract to certain stimuli Contractility • Ability to contract forcefully when stimulated Extensibility • Ability to stretch without being damaged 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 sarcomere  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 types  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 midline Supination- turning a body part upward Pronation- turning a body part downward

 

Inversion- turning the foot inward Eversion- turning the foot outward Retraction- moving a body part backward Protraction- moving a body aprt forward

Muscles of the face
1.  2.  3.  4.  5.
 

Frontalis Orbicularis oculi orbicularis oris Buccinator Zygomaticus

Facial Nerve innervation

Muscles of Mastication

1. Masseter

2. Temporalis  3. Pterygoid muscles
 


Muscles of the neck
 

1. Platysma 2. Sternocleidomastoid

Muscle of the upper limb
  

1. 2. 3.

Biceps triceps deltoid

Muscles of the lower limb
   

1. 2. 3. 4.

Hamstring muscles Quadriceps Gluteal muscles 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 structure. The human skeleton contains 206 bones 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 legs

 

Long bones- - These bones have a shaft and ends. Ex: tibia, humerus, femur 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

Classification of Bones

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 calcium 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 sounds Frontal, maxillary, ethmoid and sphenoid

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 attachment  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 ischium 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 absorber

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 thumb  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 thick, diffuse branching processes that receive impulses and conduct them towards the cell

•The dendrites are short,

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 Systemthe cranial nerves and spinal nerves

The Organization of the nervous System
The Peripheral Nervous System is further classified into THREE Functional Divisions 1. The Somatic Nervous Systemcontrols the skeletal muscles 2. The Autonomic Nervous System- controls the visceral organs 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. • Diencephalon- Thalamus. Hypothalamus and pineal body • Brainstem- Pons, medulla and Midbrain

Fig. 8.23

The Cerebrum
• This is the largest part of the
brain • Consists of right and left hemisphere connected by the corpus callosum • Each cerebral hemisphere is composed of different lobesfrontal, temporal, parietal and occipital

The Frontal Lobe of the cerebrum

• Influences the personality of the
person • Also responsible for judgment, abstract reasoning, social behavior, language expression and motor movement.

The Temporal lobe of the Cerebrum

• 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 cerebrum principal center for • This is the

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 cerebrum

• This functions mainly to interpret
visual stimuli

Speech areas in the cerebrum
• 1. Wernicke’s area- responsible
for the sensory reception of speech. • 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 balance/equilibrium • 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 system

The Midbrain

•This connects with the

cerebrum •Contains numerous ascending and descending tracts and fibers

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
brainstem • 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

hypothalamus • The thalamus is the relay station of all sensory stimuli towards the brain • 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 fibers

•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
brain • The lateral ventricle- found in the cerebrum • 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 granulations

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 System
• The part of the peripheral
nervous system that innervates cardiac muscles, smooth muscles and glands Functionally divided into • Sympathetic Nervous System • Parasympathetic Nervous System

• Originates from the T1-L2/L3
segments of the spinal cord (thoracolumbar) • Utilized by the body for FLIGHT and FIGHT response • Neurotransmitter agents are Epinephrine and Norepinephrine (coming from the adrenal gland) • ADRENERGIC system

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
• CHOLINERGIC system • The vegetative system • Feed and Breed responses • Cranio-sacral location • Cranial nerves- 3, 7, 9, 10 and
S2-S4 • Neurotransmitter is Acetylcholine

Parasympathetic responses
• Increased
– Gastric secretions – Salivary secretions – peristalsis • Pupillary constriction • Decreased • Smooth muscle tone sphincters are relaxed • erection

Nerve Physiology • The nerve cells are excitable

cells • 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 pathway

• Vision is made possible by the

stimulation of the photoreceptor cells in the retina • Receptor cells are the RODS and CONES • The eye is made up of three layers – Fibrous layer- sclerae and cornea – Uvea- choroid and iris and ciliary bodies

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/ acceleration

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 buds • They are numerous in the vallate and fungiform papillae

The Gustatory apparatus
Basic taste modalities • Sweet- tip of the tongue • Salty- over the dorsum of the tongue • Sour- sides of the tongue • Bitter- back of the tongue

The Endocrine System

system is made up of widely distributed organs whose secretions (called HORMONES) are poured into the blood to reach the target cells

 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

exists an interrelated regulation between the HYPOTHALAMUS, Pituitary and the endocrine gland.

The hormonal regulation

call it the Hypothalamicpituitary-endocrine axis The exception are the pancreas and the parathyroid gland

The endocrine glands
 The

pituitary- anterior and posterior  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 hormonesACTH, TSH, FSH and LH – 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

called epiphysis cerebri Secretes melatonin

The thyroid gland

in the lower part of the anterior neck With two lobes connected by the isthmus

The thyroid gland
 Secretes

thyroxine (T4) and triiodothyronine (T3)  The T3 is the most active hormone  Function of T3/T4: Increase metabolic rate, essential for normal growth and maturation

The thyroid gland
 It

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

The parathyroid glands

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 osteoclasts Increases Vitamin D synthesis Increases Calcium level in the blood Causes retention of calcium in the kidney

The Adrenal glands

pair of gland resting on top of each kidney with 2 layers  ADRENAL CORTEX – Secretes mineralocorticoids – Secretes glucocorticoids – Secretes androgens- sex hormones  ADRENAL MEDULLA – Secretes the cathecolaminesEpinephrine, and norepinephrine

Fig. 10.17

Fig. 10.18

The Adrenal Cortex
 Mineralocorticoid-

Aldosterone – Increases sodium retention, water retention secondarily – Causes excretion of potassium

The Adrenal Cortex
 Glucocorticoids-

cortisol – Increases fat and protein breakdown – Increases glucose synthesis – Inhibit inflammation and immune response

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

The pancreas

endocrine portion of the pancreas is the ISLETS of LANGERHANS This islet is composed of three types of cells- alpha, beta and delta

Fig. 10.19

The pancreas

Alpha cells secrete GLUCAGON The Beta cells secrete INSULIN The delta cells secrete SOMATOSTATIN

Pancreatic insulin

Hypoglycemia by two mechanisms: Glucose breakdownglycolysis Glycogen productionglycogenesis

Pancreatic insulin

by most body cells to allow Glucose to enter the cell membrane The brain cells, intestinal cells, the red blood cells and the islet cells do not need insulin for glucose entry

Pancreatic glucagon

increased level of Glucose by: Glycogen breakdownglycogenolysis Glucose productionglucogenesis

The Gonads : Male- Testes
 The

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

The Androgens
 Aid

in spermatogenesis  Maintain functional reproductive organs  Responsible for secondary sex characteristics  Responsible for male sexual drives

The Gonads: Female- Ovary
 The

Follicular cells of the ovarian follicle secrete ESTROGEN and the corpus luteum secretes PROGESTERONE

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 peristalsis  Maintains pregnancy



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

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

The Gross Anatomy of the Heart

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 ICS LMCL

Heart Surface

SURFACE Right ventricle POSTERIOR SURFACE 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

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 supply There are two main coronary arteriesthe 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
 Coronary

sinus will collect all the venous blood from the heart into the RIGHT atrium anterior cardiac vein drains NOT into the coronary sinus but DIRECTLY into the right atrium

 The


Fig. 12.11

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

The Heart: Physiology

conducting system of the heart is a group of specialized heart cells that functions to conduct electrical impulses independent of any nerve supply

The Heart: Physiology

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

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 conduction This electrical activity is recorded by the Electrocardiogram (ECG)

The Heart: Physiology

cardiac cycle consists of the contraction phase and the relaxation phase in each heartbeat The SYSTOLE is the contraction phase The DIASTOLE is the relaxation phase

The Heart: Physiology

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 valves S3 is due to the rushing of blood through the AV opening S4 is due to contraction of the atrium

The Heart: Physiology

amount of blood the heart pumps out in each beat is called the STROKE VOLUME When this volume is multiplied by the number of heart beat in a minute (heart rate), it becomes the CARDIAC OUTPUT When the Cardiac Output is multiplied by the Total Peripheral Resistance, it becomes the BLOOD PRESSURE

The Heart: Physiology

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

Law 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 increases But when the maximum length has been reach, any further stretching will impair the contraction

The Blood vessel: Anatomy

consists of the artery, vein and capillary together with the lymphatic vessels 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 tissues

The Blood vessel: Anatomy

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

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

Terminology& Anatomy
Chronotropic effect

Refers to a change in heart rate A positive chronotropic effect refers


to an

increase in heart rate A negative chronotropic effect refers to a decrease in heart rate Dromotropic effect

to a change in the speed of conduction 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
Refers to a change in myocardial contractility A postive inotropic effect results in an increase

Inotropic effect


myocardial contractility A negative inotropic effect results in a decrease in myocardial contractility

Basic Electrophysiology Myocardial Cell Types
Kinds of Cardiac Cells Myocardial cells Electrical Specialized cells conduction of the system electrical conduction system Where Found Myocardium Primary Function Primary Property Contraction and Contractility Relaxation Generation and conduction of electrical impulses Automaticity Conductivity

Systemic circulation

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

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 PULSE PRESSURE = SP-DP

Physiology of circulation

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

nervous system (vagus)– decreases heart rate

BP regulation
Baroreceptors Receptors sensitive to stretch located in the carotid sinuses and aortic arch ↓ stretch reflex increase in heart rate ↑BP ↑ stretch reflex decrease in heart rate ↓BP

BP regulation
 Hormonal  Epinephrine

vasoconstriction increased resistance increased BP lung blood  Angiotensinogen A1 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
Inspection 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

tissue  Total blood volume is about 5 liters  Blood is composed of two portions: 1. Formed elements- RBC, WBC, Platelets 2. Plasma- the liquid portion

is a special connective

Fig. 11.2

The RED Blood Cell
 Non-nucleated

the blood  Biconcave  Transports Oxygen loosely bound to Hemoglobin  Red pigment is due to hemoglobin  Lifespan is 120 days  Reticulocytes are immature RBC

cellular element in

Fig. 11.4

The Leukocytes or WBC

the RBC Divided into Granulocytes and Agranulocytes

larger than

GRANULOCYTES 2. Neutrophils- most abundant WBC, 60-70%. This is the first cell to arrive in injury/inflammation.  Increased in bacterial infection  In females, there is the presence of the Barr bodies, the condensed X chromosome

The Leukocytes or WBC

 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.

Agranulocytes:  1. Lymphocyte- second most abundant (next to neutrophils)
– Found increased in Viral
infection and chronic infection. This can be: – T-lymphocyte – B-lymphocyte

Agranulocytes: – 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 mechanism

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 blood  The “D” antigen is the most prevalent  A person with “D” antigen is Rh (+)  A person with no “D” antigen is Rh (-)

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