ANATOMY AND PHYSIOLOGY Mr. Vidyadhara.

K Unit-I Introduction to anatomical terms

Anatomy and physiology are branches of biology. The human body is a very complex multi cellar organism in which the maintenance of life cycle depends upon a most number of physiological activities.

Definition:

Anatomy: is the study of the structure and architecture of the body and of the relationship of its surrounding structure. Process of cutting the human body to understand anatomy is Dissection. Physiology deals with functions of the body it explains the working of different body parts in supporting life.

Anatomy is subdivided into specific areas of study. They are,

1. 2. 3. 4. 5. 6. 7. 8.

Gross Anatomy: It is the study of body parts visible to naked eye. Cytology: It is the study of individual cell microscope. Histology: It is the study of microscopic structures of tissues. Embryology: It is the study of developing embryo. Osteology: It is the study of the bones. Arthrology: It is the study of the joints. Myology: It is the study of the muscular system. Neurology: It is the study of the brain and nerves.

Positions:

Anatomical position: The subject stands erect facing the examiner, eye facing forwards, feet flat on the floor directed forwards and arms by side with the palms facing forwards.
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Prone position: In this the subject is lying with face down. Supine position: In this the subject is lying with face up. Sagittal plane: It is the vertical plane that divides the body or an organ into right and left sides. Coronal plane: It divides the body into anterior (front) and posterior (back) portions. Transverse plane: It divides the body into superior (upper) and inferior (lower) portions. Oblique plane: It passes through the body at an angle between transverse, Sagittal plane.

Body planes:

Terms used to describe the body parts:

Medial: Is nearer to midline or median plane. Lateral: Is away from midline or median plane. Anterior/Ventral: Is nearer to front of the body. Posterior/Dorsal: Is closer to back of the body. Superior: Is towards the head or upper part of the structure that is studied. Inferior: Is away from the head or lower part of the structure. Superficial: Is towards or on the surface of the body. Deep: Is away from the surface of the body. Proximal: Is nearer to the point of origin or nearer to attachment of limb to the trunk.

Terms used to movement:

Joint: Is a site where two or more bones come together. Movements are take

place in the body at joints.

Flexion: Is a movement in the Sagittal plane, anterior surface of the forearm

moves towards anterior surface of arm. There is a decrease in angle between the articulating bones.

Extension: Is a movement in the posterior direction, an increase in angle Abduction: Is the movement of limb away from midline of the body in coronal Adduction: Is the movement of limb towards the body in coronal plane. Rotation: Is the movement of body parts around its own long axis. Medial rotation: Is the movement in which anterior surface of the part moves Lateral rotation: Is the movement in which anterior surface of the part moves Pronation: The forearm is medial rotation of the forearm, palm faces Supination: The forearm is lateral rotation of the forearm, palm faces Opposition: the movement of thumb across the palm to touch fingertips.

between the articulating bones.

plane.

medially.

laterally.

posteriorly.

interiorly.

Circumduction: The movement of distal part of the body in a circle. Elevation: An upward movement of a part of the body. Inversion: The movement of foot where sole of the foot turns medially. Eversion: The movement of foot where sole of the foot turns laterally. Abnormal movements: Dislocation means the displacement of bone from its joint.

Terms used in disease:

Pathology: It is the study of diseases. Etiology: It is the study of factors involved in the causes of disease.
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Pathogenesis: It is the pattern of development of the disease. Epidemiology: It is the study of occurrence, distribution and transmission of a disease. Diagnosis: It is the process of identifying the disease based on signs and symptoms. Signs: Abnormalities produced by a disease that can be seen or measured. Symptoms: Subjective abnormalities complained by the patient. Acute disease: A condition in which the sign and symptoms appear suddenly, remain for a short duration and disappear. Chronic disease: Those that develop slowly, remain for a long time. Idiopathic disease: They are those where the cause is not established. Communicable disease: They are those that spread from one person to another. Endemic disease: Those occur in a localized region. Epidemic: Is the spread of disease to a number of individuals at the same time. ********** Unit-II Organization of body

In human each and every function is performed by specific system of the body.

Each organ system is made up of various tissues. Each tissue is made up of

millions and millions of small units, termed Cells. Cell contains,

Water: 70- 75% of the cell is made up of water.

Electrolytes: major electrolytes include potassium, magnesium, sodium, phosphate, sulphate, bicarbonate, chloride and calcium. Proteins: They constitute 10-20% of the cell mass. They are of types; Globular and Structural Proteins. Lipids: They constitute 2% of cell mass. They are made up of phospholipids and cholesterol. Carbohydrates: They form around 1% of cell mass. They play a major role in providing nutrition to the cell.

Structure of Cell: Cell is made up of two major parts; Nucleus & Cytoplasm

Cytoplasm is the fluid part of cell containing the organelles. It is covered by an envelope termed as Cell membrane. Cell membrane: It is the membrane surrounding the cell. It covers the nucleus and the cytoplasm. It is a semi permeable membrane. It is 7-10 mm thick. The membrane is made up of proteins, lipids, and a little of carbohydrates. It is made up of two layers of phospholipids. 1. Function of lipids: They foam the cell membrane. They allow fat soluble substances to pass through them easily. 2. Function of proteins: They act as structural proteins, form ion channels, act as receptors and enzymes. 3. Function of carbohydrates: They act as receptors for binding hormones, and participate in immune reactions. Nucleus: It is a spherical shape structure covered by a nuclear membrane. It is controls chemical reactions and reproduction of the cell. Nucleus is mainly made up of water, 80% of the dry weight is proteins, 18% DNA and 2% RNA. It contains densely staining network of DNA and protein, is called Chromatin.

Genes are the units of heredity. Each gene is a portion of DNA molecule. They are present on the chromosome. Human beings have 23 pairs of chromosomes.
1.

Nuclear membrane: It has two layers, the outer and the inner layer. The outer layer is continuous with endoplasmic reticulum. Nucleoli: These are lightly stained structures in the nucleus. Nucleoli synthesize and store RNA and proteins, which play an important role in protein synthesis.

2.

Cytoplasm: It contains a fluid portion of the cell in which organelles are present. The fluid portion is called Cytosol. It contains dissolved proteins, glucose and electrolytes. It contains the following cellular organelles.

Mitochondria: It is the also called Power house of the cell. It is a sausage shaped structure made up of an outer membrane and an inner membrane. Inner membrane is folded to form shelves called Cristae, filled with Matrix containing dissolved enzymes. Ribosomes: They are present on the outer surface of endoplasmic reticulum. They are also present freely in the cytoplasm; Ribosomes are made up of RNA and proteins. Endoplasmic reticulum: This is a network of tubular and flat vesicular structure interconnected with each other, space between the tubules and vesicles are filled with watery fluid termed Endoplasmic matrix. This is of two types;
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Rough E.R: Granular (Ribosomes) structure on it surface helps in synthesis of proteins. Smooth E.R: Does not have Ribosomes on its surface helps in synthesis of lipids, glycogen metabolism.

Golgi apparatus: This same like smooth endoplasmic reticulum. It is made of multiple layers of thin flat vesicles lying near the nucleus. Its helps in the synthesis of carbohydrate.

Lysosomes: They are formed by Golgi apparatus and are present throughout the cytoplasm. Function is removal of unwanted, damaged substances and foreign bodies like bacteria. Centrosomes: They are structures present near the nucleus. They are made up of structures called Centrioles. It plays an important part during the steps of cell division. Microtubules: These are long hollow structures and are formed by organization of microfilament into tubular structures. It helps to transportation of organelles like mitochondria from one part of cell to another.

Cell division: There are two type of cell division; Mitosis and Meiosis.
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Mitosis: Cell division begins with fertilized egg or single cell zygote. In this replication of DNA in form of 23 pairs of chromosomes and the division of the cytoplasm. This has four phases;
1.

Prophase: In this phase Centrioles move apart and form poles of mitotic spindle. Each chromosome is made of a pair of chromatids attached to the centromere. Metaphase: Chromosomes move to equator of the spindle. Chromosomes split and chromatids get separated, Centrioles duplicate resulting in two Centrioles at each pole of the spindle. Anaphase: Separated chromatids move towards opposite pole with the help of the spindles. A constriction appears in middle of the cell indicating formation of two daughter cells. Telophase: Chromosomes are converted to chromatin network. Nucleoli and nuclear membrane reappears, spindle fibres disappear and finally to daughter cells formed.

2.

3.

4.

Meiosis: This is process of cell division that occurs in the formation of reproductive cells (Gametes; the ova the spermatozoa). The pairs of chromosomes separate and one from each pair moves to opposite poles of the parent cell. When it divides each of the daughter cell has only 23 chromosomes. Determination of sex depends upon one pair of chromosomes, thats sex chromosomes. In the female both sex chromosomes are the same size and shape called X chromosomes. In the male, there is one X chromosomes and slightly smaller Y chromosome.

 Notes:
1.

The portion of chromosome which codes a particular character is called a Gene. The continuous movement of molecules or substances among one from another in liquids or in gaseous state is termed Diffusion.

2.

3. The total amount of fluid present inside 75 trillion cells of our body is intracellular fluid, normal volume is 28 litters. 4. The total amount of fluid present outside the cells is extra cellular fluid, normal volume is 14 litters.

Tissues:
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The tissue is a group of similar cells performing similar function. They are classified according to the size, shape and function of these cells. There are four main types of tissues, 1. Epithelial tissue 2. connective tissue 3. muscle tissue
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4. nervous tissue

Epithelial tissue: It is made up of cells arranged continuously in single or multiple layers. It is found covering the body surface and lining cavities, tubes and also in glands. Functions: - Cover and protect the body surface. - Form the lining for cavities. - Help in secretion, absorption and excretion of substances. - Form the glands.
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The cells are very closely packed and the intercellular substance called the Matrix. The cells are usually lying on a Basement membrane. Epithelial tissue may be; - Simple epithelium: a single layer of cells. - Stratified epithelium: several layers of cells.

Simple epithelium: It is single layer cells and is divided into four types. It is usually found on absorptive or secretary surface.
1.

Squamous epithelium: This is composed of a single layer of flattened cells; various substances can rapidly pass through this epithelium. Cuboidal epithelium: This consists of cube shaped cells lying on a basement membrane. They have finger like projection called Microvilli. Their main functions are secretion, absorption, and excretion. Columnar epithelium: These cells have greater height compared to their width. It is found lining the organs of alimentary tract, help to absorb the products of digestion and secretion of mucus.

2.

3.

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4.

Ciliated epithelium: This formed by columnar cells which have fine hair like process called Cilia. It lines the respiratory passages and uterine tubes.

Stratified epithelium: It consists of several layers of cells of various shapes. Basement membranes are usually absent. There are two main types; Stratified Squamous and Transitional.
1.

Stratified Squamous epithelium: In the deepest layers the cells are mainly columnar and as they grow towards the surface, they become flattened. It is of two types; i. Non-keratinised: Found on wet surfaces i.e. conjunctiva of eyes, lining of mouth, pharynx etc. ii. Keratinised: Found on dry surface i.e. skin, hair, and nails.

2. Transitional epithelium: This is composed of several layers of pear shaped cells and is found lining the urinary bladder. They help during the distension of organs.

Connective tissue: It connective tissue consists of cells and matrix fills the space between the cells. Functions are; - They are specialized to support the body and its parts. - Connect different tissues to form organ. - Help in transport of substances through the body. - It involved in repair of tissues following injury. - The different types of cell involved include;

Fibroblasts: They are large flat cells with irregular process. They produce collagen and elastic fibres and matrix of extra cellular material. Macrophages: They are irregular shaped cells with granules in the cytoplasm.
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Plasma cells: They are derived from -lymphocytes. They synthesis and secrete specific antibodies into the blood. Mast cells: They are found in loose connective tissue and under the fibrous capsule of some organs ex; liver and spleen. Fat cells: These cells occur singly or in groups in many types of connective tissue. They vary in size and shape according to the amount of fat they contain.

Types of connective tissue:

a.

Areolar tissue: It contains collagen, elastic and cells like fibroblasts. They are present between the tissue and organs to proving elasticity, strength. Adipose tissue: It consists of fat cells, containing large fat globules; there are two types; white and brown. Fibrous tissue: This is a dense fibrous connective tissue made up mainly of closely packed bundles of collagen fibres with very little matrix. Elastic tissue: It is capable of considerable extension and the matrix consists mainly of masses of elastic fibres secreted by fibroblasts. Cartilage: This is firm and flexible supporting tissue. It is made up of elastic and collagen fibres, matrix containing chondroitin sulphate, these cells called chondrocytes. The types of cartilage are
i.

b.

c.

d.

e.

Hyaline cartilage: It appears as a smooth bluish white tissue. Chondrocytes are in small groups and the matrix is solid and smooth. It is located at the ends of long bones, nose, anterior part of ribs and respiratory passage. Fibrous cartilage: This consists of dense masses of white fibres in a matrix similar to that of hyaline cartilage with the cells
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ii.

widely dispersed. It is located as discs between vertebrae, at symphysis pubis.

iii.

Elastic cartilage: This consists of elastic fibres lying in a solid matrix. The cells lie between the fibres. They present in auditory tube, external ear and blood vessel walls.

f.

Bone tissue: Bones are organs composed of different types of connective tissue. Mature cells of the bones are osteocytes. Bones form the skeleton that supports other soft tissue. They store calcium and phosphorus. Bone has red and yellow bone marrow. Lymphoid tissue: It is present in lymph nodes, tonsils, spleen, appendix and intestine. It is made of semisolid matrix which has branching reticulin fibres. It contains lymphocytes and monocytes lymph is fluid connective tissue present in the lymphoid system. Blood tissue: It is fluid connective tissue made up of fluid part, plasma and the cellular components. It is present within the blood vessels. It helps in transport of gases, provides immunity and helps in clotting mechanism.

g.

h.

Muscle tissue: Muscles help in moving body and its parts. There are three types of muscle tissue.
1.

Striated muscle tissue: This also described as skeletal or voluntary muscle. It is called voluntary because contraction is under the control of the will. Microscopic examination of this muscle shows alternate light and dark bands called Sarcolemma. Non-striated muscle tissue: May also be described as visceral or smooth or involuntary. It is not under the control of the will. It is found in the walls of hollow organs i.e. blood vessels, alimentary tract, respiratory tract etc.
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2.

3.

Cardiac muscle tissue: This type of muscle tissue is found exclusively in the wall of the heart. The activity of cardiac muscle is controlled by some chemicals and autonomic nervous system.

Nervous tissue: They are responsible for communication between the tissues. They help in coordination of activities of the body. Two types of tissue are found in the nervous system. - Excitable cells (Neurons): Receive, conduct and transmit information. - Non-excitable cells: They support the neurons.

Membranes: - Membranes are sheets of epithelial tissue and their basement membranes that cover or line internal structures or cavities. - The main membranes are, Mucous membrane: - It has a layer of epithelium and underlying connective tissue. - Some of which produce a secretion called mucus.
-

As the cells fill up with mucus they have appearance of flask known as Goblet cells.

Serous membrane:
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It has Areolar connective tissue covered by simple Squamous epithelium.

- This has two layer namely visceral and parietal layers. - E.g. Pleura covering the lungs, peritoneum surround the abdominal organs, pericardium surrounds the heart. Synovial membrane: - This membrane is found lining the joint cavities; it helps to control injury to articulating surface of bones. - Synovial membrane secrets Synovial fluid which acts as a lubricant to the joints and helps to maintain their stability.
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Glands: - Some groups of epithelial cells are called glands. - They produce specialized secretions. Glands that discharge their secretion on surface of an organ through a duct are called Exocrine glands.
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Other groups of cells that have become discharge their secretions into blood and lymph are called endocrine glands. (Ductless glands).

Systems: The related organs with a common function form a system. Human body is made up of following systems.

Skeletal system: It consists of bones and joints with cartilage. Functions; 1. It supports the body. 2. Helps in movement. 3. Stores minerals and fat. 4. Produces blood cells. Cardio vascular system: It is formed by heart & blood vessels. Functions; 1. Heart pumps blood to different parts of the body. 2. Help in transport of respiratory gases like oxygen, and carbon dioxide, nutrients and waste products. Muscular system: It is made of skeletal muscles. Function is helps in movement of the body and its parts. Respiratory system: It is made up of lungs, respiratory passage like larynx, trachea and bronchi. Functions; 1. It helps in production of sound.
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2. It helps in supply of oxygen to the tissue and removal of carbon dioxide from the body.

Digestive system: It consists of parts of gastrointestinal tract, associated organs like liver, gall bladder and pancreas. Functions; 1. It helps in breakdown of complex food particles. 2. Helps in absorption of nutrients 3. Eliminates solid waste products. Renal system: It has kidneys, ureters, urinary bladder and urethra. Functions; 1. It produces and stores urine. 2. Eliminates metabolic waste. 3. Maintains acid base balance.
4.

Regulates production of RBC.

Nervous system: It has brain, spinal cord and special sense organs. Functions; 1. It controls and integrates activities of the body. 2. It responds to changes in the external environment. Endocrine system: It has the glands releasing their secretions (hormones) directly in to blood stream. Functions; 1. Hormones regulate activities of the body.
2.

Endocrine system co-ordinates with nervous system in various controlling mechanisms.

Reproductive system: females.

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- It is made up of primary organ of sex like testes in males and ovaries in

- The associated organs in males are epididymis, ducts deferens and penis.
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Uterus, fallopian tube and vagina are associated organs in females. Functions: 1. It helps in production of male and female gametes. 2. Helps to form new organism by fusion of male and female gametes. Integumentary system: It is made up of skin and the associated structures like hair, nails, sweat and sebaceous glands. Functions; 1. It protects the body. 2. Regulates body temperature. 3. Functions as an excretory organ. 4. Helps to sensations like touch, pain and temperature. Immune system: Immune system consists of spleen, thymus, tonsils, lymph nodes and lymph. Functions; 1. It protects the body against invading microorganisms. 2. Lymph moves proteins and fluid in to the vascular compartment from different parts of the body. *********** Unit-III Skeletal System

The skeleton is the framework of the body. Bone is a connective tissue. There are two types of bone tissue, compact bone and cancellous bone.

Compact bone: In microscope examination large numbers of haversian systems can be seen.
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i. ii. iii. iv.

Haversian canal: It is the central canal containing blood vessels and nerves. Lamellae: It is the arrangement of plates of bone or calcified matrix in a concentric manner. Lacunae: These are small spaces in matrix containing mature bone cells (osteocytes) and tissue fluid. Canaliculi: These are very small canals radiating from lacunae. They connect the lacunae with each other and the Haversian canal.

Cancellous / Spongy bone: - There is irregular arrangement of thin column of bones filled with open spaces. - Redbone marrow is always present in cancellous bone. - Major part of short, flat and irregular bones are made up spongy bone. Periosteum: - Bones are almost completely covered by this vascular fibrous membrane. - It gives attachment to muscle and tendons and protects bone from injury. Functions of bone: - Bones provide structural frame work for the body. - Give attachment to muscles and tendons. - Form the boundaries of the cavities, protecting the organs they contain. - Help the cells, develop in red bone marrow. - Provide a reservoir of calcium phosphorus and fat. - Permit the movement of the body and its parts. Types of bones: Bones are classified based on their structure. They are; Long bones Short bones Flat bones
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 Irregular bones Sesamoid bone

Long bones: - They have a diaphysis or shaft and two epiphysis/ extremities. - Diaphysis is hollow, cylindrical in shape and made up of compact bone with a central medullary canal forming yellow bone marrow.

Epiphysis is provides area for muscle attachment and stability for the joint. Articular cartilage is thin layer of hyaline cartilage covering joint surface of epiphysis. Periosteum is fibrous membrane covering the bone except at joint surfaces. Endosteum is thin epithelial membrane lining the medullary cavity of long bones.

E.g.: femur, humerus tibia etc.

Short, flat and irregular bones: - They have a thin outer layer of compact bone with cancellous bone inside, containing red bone marrow. Ex;

Short bones: bones of the wrist (carpal bones). Irregular bones: some skull bones and vertebrae. Flat bones: some skull bones, sternum and ribs. Sesamoid bone: Patella.

Types of bone cells: There are

Osteoblasts are bone forming cells. They form collagen fibres and matrix. Osteocytes are mature bone cells. They dont undergo cell division. Osteoclasts are resorption of bone to maintain the optimum shape. Note: Bone is formed by the process of ossification or Osteogenesis.
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Bones of the skeleton: The bones of the skeleton are dived into two groups.

Axial skeleton Appendicular skeleton

- Axial skeleton consists of bones of skull, vertebral column, and ribs sternum. - Appendicular skeleton consists of bones of shoulder girdle with upper limbs, pelvic girdle with lower limbs.

Skull: - The skull is the bony frame work of the head arranged into two parts. - The cranium consists of 8 bones. - The face consists of 13 bones. Cranium: - It provides a bony protection for the brain formed by flat and irregular bones. - The upper surface of the cranium is known vault of skull, the lower surface of the cavity is known base of skull. Frontal bone- 1 Parietal bone- 2 Temporal bone-2 Occipital bone-1 Sphenoid bone-1 Ethmoid bone-1 Frontal bone: - This is the bone of the fore head. It forms part of the orbital cavity. - The prominent ridges above the eyes the supra orbital margins. - Just above the margins air filled cavities lined by ciliated mucous membrane called Sinuses. Parietal bones: - The two parietal bone together forms the roof and sides of the skull.
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They articulate with each other at the sagittal suture, with the frontal bone at the coronal suture, with the occipital bone at the lambdoidal sutures, with the temporal bones at squamous sutures.

Temporal bones: - These bones lay one on each side of the head and each temporal bone has;
-

Squamous part: Is the thin fan shaped part that articulates the parietal bone. Mastoid process: Is a thickened part behind the ear. Petrous part: Forms the base of the skull and contains the organ of hearing. Zygomatic process: Project forwards from Squamous part to join the zygomatic bone behind and below the roof of this process lies the external auditary meatus.

Occipital bone: - This bone forms the back of the head and part of the base of the skull. - Two Articular condyles that form hinge joints with the first bone of the vertebral column, the Atlas. - Between the condyles there is the foramen magnum through which the spinal cord passes.

Sphenoid bone: - This bone occupies the middle portion of base of skull and it articulates with the temporal, parietal and frontal bones. - The body having two greater and lesser wings. The body shows a depression named the hypophyseal fossa in which the pituitary gland rests. Ethmoid bone: - It occupies the anterior part of the base of skull and helps to form the orbital cavity. - On each side there are two projections in to the nasal cavities, the upper and middle conchae.
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- It is a very delicate bone containing many air sinuses openings into the nasal cavities

Face: The skeleton of face is formed by 13 bones in addition to the frontal bone. 2 zygomatic bones 1 maxilla 2 nasal bones 2 lacrimal bones 1 vomer 2 palatine bones 2 inferior conchae 1 mandible

Zygomatic /cheek bone: Its form the prominences of the cheeks and part of the floor and lateral walls of the orbital cavities. Maxilla: It forms the upper jaw, the anterior part of the roof of mouth, the lateral walls of the nasal cavity. On each side there is a large air sinuses, the maxillary sinus, lined with ciliated mucus membrane openings into the nasal cavities. Nasal bones: These are two small flat bones which form the greater part of bridge of the nose. Lacrimal bones: These are the smallest bone of the face. This forms the tear ducts and part of medial walls of orbital cavities. It consists of ducts which carry the tears from eye to nasal cavity. Vomer bone:
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It thin flat bone forms the part of the nasal septum. It articulates with the perpendicular plate of the Ethmoid bone.

Palatine bone: These are L shaped and form the roof of the mouth and the floor of the nose. (Hard palate, leteral walls of nasal cavities, part of orbital cavities). Inferior conchae: These form the part of the nasal cavity and situated below the superior and middle nasal conchae of Ethmoid bone. Mandible: This is the only movable bone of the skull. Each half consists of two main parts; a curved body with alveolar ridge, a ramus which projects upwards almost at right angles with condyloid process and coronoid process. The point where the ramus joins the body is the angle of the jaw Hyoid bone: This is an isolated horse-shoe shaped bone lying in the soft tissues of neck just below the mandible. It does not articulate with any other bone but is attached to temporal bone by ligaments

Sutures of the skull: The bones of the skull are united together by immovable joints are called Sutures. The coronal suture between the frontal bone and the two parietal bones.

The sagittal suture between the 2 parietal bones. Lambdoidal suture between the occipital and two parietal bones. The Squamous suture between the parietal bone and the temporal bone.

Fontanelles of skull:

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- At the birth, ossification of the cranial sutures is incomplete. Where 3 or more bones meet there are distinct membranous areas of fontanelle. There are, - The anterior fontanelle, not fully ossified until the 12 to 18 months. - The posterior fontanelle, usually ossified 2 to 3 months after birth

Sinuses:
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Sinuses containing air present in the sphenoid, Ethmoid, maxillary and frontal bones. The functions are,

- To give resonance to the voice. - To lighten the bones of the face and cranium.

Vertebral column: The vertebral column consists of 24 separate movable, irregular bones, the sacrum and coccyx. The 24 separate bones are in 3 groups; 7 cervical, 12 thoracic and 5 lumbar. Typical vertebra:
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The body of each vertebra is situated anteriorly. The size varies with the site.

- The neural arch encloses a large vertebral foramen. - The ring of bone consists of 2 pedicles that project backwards from the body to laminae. - Transverse processes project laterally and spinous processes at place of 2 laminae meet in midline. - The vertebral foramina from the neural canal that contains the spinal cord.

Cervical vertebrae: - These are irregular bones, and peculiar in shape or atypical. - The atlas is first cervical vertebrae and the axis is second cervical vertebrae. - The cervical vertebrae have some common characters. - The bodies are small and oblong in shape. - The neural arch is large.
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- The spinous processes are divided in terminal. - The transverse processes are perforated by foramina for the passage of vertebral arteries.

Thoracic vertebrae: - These are larger than cervical vertebrae. - The bodies and transverse processes have facets for articulation with the ribs. - The body is look heart in shape. Lumbar vertebrae: - These are largest and kidney shaped in structure. - The spinous process is broad and transverses processes are long. Sacrum: - This consists of five fused vertebras. - The upper part articulate with fifth lumbar vertebrae, on each side with ileum to form a sacro-iliac joint, inferiorly with coccyx. - These have the foraminas for passage of nerves. Coccyx:
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This consists of the 4 terminal vertebraes fused to form a very small triangular bone articulates with tip of the sacrum.

Functions of the vertebral column: - Provide a strong bony protection for the spinal cord. - The pedicles are adjacent to form foramina. - It supports the skull. - Help to certain amount of movement. - It forms the trunk, shoulder girdle and pelvic girdle and thoracic cage. The thoracic cage:
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The bones of the thorax or thoracic cage are; 1 sternum.

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 12 pairs of ribs. 12 thoracic vertebrae.

Sternum or breast bone: - This flat bone can be felt just under the skin in the middle of the front of the chest.
-

The manubrium is uppermost and articulates with the clavicles at the sternoclavicular joints and with the first 2 pairs of ribs.

- The body or middle part gives attachment to the ribs. - The xiphoid process is tip of bone. It gives attachment to diaphragm, muscles of abdominal wall.

Ribs:
-

There are 12 pairs of ribs which form the body walls of thoracic cage & articulate posteriorly with the thoracic vertebrae. The first 10 pairs are attached anteriorly to sternum by costal cartilages; last two pairs have no anterior attachment. Characteristics: transverse process.

- The head articulates posteriorly with the body & tubercle articulates with - The steral end is attached to the sternum by costal cartilage. - It consists of superior rounded & smooth inferior border. - The first rib does not move during respiration. - The spaces between the ribs are occupied by the intercostals muscles.
-

(The costal cartilages are bars of hyaline cartilage connect the ribs the sternum by means of their elasticity allows of considerable movement).

Appendicular skeleton: - The Appendicular skeleton consists of the shoulder girdle with the upper limbs and the pelvic girdle with the lower limbs.
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Shoulder girdle and upper limb: - Each shoulder girdle consists of 1 clavicle and 1 scapula. Each upper extremity consists of the following bones. 1 Humerus 1 radius 1 ulna 8 carpal bones. 5 meta carpel bones 14 phalanges. Clavicle or collar bone: - The clavicle is along bone which has a double curve.
-

It articulates with manubrium of sternum at the sterno clavicular joint and forms the acromio-clavicular joint with the acromian process of scapula.

- The clavicle provides the link between the upper extremity and the axial skeleton.

Scapula or shoulder blade: - The scapula is a flat triangular shaped bone lying on the posterior chest wall superficial to the ribs and separated from them by muscles.
-

At the lateral angle there is articular surface, the glenoid cavity with the head of the humerus.

- On the posterior surface there is spine that projects lateral angle, the acromian process articulates with clavicle. - The coracoids process projection from the upper border of bone gives attachment to the muscles.

Humerus: - This is the longest bone of the upper arm.

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- The head articulates with the glenoid cavity of scapula, forming the shoulder joint. - Below the head there is a neck and there are two rough end projection of bone, the greater and lesser tubercles and below them a deep groove is bicipital groove. - A rough tubercle on the lateral aspect of shaft is deltoid tuberosity. - The distal end of bone presents two surfaces. The trochlea articulates with ulna and the capitulums with radius.

Ulna and radius: - These are the two bones of the forearm. - The ulna is medial to the radius when the arm is in anatomical position. - They articulate with the humerus at the elbow joint, the carpal bones at wrist joint and with each other at the superior and inferior radio ulnar joints. Carpal or wrist bones: - There are 8 carpal bones arranged in two rows of four. - From without in wards they are, - Proximal row: scaphoid, lunate, triqetral, pisiform. - Distal row: trapezium, trapezoid, capitate, hamates. - Ligaments hold carpal bones together. - Bones of the proximal row are associated with the wrist joint and the distal row from joints with the metacarpal bones. Meta carpel bones: - These five bones form the palm of the hand. - They are numbered from thumb side inwards. - The proximal ends articulate with the carpal bones and the distal ends with the phalanges. Phalanges or finger bones:
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- There are 14 phalanges, three in each finger & two in the thumb. - They articulate with the metacarpal bones & with each other.

Pelvic girdle & lower limb: - The bones of the pelvic girdle are 2 in nominate bones & 1 sacrum.
-

The bones of the lower extremity are; 1 femur 1 tibia 1 fibula 1 patella 7 tarsal bones 5 metatarsal bones 14 phalanges.

Innominate or hip bones: - Pelvic girdle consists of two hip bones. - Each hip bone consists of three fused bones, Ilium is superior, Pubis is inferior & anterior, and Ischium is inferior & posterior. - The ilium is the upper flattened part of the bone & it presents the iliac crest, the anterior point of which is called the anterior superior iliac spine. - The pubis is the anterior part of the bone & it articulates with the pubis of other hip bone at a cartilaginous joint, the symphysis pubis. - The ischium is the inferior and posterior part.
-

The union of the three parts takes place in the Acetabulum. The pelvis is formed by the two in nominate bones which articulate anteriorly at the symphysis pubis & posteriorly with the sacrum at the sacro-iliac joints.

The pelvis:
-

Differences between male & female pelvis: Male pelvis

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Female pelvis

Larger & stronger bones Inlet is smaller Acetabulum is large Iliac crest is more curved Coccyx is less movable Sacrum is longer & narrower Femur or thigh bone:

Wider & shallower bones Inlet is larger Acetabulum is small Iliac crest is less curved Coccyx is more movable Sacrum is shorter & wide.

- The femur is the longest & strongest bone of the body. - The head is almost spherical & articulate into the acetabulum of the hip bone to form the hip joint. - In the center of the head there is a small depression for attachment of the ligament of the head of the femur. - The neck extends outwards; upper part of shaft has projections termed greater & lesser trochanter.
-

Distal end of femur has expended portions called medial & lateral condoyle, above triangular area is papliteal surface.

- Lower end of femur articulates with tibia & patella.

Tibia or shin bone: - The tibia is the medial of the two bones of the lower leg. - The proximal extremity is broad and flat and presents two condyles for articulation with the femur at the knee joint. - The head of the fibula articulates with the inferior aspect of the lateral condyles, forming the superior- tibiofibular joint. - The distal extremity of the tibia forms the ankle joint with the talus and the fibula. - The medial malleolus is a downward projection of bone medial to the ankle joint. Fibula: - The fibula is the long and lateral bone in the leg.
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- Proximally it articulates with tibia. - The distal end has projection termed lateral malleolus. - It articulates with talus bone at ankle joint.

Patella or knee cap: - This is a triangular shaped Sesamoid bone associated with the knee joint. - Its posterior surface articulates with the patellar surface of the femur in the knee joint. - Anterior surface is in the patellar tendon, help to maintain the position of tendon during movements and protect knee joint. Tarsal or ankle bones: There are 7 tarsal bones which form the posterior part of the foot. They are, 1 Talus 1 calcaneous 1 Navicular 3 Cuneiform 1 Cuboids - The talus articulates with the tibia and fibula at the ankle joint. - The other bones articulate with each other form inter tarsal joints and with the Meta tarsal bones. Meta tarsal bones: - These are 5 bones, numbered from with in outwards, which form the inter mediate region of the foot. - At their proximal ends they articulate with the tarsal bones and at their distal ends with the phalanges. Phalanges: - There are 14 phalanges arranged in a similar manner to those in the fingers, i.e., two in the great toe and three in each of the other toes.
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Arches of the foot: - Foot has 2 longitudinal arches formed by the arrangement of bones. - The medial longitudinal arch is formed by calcaneous, talus, Navicular, three cuneiforms and 3 medial Meta tarsal bones. - The lateral longitudinal arch is formed by calcaneous, cuboids and heads of lateral two Meta tarsal bones.

THE JOINTS: A joint is the site at which any two or more bones come in contact with each other. Classification: - Joints are classified into Fibrous or fixed joints. Cartilaginous or slightly movable joint. Synovial or freely movable joint. Fibrous or fixed joint: - These immovable joints have fibrous tissue between the bones. - E.g.: Joints between the bones of the skull, distal tibiofibular joint, and joint between the teeth and the maxilla. Cartilaginous or slightly movable joint: - There is a pad of fibro cartilage between the ends of the bones making up the joint which allows for very slight movement. - E.g.: Symphysis pubis and the joints between the bodies of the vertebrae. Synovial or freely movable joints: - The bones forming this joint have an irregular connective tissue capsule & a Synovial cavity. It has different types of movements. They are, - Flexion extension, abduction, adduction, circumduction, rotation, pronation, supination, inversion, eversion.
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- Synovial joints are classified according to the range of movement possible. Ball and socket Hinge joints Gliding joints pivot joints Condyloid and saddle joints Characteristics of a Synovial joint: - All Synovial joints have certain characteristics in common. - There is a space between the articulating bones called Synovial cavity. - Bones at the joint are covered by articular cartilage. - The joint is covered by articular capsule. It has an outer fibrous layer and inner Synovial membrane. - Inner Synovial membrane secretes Synovial fluid. Synovial fluid lubricates the joints, supplies nutrients. - Some joints have additional ligaments termed extra capsular and intracapsular ligaments. - Extra capsular structures like ligaments, muscles give additional support, stability, movement of bones forming the joint. - Nerves and blood vessels crossing a joint usually supply the capsule and the muscles. Main Synovial joints of the limbs: Shoulder joint: - This ball and socket joint is formed by the glenoid cavity of the scapula and the head of the humerus. - The glenoid cavity is deepened by a rim of fibro cartilage is the glenoidal labrum.
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- Articular capsule covers the joint extending from glenoid cavity to anatomical neck of humerus. - The tendon of the long head of the biceps muscle, attached to the upper rim of glenoid cavity, lying in groove of the humerus. - Glenohumeral ligaments extend from glenoid cavity to anatomical neck of humerus to strengthen the capsule. - The transverse humeral ligament, retaining the biceps tendon in the inter tubercular groove. - Muscles and movements:

Flexion; coracobrachialis, anterior fibres of deltoid and pectoralis major.

Extension; Teres major, latissimus dorsi and posterior fibres of deltoid. Abduction; deltoid Adduction; combined action of flexors and extensors. Circumduction; Flexors, extensors, abductors and extensors. Medial rotation; Pectoralis major, latissimus dorsi, teres major and anterior fibres of deltoid. Lateral rotation; Posterior fibres of deltoid. Elbow joint: - This hinge joint is formed by the trochlea and the capitulums of the humerus and the trochlear notch of the ulna of the head of the radius. - Extra capsular structures consist of anterior, posterior, medial, and lateral strengething ligaments. - Articular capsule is formed by the anterior and posterior parts covering the joint. - Ulnar collateral ligament extends from medial epicondyle of humerus to coronoid process and olecranon of ulna.
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- Muscles and movements Flexion; biceps and brachialis. Extension; Triceps. Radio ulnar joints: - Proximal radioulnar joint is formed by head of radius and radial notch of ulna. - Distal radio ulnar joint is piviot joint formed by distal end of radius and head of ulna. - Muscles and movements: Pronation: pronator teres. Supination: Supinator and biceps. Wrist joint: - This is a condyloid joint between the distal end of the radius and the proximal ends of the scaphoid, lunate, triquetral. - A disc of fibro cartilage separates ulna from the joint, articulates with the carpel bones. - The joint is surrounded by anterior and posterior radio carpel ligaments, medial and later ligaments. - Muscles and movements: Flexion: Flexor carpi radialis and flexor carpi ulnaris. Extension: Extensors carpi radialis and the extensors carpi ulnaris. Adduction: Flexor and extensor carpi ulnaris. Abduction: Flexor and extensors carpi radialis. Hip joint: - This ball and socket joint is formed by the cup shaped acetabulum of the hip bone and head of the femur.
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- Acetabular labrum is a rim of fibro cartilage attached to rim of acetabulum, which makes it deep. - Articular capsule extends from rim of acetabulum and neck of femur. - Ligament of head of femur extends form the fossa. - Transverse ligament of acetabulum supports a part of acetabulum labrum. - Muscles and movements: Flexion: Psoas, iliacus, rectus femoris and sartorius. Extension: Gluteus maximus and the hamstring. Abduction: Gluteus medius and minimus, sartorius and others. Adduction: Adductor group. Lateral rotation: Mainly gluteal muscles and adductor group. Medial rotation: Gluteus medius and minimus and others. Knee joint: - This hinge joint is formed by the condyles of the femur, the condyles of the tibia and the posterior surface of the patella. - The knee joint is strengthened by medial and lateral ligament, ligament, patellar ligament, and popliteal ligament, Tibial and fibular collateral ligament. - Anterior and posterior cruciate ligaments stabilize the joint. - Articular discs are two discs made up of fibro cartilage present between femoral and Tibial condyles (semi lunar cartilages). - Muscles and movements: Flexion: Gastrocnemius and the hamstring. Extension: Quadriceps femoris muscle. Ankle joint: - It is a hinge joint formed by the distal end of tibia, distal end of fibula and the talus.
36

- The deltoid, anterior, posterior, medial and lateral ligaments strengthen this joint. - Muscles and movements: Flexion: Anterior tibialis assisted by the muscles extend the toes.

Extension: Gastrocnemius and soleus assisted by the muscles flex the toes. ************* Unit-IV Muscular system

Muscles are excitable tissues of the body. They contract in response to a stimulus. There are three types of muscle tissue;

Striated muscle tissue: This may be described as skeletal, striated, voluntary muscle. It is called voluntary because contraction is under the control of the will. Non Striated muscle tissue: May also be described as smooth or in voluntary muscle. It is not under the control of the will. Cardiac muscle tissue: Its found exclusively in the wall of the heart. It is not under the control of the will.

Structure of skeletal muscle: - Skeletal muscle as a whole is covered by connective tissue covering called epimysium. - Epimysium is made up of groups of skeletal muscle fibres called fascicles. - These fascicles are covered by perimysium. These made up of some muscle fibres are covered by endomysium.
37

- Striated muscle show alternate dark & light bands. Skeletal muscle has the fibrous tissue ending called tendon.
-

The structural and functional unit of the muscle is termed as Sacomere. muscle attachment to the bone that moves during muscle contraction. Between these both part of muscle termed as muscle belly.

- Origin is the point of attachment of muscle to bone and insertion is the site of

Functions of muscle: - Maintenance of posture in the sitting and standing positions. - They are stimulated by motor nerve impulses. - Help to storage of the energy in the form of fat and carbohydrate. - Help to produce body movements at joints. - Provide shape of the body and structure of the body. Muscles of the face: - These are many muscle involved in changing facial expression and with movement of lower jaw during chewing and speaking. Here indicated the muscles are present in pairs, one on each side. Occipitofrontalis Levator palpebrae superioris

Orbicularis oculi

Buccinator Orbicularis oris Masseter Temporalis Pterygoid Muscles of the neck: - These are many muscles situated in the neck but only the two largest are considered here.
38

 Sternocleidomastoid Trapezius Muscles of the back: - These are six pairs of large muscle in the back in addition to those that form the posterior abdominal wall. The arrangement of these muscles is the same on each side of the vertebral column. They are Trapezius Teres major Psoas Latissimus dorsi Quadratus lumborum Sacrospinalis - The anterior abdominal wall is divided longitudinally by a very strong extends from the xiphoid process of the sternum to the symphysis pubis.

Muscles of the pelvic floor: - The pelvic floor is divided into two identical halves that unite along the midline. Each half consists of fascia and muscle. They are Levator ani Coccygeus

Muscles of the thigh: Hamstring muscles: These lie on the posterior aspect of the thigh. They originate from the ischium and are inserted into the upper end of the tibia. Gluteal muscles: These consist of the gluteus maximus, medius and minimus which together form the fleshy past of the buttock. Ilicus muscle Psoas Adductors group
39

 Rectus femoris Vastus lateralis Vastus medialis Muscles of the arm: Deltoid muscle: These muscle fibres originate from the clavicle, acromion process and spine of scapula and radiate over the shoulder joint to be inserted into deltoid tuberosity of the humerus. Biceps Brachialis Coracobrachialis Triceps Neuromuscular junction:
-

Neuromuscular junction is a specialized area where a motor nerve ends on the skeletal muscle fibre. Neuromuscular junction consists of

Pre-junctional membrane is the terminal part of motor nerve with vesicles containing acetylcholine. Synaptic cleft is a potential space between the nerve terminal and muscle. Motor end plate is the muscle membrane containing acetylcholine receptors.

Notes:
-

Tone: It is a state of partial contraction of muscle at rest. And also termed as the resistance offered by muscle to its passive movement. Hypertonia: It is state of the muscle where tone is increased, described as rigidity or spasticity. Hypotonia is state of reduction in tone of the muscle. Atonia is total absence of tone.
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************** Unit-V Blood: - Blood is a fluid connective tissue present in the circulatory system. - It is communication between the cells of different parts of body and the external environment. - Blood is made up of fluid component; Plasma (55%) and cells (45%) - Total volume of blood is around 5L in an average adult male. - The normal pH of the blood is 7.4. Function of blood: 1. Transport of oxygen and carbon dioxide. 2. Supply of nutrition to various tissues. 3. Transport of waste products for excretion. 4. Transport of hormones, vitamins, drugs and chemicals. 5. Maintenance of acid base balance. 6. Regulation of body temperature. 7. Protection against infection. 8. Helps in blood clotting. Plasma: - Plasma is the fluid portion of blood. It is mainly composed of water (90%) and dissolved substances.
A.

Cardio Vascular System

Plasma proteins: They are the proteins present in plasma. Most of the plasma proteins are synthesized in liver. Normal concentration is 6-8 gm/dl. Important plasma proteins are

41

Albumin: This is formed in the liver. Albumin is mainly responsible for maintenance of osmotic pressure, helps in transport of bilirubin, hormones and drugs. Globulin: Globulins include transport proteins, lipoproteins and immunoglobulins. Clotting factors: These are substances essential for coagulation of blood. Ex: Prothrombin. Fibrinogen: This is synthesized in the liver and is essential for blood coagulation. Functions: a. Plasma proteins maintain the osmotic pressure.
b.

They are responsible for maintainance of viscosity of blood.

c. They act as buffers to regulate pH. d. They act as protein reserve.

e.

globulins provide immunity.

f. They are responsible for blood clotting. g. They help in transport of hormones, drugs etc.
B.

Inorganic salts: They present in the plasma are involved in a wide range of activity. This includes formation of cell, muscle, contraction, transmission of nerve impulses. E.g. iron, copper, potassium, sodium. Nutrient materials: Food is digested by the GI tract and nutrients are absorbed into the blood. Therefore plasma contains glucose, amino acids, fatty acids and vitamins. Organic waste products: Like urea, uric acid and creatinine are formed in liver during proteins metabolism is carried by the plasma to the kidneys for excretion.

C.

D.

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E.

Antibodies (Ig): These are protective substances, produced by lymphoid tissue mainly in lymph nodes and in the spleen. Gases: Oxygen, carbon dioxide and nitrogen are transported round the body in solution in plasma.

F.

Cellular contact of blood: There are three types of blood cells. There are circular non nucleated discs with a diameter of about 7, thickness is 2. - Normal life span of RBC is 120 days. - RBCs can easily pass through the narrow capillaries, its very flexibility.
-

Erythrocytes or red blood cells:

-

They do not have nucleus, mitochondria, and Ribosomes. They contain pigment hemoglobin in jelly form. A normal value of erythrocyte count is in male 4.5 to 6.5 million cells/cu.mm. In female 4.5 to 5 million cells/cu.mm. In infants 6 to 7 million cells/ cu.mm.

- Functions of RBC are due to the presence of Hb. They include transport of oxygen and carbon dioxide and regulation of acid base balance. Erythropoiesis: - This is the process of formation of RBCs. - It occurs in bone marrow. - The process of erythropoiesis takes 7 days.
-

Erythropoiesis involves maturation of the cell and formation of Haemoglobin. During maturation of the cell it loses its nucleus and also decreases in size.

- Haemoglobin is a conjugated protein made of heam and globin. Haemoglobin: - Hb is a conjugate protein present in the RBC.
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A normal value is in males 14 to 16 gms/dl and females 12 to 15 gms/dl. Functions are; carries oxygen from lungs to the tissues. It is also involved in transport of carbon dioxide and acts as a buffer.

Thrombocytes or Platelets:
-

These are very small non-nucleated discs, 2 to 4 m in diameter. Normal count is 1.5 to 4 lakh cells / cu.mm. Life span is 8 to 12 days. Formed in the born marrow.

Functions: - Help in haemostasis by forming platelet plug - Accelerate the process of clotting. - Involved in phagocytosis of antigen-antibody. - Help in the repair of damaged endothelium. - Store & transport of histamine. - Play a role in inflammation. Haemostasis: - When a blood vessel is damaged lose of blood is stopped and healing occurs in same mechanisms called haemostasis. That mechanisms are, - Blood vessel is ruptured or cut the vessels automatically vasocontricts - The damaged vessels going to plug by platelets dump to each other. - Next blood clotting process forms a semisolid jelly like substance in about 15-20 seconds. - Coagulation is complete fully in 3 to 6 minutes. - Fibroblasts are formed within few hours following clot formation. Latter in 1-2 weeks, clot is completely organized into fibrous tissue. Mechanism of blood coagulation: - Clotting or co-agulation occurs in three basic stages.

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- Whenever the blood vessel ruptures a cascade of chemical reactions occur in blood, finally form a complex of activating substances called Prothrombin activator. - Prothrombin activator catalyses the conversion of prothrombin to thrombin (Intrinsic mechanism). - Thrombin acts as an enzyme to convert fibrinogen to fibrin (Extrinsic mechanism). Leucocytes or white blood cells: - These cells have an important function in defending the body against microbes & other foreign materials. - Normal WBC count is 4000- 11,000 cells/ cu mm. of blood
-

They are the largest blood cells and the account for about 1% of blood volume.

- They contain nuclei & some have granules in their cytoplasm. - There are two main types; a. Granulocytes Neutrophils, eosinophils & basophiles. b. A Granulocytes Monocytes & lymphocytes. Neutrophils:
-

They are about 10-12 in diameter.

- They form about 60% of the total leukocyte. - Life span of neutrophils is about 6-7 hours in the blood & 1-4 days in the tissues. - The main function of neutrophils is destruction of microorganisms by phagocytosis. Eosinophils:
-

They are around 10-14 in diameter.

- They form 4% of total leucocytes.

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- They stay in blood for 6-8 hours & in the tissues for 4-5 days.
-

They are increased in allergic conditions; such as asthma, hay fever etc. (Anti allergic function).

Basophiles:
-

They are around 8-10 in diameter.

- They form less than 1% of total leucocytes. - The nucleus is irregular or S shaped. - They remain in blood for short duration & later migrate to the tissues. - They contain heparin, which an anticoagulant substance. Monocytes:
-

These are very large cells, around 12-18 in diameter. Life span of monocytes in the blood is around 10-20 hours & in the tissues for months to years.

- They form 8% of total leucocytes.

-

Lymphocytes: - They form around 25-30 % of total leucocytes.

-

They are of two types, large of small lymphocyte. Large are about 7 in diameter.

Immunity: - The resistance possessed by body to infectious diseases. - There are two type; Active and Passive Immunity, both consists of natural and artificial types respectively. Blood Groups:
-

Blood is categorized into different groups based on their antigenic properties.

- Most important blood group systems are the ABO system and Rh system. ABO system:
46

- Human blood is categorized into four major groups depending on the presence or absence of antigens. - There are four blood groups in this system A, B, AB & O. Rh system: - It is also an important system of blood grouping.
-

There are six agglutinogens in Rh system. They are C, D, E, c, d, e. (D absent Rh ve, presents Rh +ve)

ABO incompatibility: - When mismatched blood is transfused to a person, serious reactions can occur resulting in death of the person. Blood Transfusion: - It is a procedure in which blood collected from the donor is transfused to the recipient. - Indications: a. Sudden blood loss due to accidents. b. During major surgeries. c. Patients with bleeding disorder. d. Patients with severe burns. e. Patients with severe anemia & leukemia. The circulatory system: - It consist of, Heart help to pumps blood to all parts of the body. Blood vessels help to blood reaches different part of body. Lymphatic system, consist of lymph nodes and lymph vessels.

Heart: - The heart is a roughly cone shaped hollow muscular organ. - It is about 10 cm long and is about the size of the owners fist.
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- It weights about 225 g in women and is about 310 g in men. Position: a. The heart is in the thoracic cavity in the mediastinum between the lungs.
b.

It lies obliquely, a little more to the left than the right, and presents a Base above, and an Apex below. The apex is about 9 cm to the left of the Medline at the level of 5th intercostals space.

c.

d. The base is extends to the level of 2nd Rib. Organs Associated:

-

Superiorly: The great blood vessels i.e., aorta, superior venacava, pulmonary artery and vein. Inferiorly: The apex rest on the central tendon of diaphragm. Anteriorly: The sternum, ribs and intercostals muscles. Laterally: The lungs. Posteriorly: The esophagus, trachea, bronchus, descending aorta, inf. Vena cava and vertebrae.

Structure: The heart is composed of three layers of tissue, Pericardium Myocardium Endocardium Pericardium: - The pericardium is outer most layer of heart, is made up of two sacs. - The outer sac consists of fibrous tissue and the inner of the double layer of serous membrane. [Outer parietal pericardium, inner visceral pericardium] - The serous membrane consists of pericardial space with fluid.

Myocardium:

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- The myocardium is middle layer of heart muscle is composed of specialized cardiac muscle tissue found only in the heart not under the control of our will but, like voluntary muscle. Endocardium: - This is inner layer forms the lining of the myocardium and the heart valves. It is a thin, smooth, glistening membrane which permits smooth flow of blood inside the heart.

Interior of the heart: - The heart is divided into right and left side by the septum. - After birth blood cannot cross the septum from one side to the other. - Heart has 4 chambers superiorly 2 Atrium and Inferiorly 2 ventricles. (Inter Atrial and ventricular septum)
-

Each side is divided by an atrioventricular valve into upper chamber (The Atrium) and lower chamber (The Ventricle). The right Atrioventricular valve (Tricuspid valve) has three flaps / cups. The left Atrioventricular valve (Mitral valve) has two flaps /cups. Inf. Surface of the cups to little projection of the myocardium covered with endothelium, called Papillary muscles.

Flow of blood through the heart: - From body parts blood comes to atrium through superior and inferior vena cava. - This blood passes via the right Atrioventricular valve into the right ventricle; from there it is pumped into the pulmonary artery / trunk. - After leaving the heart the pulmonary artery divides into left and right pulmonary arteries. - Which carry the venous blood to the lung where interchange of gases takes place is.
49

Two pulmonary veins from each lung carry oxygenated blood to the left atrium. Then passes through it atrioventricular valve into the left ventricle, and from there it is pumped into the aorta.

- The opening of the pulmonary artery is guarded by the pulmonary valve. - The opening of the aorta is guard by the aortic valve

Blood supply to heart:

-

Arterial Circulation: The is supplied with arterial blood by the right and left coronary arteries which branches from the aorta immediately distal to the aortic valve. Venous Drainage: Most of the venous blood is collected into several small veins that joints to form coronary sinus. The remainder passes directly into the heart chambers through little venous channels.

Conducting system of heart: - The heart has an intensic system where by the cardiac muscle is automatically stimulated to contract without the needs for a nerve supply from the brain. - There are small groups of specialized neuromuscular cells in the myocardium which initiates and conduct impulses causing coordinated and synchronized contraction of the heart muscle.
-

Sino atrial Node (SA Node/Pace Maker): This small mass of specialized cells in the wall of right atrium near to the opening of sup. Vena cava.

Atrioventricular Node (AV node):

-

This small mass of neuromuscular tissue is situated in the walls of the atrial septum near atrioventricular valves.

50

Normally the AV node is stimulated by impulses that sweep over the atrial myocardium.

Atrioventricular Bundle (Bundle of His):

-

This consists of a mass of specialized fibres that originate from the AV node. It crosses the fibrous ling that separates Atria and Ventricular septum; it divides into right and left Bundle branches. Within the ventricular myocardium the branches break up into fine fibres, called the Purkinje fibres. AV bundle, bundle branches and purkinje fibres convey electrical impulses from AV node to the Apex of the myocardium.

Nerve Supply to Heart: - Heart is influenced by automatic nerve originating in the cardio vascular center in the Medulla oblongata which reaches it through the autonomic nervous system.
-

The Vagus nerves (parasympathetic) supply mainly the SA and AV nodes and atrial muscle. The sympathetic nerves supply the SA and AV nodes and the myocardium of atria and ventricles.

The Cardiac Cycle: - The function of the heart is to maintain a continuous circulation of blood through the body.
-

The heart acts as a pump and its action consist of a series of events known as the Cardiac cycle. During each cycle, the heart contracts and then relaxes. The period of contraction is called Systole and that of relaxation is called Diastole.

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Stages: The normal number of cardiac cycles per minute ranges from 60 to 80. It consists

Atrial systole: contraction of the atria. Ventricular systole: contraction of the ventricle. Complete cardiac diastole: relaxation of the atria and ventricles.

Blood Pressure: - BP is the force / pressure which the blood exerts on the walls of the blood vessels. - When the left ventricle contracts and pushes blood into the aorta the pressure produced within the arterial system is called as systole B.P. In adults it is about 120mm of Hg. - When the complete cardiac diastole occurs and the heart is resting following the ejection of blood, the pressure within the arteries is called diastole B.P. In an adult this is about 80mm of Hg.
-

Arterial blood pressure is measured with a Sphygmomanometer meter and is usually expressed in the following manner.

- Normal B.P = 120/80mm Hg or B.P. = 16/11 kpa (kilo pascals). - Factors influencing Blood Pressure:

Age: Blood pressure increase with age. In infants BP is around 70/50 mm of hg. In young healthy adult Bp will be around 120/80 mm of hg or more at any age is considered abnormal. Sex: Females (before menopause) have slightly lower BP than males of same age group. Sleep: There is a decrease in blood pressure during sleep. Meals: Blood pressure rises after meals. Emotion: Fear or anger increase blood pressure. Exercise: Systolic blood pressure increases during exercise.
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Build: Obese person have higher blood pressure. Posture: Blood pressure varies with posture. It is least in lying down posture. Respiration: It varies with different phases of respiration. It increases during expiration. Diurnal variation: BP is lowest in the mornings; it is higher in late afternoon & evening.

Circulation of the blood: - Although circulation of the blood round the body is continuous, it is convenient to describe it in two parts. a. Pulmonary circulation. b. Systemic / general circulation. Pulmonary circulation:
-

This consist of the circulation of blood from the right ventricle of the heart to the lungs & back to the Lt Atrium.

- In the lungs, carbon dioxide is excreted & oxygen is absorbed.

-

The pulmonary artery / trunk, carrying deoxygenated blood, leave the upper port of the right ventricle of the heart.

- The trunk runs & divided into two branches that reach near to lung after its divided into two branches to each lung. - The interchange of gases takes place between capillary blood & air in the alveoli of the lungs.
-

Two pulmonary veins leave each lung, returning oxygenated blood to the left Atrium of the heart.

Systemic circulation:

53

The blood pumped out from the ventricle is carried by the branches of aorta around the body & is returned to right atrium of the heart by the sup. & inf. Venue cava.

Aorta:
-

The aorta begins at the upper part of the left Ventricle. After passing upward for a short way, it arches backward & to the left. It passes behind the diaphragm then downwards in the abdominal cavity to the level of 4th lumbar vertebra, where its divides into the right & left common iliac arteries. Thoracic Aorta: This part of the aorta is above the diaphragm & is described in three parts. 1. Ascending aorta. 2. Arch of aorta.
3.

Descending aorta in the thorax.

- Three branches are given off from its upper aspect Beachiocephalic artery Lt common carotid artery Lt subclavian artery.

Circulation of blood to head & neck: - The paired arteries supply the head & neck is the common carotid arteries & the vertebral arteries.

The carotid arteries (External & internal carotid artery)

Circulars arteriosus (Circle of Willis) - The circulars arteriosue is therefore formed by

2 anterior cerebral arteries. 1 anterior Communicating artery.

54

2 internal carotid arteries

2 posterior Communicating arteries. 2 posterior cerebral arteries.

1 basilar artery.

Venous return from the head & neck: - The venous blood from the head & neck is returned by deep & superficial veins.
-

Mainly this blood return to the right & left internal jugular vein. The venous blood from the deep area of the brain is collected into channels called the Dural venous sinuses.

- The main venous sinuses are, 1 sup. Sagittal sinus.

1 inf. sagittal sinus.

1 Straight sinus. 2 Transverse/lateral sinuses. 2 Sigmoid sinuses.

Circulation of blood to the upper limb: The subclavian arteries:

-

The right subclavian artery arises from the Beachiocephalic artery, the left Branches from the arch of the aorta.

- They continue as the axillary arteries, lies in the axillae.

-

The brachial artery is a continuation of the auxiliary artery, runs down the medial aspect of upper arm, divides into Radial & ulnar arteriols.

- The radial artery passes down lateral side of forearm of wrist, the ulnar artery runs downwards on the medial aspect of forearm to cross wrist & pass into the hand. - There are anastomoses between the radial & ulnar arteries, called the deep & superficial palmer arches, from which palmer metacarpal & palmer digital arteries arise.
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Venous return from the upper limb:

-

The veins of the upper limb are divided into two groups; Deep & superficial veins.

- The deep veins follows; Palmer metacarpal veins. Deep palmer venous arch. Ulnor & radial vein. Auxiliary vein. Subclavian vein. - The superficial veins follows; Cephalic vein Basilica vein Median vein Median cubital vein

Descending aorta in the thorax: - This part of aorta is continuous with the arch of the aorta, its extends downwards on ant. Surface of vertebrae column. - The descending aorta in the thorax gives off many paired branches including Bronchial arteries Esophageal arteries. Intercostals arteries. Venous return from the thoracic cavity:
-

Most of the venous blood from the organs in the thoracic cavity is drained into the Azygos vein & the Hemiazygos vein.

- Some of the main vein which joins them is the bronchial, esophageal & intercotal veins.

Abdominal aorta:
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- The abdominal aorta is a continuation of the thoracic aorta.

-

At level of the 4th lumber vertebrae, its divides into the right & left common iliac arteries.

- Many branches arise from the abdominal aorta, some of which are paired & some unpaired. - Paired branches; Inf. Phrenic arteries. Renal arteries. Testicular artery. Ovarian arteries. - Unpaired branches;

Left gastric artery.

Splenic artery. Common hepatic artery.

Venous return from the abdominal organs:

-

Right & left common iliac veins join form inf. Vena cava at the level of the body of 5th lumbar vertebra.

- Paired testicular, ovarian, Renal & adrenal veins joined the inf. Vena cava. - Blood from the remaining organs in the abdominal cavity passes through the liver via the portal circulation before entering the inf. Vena cava.

Portal Circulation: - In the portal circulation, venous blood passes from the capillary beds of the abdominal part of the digestive system, the spleen & pancreas to the liver. - It passes through a second capillary bed, the hepatic sinusoids, in the liver before entering the general circulation via the inf. Vena cava.
-

Portal vein is formed by the union of the following veins each of which drains blood from the area supplied by the corresponding artery.
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 Splenic vein Inferior mesenteric vein Superior mesenteric vein Gastric veins Cystic vein.

Circulation of blood to the pelvis & lower limb:

-

The right & left common iliac arteries are formed by abdominal aorta, in front of the sacroiliac joint each divides into inferior iliac artery. & ext.iliac artery.

- The int.iliac artery runs medially to supply the organs within the pelvic cavity. E.g.: uterine artery in female. - The ext. iliac artery runs obliquely downwards, its becomes femoral artery, papliteal artery, ant.tibial artery, doralis pedis artery, post. Tibial artery, plantar artery.

Venous return: - There are both deep & superficial veins in the lower limb. - The deep veins are femoral vein, ext. iliac vein, and two common iliac veins. - The superficial veins are small saphenous vein, great saphenous vein, and many communicating veins. Blood vessels: - The heart pumps blood into vessels that vary in structure, size & function, & there are several types, arteries, arteriols, capillaries, venuls& veins. - Arteries are blood vessels that transport blood away from the heart. They vary considerably in size & their walls consist of three layers of tissues. Tunica adventitia /outer layer. Tunica media / middle layer. Tunica intima / inner layer.
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 Pulse: - Pulse is described as a wave of expansion & elongation felt in an arterial wall traveling along the walls of blood vessel. - Normal pulse rate is 60-80 beats/ min. - Types of pulsations are arteriole & venous. - Radial artery is commonly used to examine arterial pulse. - Venous pulsations are observed in the jugular vein. - Information that may be obtained from the pulse include; a. Rate: Number of beats counted for one complete minute. b. Rhythm: Regularity of occurrence of pulse wave. c. Volume/ strength: Extent of displacement of the palpating finger. d. Tension: The artery wall should feel soft under the fingers. e. Equality of pulse: Equal/ unequal in volume in both the under limbs. Factors Affecting The Pulse Rate:
a. b. c. d. e.

Position: In standing up rate is usually more rapid than lying down. Age: In children is more rapid than in adults. Gender: To be more rapid in female than in males. Exercise: Any exercise will increase the rate of the pulse. Emotion: In strong emotional stress the pulse rate is increased.

Pulse Pressure (P.P): - It is the difference between systolic & diastolic blood pressure. - PP = systolic B.P diastolic B.P PP= 40. Stroke volume: - It is the volume of blood ejected out per ventricle per beat. It is about 70 to 80 ml. Cardiac output:
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It is the volume of blood ejected out from each ventricle per minute. It is about 5-6 L/ minute.

- Cardiac Output = Stroke vol. Heart rate = 70 ml 72 beats/ min Circulatory shock: - It is a state at which failure in the circulatory system. In this condition circulatory system cannot meet the oxygen & nutritional requirements of the tissues& decreased in the cardiac output. Note:
-

Angina pectoris is a severe constricting pain in the chest radiating from pericardium due to ischemia of cardiac muscles. Myocardial infraction is the death of myocardial tissue due to sudden stoppage of blood supply to an area of myocardium. Angiography is a procedure to detect the presence of block in the blood vessels due to a clot. Angioplasty is the procedure by which clot obstructing the coronary artery is removed by catheterization. Echo-cardiography is non- invasive technique to evaluate cardiac function when ultrasonic waves are emitted towards the organ & reflected waves are analyzed. It is also used to measure the velocity & volume of blood flow. Tachycardia is an increase in pulse rate above 90 beats / min. Bradycardia is a decrease in pulse rate below 60 beats / min. Pulse deficit is a condition in which pulse rate is less than the heart rate.

The lymphatic system:

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- Lymphatic system is an additional drainage system; it carries the fluid which comes out of the blood vessels. It returns plasma proteins & tissue fluid to the blood. - The lymphatic system consist of Lymph Lymph vessels. Lymph nodes & Lymphatic tissue. Lymphatic organs like spleen & thymus. - Functions of Lymphatic system. Helps in the absorption of fat & fat soluble substances from digestive system. Returns fluid from the extra vascular compartment back to general circulation. Lymphocytes produced from lymphatic organs provide immunity.

Lymph: - Lymph is a watery fluid, resembles plasma in its composition. - It appears milky in the intestine due to the presence of fat in it.
-

Plasma proteins which have escaped from blood vessels will be transported back to the blood stream by lymph.

Lymph vessels: - They are similar to blood capillaries in their structure, having a layer of endothelial cells. - Lymph capillaries arise from interstitial space; join to form larger lymph vessels. - Central nervous system, bones & superficial layers of skin do not have lymphatic supply. Larger lymph vessels:
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- The walls of the lymph vessels are about the same thickness as those of small veins & have the same layers of tissue. - Lymph vessels have numerous cup-shaped valves which ensure that lymph flows in one way only. - Lymph is moved in the lymph vessels by contraction of muscle present in their walls.
-

Larger lymph vessels join to form thoracic duct & right lymphatic duct, which drains into subclavian veins.

Thoracic duct: - It begins at the level of first two lumbar vertebrae. It opens into Lt Subclavian vein at the root of neck.
-

It drains lymph from legs, pelvic, abdominal structures, left half of thorax, left Arm, head & neck.

- Thoracic duct measures about 40 cm.

Right lymphatic duct:

-

It lies in the root of the neck & opens into the right subclavian vein. It drains lymph from the right half of the thorax, head& neck & the right arm. - Lymph nodes are oval in shape. They are present along the lymphatic vessels.
-

Lymph nodes:

Lymph nodes are arranged in superficial & deep groups. Structure: Lymph nodes have a surrounding capsule of fibrous tissue. As many as four or five afferent lymph vessels may enter a lymph node Functions:
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- The main substance of the node consists of reticular & lymphatic tissue.
-

while only one efferent vessel carries lymph away from node.
-

- Filter particles present in lymph. - Organic materials are destroyed by macrophages & antibodies. - Insoluble particles are engulfed by the macrophages. Other lymphatic tissue: - Lymphatic tissue is found in a number of situations in the body in addition to the lymph nodes. E.g.: palatine tonsil, pharyngeal tonsil, vermiform appendix etc. Spleen: - The spleen the largest lymph organ in the body. It is formed by reticular & lymphatic tissue. - The spleen lies in the left hypochondriac region of the abdominal cavity. - It is purplish in colour & varies in size in different individuals, but is usually about 12 cm long, 7 cm wide & 2.5 cm thick. It weights about 200g. - Organs associated: - Superiorly & Posteriorly: - Diaphragm. - Inferiorly: - Lt Colic flexure of large intestine. - Anteriorly: - Fundus of the stomach. - Medially: - Pancreas & the Lt Kidney.

Laterally: - 9th, 10th, & 11th ribs along with intercostals muscles.

Structure: - The spleen is slightly oval in shape with the Hilum on the lower medial border. - It is enclosed in a fibro elastic capsule that dips into the organ, forming trabeculae.
-

The cellular material, consisting of lymphocytes & microphages is called splenic pulp.

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- The structure entering & leaving the spleen at the Hilum are; Splenic artery, a branch of the co celiac artery. - Splenic vein, a branch of the portal vein. - Lymph vessels. - Nerves.

Function of spleen: - Destroy old & abnormal red blood cells. - Phagocytosis of Microbes, Platelets & Leucocytes. - It is important site of fetal blood cell production. Thymus gland: - The thymus gland lies in the upper part of the mediastinum, extends upwards into the root of the neck. - It weights about 10 to 15 g at birth & maximum weight, at puberty, is between 30 to 40 g. Organs associated: - Anteriorly: Sternum & upper four costal cartilages.
-

Posteriorly: Aortic arch & its branches, brachiocephalic veins, trachea.

- Laterally: Lungs. - Superiorly: Structures in the root of the neck. - Inferiorly: Heart.

Structure: - The thymus consists of two lobes joined by Areolar tissue. It is covered by fibrous capsule.
-

Each lobe is further divided into lobules contain epithelial cell & lymphocytes; they secrete a hormone called Thymosin.

- Function of thymus is processes & helps in the formation of mature T lymphocytes.

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*********** Unit-VI The Respiratory System

The cells of the body need energy for their chemical activity that maintains the Homeostasis. Exchange of gases between the blood and the lungs is called External Respiration. Exchange of gases between the blood and the cells is called as Internal Respiration. The Organs of the respiratory system are Nose Pharynx Larynx Trachea Two Bronchi (one bronchus to each lung) Bronchioles and smaller air passages Two lungs and their coverings, the pleura Muscles of respiration the intercostals muscles and the diaphragm. Nose and Nasal cavity:
-

The nasal cavity is the first of the respiratory organs, consists of large irregular cavity divided into two equal passages by a Septum.

- The posterior bony part of the Septum is formed by the perpendicular plate of the Ethmoid bone and the Vomer. - The floor is formed by the roof of the mouth and consists of the Hard palate in front and soft palate behind.
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- The lateral walls are formed by the maxilla and the ethmoid bone and the inferior conchae. - The posterior wall is formed by the posterior wall of the Pharynx. - The nose is lined with very ciliated columnar epithelium tissues which consist of mucus-secreting goblet cells. - The Para nasal sinuses are cavities in the bones of the face and the cranium which contain air. - The function of the sinuses is speech output and also serves to lighten the skull.
-

Function of nose: Nose is to begin the respiratory process by which the air warmed, moistened and filtered. Olfactory function: Nose is the organ of sense of Smell. The Olfactory nerves which are present in the brain help the nose to perceive the smell.

The pharynx:
-

The pharynx is a tube 12 to 14 cm long that extends from base of the skull to the level of the 6th cervical vertebrae.

- The pharynx is divided into three parts: - The Nasopharynx, - The Oropharynx, - The Laryngopharynx - Nasopharynx is part of pharynx lies behind the nose, above the level of the soft palate. - On the posterior wall there are the pharyngeal tonsils consist of the lymphoid tissue.
-

Oropharynx is part of the Pharynx, which lies behind the mouth, extends from below of soft palate to upper part of 3rd cervical vertebrae.

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- Laryngopharynx is part of pharynx, which extends from oropharynx above and continues as the esophagus below. - Pharynx is composed of three layers of tissues: mucous membrane lining, fibrous tissue, and muscle tissue. - Blood supplied by branches of facial artery and venous return is facial and internal Jugular veins. - Parasympathetic nerve supply is by vagus and glosopharygeal nerves, sympathetic supply is by nerves from the superior cervical ganglia. - Functions: It is the passage way of air and food. It helps in the warming and humidification of the air inspired. It helps in the hearing process.

Laryngeal tonsils produce anti-bodies in response to antigens. E.g. microbes.

It helps to give voice to individual characteristics.

The larynx (voice box):

-

It lies in front of Laryngopharynx at the level of. 3rd, 4th, 5th and 6th cervical vertebrae. Superiorly hyoid bone and root of tongue Inferiorly continuous with Trachea. Anteriorly muscles of the neck.

Posteriorly 3rd to 6rh cervical vertebrae.

Laterally Lobes of the thyroid gland. - The larynx is composed of several irregularly shaped cartilages attached to each other by ligaments and membranes. - The main cartilages are 1 thyroid cartilage
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 1 cricoid cartilage 2 arytenoid cartilages 1 epiglottis - Blood supplied by superior and inferior Laryngeal Artery and drained by thyroid veins. - Nerve supply from vagus nerve and cervical ganglia. - Interiorly the vocal cords present. The vocal cords have two pale folds of mucous membrane with cord like free edges. - Functions: Production of sound. Helps in speech production. Protection of the lower respiratory tract

The trachea (wind pipe):

-

It is the continuation of the Larynx, extends downwards to about the level of the 5th thoracic vertebrae where it divide at the carina into right and left bronchi for each lung.

- It is approximately 10cm to 11cm long and lies in front of the esophagus. Superiorly: The larynx Inferiorly: The right and left bronchi Anteriorly: The isthamus of thyroid glad and arch of aorta Posteriorly: The esophagus

Laterally: The lungs and lobe of thyroid gland

- Trachea is composed of from 16 to 20 incomplete rings of hyaline cartilages lying one above the other. - There are three layers of tissues, which clothe the cartilages of the trachea. The outer layer (fibrous and elastic tissue) The middle layer. (Cartilages and smooth muscles)
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 The inner lining (ciliated columnar epithelium) - Blood supplied by inferior thyroid and bronchial artery and venous return by thyroid veins. - Nerve supply by recurrent laryngeal nerves and sympathetic ganglia. - Functions: The cartilages in the trachea prevent the collapse of the tube. The cartilages and the elastic tissue prevent any obstruction in the airway. Vagus nerve stimulates the cough reflex to remove any secretions in airway. The trachea helps in warming, humidifying and filtering of air. Bronchi and bronchiole: - There are two bronchi: The left Bronchus and the right bronchus. - The left bronchus: It is 5cm long, gives two branches; one to each lobe of the left lung. It is narrower than the right bronchus. - The right bronchus: It is wider, shorter, 2.5cm in length. It gives three branches; one to each lobe of the right lung. - The bronchi are composed of the same tissues of the trachea.
-

The bronchi progressively subdivided into bronchioles, terminal bronchioles, alveolar ducts and finally Alveoli (Structural and functional unit of the Respiratory system)

- Blood supplied by right and left bronchial arteries. Venous return from superior intercostals vein and azygos vein.
-

Nerve supply by sympathetic and parasympathetic nerves. The bronchi and bronchiole regulate the entry of air into the lungs. Helps in warming and humidifying the air entering the lung.
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- Functions:

 The alveoli: - The alveolus is the terminal part of the respiratory system. In these structures the process of gas exchange occurs with the help of network of capillaries surrounding it. - The alveoli contain macrophages and fibroblasts, which help in destroying the foreign substances (Antigens).
-

The Squamous cells present in the alveolar duct secrete Surfactant, which prevents the alveoli from drying out.

- The alveolus helps in the warming and humidifying of the air. The lungs: - There are two lungs, one lying on each side of the midline in the thoracic cavity.
-

They are cone-shaped and are described a having an apex, a base, costal surface and medial surface.

- The Apex: It is the upper, rounded part of the lungs, present at the level of the clavicle. - The Base: This is concave and semi lunar in shape and is closely associated with the surface of the diaphragm. - The Costal surface: This surface is concave and is associated with the ribs and intercostals muscle.
-

The Medial Surface: This surface is concave and has a roughly triangularshaped area called the Hilum.

- The area between the lungs is called the Mediastinum. It is occupied by the esophagus, trachea, heart, lymph and great vessels - The right lung is divided into three distinct lobes: Superior, middle and inferior. - The left lung is divided into only two lobes: superior and inferior.
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- The interior of the lung consist of the bronchi, air passages, alveoli, connective tissues, blood and lymph vessels and nerves. Pleura and pleural cavity: - The pleura consist of a closed sac of serous membrane consist of a small amount of serous fluid. - It forms two layers:

The visceral pleura: It covers each lobe of the lung and passes into the fissures which separate them. The parietal pleura: It is present over the visceral pleura and forms a Cavity, called the pleural cavity.

The pleural cavity: - Its filled with pleural fluid, which allows two layers to glide over each other, preventing friction. - The serous fluid is secreted by the epithelial cells of the layers. - Blood supplied by pulmonary arteries: they are divided into; one branch carrying deoxygenated blood to each lung. - Capillaries join up eventually becoming to pulmonary veins in each lung. - The main muscles of respiration in normal quiet breathing are the intercostals muscles and the diaphragm. - Intercostals muscles are 11 pairs; occupy the spaces between the 12 pairs of ribs. - They are arranged in two layers, the external and internal intercostals muscles. - The intercostals muscles are stimulated to contract by the intercostals nerves.

Diaphragm:

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- The diaphragm is the dome shaped structure separating the thoracic and abdominal cavities. It forms the floor of thoracic cavity and the roof of the abdominal cavity. - Diaphragm decreases pressure in the thoracic cavity and increases it in the abdominal and pelvic cavities. The diaphragm is supplied by the phrenic nerves. Respiration: - There are two types of respiration; Internal respiration and external respiration. - Internal Respiration is exchange of gases by diffusion between the blood in the capillaries and the body cells. - External Respiration is exchange of gases by diffusion between the alveoli and the blood. - Cycle of Respiration: this occurs 12 to 15times per minute and consists of three phases.
-

Inspiration: The process of taking the air inside the lungs. The negative pressure created in the thoracic cavity aids venous return to the heart and is known as the Respiratory Pump. Expiration: The pressure in the lungs exceeds that in the atmosphere and therefore air is expelled from the respiratory tract. The lungs still contain some air, which prevents the complete collapse of the intact pleura. Pause: After expiration, there is a pause before the next cycle begins. Hypoxia is condition characterized by deficiency of oxygen at tissue level. Cyanosis is the bluish discoloration of skin and mucus membrane. It occurs when amount of reduced Hb in blood is more than 5g/dl.

Notes:
-

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Asphyxia is condition characterized by decreased oxygen and increased carbon dioxide in the body. Dyspnoea is condition abnormal awareness of breathing. Apnoea is condition which temporary cessation of respiration. has stopped suddenly.

- Artificial respiration is a process of restoring the respiratory activity which Dysbarism is a condition occurring in persons who move to a region of low barometric pressure from a region of high barometric pressure.
-

Tidal volume is the volume of air inspired or expired during normal breathing at rest. Normal value is 500ml. Hydrothorax is the collection of watery fluid in the pleural cavity. Haemothorax is the collection of blood in the pleural cavity. Pyothorax is the collection of pus in the pleural cavity. Pneumothorax is the collection of air in the pleural cavity. Pharyngitis is the infection of pharynx. Tonsillitis is the infection of tonsils. ************ Unit-VII The Digestive System

The digestive system is the collective name used to describe the alimentary canal, some accessory organs. The alimentary canal begins at the mouth, passes through the thorax, abdomen and pelvis and ends at the anus. Gastrointestinal system is the route through which nutritive substances, vitamins, minerals and fluid enter the body.

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 The main function of GI system is to break down complex food substances into simple ones suitable for absorption. The activities in the digestive system can be grouped under five main headings:

Ingestion is taking food into the alimentary tract. Propulsion is moves the contents along the alimentary tracts. Digestion is break down of food contents by mastication and help of enzymes. Absorption is digested food substances pass through the walls into the blood and lymph capillaries for circulation round the body. Elimination is eaten food cannot be digested and absorbed are excreted by the bowel as faeces.

Organs of GIT: - Alimentary tract is a long tube through which food passes. - It commences at the mouth and terminates at the anus and various parts are: Mouth Pharynx Esophagus Stomach Small intestine Large intestine Rectum and anal canal Accessory organs: - Various secretions are poured into GIT from some organs like; Three pairs of salivary glands Pancreas Liver and the biliary tract General structure of GIT:
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- The walls of alimentary tract are formed by four layers of tissue; Outer serous layer Muscular layer Sub mucous layer Mucosal layer Outer covering: - Serous layer is the outer covering of GIT. It is consist of loose fibrous tissue in thorax and peritoneum in abdomen. The peritoneum: - It is the largest serous membrane of the body. - It consists of a closed sac, containing a small amount of serous fluid, within the abdominal cavity. - It has two layers;

The parietal layer-which lines the abdominal wall. The visceral layer-which covers the organs within abdominal and pelvic cavities.

Peritoneal cavity is space separating adjacent layer of peritoneum. It is divided into greater sac and lesser sac. (Greater sac is the main layer and lesser sac is the smaller part).

Muscle layer: - This is made up of two layers of smooth muscles. - The outer layer is made up of longitudinal muscle fibres and inner layer is made up of circular muscle fibres.
-

Contraction of these muscles causes propulsion of food. The pattern of contraction is termed peristalsis.

Sub mucous layer:

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- This layer consists of loose connective tissue with some elastic fibres, blood vessels, and lymphatic and nerve plexus. Mucosal layer: - It consists of either stratified Squamous epithelium or columnar epithelium depending on the function. - Below the surface of columnar epithelium there are glands or cells secreting digestive juices. They are;

Saliva from salivary glands. Gastric juices from gastric glands. Intestinal juices from intestinal glands. Pancreatic juice from pancreas. Bile from the liver.

Nerve supply: - The alimentary tract is supplied by nerves from both parts of the autonomic nervous system. - The parasympathetic supply by one pair of cranial nerves, the vagus nerve and distal part of the tract is supplied by sacral nerves. - The sympathetic supply by numerous nerves from spinal cord in the thoracic and lumbar regions. - The myentric plexus lies between the two layers of smooth muscles that help to peristalsis. - The sub mucosal plexus lies in the sub mucosa and secretory glands. Arterial blood supply: - The oesophagus is supplied by paired oesophageal arteries, the alimentary tract, pancreas, liver and some parts supplied by unpaired coeliac artery and superior and inferior mesenteric arteries.

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- The distal part of rectum and the anus are supplied by the middle and inferior rectal arteries. Venous drainage: - Venous drainage from oesophagus is by azygos and hemiazygos veins. - The veins draining blood from lower part of oesophagus, stomach, pancreas, large intestine, small intestine and most of the rectum join together to form portal vein. Functions: - Digestion of food particles into smaller molecules. - Secretion of digestive juices is by liver, salivary glands, pancreas, and intestinal epithelial cells. - Absorption of digested food particles, water and electrolytes. - Movement of food from the mouth towards the anus. - Protection of gut against harmful and toxic substances in food. - Elimination of solid waste products. Mouth (oral cavity): - The mouth or oral cavity is bounded by muscles and bones. It contains two parts, vestibule and oral cavity proper. - Vestibule is a cavity bounded by lips and cheek externally and gums and teeth internally. Anteriorly by the lips Posteriorly oropharynx Laterally muscles of the cheeks. Superiorly- hard palate and muscular soft palate. Inferiorly - muscular tongue and floor of mouth. - The lips are folds that form the orifice of the mouth, lined externally by the skin and internally by mucosa.
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Palate: The palate forms the roof of the mouth and is divided into the anterior hard palate and posterior soft palate.
-

Hard palate is formed by maxilla and palatine bones and soft palate by muscles. The uvula is a curved fold of muscle covered with mucous membrane, hanging down from the middle of free border of soft palate.

- Palatine tonsils lie between the arches, on either side. Tongue: - It is a voluntary muscular organ present in the floor of oral cavity. - Root of the tongue is attached to hyoid bone and mandible.
-

The inferior surface of the tongue is connected to the floor of the mouth by a mucosal fold called frenulum.

- The superior surface consists of stratified Squamous epithelium, with numerous papillae.
-

The papillae are contains nerve endings of sense of taste called the taste buds.

- There are three varieties of papillae; Vallate papillae, filiform papillae and fungiform papillae.
-

Vallate papillae are present on base of the tongue, largest in size most easily seen. Filiform papillae are small and conical in shape present numerous on the anterior two - third of tongue. Fungiform papillae are present mainly at the tip and sides of the tongue. vein drains into internal jugular vein.

- Blood supply by lingual artery branch of external carotid artery and lingual - Nerve supply is supplied by the hypoglossal nerves, the mandibular nerves, the facial and glossopharyngeal nerves.
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Functions of the tongue: The tongue plays an important part in; - Mastication(chewing) - Deglutition(swallowing) - Taste sensation - Speech.

Teeth: - The teeth are hardest structures present in the sockets of alveolar ridges of mandible and maxilla.
-

Each individual has two sets of teeth; temporary teeth and permanent teeth. when the child is about six months old, and should all be present by the end of the 24 months. The permanent teeth begin to replace the temporary teeth in the sixth year of age and consisting of 32 teeth, are usually complete by the 24th year.

- The temporary teeth are 20 in number, 10 in each jaw. They begin to except

- The permanent teeth include three pairs of molars, two pairs of premolars, one pair of canine and two pairs of incisors in each jaw. Structure of tooth: - Most of all the structures is the same and consists of ;
-

The crown- the part which protrudes from the gum. The root the part embedded in the bone. The neck the constricted part where crown joins the root. lymph vessels and nerves.

- In the centre of the tooth there is the pulp cavity containing blood vessels, Pulp cavity is surrounding by hard substance called dentine. Outside the dentine of the crown there is a thin layer of very hard substance, the enamel.

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The root of the tooth is covered with a substance resembling bone called cement.

- The arterial blood supply to the teeth is by branches of the maxillary arteries. The venous drainage is by a number of veins into the internal jugular veins.
-

The nerve supply by maxillary and mandibular nerves, both is branches of trigeminal nerves. (5th cranial nerve.)

Salivary glands: - These are three pairs of compound racemose glands which pour their secretion into the mouth. They are; Two parotid Two submandibular Two sub lingual Parotid gland: - These are situated one on each side of the face just below the external acoustic meatus. - Each gland has a parotid duct opening into the mouth at the level of the second upper molar tooth. Submandibular glands: - These lies one on each side of the face under the angle of the jaw. - The two sub mandibular ducts open on the floor of the mouth, one on each side of the frenulum of the tongue. Sub lingual glands: - They are smallest salivary glands. They lie below the tongue on each side of the frenulum. - They pour their secretions into the floor of the mouth through multiple small openings.

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- These glands are all surrounded by a fibrous capsule. They consist of a number of lobules made up of secretory cells. - All the salivary glands are supplied by parasympathetic and sympathetic nerve fibres. - Arterial supply is by various branches from the external carotid arteries and venous drainage is into the external jugular veins. Saliva: - This is the combined secretions from salivary glands and about 1 to 1.5 liter of saliva is produced daily and it consists of; water, mineral salts, enzymes, mucus, immunoglobulin etc.
-

Functions of saliva is converts food into a bolus, keeps the mouth moist and helps in speech, helps in taste sensation, excretes heavy metal, drugs, urea etc.

The pharynx: - It is a common passage for both air and food. - It measures about 12 to 14cm in length and extend from base of skull to the level of sixth cervical vertebra. - The pharynx is divided into three parts; Nasopharynx, Oropharynx, Laryngopharynx. Structure is made by the lining membrane is stratified Squamous epithelium, the middle layer consist of fibrous tissue, the outer layer consists of involuntary constrictor muscles. - Arterial supply by several branches of the facial arteries. Venous drainage is into the facial veins and the internal jugular veins. Oesophagus: - It is first part of the alimentary tract, hollow muscular tube about 25cm long and 2cm in diameter.
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- It is lies in the median plane in thorax in front of the trachea and the heart. - It is continuous with pharynx above and just below the diaphragm, it joins the stomach. - Structure is same in general plan, but outer covering consists of elastic fibrous tissue. - Arterial supply by esophageal arteries branches from aorta. Venous drainage by azygos and hemiazygos veins. - Nerve supply is sympathetic and parasympathetic nerves; it is branches of vagus nerve. - Functions of these acts as a passage for food from the pharynx to the stomach. Deglutition or swallowing: - This is a process of transfer of food from mouth to the stomach. It is controlled by the deglutition centre present in the medulla. - Deglutition is consist of three phases;
-

Buccal phase: Food in the mouth is converted to a bolus by mastication mixing with saliva, later pushed backwards into pharynx. Pharyngeal phase: The soft palate rises up and the tongue and pharyngeal folds close the way back into the mouth. Contraction of the muscle propels the bolus down into the oesophagus. It is carrying by the help of the action of medulla and brain stem. Esophageal phase: Oesophagus conducts food bolus from the pharynx to the stomach by peristaltic movements.

Stomach: - The stomach is a J shaped hollow structure of the abdominal cavity. It is about 25cm long, capacity of 1.5 to 2L in adults. - Organs associated with the stomach:
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 Anteriorly left lobe of liver and anterior abdominal wall. Posteriorly abdominal aorta, pancreas, spleen, left kidney and adrenal gland. Superiorly diaphragm, oesophagus and left lobe of liver. Inferiorly transverse colon and small intestine. Structure: - The stomach is continuous with oesophagus at the cardiac orifice, with the duodenum at the pyloric orifice. - It is having two curvatures; lesser curvature is right border and greater curvature is left border.
-

The stomach is divided into above the cardiac orifice is the fundus, the main part of the body and the lower part the pyloric antrum / pylorus.

- At the distal end of the pyloric antrum there is the pyloric sphincter, guarding the opening between the stomach and the duodenum. - Wall of stomach contains the four layers of alimentary tract; there are outer peritoneal layer forms the serous layer. - Muscular layer forms by three layers of smooth muscle fibres; outer longitudinal fibres, middle circular fibres and inner oblique fibres. - Sub mucus layer contains blood vessels, lymphatic and nerve fibres. - Mucus membrane contains numerous gastric glands within it. These specialized cells that secrete gastric juice into the stomach.
-

Arterial blood is supplied to the stomach by branches of the coeliac artery and venous drainage is into the portal vein. Nerve supply to the stomach is sympathetic from the celiac plexus and parasympathetic from the vagus nerve.

- Functions of stomach: Help in temporary storage of food particle for some time.
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 Chemical digestion is pepsins convert protein into polypeptides. Mechanical digestion is causes proper mixing of food, converts into semisolid substance.

Hydrochloric acid destroys microorganisms and other harmful substances present in the food.

Gastric juice: - About 2 to 3L of gastric juice is secreted daily by special secretory glands in the mucosa. - It consists of; Water Mineral salts Mucus Hydrochloric acid Intrinsic factor. - Functions of gastric juice: Pepsinogens are activated to pepsins by Hcl. Hcl acts as a antiseptic. Toxins, heavy metals, certain alkaloids are excreted through gastric juice. Provides the acid environment needed for effective digestion. Small intestine:
-

It is continuous with the stomach at the pyloric sphincter and leads into the large intestine at the ileocaecal valve.

- IT is 5 to 6m long and lies in the abdominal cavity surrounded by the large intestine. - It is described in three parts which are continuous with each other; Duodenum
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 Jejunum Ileum
-

The duodenum is about 20 to 25cm long and curves around the head of the pancreas.

- The bile duct and the pancreatic duct open into the midpoint of duodenum.
-

The jejunum is the middle part of the small intestine and is about 2m long. The ileum is terminal part, is about 3m long. to the caecum.

- Its end at ileocaecal valve which controls the flow of material from the ileum Structure of small intestine: - The walls of the small intestine are composed of the four layers of tissue described in general plan.
-

A double layer of peritoneum called the mesentery attaches the jejunum and ileum at the posterior abdominal wall. Mucosa of small intestine is greatly increased by permanent circular folds villi and Microvilli.

- The villi are tiny finger like projections of the mucosa layer, about 1 mm long and wall consists of columnar epithelial cells with tiny Microvilli on their free border. - The intestinal glands are simple tubular glands situated below the surface between the villi. - Arterial blood supply by the superior mesenteric artery and venous drainages is by the superior mesenteric vein. - Nerve supply by sympathetic and parasympathetic nerves. Chemical digestion in small intestine: - Acid chime passes into the small intestine it is mixed with pancreatic juice, bile and intestinal juice.
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Pancreatic juice is alkaline, enters the duodenum at ampulla of the bile duct and consists of water, mineral salts, enzymes etc.

- Functions are helpful for digestion of proteins, carbohydrates and fats.

-

Bile is secreted by the liver, then pass through hepatic duct, joined to cystic duct of the gall bladder where it is stored. Bile has a pH of 8 and between 500 to 1000ml is secreted daily. It is consists of water, mineral salts, mucus, bile salts, bile pigment (bilirubin). Intestinal juice: About 3L of intestinal juice secreted daily by the glands.

- It consists of water, mucus, mineral salts, and enzymes. - Functions are: helps in proper mixing of the food and enzymes secreted by the small intestine digests the food particles and absorption of nutrient materials and protection against infection by microbes. Large intestine, rectum and anal canal: - The large intestine is about 1.5m long, start at caecum and terminating at the rectum and anal canal.
-

The colon is divided into the caecum, ascending colon, transverse colon, descending colon, sigmoid or pelvic colon, rectum and anal canal. Caecum is the first part of the colon, continuous with the ascending colon superiorly. The opening from ileum to large intestine is guarded by ileocaecal valve. The vermiform appendix is a narrow tube attached to caecum, usually about 13cm long and has the same structure as the wall of colon but contains more lymphoid tissue. The ascending colon (15cm) passes upwards from the caecum bends to left at the hepatic flexure to become the transverse colon.

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The transverse colon (40 to50cm) is extends across the abdominal cavity in front of duodenum and stomach, bending downwards at Splenic flexure to become the descending colon. The descending colon (25cm) passes down the left side of the abdominal cavity then curves towards midline become the sigmoid or pelvic colon. The sigmoid colon curves in the pelvic then continue downwards to become the rectum. The rectum is continuation of sigmoid colon and terminates in the anal canal, about 13cm long. The anal canal is short canal about 4cm long in adult open to the exterior, the anus. There are two sphincter muscles which controls the anus by nervous system; the internal sphincter and the external sphincter. Structure of colon as like general plan and longitudinal muscle fibres in the colon are modified into bands called taeniae coli.

- Arterial blood supply by superior and inferior mesenteric arteries and internal ileac arteries. - Venous drainage is mainly by superior and inferior mesenteric veins and internal ileac veins.
-

Functions: absorption of water and electrolytes from the chime. And storage of faecal matter until it is excreted. Defecation: It is usually the rectum is empty when mass movements force the contents of sigmoid colon into the rectum, happen by nerve reflex under the conscious control. Faeces: It is a semisolid mass, brown in colour due to the presence of bilirubin, nearly 60 to 70% of water within it. The remaining consist are

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undigested food particles, microorganisms, epithelial cells, fatty acids, and mucus. Pancreas:
-

The pancreas is a pale grey colour gland weighing about 60gms. hypochondriac regions of the abdominal cavity.

- It is about 12 to 15cm long and is situated in the epigastric and left It consists of a broad head, a body and a narrow tail. the tail lies in front of the left kidney, reaches the spleen. - Structure of pancreas is both an exocrine and endocrine gland.
-

- The head lies in the curve of the duodenum, the body behind the stomach and

The exocrine pancreas contains large number of lobules made up of small alveoli, consists of secretory cells, secrets the pancreatic juice.

- Each lobule is drained by small duct; finally form the pancreatic duct which opens into the duodenum at its midpoint.
-

Just before entering the duodenum the pancreatic duct joins the common bile duct to form the ampulla of bile duct (hepatopancreatic ampulla). The endocrine pancreas consists of cluster of cells between the exocrine tissues, called the pancreatic islets.

- Arterial supply to pancreas is by Splenic and mesenteric arteries. Venous drainage is by veins to form the portal vein. - Nerve supply is by parasympathetic stimulation increases the secretion of pancreatic juices and sympathetic decreases it. Liver: - The liver is the largest gland in the body, weighing between 1 to 2.2kg. - It is situated in the right hypochondriac region, part of the epigastric region and extending into the left hypochondriac region. - Organs associated with the liver:
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 Superiorly and anteriorly- diaphragm and anterior abdominal wall. Inferiorly- stomach, bile duct, duodenum, hepatic flexure, right kidney and adrenal gland. Posteriorly- oesophagus, inferior venacava, aorta, gall bladder and diaphragm. Laterally- lower ribs and diaphragm.
-

The liver is covered by a layer of peritoneum, divided into a four lobes; large right lobe, small left lobe, posterior surface have caudate lobe and quadrate lobe.

The porta hepatic: - This is the part located on the posterior surface of the liver where various structures enter and leave the gland. - The portal vein, hepatic artery enters and nerve fibres enter the liver to give the supply. - The right and left hepatic ducts and lymph vessels leave the liver to carrying bile to gall bladder and lymph respectively. Structure of liver:
-

The lobes of liver are made up of lobules consists of epithelial cells termed hepatocytes. Each lobule arranged in pairs of columns from a central vein, between spaces is termed hepatic sinusoids.

- The sinusoids contain blood from the branches of portal vein and hepatic artery. - Central vein joins together to form hepatic veins which drains into inferior venacava. - Bile secreted by hepatocytes is collected through bile canaliculi. Functions of liver:
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- It helps to continuously formation and secretion of bile. - It is essential for metabolism of nutrient and vitamins. - Albumin, globulin and clotting factors are synthesized in the liver.
-

It is site of haemopoiesis during the first few weeks of intra uterine life.

- Inactivation of hormones, toxins etc. - Production of heat due to metabolism. - Storage of fat soluble vitamins and iron. Jaundice: - Jaundice is yellowish discoloration of skin and mucus membrane due to excessive deposition of bile pigments.
-

Prehepatic jaundice caused due to excessive break down of RBC increases the bilirubin in the blood. Hepatic jaundice is caused due to infection or toxic damage to the liver. Obstructive jaundice is caused due to obstruction of bile duct either by tumours or stones.

Bilary tract: (bile duct and gall bladder) Bile duct: - The right and left hepatic duct joins to form the common hepatic duct. - Hepatic duct is joined by the cystic duct which arises from the gall bladder to form the common bile duct.
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These common bile duct passes downwards behind the head of pancreas and joins the main pancreatic duct at hepatopancreatic ampulla, control by the hepatopancreatic sphincter.

- The common bile duct is about 7.5cm long and diameter of about 6mm. - Structure of bile duct same layers of tissue described in the general plan of the alimentary canal. Gall bladder:
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- The gall bladder is a pear shaped organ attached to the posterior surface of the liver. - It has a fundus, body or main part and a neck which is continuous with the cystic duct. - Structure is same layer as general plan, but peritoneal layer covers only inferior surface. - Arterial blood supply by the cystic artery branch of hepatic artery and venous return by the cystic vein into the portal vein. - Nerve impulses are conveyed by sympathetic and parasympathetic nerve fibres. - Functions of the gall bladder: - It is reservoir for bile. - It releases bile when it is required. - It secrets the mucus into the bile. - Absorption of water from bile, so it is concentrated. Metabolism: - Metabolism is refers to all the chemical reaction that occur in the body by using absorbed nutrients. - It has two types of processes: catabolism and anabolism.
-

Catabolism is breaks down large molecules into smaller releasing energy that is stored as ATP. Anabolism is building up of large molecules from smaller and utilizes the energy stored as ATP.

Notes:
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Mumps is a viral infection as affecting parotid gland. Vomiting is a process of emptying of upper tract its contents due to excessive irritated or over distended.
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Diarrhoea is produced due to rapid movement of faecal matter through the intestine. Enteritis is the infection of gastrointestinal tract caused by chronic bacterial infection. Appendicitis is inflammation of appendix due to obstruction by infection with microorganisms. Hepatitis is inflammation of liver due to causes of viral infections and any drugs. Cholelithiasis is a condition in which stones are formed in the gall bladder. *************** UnitVIII The Excretory System

The Urinary system is one of the excretory systems of the body. It consist of the following structures,

Two kidneys: This is secreting urine. Two Ureters: These convey the urine from the kidneys to the urinary bladder.

One Urinary bladder: where urine collects temporarily. One Urethra: through which the urine is discharged from the urinary bladder to the exterior. Kidneys:
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The kidneys are situated in the abdominal cavity in relation to posterior abdominal wall, one on each side of the vertebral column, behind the peritoneum and below the diaphragm

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They extend from the 12th thoracic vertebra to the 3rd lumbar vertebra. The right kidney is slightly lower than the left because of the liver on the right side.

- Kidneys are bean shaped organs, about 11cm long, 6cm wide, 3cm thick and weight is 150grams. - Relations: Right kidney: Superiorly: The right adrenal gland. Anteriorly: The right lobe of the liver and the duodenum, and right colic flexure.

Posteriorly: The Diaphragm and muscles of the posterior abdominal wall.

Left kidney: Superiorly: The left Adrenal gland.

Anteriorly: The spleen, stomach, pancreas, jejunum, left colic flexure.

Posteriorly: The diaphragm and muscle of the posterior abdominal wall.

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Gross structure: when the longitudinal section of the kidney is viewed by the naked eye. The following structure are seen,

A fibrous capsule- surrounding the kidney The cortex- reddish brown layer below the capsule and between the pyramids. The medulla- inner most layers consisting of pale conical shaped striations, the renal pyramids.

- Hilum is the concave medial border of the kidney, where the renal blood and lymph vessels and nerves enter the renal pelvis. - It is the funnel shaped structure where it receives urine from the major calyces.
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- Urine passes through a papilla at the apex of the pyramid into a lesser calyx, than into greater calyx, from there to pelvis of urethra. - Normal renal blood flow is 1100 to 1200 ml/min. - Blood supply is from the renal artery, a branch of abdominal aorta. - Blood return is from the renal vein, a branch of inferior venacava.
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Nerve supply to kidney is arising from celiac ganglion and passes through renal plexus along with renal arteries.

- Microscopic structure of the kidney:

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The kidney is composed of about one million functional, structural units, the Nephrons. And small number of collecting tubules. The Nephrons: It consists of a tubule at one end opening into a collecting tubule.

- The closed or blind end is indented to form the cup cup shaped glomerular capsule (Bowmans capsule). - This almost completely encloses a network of arterial capillaries, the glomerulus. The Nephrons is about 3cm long and is described in three parts; The proximal convoluted tubule The medullary loop(Loop of Henle) The distal convoluted tubule, leading to a collecting duct.
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Functions of the kidney: The main functions of the kidneys are Formation and secretion of urine. Production and secretion of Erythropoietin. Production and secretion of Rennin. It forms active form of vitamin D. Regulates acid base balance. Formation of Urine: There are three processes involved in the formation of urine; about 1.5 to 2 L of urine is formed per day by both the kidneys.
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a.

Simple filtration: Filtration takes place through the semipermiable walls of the Glomerulus and glomerular capsule, water and large number small molecules pass through, although some are reabsorbed later. The volume of filtrate formed by both kidneys each minute is called the glomerular filtration rate (GFR). Normal GFR is 125ml/min or 180 l/day. Selective reabsorption: It is the process by which the composition and volume of the glomerular filtrate are altered while passing through the renal tubules. Secretion: The substances not required and foreign materials i.e. the drugs may not be filtered through the glomerulus such substances are cleared by secretion into the convoluted tubules and passed out with urine. Urine is amber in color due to the presence of urobilin, a bile pigment altered in the intestine. (Tubular reabsorption: The filtrate contain physiologically useful substances namely glucose, sodium, amino acids, chloride, potassium and water which are absorbed in different parts of the Nephrons.)

b.

c.

Ureters: - The Ureters are the tubes that convey urine from the kidneys to the urinary bladder. - They are about 25 to 30cm long with a diameter of about 3mm. - The Ureters starts from funnel shaped renal pelvis, passes downwards the posterior abdominal wall in the abdominal cavity behind the peritoneum to the pelvic cavity and enters the bladder obliquely through the posterior wall of the urinary bladder.
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Structure: The ureters consist of three layers of tissues, An outer covering of fibrous tissue, continuous with a fibrous capsule.
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 A middle muscular layer consisting of interlining smooth muscle fibres. An inner layer, the mucosa, lined with transitional epithelium. - Functions: The ureters propel the urine from kidneys into the bladder by a peristaltic contraction of the muscular wall. Peristaltic waves occur at about 10sec intervals, sending drops of urine into the bladder. Urinary Bladder: - The urinary bladder is a reservoir for urine. It is oval or pear shaped organ. It is situated in pelvic cavity almost in the median plane. - Its size and shape varies depending on the amount of urine it contains. When distended the bladder rises into the abdominal cavity. - Relations: Anteriorly: The Symphysis pubis. Posteriorly: The uterus and part of vagina in Female. Rectum and seminal vesicles in Males. Superiorly: The small intestine. Inferiorly: Urethra, prostate gland in male.
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Structure: The bladder is roughly pear shaped but becomes more oval as it fills with urine. It has anterior, superior and posterior surfaces. The posterior surface is the base. The bladder opens into the urethra as its lowest point, the neck. Peritoneum covers the superior surface and it is reflected to abdominal wall as parietal peritoneum. The bladder wall is composed of three layers of tissues, Outer layer of loose connective tissue. Middle layer, thick muscles arranged in three layers called the detrusor muscle.
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 The mucosa, lined with transitional epithelium. - When the bladder is empty, the inner lining layers is thrown into folds and these gradually disappear as the bladder fills. Three opening or orifices in the bladder will form a triangle of trigone. - The upper two orifices on the posterior wall are the opening of the ureters. The lower orifice is the point of origin of the urethra. - Internal urethral sphincter is formed by circular fibres of smooth muscle around the opening of urethra. Urethra: - The urethra is the canal extending from the neck of the bladder to the exterior. It measures about 15-20cm. - Its length differs in the male and in female. The male urethra is associated with the reproductive system. - The female urethra is approximately 4cm long. It runs downwards and forwards behind the Symphysis pubis and opens at the external urethral orifice, just in front of the vagina.
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Structure: Its walls consists of three layers of tissue, The muscle layer, continuous with that of the bladder. The sub mucosa, a spongy layer containing blood vessels and nerves. The mucosa, lining of the stratified squamous epithelium.

- Male urethra has three anatomical parts. They are, Prostatic urethra Membranous urethra Spongy urethra Micturition:
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Micturition is a spinal reflex influenced by the higher centre. Urine formed in the kidney dribble into the bladder continuously.
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- Micturition occur when autonomic efferent fibres convey impulses to the bladder causing contraction of the detrusor muscle and relaxation of the internal urethral sphincter. - When 300 to 400ml of urine has accumulated, afferent autonomic nerve fibres in the bladder wall sensitive stretch are stimulated. Normal constituents of urine, - Inorganic: Sodium, potassium, calcium and phosphate. - Organic: Urea, uric acid and creatinine. - Others: Ammonium chloride and minerals. Abnormal constituents of urine, - Proteins in case of nephritic syndrome. - Glucose in case of diabetes mellitus and renal glycosuria. - Bilirubin in case of jaundice
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Blood in case of nephritis.

- Creatine bythere is muscle wasting as in myipathies. Notes:

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Diabetes insipidus is deficiency of ADH results in excretion of large quantities of dilute urine. Cystometrogram is the graphical representation of relationship between the volumes of urinary bladder and the pressure within it. Renal failure is a condition in which kidneys stop functioning normally. It is of two types, acute renal failure and chronic renal failure. Chronic renal failure is managed by dialysis and renal transplantation. Dialysis is a process by which normal composition of blood is restored by used into the dialyzing fluid. Renal transplantation is method of long term management of chronic renal failure. Kidney of the matched donor is transplanted to the recipient.
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Diuresis is the condition urine output is increased. Diureties are substances which increase the output of urine by modifying the functions of Nephrons. Polyuria is a condition of increased urine output with reduced solute concentration. Nocturia is excessive voiding of urine during night. Oliguria is reduction in the urine output less than 400 ml/day, commonly seen in renal failure. Anuria is the absence of urine output commonly seen in shock and renal shutdown. Glomerulonephritis is an inflammatory condition of glomerulus. Nephrotic syndrome is group of symptoms seen in several renal diseases ex; proteinuria, oedema etc. Renal calculi are the formation of stones in kidney and urinary bladder.

The Skin: The skin completely covers the body and is continuous with the membranes lining the body orifices.

Structure of the skin: - The skin has a surface area contains glands, hair and nails. There are two main layers; Epidermis Dermis or corium - Between the skin and underlying structures there is a layer of subcutaneous fat. Epidermis:

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- The epidermis is the most superficial layer of the skin and is composed of keratinised stratified epithelium which varies in thickness in different parts of the body. - The cells on the surface are flat, thin, non nucleated, dead cells in which the cytoplasm has been replaced by keratin. - There are several layers of cells in the epidermis; The surface stratum corneum After surface stratum lucidum Next surface stratum granulosum End surface is germinative layers - Complete replacement of the epidermis takes about 40 days. - Hairs, secretion from sebaceous glands and ducts of sweat glands pass through the epidermis to reach the surface. - The surface of the epidermis is ridged by projections of cells in the dermis called the papillae. - The colour of the skin is effected by three main factors : - Melanin, a dark pigment secreted by melanocytes - The level of oxygenation of hemoglobin give the skin its pink colour - Bile pigment in blood of carotenes in subcutaneous fat give the skin a yellowish colored Dermis: - The dermis is tough and elastic. - It is composed of collagen fibers interlaced with elastic fibers - There are fibroblasts and mast cells in the dermis - Underline its deepest layer there is Areolar tissue and varying amounts of fat. - The structures in the dermis are;

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Blood vessels: Fine branches supplying blood to sweat glands, sebaceous glands, hair follicles and the dermis (The epidermis has no blood supply) Lymph vessels form a network through out the dermis and the deeper layer of the epidermis Sensory nerve endings which are sensitive to touch, change in temperature, pressure and pain are widely distributed in the dermis Sweat glands are found widely distributed through out the skin they are composed of epithelial cells. Most numerous in the palms of the hands, soles of feet, axillae and groins.

The most important function of sweat secreted by glands opening into the skin surface is in the regulation of body temperature.

Hairs are formed by a down growth of epidermal cells in to the dermis or subcutaneous tissue called hair follicles. At the base of the follicle there is a cluster of cells called the bulb. The part of the hair above the skin is the shaft and the remainder is the root.

The arrectors pilorum are little bundles of involuntary muscle fibres attached to the hair follicles. It help contraction makes the hair stand erect.

The subcutaneous glands consist of secretary epithelial cells derived from the same tissue as the hair follicles. They pour their oily secretion, sebum, into the hair follicles so they are present in the skin of all parts of the body except the palms of the hands and the soles of the feet. Nails: - They are derived from the same cells as epidermis and hair and consist of a hard horny type of keratinised dead cell. - The root of the nail is embedded in the skin, is covered by the cuticle and forms the hemispherical pale area called the lunula.

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- The body of the nail is the exposed part which has grown out from the germinative zone of the epidermis called the nail bed. Functions of the skin: The skin is main protective organs of the body. Maintain regulation of body temperature. Helps to formation of vit D. Its helps to sensation like touch, pressure, temperature or pain. Helps to absorption of the substances. Minor excretory organ for some substances like sweat, urea etc Regulation of body temperature: - The constant temperature a fine balance is maintained in skin between heat produced in the body and heat lost to the environment. Heat production: - Some of the energy released in the cells when carbohydrates, fats and deaminated acids are metabolized is in the form of heat. - The principal organs involved are;

Muscles: contraction of voluntary muscles produces a large amount of heat. The liver: It is very chemically active, heat is produced as a by product. The digestive organs: produce heat by the contraction of smooth muscle. The action increase in the metabolic rate that occurs when food is eaten produces heat.

Heat loss: - Most of the heat loss from the body occurs through the skin. - Only the heat lost through the skin can be regulated to maintain a constant body temperature.
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- Heat loss through the skin is affected by the difference between body and environmental temperatures. - Control is achieved mainly by thermo receptors in the hypo thalamus. Nervous control: - The temperature regulating centre in the hypo thalamus is responsive to the temperature of circulating blood. - The vasomotor centre in the medulla oblongata controls the diameter of the small arteries and arterioles, circulates in the capillaries in the dermis. - The body is cooled by loss of the heat used to evaporate the water in sweat. - The amount of heat lost from the skin depends to a vasodilatation of blood in the vessels in the dermis. *********** Unit-IX Nervous system

The nervous system detects and responds to changes inside and outside the body. Together with the endocrine system it controls important aspects of body function and maintains homeostasis. The nervous system consists of the brain, the spinal cord and peripheral nerves. Organization of nerves tissue within the body enables rapid communication between different parts of the body. For descriptive purposes the parts of the nervous system are divided into; - The central nervous system, consisting of the brain and the spinal cord.
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The peripheral nervous system, consisting of the 31 pairs of spinal nerves. The autonomic nervous system, consisting of 12 pairs of cranial nerves. (Sympathetic & Parasympathetic division)
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 Neurons: - Neurons are the structural and functional unit of the nervous system. - Neurons supported by a special type of connective tissue, termed as neuroglia. - Each neuron consists of a cell body and its processes, axons and dendrites. Cell bodies: - They form the grey matter of the nervous system and are found at the periphery of the brain, in the centre of the spinal cord. - Groups of cell bodies are called nuclei in the central nervous system and ganglia in the peripheral nervous system. - These contains nucleus, endoplasmic reticulum, ribosomes and golgi apparatus having similar structure and function as in other cells. Axons:
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It is the long process of a neuron, arises from portion of the cell body termed the axon hillock. They are carrying nerve impulses away from the cell body.

- The membrane of the axon is called axolemma and it encloses the cytoplasmic extension of the nerve cell.
-

Large axons are surrounded by a myelin sheath, consists of a series of Schwann cells.

- Between the layers of plasma membrane there is a small amount of fatty substance called myelin. - The outermost layer of Schwann cell plasma membrane is sometimes called neurilemma. - This help in rapid transmission of nerve impulse. Dendrites: - These are the short processes or nerve fibres 5 to 7 in number which carry impulses towards cell bodies.
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- They have the same structure as axons but they are usually shorter and branching. The meninges:
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The brain and spinal cord are completely surrounded by three layers of tissue called meninges.

- They lying between the skull and the brain, between the vertebral foramina and the spinal cord.
-

Named from outside inwards they are; Dura mater, Arachnoid mater and Pia mater.

Dura mater: - The Dura mater is the outermost and toughest layer, strong, thick, fibrous membrane consisting largely of white collegen fibres. - The cerebral dura has two layers: Outer endosteal layer and Inner meningeal layer.

Arachnoid mater: - It is delicate, transport, vascular membrane situated between the dura mater and pia mater.
-

It is closely applied to the dura mater but separated from pia mater by a subarachnoid space.

- Arachnoid is separated from the dura a sub dural space.

Pia mater: - It is the inner most layer of the meninges, closely applied to the brain and spinal card. - It is very delicate, vascular membrane, which carries small capillaries to the brain and spinal card.

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Ventricles of the brain: within the brain three are four irregular-shaped cavities called ventricles. They are; Right and left ventricles, Third ventricle and Fourth ventricle. Properties of neurons: They have the characteristics of irritability and conductivity.
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Irritability: it means to initiate nerve impulses in response to stimuli. Outside the body e.g.; touch, light, waves. And inside the body e.g.; Conductivity: it means the ability to transmit an impulse.

change in concentration of gases.

Types of nerves: There are two types of nerves, Sensory or afferent nerve and motor or efferent nerve.

************* Unit-X The Endocrine System

There are two major regulatory systems of the body are Endocrine and nervous system.

The Chemicals secreted by endocrine glands directly into the blood stream are called Hormones. Endocrine glands consists of groups of secretory cells, secretes the hormones into the blood stream referred to as the ductless glands. The endocrine system consists of a number of distinct glands and some tissues in other organs. They are - One Pituitary Gland - One Thyroid Gland
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- Four Para-Thyroid Glands - Two Adrenal Glands - One Pineal Gland or body - Two Ovaries in the Female - Two Testes in Male - One Thymus Gland - The Pancreatic Islets. When a Hormone arrives at its target cells, it binds to a specific area, the receptor, where it acts as a switch influencing chemical or metabolic reactions inside the cell.

Pituitary Gland: (Hypophysis Cerebri)

The Pituitary Gland and Hypothalamus act as a unit, regulating the activities of most of the other Endocrine Glands. So this is described as the Master Gland of the Body. It lies in the Hypophyseal Fossa of the Sphenoid Bone below the Hypothalamus, to which it is attached by a stalk. It is Reddish grey colour, size like a pea, weighs about 500gms to 1000gms and consist of three distinct parts that originate from different types of cells; the anterior Pituitary, the posterior pituitary, the intermediate lobe (Pars intermedia). A pars inter medium is a small zone in between the anterior and posterior lobes of pituitary.

Arterial blood supplied by internal carotid artery, venous drainage by the venous sinuses between the layers of Duramater.

The Anterior Pituitary: (Adenohypophysis)

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 This is supplied by network of blood vessels forms part of pituitary portal system, which transports blood from the hypothalamus to the anterior pituitary very close contact with secretory cells. Some of hormones secreted by the anterior lobe stimulate or inhibit secretion by other endocrine glands while others have a direct effect on target tissues. Hormones Target Tissues

Growth Hormone(GH) Thyroid Hormone (TSH)

Most Tissues

stimulating Thyroid gland

Adreno cortico trophic Adrenal cortex hormone (ACTH) Prolactin LH) Breast(Milk Production)

Gonadotrophins (FSH & Ovaries & Testes

Growth Hormone is small hormone. Secretion of growth hormone is controlled by Growth hormone releasing hormone and Growth hormone inhibiting hormone produced in hypothalamus.

Actions: - Increase rate of protein synthesis in all the cells, increasing in blood glucose concentration. - Increases metabolism of fats from Adipose tissue, also stimulates the bone growth.

Increased Growth Hormone secretion before puberty causes Gigantism.

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Increased Growth Hormone secretion after puberty causes Acromegaly. Decreased Growth Hormone secretion causes Dwarfism. Thyroid stimulating hormone is also known as Thyrotropin, secreted by Anterior pituitary is influenced by Thyroid Hormone levels in the blood.

Actions: - It controls the secretions of Thyroid Gland by increasing size and number of thyroid cells and increase formation of thyroid hormones.

Adrenocorticotropic hormone is a polypeptide secreted by the anterior lobe of pituitary gland.

Actions: - It stimulates the growth of Zona fasciculata and Zona rericularis of Adrenal Cortex. - It controls the secretion of Cortisol.
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ACTH secretion is mainly controlled by Corticotropin releasing hormones secreted by the Hypothalamus.

Follicle Stimulating Hormone is a small molecular weight glycoprotein secreted from the Anterior Pituitary. Actions: - FSH acts on the Ovaries helps to form Estrogen. - It helps in Spermatogenesis in Males. - Prolactin is an anterior Pituitary hormone responsible for the production of milk.

The Posterior Pituitary: (Neurohypophysis) This is formed from nervous tissue and consists of nerve cells surrounded by supporting cells called Pituicytes.

Oxytocin and Anti diuretic hormone (ADH or Vasopressin) are the hormones synthesized in the Hypothalamus.
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Oxytocin is formed primarily in Para ventricular nucleus of Hypothalamus and stored in posterior pituitary.

Actions: - Causes contraction of the smooth muscles of pregnant uterus and relaxation of cervix. - Plays important role in lactation and causes ejection of milk from the nipple.
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Synthetic Oxytocin is used during delayed labour to induce uterine contractions.

The Thyroid Gland:

It is situated in the neck in front of the Larynx and Trachea at the level of the 5th, 6th, 7th cervical and 1st thoracic vertebrae.

It is a highly vascular gland that weighs about 20 25gms and is surrounded by a fibrous capsule. It resembles a butterfly in shape, consisting of two lobes, one on either side of thyroid cartilage and upper cartilaginous rings of the Trachea. The lobes are joined by a narrow isthmus, lying in front of trachea.

The lobes are roughly cone-shaped, about 4 5 cm long and 3 cm wide. External Carotid Artery, Inferior Thyroid Artery branch of the Subclavian Artery. Venous return is by thyroid veins which drain into the internal jugular veins.

Arterial blood supply to the gland is Superior Thyroid Artery branch of

Nerve supply by the recurrent laryngeal nerve. Two parathyroid glands lie against the posterior surface of each lobe. The gland is composed of Cuboidal epithelium that forms spherical follicles. These secrete and store colloid, a thick sticky protein material.

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Between the follicles there are other cells found single or in small groups; Para follicular cells also called C-cells, which secrete the hormone Calcitonin. Thyroxin, tri-iodothyronin and Calcitonin hormones secreted by thyroid gland.

Iodine is the most essential raw material for the synthesis of thyroid hormone. Functions: - Thyroid Hormones increase the metabolism in almost all tissue of the body. - They are essential for general growth and maintainence of skeletal muscles. - They increase blood glucose level and heart rate. - Excess of thyroid hormone decrease the body weight due to increased catabolism. - They have a marked effect on brain development. - Maintain normal sleep pattern, normal ovarian cycle in females.

Deficiency of thyroid hormone causes Myxoedema in adults and Cretinism in children. Excess of thyroid hormones causes gravess disease. Goiter is an enlargement of thyroid gland due to deficiency of iodine.

The Parathyroid Glands: There are four small parathyroid glands, two embedded in the posterior surface of each lobe of the thyroid gland. They are oval in shape and yellowish brown in colour. Total weight is 140mg. They are surrounded by fine connective tissue capsules.
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 They are arranged in columns with channels containing blood connection between them. Blood supply by inferior thyroid arteries and middle thyroid veins. Nerve supply by the sympathetic nervous system. Parathyroid consists of chief cells secrete the parathormone. Parathormone is to increase blood calcium level when it is low. Blood calcium levels needed for muscle contraction, blood clotting. Nerve impulse transmission.

Deficiency of parathormone due to removal of parathyroid gland causes Hypocalcaemia.

Increase of parathormone due to tumour or hyperplasia of parathyroid glands leads to hypercalcemia. It causes demineralization of the bones; calcium may be deposited in the kidney causing renal stones. The Adrenal or Suprarenal Glands:

There are two adrenal glands, one situated in the upper pole of each Kidney enclosed within the renal fascia but separated by fibrous tissue.

They are about 4cm long and 3cm thick and each weighs around 5gm. The glands are composed of two parts which have different structures and functions. The outer part is the cortex and the inner part is the medulla. Arterial blood supply to the glands by branches from the abdominal aorta and renal arteries. Venous return is by inferior venacava to right and left renal vein.

The adrenal cortex produces three groups of steroid hormones, collectively called Adrenocorticocoids (Corticosteroids). They are

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1. Glucocorticoids:

Cortisol

and

Coticosterone

are

the

main

Glucocorticoids. They are essential for life. They have widespread effects on the body systems. For example - Regulation of carbohydrate metabolism. - Reduce protein stores in the body. - Have an anti-inflammatory action.
-

It stimulates Gluconeogenesis causing a rise in blood glucose levels.

2. Mineralocorticoids: Aldosterone is the main mineralocorticoids. Its function is helps in regulation of volume of body fluid. It helps in control of acid base balance.
3.

Sex hormones (Androgens): Adrenal gland produces testosterone in males. Estrogen and progesterone in females. They help in development of secondary sexual characters.

Adrenal medulla is completely surrounded by the cortex. It is stimulated by its extensive sympathetic nerve supply to produce the hormones; Adrenaline and Noradrenaline.

Functions: - Constriction of all the blood vessels of the body. - Dilating blood vessels of muscles, heart and brain. - Converting Glycogen into Glucose. - Increases in metabolic activities of the body. - Causes dilation of pupils. The Pancreatic Islets: The cells which make up the Pancreatic Islets are found in clusters irregularly distributed throughout the substance of the Pancreas. Pancreatic Hormones are secreted directly into the blood stream and circulate through out the body.
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 There are three main types of cells in the pancreatic islets. 1. Alpha Cells; that secrets glucogon. 2. Beta Cells; that secrets insulin. 3. Delta cells; that secrets somatostatin.

Glucogon and Insulin act in a complementary manner; glucogon increases blood sugar level and insulin decreases blood sugar level.

The normal blood glucose level is between 2.5 5.3 mmol/lt. Functions of Insulin: - It decreases blood glucose levels. - Increasing fat content of body. - Preventing the breakdown of protein and fat & Gluconeogenosis. - Helps to actions of growth hormone to promote growth.

Diabetes Mellitus is a condition caused due to deficiency of insulin or decreased sensitivity of tissues to insulin.

There are two types. - Insulin dependent diabetes mellitus. & - Non insulin dependent diabetes mellitus Symptoms are - Increased urination, - Increased fluid intake, - Increased food intake, - Delayed wound healing. Functions of Glucogon: - It increases blood glucose level. - It breaks down lipids into fatty acids. - It converts amino acids into Glucose.

Somatostatin is to inhibit the secretion of both Insulin and Glucogon.

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 The Pineal Gland or Body:

-

It is a small body attached to the roof of the 3rd ventricle and is connected to it by a short stalk containing nerves.

- It is about 10mm long, reddish brown in colour, weighs about 150mgms, surrounded by a capsule. - It contains pinealocytes secrets the hormone, the melatonin. Functions: - Controls reproductive functions. - Influences the functions of other Endocrine glands. - It helps to maintain biological rhythms of the body. *************** Unit-XI The Eye and Vision: The eye is the organ of the sense of sight or vision located in the orbital cavity. Optic nerve provides the nerve supply to eyes. It is almost spherical in shape and is about 2.5cm in diameter. The space between the eye and orbital cavity is occupied by fatty tissue.

Sense organs

The Accessory Organs of the Eye: - The eye is a delicate organ which is protected by several structures. - Eyebrows - Eyelids - Eyelashes - Lacrimal apparatus - Extrinsic muscles of eye
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 Eyebrows: - These are ridges on the supra orbital surface of frontal bone. - Numerous hairs project obliquely from the surface of the skin - They protect the eye from direct sunlight and foreign particles. Eyelids: - The eyelids are two movable folds of tissue situated above and below the front of each eye. - On their free edges there are short curved hairs, the eyelashes. - Eyelids have skin, Areolar tissue, muscles, connective tissue and lining of conjunctiva. - Functions are protecting the eye from bright light and cover the eyes during sleep. - Eyelashes form margin of eyelids. Edge of eyelids has sebaceous glands. Conjunctiva: - It is a thin transparent membrane which covers front of eyeball and inner surface of eyelid. - When the eyelids are closed the conjunctiva becomes a closed sac. - When drops of a drug are put into the eye they are placed in the conjunctival sac. Lacrimal apparatus: - Lacrimal apparatus produce and drain tears. It contains. Lacrimal glands Lacrimal ducts Lacrimal canaliculi Lacrimal sacs Naso Lacrimal ducts

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Lacrimal glands are located in supero-lateral part of the eye under upper eyelids.

- Each glands composed of secretory epithelial cells secrete tears composed of water, mineral, salts, antibodies, a bactericidal enzyme. - It passes through lacrimal ducts over the surface of upper eyelids and anterior surface of the eyeball. - Tears pass to lacrimal sac through lacrimal canaliculi then to the nose through naso lacrimal duct. - Lacrimal secretion increases due to irritation of conjunctiva, inflammation of nasal mucosa, during emotional conditions like extreme happiness or sadness. - Functions of lacrimal fluid: It lubricates and cleans the eyeball. Helps to keep the eyeball moist. It destroys bacteria due to presence of enzyme lysozyme. Washing away irritating materials. e.g.: dust.

Extrinsic muscles: (Extra ocular muscles): - The eyeballs are moved by six extrinsic muscles, attached at one end to the eyeball and at the other to the wall of the orbital cavity. - There are four straight muscles and two oblique muscles. 1. The medial rectus rotates the eyeball inwards. 2. The Lateral rectus rotates the eyeball outwards. 3. The superior rectus rotates the eyeball upwards. 4. The inferior rectus rotates the eyeball downwards. 5. The superior oblique rotates the eyeball to downwards and outwards. 6. The inferior oblique rotates the eyeball to upwards and outwards.

Structure of eye:
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- Eyeball which is fully formed has a diameter of 2.5cm. - There are three layers of tissue in the wall of the eye. They are: The outer fibrous layer: sclera and cornea. The middle vascular layer: choroids, ciliary body and iris. The inner nervous tissue layer: retina - Structures inside the eyeball are the lens, aqueous fluid and vitreous body. Sclera and cornea:
-

The sclera or white of the eye forms the outermost layer of tissue of the posterior and lateral aspects of the eyeball.

- Sclera is continuous anteriorly with the transparent cornea. - Sclera is made up of collagen fibres and fibroblasts. It gives shape to the eye and protects the internal structures. - Light rays passes through the cornea to reach the retina. Choroids: - The choroids line the posterior- inner surface of the sclera.
-

It is very rich in blood vessels and provides nutritions to retina. choroids.

- Light is stimulates the nerve endings in the retina then is absorbed by the Ciliary body: - The ciliary body is the anterior continuation of the choroids consisting of ciliary muscle and secretory epithelial cells. - It gives attachment to the suspensory ligament, which attached to the capsule enclosing the lens. - Ciliary muscles change the shape of lens to make it suitable vision. - The epithelial cells secrete aqueous fluid into the anterior segment of the eye. Iris:

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- The iris is the visible colored part of the eyes and extends anteriorly from the ciliary body. - It is lying behind the cornea in front of the lens. - It divides the anterior segment of the eye into anterior and posterior chambers which contain aqueous fluid secreted by the ciliary body. - In the center there is an aperture, the pupil. - The pupil varies in size depending upon the intensity of light. - In bright light the circular muscle fibres of the iris contract and constrict the pupil. - In dim light the radiating muscle fibres contract, dilating the pupil. - The iris is supplied by parasympathetic and sympathetic nerves. Lens: - The lens is a highly elastic circular biconvex transparent body, lying immediately behind the pupil. - It is suspended from the ciliary body by the suspensory ligament and enclosed within a transparent capsule. - Its thickness is controlled by the ciliary muscle through the suspensory ligament.
-

Lens helps in refraction of light to focus it on the retina.

Retina: - The retina is the innermost layer of the wall of the eye. It is photosensitive part of the eye. - It is layers of nerve cells and their fibres. - It contains visual receptors like rods and cones. - Rods are sensitive to dim light vision and cones are sensitive to bright light and colour vision. - They convert light energy to nerve impulses.
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- Centre of the posterior part of the retina has an area called yellow spot or macula lutea. - The small area of retina has no light sensitive cells, nerve leaves the eye is the optic disc or blind spot. - Arterial blood by the ciliary arteries and the central retinal artery, branches of the internal carotid artery. - Venous drainage is by a number of veins, including the central retinal vein. Interior of eyeball: - Eyeball is divided into anterior and posterior chambers or cavities by the iris and lens. - Behind the lens, filling cavity of the eyeball is the vitreous body. - Aqueous fluid is responsible for the pressure in the eyeball called intraocular pressure. Normal intraocular pressure is 10 to 20 mm of Hg. - The eye keeps its shape because of the intraocular pressure exerted by the vitreous body and the aqueous fluid. - Jelly like substance help to intraocular pressure to support and prevent the walls of eyeball from collapsing. - Both chambers contain a clear watery fluid called aqueous fluid (humour). - Aqueous fluid secreted into the posterior chamber by ciliary glands. - It passes in front of the lens, through the pupil into the anterior chamber and returns to the venous circulation by scleral venous sinus. Physiology of sight: - Light waves travel at a speed of 3,00,000 kilometers per second. - Light is reflected into the eyes by objects within the field of vision. - White light is a combination of all the colours of the visual spectrum that is, red, orange, yellow, green, blue, indigo and violet.

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- The processes involved in producing a clear image are refraction of the light rays, changing the size of the pupils and accommodation of the eyes. - Before reaching the retina light rays pass successively through the conjunctiva, cornea, aqueous fluid, lens and vitreous body. - Lens is the only structure in the eye that changes its refractive power. - All light rays entering the eye need to be bent to focus them on the retina. - Pupil size influences accommodation by controlling the amount of light entering the eye. - In a bright light the pupils are constricted. In a dim light they are dilated. Notes:
-

Conjunctivitis is inflammation of the conjunctiva may be caused by dust, smoke, wind, cold or dry air, microbial infection or allergic reactions. Trachoma is a chronic inflammatory condition of the conjunctiva and cornea, leading to eyelid deformity and possibly blindness. Corneal ulcer is the local necrosis of corneal tissue, usually associated with corneal infection. Glaucoma is a group of condition in which there is increased intraocular pressure due to defective drainage of aqueous fluid through the scleral venous sinus. Cataract is opacity of the lens in the eye may be causing partial or complete blindness. Retinopathy is any non-inflammatory disease of retina due to other conditions. Eg; diabetes, hyper tension. Keratomalacia is condition there is corneal ulceration, usually with secondary infection. Myopia or shortsightedness is condition the eyeball is too long and distant objects are focused in front of the retina.
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Hypermetropia or long-sightedness is condition a near image is focused behind the retina because the eyeball is too short.

The Ear and Hearing: The ear is the organ of hearing. It is supplied by the eighth cranial nerve. With the auricle (pinna), the structures that form the ear are encased within the canal portion of the temporal bone. Structure: - The ear is divided into three distinct parts; External ear Middle ear Internal ear External ear: - The external ear consists of the auricle (pinna) and the external acoustic meatus. The auricle (pinna): - The pinna is the portion projecting from the side of the head. - It is connected to the head with the help of ligaments and muscles. And composed of fibro elastic cartilage covered with skin. - It is deeply ridged and the most prominent outer ridge is the Helix. - The soft part of the lower extremity called lobule, composed of fibrous and adipose tissue. The external acoustic meatus(auditory canal): - This is a slightly S shaped tube about 2.5cm long extending from the auricle to the tympanic membrane (ear drum). - The lateral third is cartilaginous and the remainder is a canal in the temporal bone. - The meatus is lined with hairy skin, continuous with that of the auricle.
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- There are numerous sebaceous and ceruminous glands, secretes cerumen (wax). - The tympanic membrane (ear drum) completely separates the external acoustic meatus from the middle ear. - It is oval shaped with slightly broader edge upwards and is formed by three types of tissue; The outer covering of hairless skin. The middle layer of fibrous tissue. The inner lining of mucous membrane continuous with that of the middle ear. Tympanic cavity or middle ear: - This is an irregular shaped cavity within the petrous part of temporal bone. - Middle ear is lined by Squamous or Cuboidal epithelium. - Air fills the cavity, reaching it through the pharyngo-tympanic tube (Eustachian) which extends from the nasopharynx. - The lateral wall of the middle ear is formed by the tympanic membrane. - The roof and floor are formed by temporal bone. - The posterior wall is formed by the temporal bone with opening leading to the mastoid Antrim. - The medial wall is a thin layer of temporal bone in which there are two openings; Oval window Round window - The oval window is occluded by port of a small bone called stapes and the round window by a fine sheet of fibrous tissue. Auditory ossicles:

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- These are three very small bones that extend across the cavity from the tympanic membrane to the oval window. - They form a serious of movable joints with each other. They are; malleus, incus and stapes.
-

The malleus is the lateral hammer shaped bone. The handle is in contact with tympanic membrane and the head forms movable joints with incus. The incus is the middle anvil shaped bone. Its body articulates with the malleus, the long process with the stapes, it is fixed to the posterior wall of middle ear cavity. The stapes is the medial stirrup shaped bone. Its head articulates with the incus and its footplate fits into the oval window.

Internal ear: - The internal ear contains the organs and is generally described in two parts, the bony labyrinth and the membranous labyrinth.
-

Bony labyrinth is a cavity with the temporal bone lined with periosteum. called perilymph.

- Between the bony and membranous labyrinths there is a layer of watery fluid - Within the membranous labyrinth there is a similarly watery endolymph. - The bony labyrinth consists of one vestibule, one cochlea, and three semicircular canals. - The vestibule is the expanded part nearest the middle ear consists of utricle and saccule. - The cochlea has a broad base where it is continuous with the vestibule. - The semicircular canals are three tubes arranged so that one is situated in each of the three planes. - They provide information about the position, direction of the head in space.

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Membranous labyrinth is the same shape as its bony counter part, contains endolymph.

- Neuroepithelial cells and their nerve fibres lie on the basilar membrane. - The nerve fibres combined to form the auditory part of the vestibulocochlear nerve. Physiology of hearing: - Every sound produces sound waves or vibrations in the air. - Waves are causing the tympanic membrane to vibrate, that transmitted through the middle ear by movement of ossicles. - At their medial end the footplate of the stapes rocks to membranous labyrinth, causing a wave motion in the endo lymph. - Next this stimulates the neuroepithelial cells, its pass to the brain in the cochlear portion of the vestibulocochlear nerve (8th cranial nerve). - The vestibulocochlear nerve transmits the impulses to the hearing area in the cerebrum where sound is perceived. - Sound waves have properties of pitch and volume. The pitch is determined by the frequency of the sound waves, measured in hertz (Hz). The volume depends on the amplitude of the sound waves, measured in decibels (dB). - Note: Very loud noise is damaging to the ear.
-

Otitis media is inflammation of the middle ear may be due to spread of microbes from external ear and through URT.

Sense of smell: - The nose has a duel function: Respiration and sense of smell.
-

Olfactory nerves (first cranial nerves): These are the sensory nerves of smell. They have their origins in special chemoreceptor nerve cells in the mucous membrane of roof in nasal cavity.

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- Nerve fibres from the cell bodies pass through the plate of ethmoid bone to the olfactory bulb. - From the bulb, bundle of nerve fibres form the olfactory tract, pass backward the area. Physiology of smell: - The air entering the nose number of olfactory receptor cells stimulated and thus the perception of the smell. - Sniffing occurs concentrates more particles more quickly in the roof of the nose. - The sense of smell may affect the appetite, the long lasting memories.
-

Adaptation: Continuously exposed to a same odour, Perception of odour quickly decreases. It occur both in the cerebrum and nerve endings in the nose.

- Inflammation of nasal mucosa prevents perception of smell, usually cause by common cold. Sense of taste: - Tongue is concerned with special sensation of taste, lies in floor of mouth. - Taste buds are the receptors for taste, found in papillae of tongue, soft palate, pharynx and epiglottis. - Taste buds are oval shaped structures contains taste cells, taste hair or pores, supporting cells and nerve endings. (glosso pharyngeal , facial and vagus nerve). Physiology of taste: - The nerve cells are stimulated by chemical substances in solution that enter the pores. - Nerve impulses are generated and transmitted to the thalamus than to the taste area in the cerebral cortex.
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- Four fundamental sensation of taste have been described- sweet, sour, bitter and salt. - Stimulation of taste buds in specific part of the tongue; Sweet and salty, mainly at the tip. Sour, at the sides Bitter, at the back. - The sense of taste is impaired when the mouth is dry and lack of saliva water. *************** Unit-XII The Reproductive System

Both males and females produce specialized reproductive germ cells called Gametes. The male Gametes are called Spermatozoa and female gametes are called ova.

They contain the genetic material or genes on chromosomes, there are 46 chromosomes arranged in 23 pairs but in the gametes there are only 23, one from each pair. Female Reproductive system: - Functions: Formation of female gametes: Ova. Reception of male gametes: Spermatozoa. Provision of suitable environments for fertilization. Parturition (Child Birth) Lactation: The production of breast milk. - The Female reproductive organs or genitalia are divided into external and internal organs.
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 External Genitalia(Vulva):

Labia Majora: These are the two large folds which form the boundary of the Vulva, composed of skin, fibrous tissues, and fat and contain sebaceous glands. At puberty hair grows on the mons pubis and on lateral surfaces of labia majora. Labia Minora: These are two smaller folds of skin between the labia majora, containing numerous sebaceous glands. The Cleft between the labia minora is the Vestibule. Clitoris: The Clitoris corresponds to the Penis in the male and contains sensory nerve endings. Hymen: It is the thin layer of mucous membrane which partially includes the opening of the vagina. Vestibular Glands: They are situated one on each side near the vaginal opening, they secrete mucous that keeps the Vulva moist. - The arterial supply by internal and external Pudendal arteries branch from femoral arteries. - The venous drainage forms a large plexus drains into the internal iliac veins. - Lymph drainage is through the superficial inguinal nodes. - Nerve supply by branches from Pudendal nerves. - Perineum: The Perineum is the area extending from the base of the labia minora to the anal canal. It is the roughly triangular; consist of connective tissue, muscles and Fat.

Internal Genitalia: - The internal organs of female reproductive systole in the pelvic cavity and consist of the vagina, uterus, two uterine tubes and two ovaries. Vagina:
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- It is the fibro muscular tube lined with stratified Squamous epithelium, connecting the internal and external organs of reproduction. - It runs obliquely upwards and backwards at an angle of about 45 degree between the bladder and rectum. - In the adult the anterior wall is about 7.5cm long posterior wall about 9cm.
-

Structure of vagina: It has three layers; an outer covering of Areolar tissue, a middle layer of smooth muscle and an inner lining of stratified Squamous epithelium that forms ridges or rugae.

Arterial supply by vaginal Arteries, branches of internal iliac arteries. Venous drainage by plexus drains into the internal iliac veins. Lymph drainage through the deep and superficial iliac glands. Nerve supply by Nerves of sacral outflow, lumbar outflow. - Functions: Vagina acts as the Receptacle for the Penis during Coitus and provides an elastic passage way through which the baby passes during childbirth. Uterus: - The Uterus is hollow muscular pear shaped organ, flattened anterioposteriorly. - It lies in the pelvic cavity between the urinary bladder and the rectum. When the body is in upright position the uterus lies in an almost horizontal position. - It is about 7.5cm long, 5cm wide and its walls are about 2.5cm thick. It weighs from 30 to 40 grams. - The parts of the uterus are the Fundus, Body and Cervix.
-

The Fundus is the dome shaped part of the uterus above the opening of the uterine tubes.

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The Body is the main part, narrowest inferiorly at the internal os where it is continues with the cervix. The Cervix protrudes through the anterior wall of the Vagina, opening into it at the external os. Structure of the Uterus: Perimetrium, Myometrium and endometrium

- The walls of the Uterus are composed of three layers of tissues: Perimetrium: Which is distributed differently on the various surface of the Uterus, anteriorly is extends over the fundus forms the vesicouterine pouch, posteriorly the peritoneum extends over the fundus forms the Recto uterine pouch. Laterally covers the uterine tubes in upper free border form a double fold (Broad ligament).
-

Myometrium: It is thickest layer of tissue in the uterine wall. It is a mass of smooth muscle fibres interlaced with areolar tissues, blood vessels and nerves. Endometrium: This consists of coloumnar epithelium containing a large number of mucous secreting tubular glands. It has two layers; the upper layer it is the functional layer & the basal layer lies next to the Myometrium.

Arterial supply by uterine arteries, branches of internal iliac arteries. Venous drainage by veins follows the same route as arteries drain into internal iliac veins. Lymph drainage by deep and superficial lymph vessels drain from aortic lymph nodes. Nerve supply by the nerves of sacral outflow and Lumbar outflow. - Supporting structure: The Uterus is supported in the pelvic cavity by surrounding organs, muscles of the pelvic floor and ligaments such as; the
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broad ligaments, the round ligaments, the uterosacral ligaments, the transverse cervical ligaments. - Functions: The Uterus helps in implantation, protection, nourishment of a fertilized Ovum It helps in the attachment of the Placenta on its surface, this provides the means by which the growing baby receives oxygen and nutrients, and gets rid of its wastes. It helps in the expelling of the fetus by producing high level of Progesterone hormone by the placenta. During the labour, the uterus forcefully expels the body by means of powerful rhythmical contractions.

Uterine Tubes (Fallopian Tubes): - The uterine tubes are about 10cm long and extend from the sides of the uterus between the body and the fundus.
-

The end of each tube has finger like projections called Fimbriae. They lie on the upper free border of the broad ligament.

- Structure: They have an outer covering of peritoneum, a middle layer of smooth muscles and are lined with ciliated epithelium. - The blood supply, lymph drainage, nerve supplies are same as for the Uterus. - Functions: The mucous secreted by the lining membrane provides ideal conditions for movement of ova and spermatozoa. Fertilization of the Ovum usually takes place in the uterine tube. Ovaries: - The ovaries are the Female Gonads or glands; they lie in the shallow fossa on the lateral walls of the pelvis.

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- There are 2.5 to 3.5 cm long, 2cm wide and 1cm thick. Each is attached to the upper part of the uterus by the ovarian ligament and to the back of the broad ligament by a broad band of tissue, the mesovarium. - Structure of the ovaries: - The ovaries have two layers of tissues; the medulla and the cortex. - The medulla lies in the centre and consists of fibrous tissues, blood vessels and nerves. - The Cortex surrounds the medulla; it has a frame work of connective tissue or stroma, covered by germinal epithelium. It consists of ovarian follicles in various stages of maturity.
-

During the child bearing years about every 28 days one ovarian follicle matures, ruptures and releases into peritoneal cavity. This is called as ovulation and it occurs during most menstrual cycles. The Arterial supply by ovarian arteries branch from the abdominal aorta. The right ovarian vein opens into inferior venacava and the left into the left renal vein. Lymph drainage is to the lateral aortic and pre aortic lymph nodes. Nerve supply from the sacral and lumbar outflow.

- Functions: Maturation by the follicle is stimulated by the FSH and estrogen hormone. The corpus luteum present in the follicle secretes progesterone and estrogen. After ovulation, if the ovum gets fertilized, then it produces the hormone Human Chorionic gonadotrophin (hCG). The corpus luteum now degenerates into a fibrous tissue called corpus albicans.
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 Puberty in the Female:

-

Puberty is the age at which the internal reproductive organs reach maturity. This is called Menarche, and marks the beginnings of the child rearing period.

- The age of the puberty varies between 10yrs and 14yrs and a number of physical, psychological changes take place at this time: - The uterus, the uterine tubes and the ovaries reach maturity. - The menstrual cycle and ovulation begin, the breast develop and enlarge. - Pubic and axillary hair begins to grows, widening of the pelvis takes place. - Increasing amount of fat deposited in the sebaceous tissues especially at the hips and breasts. The Menstrual Cycle: - This is a series of events, occurring regularly in females every 26 to 30 days through out the child bearing period of about 36 yrs. - The FSH promotes the maturation of ovarian follicles and the secretion of estrogen, leading to ovulation. - Luteinizing hormone (LH) stimulates the development of corpus luteum and secretion of progesterone. - The average length of the menstrual cycle is about 28days. By convention the day of the cycle are numbered from the beginning of the menstrual phase which usually lasts for about 4days. - This is followed by the Proliferative phase about 10days, then by the secretary phase for about 14days.

Menopause: - The Menopause usually occurs between the ages of 45yrs and 55yrs, marking the end of the child bearing period.

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- The ovaries gradually become less responsive to FSH, LH and Ovulation and the menstrual cycle becomes irregular. Several other phenomenons may occur at the same time including, - Shrinkage of the Breasts, axillary and pubic hairs become sparse. - Atrophy of the sex organs. - Gradual thinning of the skin, loss of bone mass. (Osteoporosis) - Slow increase in the blood cholesterol levels leading to cardiovascular disorders. Breasts or mammary glands: - The breasts are the accessory glands of the female reproductive system. - After the baby born the hormone prolactin helps in the production of the milk, oxytocin stimulates the release of milk in response to the stimulation of nipple by sucking baby. - Structure: - The mammary glands consist of glandular tissue, fibrous tissue and fatty tissue. - Each breast consists of about 20 lobes of glandular tissue, each lobe being made up of umber of lobules that radiate around the nipple. - The lobules consist of a cluster of alveoli which open into small ducts and these unite to form large excretory ducts, called lactiferous ducts. - The Nipple: - Nipple is a small conical eminence at the centre of the breast surrounded by a pigmented area, the areola, consist of numerous sebaceous glands helps to lubricate the nipple during lactation. Arterial blood supply from the thoracic branches axillary arteries. Venous drainage by the axillary and mammary veins. Lymph drainage mainly into the axillary lymph vessels and nodes.
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Nerve supply by branches from 4th, 5th & 6th thoracic nerves.

- Functions: The mammary glands are only active during late pregnancy and after the birth of the baby, when they produce milk. Lactation is stimulated by the hormone prolactin.

Male Reproductive System: - The Male reproductive system consists of the following organs. Such as Two testes Two epididymides Two deferent ducts(Vas deferens) Two spermatic cords Two seminal vesicles Two ejaculatory ducts One Prostate gland One Penis

Scrotum: - The Scrotum is a pouch of deeply pigmented skin, fibrous and connective tissue and smooth muscles. - It is divided into two compartments each of which contains one testis. It lies below the symphysis pubis, in front of upper part of the thighs and behind the penis. Testes: - The Testes are the reproductive glands of the male and are the equivalent of the ovaries in the female. - They are about 4.5cm long, 2.5cm wide and 3cm thick and are suspended in the scrotum by the spermatic cords. - They are surrounded by three layers of tissues,

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Tunica Vaginalis: This is a double membrane forming the outer covering of the testes, and is a down growth of the abdominal and pelvic peritoneum. Tunica Albuginea: This is a fibrous covering beneath the Tunica Vaginalis that surrounds the testes. Ingrowths form septa dividing the glandular structure of the testes into lobules. Tunica Vasculosa: This consists of a network of capillaries supported by delicate connective tissue. Structure of the Testes: In each Testis are 200 to 300 lobules and within each lobule are 1 to 4 convoluted loops composed of germinal epithelial cells, called seminiferous tubules.

- At the upper pole of the testis the tubules combine to form a single tubule. This tubule, about 6m in its full length is repeatedly folded and tightly packed into a mass called the Epididymis. - It leaves the scrotum as the deferent duct in the spermatic cord. The blood and lymph vessels pass to the testes in the spermatic cord. - Functions: Spermatozoa are produced in the seminiferous tubules of the testes. The hormone controlling sperm production is FSH from the anterior pituitary. The body of the sperm is packed with mitochondria, which fuels the propelling action of the tail that powers the sperm on its journey into the female reproductive tract. The Testes are cooled by their position outside abdominal cavity. The Spermatic Cords: - The spermatic cord suspended in the testes in the scrotum.

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- Each cord contains a testicular artery, veins lymphatic, nerves, a deferent duct. - The cord, which is covered in a sheath of a smooth muscle and connective and fibrous tissues, extends through the inguinal canal and it attaches to testis on the posterior wall. Arterial supply by testicular artery branches from abdominal aorta just below the renal arteries. Venous drainage by testicular vein left vein open into the left renal vein and the right into the inferior venacava. Lymph drainage is through lymph nodes around the aorta.

Nerve supply by branches from the 10th and 11th thoracic nerves.

Deferent Duct:
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This is some 45cm long. Is passes upwards from the testis through the inguinal canal and ascends medially towards the posterior wall of the bladder where it is joined by the duct from the seminal vesicle to form the ejaculatory duct.

Seminal Vesicles: - They are two fibro-muscular pouches lined with columnar epithelium, lying on the posterior aspect of the bladder. - As its lower end each seminal vesicle opens into a short duct which joins with the corresponding deferent duct to form an ejaculatory duct.
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Functions: They contract and expel their stored contents, seminal fluid, during ejaculation.

Ejaculatory Ducts: - They are two tubes about 2cm long, each formed by the union of the duct from a seminal vesicle and a deferent duct.

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- They pass through the prostate gland and join the prostatic urethra, carrying seminal fluid and spermatozoa to the urethra. Prostate Gland: - The Prostate gland lies in the pelvic cavity in front of the rectum and behind the symphysis pubis, surrounding the first part of the urethra. - It consists of an outer fibrous covering a layer of smooth muscle and glandular substances composed of columnar epithelial cells. - Functions: This secretes a thin, milky fluid that makes about 30% of semen. This provides a protective local environment for sperm arriving in the acidic vagina. Urethra: - The male urethra provides a common pathway for the flow of urine and semen.
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It is about 19 to 20cm long and consist of the three parts; the prostatic urethra, membranous urethra and the spongniose or penile urethra, it terminate at the external urethral orifice in the glans penis. There are two urethral sphincters; the internal sphincter at the neck of the bladder above the prostate gland. The external sphincter consists of skeletal muscle fibres surrounding the membranous part.

Penis: - The Penis has a root and a body. The root lies in the perineum and the body surrounds the urethra. - It is formed by three cylindrical masses of erectile tissue and involuntary muscles.

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The two lateral columns are called as the corpora cavernosa; medially it is covered by the corpus spongiosum. At its tip it is expanded into the triangular structure know as the Glans Penis. Just above the glans the skin is folded upon itself and forms a moveable double layer, the fore skin or prepuce.

- A series of the vein drain blood to the internal Pudendal and internal iliac veins. - Arterial supply by the branches from internal Pudendal arteries. - The penis is supplied by the autonomic and somatic nerves. Puberty in Males: - This occurs between the ages of the 10yrs to 14yrs. - Luteinising hormone influence the development of the body to sexual maturity. - The changes which occur at puberty are; Growth of the muscles and bones, markedly increase in the weight and height. Enlargement of the larynx, deepening of the voice. Growth of hair on the face, axillae, chest, abdomen and pubis. Enlargement of the penis, scrotum and prostate gland. Maturation of the seminiferous tubules and production of spermatozoa. The skin thickens and becomes more oily. Notes:
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Testosterone is sex hormone in males formed by cells present in the seminiferous tubules of testis. Amenorrhea is the absence of menstruation, physiologically it occurs during pregnancy. Polymenorrhea is increased frequency of menstruation.
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Dysmenorrhea is painful menstruation. Contraceptive methods are used to prevent or control conception or pregnancy. Mainly two methods; temporary and permanent methods. In males temporarily used the condom and permanently used the vasectomy. In females temporarily used the intra uterine devices, hormonal methods and permanently used the tubectomy. ***********

- The ovarian hormones are estrogens and progesterone.

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