Nursing Review of

Anatomy and Physiology

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

Basic Structural and

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

Composed of the Cytoplasm,

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

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

 Endocytosis- cell engulfment

 Exocytosis- cell excretion

Cell connections

Tight junction= binds adjacent cell together and form

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

 Contains chromosomes DNA +

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

 Formation of two daughter cell

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

 All body cell undergo mitosis except sex

cell. There are two step in mitosis:

a. Genetic material within the cell is

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

 Nucleus and nuclear envelope disappear.

2. Metaphase – chromosome aligned at the center, w/

spindle fiber.
3. Anaphase – chromatin separate to form two sets of
identified chromosome. Chromosome assisted by
spindle fiber.
4. Telophase – chromosome disperse.
 Nuclear membrane and nucleolus
formed.
 Cytoplasm divided into two cell.
Differentiation – process by which cell develop
with specialized function.

 Egg and sperm cell formed single cell during

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

A special type of osmotic

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

There are four (4) Basic types

1. Epithelial

2. Connective

3. Muscle

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

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

2. Simple cuboidal- glands

3. Simple columnar- GI tract

4. Pseudo stratified epithelium-

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

2. Stratified cuboidal-

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

 Cartilage

 Muscle

 Blood

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

the skin: Epidermis,

dermis, and hypodermis.
Skin cells
 There are many other cells aside from
the keratinized squamos cells of the
skin.
 Melanocytes produce pigment
melanin.
 Langerhan’s cells participates in the
immune system.
 Histiocytes are specialized
macrophages
Skin as temperature
regulator
 Abundant nerves, blood vessels
and glands are within the skin’s
deeper layer
 They aid in temperature
regulation
 Blood vessels constrict or dilate
depending on the temperature
Skin functions
 Sweat glands produce sweat
to control temperature by
evaporation
 The piloerector (arrector pili)
muscles will contract to raise
the hairs to trap the heat
 Other skin functions
 Vitamin D synthesis
 7-dehydrocholesterolCholecalciferol
(D3)
 Route of excretion
 Insensible fluid loss of about 500

ml/day
 Sweat contains water, electrolytes,

urea and lactic acid

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

skin
 Functions to insulate the

body to conserve heat

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

scant nerve supply

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

 This system consists of the

muscles, tendons, ligaments,
bones, cartilage, joints, and
bursae
 The Musculoskeletal System

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

 Involuntary cardiac muscle

 Involuntary visceral smooth

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

myosin filaments arranged in a

sarcomere
 This sarcomere is the basic

structural unit of the muscle

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

metric=distance: The length of the

muscle does not change, but the
tension increases
 2. ISOTONIC- iso=same, tonus=tone:

The amount of muscle tension is

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

FAST-twitch muscles= contract

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

 Cardiac muscle- is striated, is

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

 Facial Nerve innervation

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

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

matrix occupied by bone cells.

 The outer layer of bone is

composed of dense compact bone

(cortical bone)
 The inner layer is composed of

spongy cancellous bones

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

 OSTEOCLAST- bone cell responsible

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

 3. Allows spinal nerves to exit the

spinal cord
 4. Provides a site for muscle

attachment
 5. Permits the movement of the

head and trunk

 The Cervical Vertebrae
 7 in number
 C1- atlas

 C2- axis

 C7- cervical prominence

 Atlas and occipital bone=

“yes” motion
 Atlas and Axis=

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

 Ulna

 Radius

 Carpals (wrist bones)

 Metacarpals

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

 The male pelvis has the following:

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

 The leg bones- Tibia and Fibula

 The ankle- tarsal bones

 The foot- metatarsal bones

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

various structures such as the ear

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

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

 Articular surface

 Synovial membrane

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

 Pivot- atlas and axis

 Condyloid- “egg-shape”

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

stress on adjacent structure

 The Nervous System

•The nervous system coordinates all body

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

•The dendrites are short, thick,

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

• This is the largest part of the brain

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

• Lies inferior to the cerebrum

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

•This connects with the

cerebrum
•Contains numerous ascending
and descending tracts and
fibers
The Pons

•Connects the cerebellum with

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

• The most inferior portion of the brainstem

• Serves as the center for autonomic reflexes
to maintain homeostasis, regulating
respiratory vasomotor and cardiac
functions
• Serves as exit of cranial nerves 9,10,11 and
12
The Diencephalon
• The thalamus and the hypothalamus
• The thalamus is the relay station of all
sensory stimuli towards the brain
• The hypothalamus controls body
temperature, appetite, water balance,
pituitary secretions and sleep-wake cycle
The Basal ganglia
Brain circulation: The circle
of Willis
The spinal cord
•A long cylindrical structure
extending from the foramen
magnum to the L1 in adult,
L3/L4 in pedia
The spinal cord
•In the cross section of the spinal
cord, we find the GRAY matter-
contains neurons; and WHITE
matter-consists of nerve fibers

•There are 31 pairs of spinal nerves

that exit the spinal cord
The spinal cord

• Each spinal nerve is formed by the

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

• These are CSF filled cavities in the

brain
• The lateral ventricle- found in the
cerebrum
• The third ventricle- in the center of the
thalamus and hypothalamus
• The fourth ventricle- located at the
base of the cerebellum
The CSF

• This is the fluid found inside the ventricles that

bathe the brain and spinal cord
• Function: provides protective cushion around the
CNS
• Produced by the choroid plexus in the ventricles
• Absorbed by the arachnoid granulations
Tracing the CSF pathway
Lateral ventricle

Interventricular foramen of Monro

Third ventricle

Cerebral aqueduct of Sylvius

Fourth ventricle

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

Luscka

Subarachnoid spaces in the cisterna magna, spinal cord

subarachnoid space of the brain

superior sagittal sinus

The cranial nerves

• Are 12 pairs of nerves that exit

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

• Decreased
– Peristalsis
– Salivary secretions
• Ejaculation
Parasympathetic system

• CHOLINERGIC system
• The vegetative system
• Feed and Breed responses
• Cranio-sacral location
• Cranial nerves- 3, 7, 9, 10 and S2-S4
• Neurotransmitter is Acetylcholine
Parasympathetic responses
• Increased
– Gastric secretions
– Salivary secretions
– peristalsis
• Pupillary constriction
• Decreased
• Smooth muscle tone sphincters are relaxed
• erection
Nerve Physiology
• The nerve cells are excitable cells
• Any stimulus will change the membrane
potential and cause an action potential to
generate impulse transmission
• The myelin sheath of the nerve cell is
responsible for the SALTATORY conduction
increases the nerve transmission
Fig. 8.11
Fig. 8.12
The SYNAPSE
• This is the region where
communication occurs between 2
neurons or between a neuron and
a target cell
• A neurotransmitter is released
from the nerve cell towards the
other cell with receptor
Fig. 8.13
The eye and the visual
pathway
Vision is made possible by the stimulation of the
•
photoreceptor cells in the retina
• Receptor cells are the RODS and CONES
• The eye is made up of three layers
– Fibrous layer- sclerae and cornea
– Uvea- choroid and iris and ciliary bodies
– Nervous coat- retina
Fig. 9.13
The optic nerve

•This is the collection of fibers

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

•This is the part of the ear that

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

• The receptor for taste are

cells in the tongue group
together called the taste
buds
• They are numerous in the
vallate and fungiform
papillae
The Gustatory apparatus

Basic taste modalities

• Sweet- tip of the tongue
• Salty- over the dorsum of the
tongue
• Sour- sides of the tongue
• Bitter- back of the tongue
The Endocrine System

This system is made up of

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

There exists an inter-

related regulation between
the HYPOTHALAMUS,
Pituitary and the endocrine
gland.
The hormonal regulation

We call it the Hypothalamic-

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

Also called Adenohypophysis

Hormones produced
– Growth hormone
– The stimulating hormones- ACTH,
TSH, FSH and LH
– Prolactin
The pituitary gland: posterior lobe

 Also called the neurohypophysis

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

Alsocalled epiphysis cerebri

Secretes melatonin
The thyroid gland

Located in the lower part

of the anterior neck
With two lobes connected
by the isthmus
The thyroid gland

Secretes thyroxine (T4) and tri-

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

 Italso secretes CALCITONIN

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

2 pairs (4) of yellowish glands

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

 Functions of the hormone:

– Increases bone breakdown by osteoclasts
– Increases Vitamin D synthesis
– Increases Calcium level in the blood
– Causes retention of calcium in the kidney
The Adrenal glands

a pair of gland resting on top of each kidney with 2

layers
 ADRENAL CORTEX

– Secretes mineralocorticoids
– Secretes glucocorticoids
– Secretes androgens- sex hormones
 ADRENAL MEDULLA

– Secretes the cathecolamines- Epinephrine, and

norepinephrine
Fig. 10.17
Fig. 10.18
The Adrenal Cortex
 Mineralocorticoid-

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

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

The endocrine portion of the

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

The Alpha cells secrete

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

Causes increased level of

Glucose by:
Glycogen breakdown-
glycogenolysis
Glucose production-
glucogenesis
The Gonads : Male- Testes

 The testes houses the Interstitial

cells of Leydig which secrete
ANDROGENS
 Testosterone
 Dehydrotestosterone
 Androsterone
The Androgens

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

 The Follicular cells of the ovarian

follicle secrete ESTROGEN and the
corpus luteum secretes
PROGESTERONE
The estrogen

 Aids in uterine and mammary gland

development
 Maintains the structure of the
external genitalia
 Produces the secondary sexual
characteristics in female
 Maintains normal menstrual cycle
The progesterone

 Together with estrogen, maintains

normal menstruation
 Increases body temperature
 Decreases muscle tone and peristalsis
 Maintains pregnancy
T he CARDIOVASCULAR
SYSTEM
 The CARDIOVASCULAR
SYSTEM

This system is composed of the heart

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

The heart is located within the

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

The shape is conical, with a base

and an apex
The base is directed upward
The apex is directed downward
to the left at the level of the 5th
ICS LMCL
Heart Surface

ANTERIOR SURFACE
Right ventricle

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

The heart has four chambers

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

The blood supply of the heart:

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

 The anterior cardiac vein drains NOT

into the coronary sinus but DIRECTLY
into the right atrium
Circulation
Fig. 12.11
The Heart : Physiology

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

The conducting system of the

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

The cardiac cycle consists of the

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

The PRELOAD is the degree of

stretching of the heart muscle when it
is filled-up with blood
The AFTERLOAD is the resistance to
which the heart must pump to eject
the blood
The Heart: Physiology
Starling’s Law of the Heart states that the force of
contraction is proportional to the degree of
stretching of the cardiac muscle fibers
As the length of the muscle fiber is stretched, the
contractile force increases
But when the maximum length has been reach,
any further stretching will impair the contraction
The Blood vessel: Anatomy
This consists of the artery, vein and
capillary together with the lymphatic
vessels
The ARTERY has thicker wall, deeply
located, pulsating, reddish, with abundant
smooth muscles and elastic tissues that
carries oxygenated blood away from the
heart towards the body tissues
The Blood vessel: Anatomy
The VEIN is thin-walled, superficially located, non-
pulsating, bluish vessel that carries
unoxygenated/deoxygenated blood towards the
heart
Arterioles are small arteries
Venules are small veins
CAPILLARIES are diffuse network of thin- walled
tubules that connect arterioles and venules together
The Blood vessel: Physiology
The diameter of the arterioles is the main
contributor of the peripheral resistance
In the presence of epinephrine, cold
temperature and irritation, the smooth
muscles of the blood vessels will contract
making the lumen smaller ↑resistance
In the presence of histamine, warm
temperature, the vessels will dilate
↓ resistance
Terminology
Anatomy & Physiology
Chronotropic Refers to a change in heart rate
effect A positive chronotropic effect refers to an increase
in heart rate
A negative chronotropic effect refers to a
decrease in heart rate
Dromotropic Refers to a change in the speed of conduction
effect through the AV junction
A positive dromotropic effect results in an increase
in AV conduction velocity
A negative dromotropic effect results in a
decrease in AV conduction velocity
Inotropic effect Refers to a change in myocardial contractility
A postive inotropic effect results in an increase in
myocardial contractility
A negative inotropic effect results in a decrease in
myocardial contractility
 Basic Electrophysiology
Myocardial Cell Types
Kinds of Where Primary Primary
Cardiac Cells Found Function Property

Myocardial cells Myocardium Contraction and Contractility

Relaxation

Specialized cells Electrical Generation and Automaticity

of the electrical conduction conduction of Conductivity
conduction system electrical
system impulses
Systemic circulation

The aorta- leaves the left ventricle to

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

Blood pressure is the measure of

force exerted by blood against the
blood vessel wall
Measured by sphygmomanometer
Normally BP is measured as systolic
pressure and diastolic pressure
PULSE PRESSURE = SP-DP
Physiology of circulation

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

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

 Parasympathetic nervous system (vagus)–

decreases heart rate
BP regulation

Baroreceptors
Receptors sensitive to stretch located in
the carotid sinuses and aortic arch
↓ stretch reflex increase in heart rate ↑BP
↑ stretch reflex decrease in heart rate
↓BP
BP regulation
 Hormonal
 Epinephrine vasoconstriction increased
resistance increased BP
 Angiotensinogen A1 Angiotensin 2
blood lung
 ADH water reabsorption ↑Blood volume
increased BP
 ANF increase sodium excretion increased
urine decreased blood volume decreased BP
Fig. 13.22
Fetal circulation
Cardiac assessment
 Inspection
 Palpation of the apical pulse and PMI at
the 5th ICS LMCL
 Auscultation for the heart sounds
 S1 and S2
 Auscultation for the heart valves
 TV
 MV
 PV
 AV
Fig. 13.23
 Blood
 Blood is a special connective tissue
 Total blood volume is about 5 liters
 Blood is composed of two portions:
1. Formed elements- RBC, WBC, Platelets
2. Plasma- the liquid portion
– Hematocrit is the percentage of RBC per unit volume
of blood
Fig. 11.2
 The RED Blood Cell
 Non-nucleated cellular element in the
blood
 Biconcave
 Transports Oxygen loosely bound to
Hemoglobin
 Red pigment is due to hemoglobin
 Lifespan is 120 days
 Reticulocytes are immature RBC
Fig. 11.4
 The Leukocytes or WBC

Nucleated, larger than

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