Anatomy and Physiology

“Dispel from your mind the
thought that an understanding

of the human body in every
aspect of its structure can be
given in words…”
- Leonardo da
Vinci
Essentials of
Anatomy & Physiology
MARY LOURDES NACEL G. CELESTE, MD, RN
Essentials of Anatomy & Physiology
Chapter 1
The Human Organism
The Human Body – An Orientation
• Anatomy – study of the structure and

shape of the body and its parts
• Physiology – study of how the body and
its parts work or function
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Anatomy – Levels of Study
• Gross Anatomy
• Large structures
• Easily observable
Figure 1.1
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Anatomy – Levels of Study
• Microscopic Anatomy
• Very small
structures
• Can only be
viewed with
a microscope
Figure 14.4
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Levels of Structural Organization
Figure 1.1 7
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Organ System Overview
• Integumentary
• Forms the external
body covering
• Protects deeper tissue
from injury
• Synthesizes vitamin D
• Location of cutaneous
nerve receptors
Figure 1.2a 8
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• Skeletal
• Protects and supports
body organs
• Provides muscle
attachment for
movement
• Site of blood cell
formation
• Stores minerals
Figure 1.2b 9
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• Muscular
• Allows locomotion
• Maintains posture
• Produces heat
Figure 1.2c 10
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• Nervous
• Fast-acting control
system
• Responds to
internal and external
change
• Activates muscles
and glands
Figure 1.2d
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• Endocrine
• Secretes regulatory
hormones
• Growth
• Reproduction
• Metabolism
Figure 1.2e
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• Cardiovascular
• Transports materials
in body via blood
pumped by heart
• Oxygen
• Carbon dioxide
• Nutrients
• Wastes
Figure 1.2f
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• Lymphatic
• Returns fluids to blood
vessels
• Disposes of debris
• Involved in immunity
Figure 1.2g
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• Respiratory
• Keeps blood
supplied with
oxygen
• Removes carbon
dioxide
Figure 1.2h
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• Digestive
• Breaks down food
• Allows for nutrient
absorption into blood
• Eliminates indigestible
material
Figure 1.2i
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• Urinary
• Eliminates nitrogenous
wastes
• Maintains acid – base
balance
• Regulation of materials
• Water
• Electrolytes
Figure 1.2j
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• Reproductive
• Production
of offspring
Figure 1.2k
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Characteristics of Life
• Organization
• Metabolism
• Responsiveness
• Growth
• Development
• Reproduction
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Homeostasis
• Maintenance of a stable internal

environment = a dynamic state of
equilibrium
• Homeostasis must be maintained for
normal body functioning and to sustain
life
• Homeostatic imbalance – a disturbance
in homeostasis resulting in disease
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Maintaining Homeostasis
• The body communicates through neural

and hormonal control systems
• Receptor
• Responds to changes in the environment
(stimuli)
• Sends information to control center
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Maintaining Homeostasis
• Control center
• Determines set point
• Analyzes information
• Determines appropriate response
• Effector
• Provides a means for response to the
stimulus
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Feedback Mechanisms
• Negative feedback
• Includes most homeostatic control
mechanisms
• Shuts off the original stimulus, or reduces
its intensity
• Works like a household thermostat
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Feedback Mechanisms
• Positive feedback
• Increases the original stimulus to push the
variable farther
• In the body this only occurs in blood clotting
and birth of a baby
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The Language of Anatomy
• Special terminology is used to prevent

misunderstanding
• Exact terms are used for:
• Position
• Direction
• Regions
• Structures
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Orientation and Directional Terms
Table 1.1
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Orientation and Directional Terms
Table 1.1 (cont)

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Body Landmarks
• Anterior
Figure 1.5a
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Body Landmarks
• Posterior
Figure 1.5b
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Body Planes
Figure 1.6 35
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Body Cavities
Figure 1.7
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Abdominopelvic Quadrants
Figure 1.8a
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Abdominopelvic Regions
Figure 1.8b
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Abdominopelvic Major Organs
Figure 1.8c
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Serous Membranes
· Specific serous membranes
·Peritoneum
· Abdominal
cavity
·Pleura
·Around the
lungs
·Pericardium
Figure 4.1d
·Around the
heart
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Chapter 3
Cell Structures and
their Functions
Cells and Tissues
· Carry out all chemical activities needed

to sustain life
· Cells are the building blocks of all living
things
· Tissues are groups of cells that are
similar in structure and function
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Functions of the Cell
The main functions of the cell include:
· Basic unit of life
· Protection and support
· Movement
· Communication
· Cell metabolism and energy release
· Inheritance
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Anatomy of the Cell
· Cells are not all the same
· All cells share general structures
· Cells are organized into three main
regions
·Nucleus
·Cytoplasm
·Cell membrane/
Plasma membrane
Figure 3.1a
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Cell Membrane/ Plasma Membrane
· Outermost component of the cell
· Encloses the cytoplasm and forms the
boundary between material inside the
cell and material outside it
· Substances outside the cell are called
extracellular substances and those
inside the cell, intracellular substances
· Selective barrier
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· Double phospholipid layer
Hydrophilic heads
Hydrophobic tails
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Figure 3.2
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Cell Membrane Specializations
· Microvilli
·Finger-like
projections that
increase surface
area for absorption
Figure 3.3
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Cell Membrane Specializations
· Membrane
junctions
·Tight junctions
·Desmosomes
·Gap junctions
Figure 3.3
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Cytoplasm
· Material outside the nucleus and inside

the plasma membrane
·Cytosol
·Fluid that suspends other elements
·Organelles
·Metabolic machinery of the cell
·Inclusions
·Non-functioning units
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Cytoplasmic Organelles
Figure 3.4
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· Nucleus
·Nuclear envelope consists of 2 separate
membranes with nuclear pores
·DNA and asociated proteins are found in
the nucleus as chromatin
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The Nucleus
· Control center
of the cell
·Contains genetic
material (DNA)
· Three regions
·Nuclear
membrane
·Nucleolus
·Chromatin
Figure 3.1b
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Nuclear Membrane/ Nuclear Envelope
· Barrier of nucleus
· Consists of a double
phospholipid membrane
· Contains nuclear pores
that allow for exchange
of material with the rest
of the cell
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Nucleoli Slide 3.5
· Nucleus contains
one or more nucleoli
· Sites of ribosome
production
· Ribosomes then
migrate to the
cytoplasm through
nuclear pores
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Chromatin Slide 3.6
· Composed of DNA
and protein
· Scattered
throughout the
nucleus
· Chromatin
condenses to form
chromosomes when
the cell divides
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· Ribosomes
·Made of protein and RNA
·Sites of protein synthesis
·Found at two locations
·Free in the cytoplasm
·Attached to rough endoplasmic reticulum
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· Endoplasmic reticulum (ER)
·Fluid-filled tubules for carrying substances
· Two types of ER
· Rough Endoplasmic Reticulum
·Studded with ribosomes
·Site where building materials of cellular
membrane are formed
·Smooth Endoplasmic Reticulum
·Functions in cholesterol synthesis and
breakdown, fat metabolism, and detoxification
of drugs
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· Golgi apparatus
·Series of closely packed membrane sacs
·Collects, modifies, packages and distributes
proteins and lipids produced by the ER
·Produces different types of packages
·Secretory vesicles
·Cell membrane components
·Lysosomes
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Figure 3.4
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Figure 3.5
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· Lysosomes
·Contain enzymes that digest nonusable
materials within the cell
· Peroxisomes
·Membranous sacs of oxidase enzymes
·Detoxify harmful or poisonous
substances
·Break down free radicals
(highly reactive chemicals)
·Replicate by pinching in half 105
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· Mitochondria
· “Powerhouses” of the cell
· Change shape continuously
· Carry out reactions where oxygen is used
to break down food
· Provide ATP for cellular energy
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· Cytoskeleton
·Network of protein structures that extend
throughout the cytoplasm
·Provides the cell with an internal framework
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· Cytoskeleton
·Three different types
· Microfilaments
· Intermediate
filaments
· Microtubules
Figure 3.6
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· Centrioles
·Rod-shaped bodies made of microtubules
·Direct formation of mitotic spindle during
cell division
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Cellular Projections
· Not found in all cells

· Used for movement
·Cilia moves materials across the cell
surface
·Flagellum propels the cell
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Cellular Physiology:
Membrane Transport
· Membrane Transport – movement of

substance into and out of the cell
· Transport is by two basic methods
·Passive transport
·No energy is required
·Active transport
·The cell must provide metabolic energy
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Solutions and Transport
· Solution – homogeneous mixture of two
or more components
·Solvent – dissolving medium
·Solutes – components in smaller quantities
within a solution
· Intracellular fluid – nucleoplasm and
cytosol
· Interstitial fluid – fluid on the exterior of
the cell
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Selective Permeability
· The plasma membrane allows some

materials to pass while excluding others
· This permeability includes movement
into and out of the cell
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Transport
Concepts
Passive
vs.
Active
Passive Active 115

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A. Passive Transport Process
– substances transported
across the membrane without
energy input from the cell
- high to low concentration

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B. Active Transport Process
- Cell moves substances across a
membrane through ATP because:
1. They may be too large
2. Unable to dissolve in the fat core
3. Move uphill against their concentration
gradient
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Passive Transport Processes
· Diffusion
·Particles tend to distribute themselves
evenly within a solution
·Movement is
from high
concentration
to low
concentration,
or down a
concentration
gradient
Figure 3.8
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· Types of diffusion
·Simple diffusion
·Unassisted process
·Solutes are lipid-soluble materials or
small enough to pass through membrane
pores
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· Types of diffusion
·Osmosis – simple diffusion of water
·Highly polar water easily crosses the
plasma membrane
·Facilitated diffusion
·Substances require a protein carrier for
passive transport
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Osmosis
Diffusion 121
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Diffusion through the Plasma
Membrane
Figure 3.9
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· Filtration
·Water and solutes are forced through a
membrane by fluid, or hydrostatic pressure
·A pressure gradient must exist
·Solute-containing fluid is pushed from a
high pressure area to a lower pressure
area
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Active Transport Processes
· Transport substances that are unable to pass
by diffusion
·They may be too large
·They may not be able to dissolve in the fat core
of the membrane
·They may have to move against a concentration
gradient
· Two common forms of active transport
· Solute pumping
· Bulk transport
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· Solute pumping
·Amino acids, some sugars and ions are
transported by solute pumps
·ATP energizes protein carriers, and in most
cases, moves substances against
concentration gradients
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Figure 3.10
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Active Transport
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· Bulk transport
·Exocytosis
·Moves materials out of the cell
· Material is carried in a membranous vesicle
· Vesicle migrates to plasma membrane
·Vesicle combines with plasma membrane
·Material is emptied to the outside
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Figure 3.11
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· Bulk transport
·Endocytosis
·Extracellular substances are engulfed by
being enclosed in a membranous
vescicle
·Types of endocytosis
·Phagocytosis – cell eating
·Pinocytosis – cell drinking
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Figure 3.12
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Cell Life Cycle
· Cells have two major periods
·Interphase
·Cell grows
·Cell carries on metabolic processes
·Cell division
·Cell replicates itself
·Function is to produce more cells for
growth and repair processes
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DNA Replication
· Genetic material
duplicated and
readies a cell for
division into two cells
· Occurs toward the
end of interphase
· DNA uncoils and
each side serves
as a template
Figure 3.13
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Events of Cell Division
· Mitosis
·Division of the nucleus
·Results in the formation of two daughter
nuclei with exactly the same genes as the
mother nucleus
· Cytokinesis
·Division of the cytoplasm
·Begins when mitosis is near completion
·Results in the formation of two daughter
cells
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Stages of Mitosis
· 1. Interphase
·No cell division occurs
·The cell carries out normal metabolic
activity and growth
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Stages of Mitosis
2. Prophase (Early, Middle Late)
First part of cell division
Centromeres migrate to the poles
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Stages of Mitosis
· 3. Metaphase
·Spindle from centromeres are attached to
chromosomes that are aligned in the center
of the cell
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Stages of Mitosis
· 4. Anaphase
· Daughter chromosomes are pulled
toward the poles
· The cell begins to elongate
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Stages of Mitosis
· 5. Telophase
·Daughter nuclei begin forming
·A cleavage furrow (for cell division) begins
to form
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Protein Synthesis
· Gene – DNA segment that carries a

blueprint for building one protein
· Proteins have many functions
·Building materials for cells
·Act as enzymes (biological catalysts)
· RNA is essential for protein synthesis
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Protein Synthesis
· Gene – DNA segment that carries a

blueprint for building one protein
· Proteins have many functions
·Building materials for cells
·Act as enzymes (biological catalysts)
· RNA is essential for protein synthesis
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Role of RNA
· Transfer RNA (tRNA)
·Transfers appropriate amino acids to the
ribosome for building the protein
· Ribosomal RNA (rRNA)
·Helps form the ribosomes where proteins
are built
· Messenger RNA
·Carries the instructions for building a
protein from the nucleus to the ribosome
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Transcription and Translation
· Transcription
·Transfer of information from DNA’s base
sequence to the complimentary base
sequence of mRNA
· Translation
·Base sequence of nucleic acid is translated
to an amino acid sequence
·Amino acids are the building blocks of
proteins
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Protein
Synthesis
Figure 3.15
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Chapter 4
Tissues, Glands
and Membranes
Body Tissues
· Cells are specialized for particular functions
· Tissue
·Group of cells with similar structure and
function, as well as similar extracellular
substances located between the cells
·Four primary types
· Epithelium
· Connective tissue
· Muscle
· Nervous tissue
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1. Epithelial Tissues
· Found in different areas

·Body coverings
·Body linings
·Glandular tissue
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1. Epithelial Tissues
Functions
·Protection- protect underlying structures
·Barrier- prevent movement of many
substances from the epithelial layer
·Permit passage of substances
·Secretion
·Absorption- certain cell membranes
regulate absorption of materials
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Epithelium Characteristics
· Cells fit closely together
· Tissue layer always has one free
surface
· The lower surface is bound by a
basement membrane
· May consist of a single layer of cells or
multiple layers
· Blood vessels do not extend from the
underlying tissues into the epithelium
· Regenerate easily if well nourished
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Classification of Epithelium
· 1. Number of cell layers

·Simple – one layer
·Stratified – more than
one layer
Figure 3.16a
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Classification of Epithelium
· 2. Shape of cells
·Squamous – scale-like;
flattened
·Cuboidal – cube-shaped
·Columnar – tall and thin;
column-like
Figure 3.16b
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Simple Epithelium
· Simple squamous
·Single layer of flat
cells
·Usually found where
diffusion and
filtration take place
· Usually forms
membranes
·Lines body
cavities
·Lines lungs and Figure 3.17a
capillaries MLNGC, MD, RN

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Simple Epithelium
· Simple cuboidal
·Single layer of cube-
like cells that carry
out active transport,
facilitated diffusion
or secretion
·Common in glands
and their ducts
·Forms walls
of kidney tubules
·Covers the ovaries Figure 3.17b
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Simple Epithelium
· Simple columnar
·Single layer of tall,
thin cells
·Often includes
goblet cells, which
produce mucus
·Lines digestive
tract
Figure 3.17c
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Simple Epithelium
· Pseudostratified
· Single layer, but
some cells are
shorter than others
· Often looks like a
double cell layer
·Sometimes ciliated,
such as in the
respiratory tract
·May function in
absorption or
secretion Figure 3.17d
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Stratified Epithelium
· Stratified squamous
·Cells at the free edge
are flattened
·Found as a protective
covering where
friction is common
·Locations
· Skin
· Mouth
· Esophagus Figure 3.17e
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· Stratified cuboidal
· Two layers of cuboidal cells
· Rare; sweat gland ducts, ovarian follicular
cells and salivary glands; functions in
absorption, secretion and protection
· Stratified columnar
· Surface cells are columnar, cells underneath
vary in size and shape
· Rare; mammary gland ducts, larynx, a portion
of the male urethra; carries out secretion,
protection and some absorption
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· Transitional
epithelium
·Shape of cells
depends upon the
amount of stretching
·Lines organs of the
urinary system
Figure 3.17f
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Glandular Epithelium
· Gland – one or more cells that secretes a
particular product onto a surface, cavity or
blood
· Two major gland types
·Endocrine gland
·Ductless; empty secretions into the blood
·Secretions are hormones
·Exocrine gland
·Empty through ducts to the epithelial surface
·Simple or compound; Include sweat and
sebaceous glands
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2. Connective Tissue
· Found everywhere in the body

· Includes the most abundant and widely
distributed tissues
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Connective Tissue Characteristics
· Variations in blood supply

·Some tissue types are well vascularized
·Some have poor blood supply or are
avascular
· Extracellular matrix
·Non-living material that surrounds living
cells
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Extracellular Matrix
· Three major components
·1.Ground substance – mostly water along with
adhesion proteins and polysaccharide
molecules
·2. Protein Fibers help form connective tissues
·Produced by the cells
·Three types
· Collagen fibers
· Elastic fibers
· Reticular fibers
· 3. Fluid
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Connective Tissue Cells
· Named according to their functions
·Blast (germ) cells produce the matrix
·Cyte (cell) cells maintain it
·Clast (break) cells break it down for
remodelling
·Fibroblasts/ Fibrocytes
·Osteoblasts/ Osteocytes/ Osteoclasts
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Connective Tissue Cells
· Macrophages – large cells that are
capable of moving about and ingesting
foreign substances, including
microorganisms in the connective tissue
· Mast cells- nonmotile cells that release
chemicals, such as histamine to
promote inflammation
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Connective Tissue
· Functions
·Enclosing and separating
·Connecting tissues to one another
·Supporting and moving
·Storing
·Cushioning and insulating
·Transporting
·Protecting
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Connective Tissue Types
· Loose (Areolar)
· Adipose
· Dense
· Bone
· Blood
· Cartilage
·Hyaline
·Fibro
·Elastic
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· Areolar connective
tissue
·Most widely
distributed
connective tissue
·Soft, pliable tissue
·Contains all fiber
types
·Can soak up excess
fluid Figure 3.18e
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· Adipose tissue
·Matrix is an areolar tissue in which fat
globules predominate
·Many cells contain
large lipid deposits
·Functions
·Insulates the body
·Protects some organs
·Serves as a site of
fuel storage
Figure 3.18f
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· Dense connective
tissue
·Main matrix element
is collagen fibers
·Cells are fibroblasts
·Examples
· Tendons – attach
muscle to bone
· Ligaments – attach
bone to bone Figure 3.18d
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· A.Hyaline cartilage
·Most common cartilage
· Composed of:
· Abundant collagen fibers
·Rubbery matrix
·Covers ends of bones;
forms surfaces of joints,
costal cartilages, cartilage
rings of the respiratory
tract and nasal cartilages
· Entire fetal skeleton is Figure 3.18b
hyaline cartilage
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· B. Fibrocartilage
·Has more collagen than
hyaline
·Highly compressible
·Can resist pulling or
tearing forces
·Example: forms
cushion-like discs
between vertebrae,
knee joint and
temporomandibular Figure 3.18c
joint (jaw) MLNGC, MD, RN

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· C. Elastic cartilage
·Contains elastic fibers, collagen and
proteoglycan
·Provides elasticity; can recoil
·Examples: supports the external ear,
epiglottis and auditory tube
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· Bone (osseous tissue)
·Composed of:
·Bone cells in lacunae
(cavities)
·Hard matrix of calcium
salts
·Large numbers of
collagen fibers
·Used to protect and
support the body Figure 3.18a
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· Blood
·Blood cells
surrounded by fluid
matrix
·Fibers are visible
during clotting
·Functions as the
transport vehicle
for materials
Figure 3.18h 179
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3. Muscle Tissue
· Function is to produce movement

· Three types
·Skeletal muscle
·Cardiac muscle
·Smooth muscle
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Muscle Tissue Types
· A. Skeletal muscle
·Can be controlled
voluntarily (consciously)
·Cells attach to
connective tissue
·Cells are striated
because of the
arrangement of
contractile proteins within
the cells
·Cells are long,
cylindrical; have more Figure 3.19b
than one nucleusMLNGC, MD, RN 181

Muscle Tissue Types
· B. Cardiac muscle
· Found only in the
heart
·Function is to pump
blood (involuntary)
· Cells attached to
other cardiac muscle
cells at intercalated
disks
· Cells are striated
· One nucleus per cell Figure 3.19c
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Muscle Tissue Types
· C.Smooth muscle
·Involuntary muscle
·Surrounds hollow
organs (except the
heart)
·Attached to other
smooth muscle cells
·No visible striations;
tapered at each end
·One nucleus per cell
Figure 3.19a
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4. Nervous Tissue
· Neurons and
nerve support
cells
· Function is to
send impulses to
other areas of
the body
Neuron: cell body,
dendrites, axon
neuroglia Figure 3.20
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4. Nervous Tissue
Figure 3.20
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Skin and Body Membranes
· Membrane- thin sheet or layer of tissue
that covers a structure or lines a cavity
- consists of epithelium and the
connective tissue on which the
epithelium rests
· Function of body membranes
·Line or cover body surfaces
·Protect body surfaces
·Lubricate body surfaces
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Classification of Body Membranes
·Mucous membrane
·Serous membrane
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Mucous Membranes
· Surface epithelium
·Type depends on site
· Underlying loose connective
tissue (lamina propria)
· Lines all body cavities
that open to the
exterior body surface
· Often adapted
for absorption,
secretion or protection
Figure 4.1b
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Serous Membranes
· Surface simple
squamous epithelium
· Underlying areolar
connective tissue
· Line open body cavities
that are closed to the
exterior of the body and
cover the organs located
within these cavities
· Serous layers separated Figure 4.1c
by serous fluid MLNGC, MD, RN

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Serous Membranes
· Specific serous membranes
·Peritoneal
· Abdominal
cavity
·Pleural
·Around the
lungs
·Pericardial
Figure 4.1d
·Around the
heart
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Cutaneous Membrane
· Cutaneous membrane = skin
·A dry membrane
·Outermost protective boundary
· Superficial epidermis
·Keratinized stratified
squamous epithelium
· Underlying dermis
·Mostly dense
connective tissue
Figure 4.1a
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Connective Tissue Membrane
· Synovial membrane
·Connective tissue
only
·Lines fibrous
capsules
surrounding joints
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MLNGC, MD, RNFigure 4.2
Inflammation
· Occurs when tissues are damaged
· Function: to isolate and destroy harmful
agents
· Mediators: histamine, kinins,
prostaglandins, leukotrienes
· 5 Symptoms: redness, heat, swelling,
pain, disturbance of function
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Inflammation
· Chronic Inflammation: when the agent
causing injury is not moved or
something else interferes with the
healing process
· Can result in the replacement of normal
tissue with fibrous connective tissue
· Loss of normal tissue leads to the loss
of normal organ functions
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Tissue Repair
· Substitution of viable cells for dead cells
· Can occur by
·Regeneration
·Replacement
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Tissue Repair
· Regeneration
·New cells are the same type as those that
were destroyed
·Normal function is usually restored
· Replacement
·A new type of tissue develops that
eventually causes scar production and the
loss of some tissue function
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Tissue Repair
· Classification of cells based on their ability to
divide and produce new cells
· Labile (not fixed) – cells continue to divide
throughout life; damage to these cells (ex:
cells of the skin and mucous membrane) can
be repaired by regeneration
· Stable cells – do not actively divide after
growth ceases, but they do retain the ability to
divide after an injury (ex: liver and pancreas,
capable of regeneration)
·Permanent cells – have little or no ability to
divide; if killed, they are replaced by
connective tissue (ex: neurons, skeletal
muscle) MLNGC, MD, RN
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Events in Tissue Repair
· Fresh wound
· Clot forms which binds the edges of the
wound together and stops the bleeding
· A scab forms after the clot dries
· Formation of granulation tissue
· Regeneration of surface epithelium
· In severe wounds, contracture can
occur
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Tissues and Aging
· Cells divide more slowly as people age.

Injuries heal more slowly.
· Extracellular matrix containing collagen
and elastic fibers become less flexible
and less elastic. Consequently, skin
wrinkles, elasticity in arteries is reduced,
and bones break more easily.
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Chapter 5
Integumentary System
Integumentary System
· Skin (cutaneous membrane)

· Skin derivatives
·Sweat glands
·Oil glands
·Hairs
·Nails
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Skin Functions
· 1. Protects deeper tissues from:

·Abrasion
·Ultraviolet light
·Prevents entry of microorganisms and
dehydration by reducing water loss from
the body
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Skin Functions
· Sensation – has sensory receptors that can
detect heat, cold, touch, pressure and pain
· Synthesizes vitamin D – When exposed to
UV light, the skin produces a molecule that
can be transformed into Vitamin D
· Temperature regulation – Body temperature
is regulated by controlling blood flow through
the skin and the activity of sweat glands
· Excretion – Small amounts of waste products
are lost through the skin and in gland
secretions
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Hypodermis
· Not part of the skin
· Subcutaneous tissue where the skin rests on
· Loose connective tissue that attaches the skin to
underlying bone and muscle, and supplies it with
blood vessels and nerves
· Fat in the hypodermis functions as padding and
insulation; responsible for some of the
differences in appearanc between men and
women and between individuals of the same sex
· Where about half of the body’s fat is stored
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Skin Structure
· Dermis
·Dense connective tissue
·10-20x thicker than the epidermis and
responsible for most of the structural strength
of the skin
·Nerves, hair follicles, smooth muscles, glands
and lymphatic vessels extend into the dermis
·Blood vessels of the papillae supply the
epidermis with nutrients
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Skin Structure
· Dermis
·Contains fibroblasts, fat cells and macrophages
·Collagen and elastic fibers provide structural
strength
·Collagen fibers are oriented in some direction that
others and produce cleavage (lines in the skin
which is most resistant to stretch; incisions made
along these lines tend to gap less and produce
less scar tissue)
·When overstretched, can produce striae
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Skin Structure
· Dermis
·Upper part has projections called dermal
papillae which contain many blood vessels that
supply the overlying epidermis with nutrients,
remove waste products, and aid in regulating
temperature
·Parallel; fingerprints/ footprints
·Increase friction and improve the grip of hands
and feet
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Dermis
· Two layers
· Papillary layer
· Projections called dermal papillae
· Pain receptors (free nerve endings)
· Touch receptors (Meissner’s corpuscles)
· Capillary loops
· Reticular layer- deepest skin layer
· Blood vessels
· Sweat and Oil Glands
· Deep pressure receptors (Pacinian
corpuscles)
· Nerve receptors
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Skin Structure
Figure 4.4
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Skin Structure
· Epidermis – outer layer
·Stratified squamous epithelium
·Often keratinized (hardened by keratin)
·Rests on the dermis
·Prevents water loss and resists abrasion
·Divided into strata
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Skin Structure
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Layer of Epidermis
· Stratum basale
·Cells undergoing mitosis
·Lies next to dermis
· Stratum spinosum
· Stratum granulosum
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Layer of Epidermis
· Stratum lucidum
·Occurs only in thick skin
· Stratum corneum
·Shingle-like dead cells
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Melanin
· Pigment (melanin) produced by

melanocytes
· Color is yellow to brown to black
· Melanocytes are mostly in the stratum
basale
· Amount of melanin produced depends
upon genetic and exposure to sunlight
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Normal Skin Color Determinants
· Melanin
·Yellow, brown or black pigments
· Carotene
·Orange-yellow pigment from some
vegetables
· Hemoglobin
·Red coloring from blood cells in dermis
capillaries
·Oxygen content determines the extent of red
coloring
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Appendages of the Skin
· Sebaceous glands
·Produce oil or sebum
·Lubricant for skin
·Kills bacteria
·Most with ducts that empty into hair follicles
·Glands are activated at puberty
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· Sweat glands
·Widely distributed in skin
·Two types
·Merocrine
·Open via duct to sweat pores on skin
surface
·Apocrine
·Ducts empty into hair follicles
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Sweat and Its Function
· Composition
·Mostly water
·Some metabolic waste
·Fatty acids and proteins (apocrine only)
· Function
·Helps dissipate excess heat
·Excretes waste products
·Acidic nature inhibits bacteria growth
· Odor is from associated bacteria
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· Hair
·Produced in the
hair bulb
·Consists of hard
keratinized
epithelial cells
·Melanocytes
provide pigment
for hair color Figure 4.7c
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Hair Anatomy
· Central medulla
· Cortex surrounds
medulla
· Cuticle on outside of
cortex
·Most heavily
keratinized
Figure 4.7b
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Associated Hair Structures
· Hair follicle
·Dermal and epidermal
sheath surround hair root
· Arrector pili
·Smooth muscle
· Sebaceous gland
· Sweat gland
Figure 4.7a
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· Nails
·Scale-like modifications of the epidermis
·Heavily keratinized
·Stratum basale extends beneath the nail
bed
·Responsible for growth
·Lack of pigment makes them colorless
225
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Nail Structures
· Free edge Figure 4.9
· Body
· Root of nail
· Eponychium –
proximal nail
fold that
projects onto
the nail body
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Skin Homeostatic Imbalances
· Infections
·Athletes foot
·Caused by fungal infection
·Boils and carbuncles
·Caused by bacterial infection
·Cold sores
·Caused by virus
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· Infections and allergies

·Contact dermatitis
·Exposures cause allergic reaction
·Impetigo
·Caused by bacterial infection
·Psoriasis
·Cause is unknown
·Triggered by trauma, infection, stress
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· Burns
·Tissue damage and cell death caused by
heat, electricity, UV radiation, or chemicals
·Associated dangers
·Dehydration
·Electrolyte imbalance
·Circulatory shock
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Rules of Nines
·Way to determine the extent of burns

·Body is divided into 11 areas for quick
estimation
· Each area represents about 9%
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Severity of Burns
· First-degree burns
·Only epidermis is damaged
·Skin is red and swollen
· Second degree burns
·Epidermis and upper dermis are damaged
·Skin is red with blisters
· Third-degree burns
·Destroy entire skin layer
·Burn is gray-white or black
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Critical Burns
· Burns are considered critical if:

·Over 25% of body has second degree
burns
·Over 10% of the body has third degree
burns
·There are third degree burns of the face,
hands, or feet
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Skin Cancer
· Cancer – abnormal cell mass
· Two types
·Benign
·Does not spread (encapsulated)
·Malignant
·Metastasized (moves) to other parts of
the body
·Skin cancer is the most common type of
cancer
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Skin Cancer Types
· Basal cell carcinoma
·Least malignant
·Most common type
·Arises from statum basale
· Squamous cell carcinoma
·Arises from stratum spinosum
·Metastasizes to lymph nodes
·Early removal allows a good chance of cure
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Skin Cancer Types
· Malignant melanoma
·Most deadly of skin cancers
·Cancer of melanocytes
·Metastasizes rapidly to lymph and blood
vessels
·Detection uses ABCD rule
·fatal
235
MLNGC, MD, RN
ABCD Rule
· A = Asymmetry
·Two sides of pigmented mole do not match
· B = Border irregularity
·Borders of mole are not smooth
· C = Color
·Different colors in pigmented area
· D = Diameter
·Spot is larger then 6 mm in diameter
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Chapter 6
Skeletal System:
Bones and Joints
The Skeletal System
· Parts of the skeletal system
·Bones (skeleton)
·Joints
·Cartilages
·Ligaments
· Divided into two divisions
·Axial skeleton
·Appendicular skeleton
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Functions of Bones
· Support of the body

· Protection of soft organs
· Movement due to attached skeletal
muscles
· Storage of minerals and fats
· Blood cell formation
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Bones of the Human Body
· The skeleton has 206 bones
· Two basic types of bone tissue
·Compact bone
·Homogeneous
·Spongy bone
·Small needle-like
pieces of bone
·Many open spaces Figure 5.2b
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MLNGC, MD, RN
TYPES OF BONES
According to According to
Structure: Shape:
1) long bone
1) cancellous or
trabecular or 2) flat bone
spongy-
3) small bone
2) cortical or compact a. short
or dense
b. irregularly-
shaped
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Classification of Bones
· Long bones
·Typically longer than wide
·Have a shaft with heads at both ends
·Contain mostly compact bone
• Examples: Femur, humerus
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· Short bones
·Generally cube-shape
·Contain mostly spongy bone
·Examples: Carpals, tarsals
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Classification of Bones on the
Basis of Shape
Figure 5.1
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· Flat bones
·Thin and flattened
·Usually curved
·Thin layers of compact bone around a layer
of spongy bone
·Examples: Skull, ribs, sternum
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· Irregular bones
·Irregular shape
·Do not fit into other bone classification
categories
·Example: Vertebrae and hip
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Classification of Bones on the
Basis of Shape
Figure 5.1
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MLNGC, MD, RN
Gross Anatomy of a Long Bone
· Diaphysis
·Shaft
·Composed of
compact bone
· Epiphysis
·Ends of the bone
·Composed mostly of
spongy bone
Figure 5.2a
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MLNGC, MD, RN
Structures of a Long Bone
· Periosteum
·Outside covering of
the diaphysis
·Fibrous connective
tissue membrane
· Sharpey’s fibers
·Secure periosteum to
underlying bone
· Arteries
·Supply bone cells
with nutrients Figure 5.2c
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· Articular cartilage
·Covers the
external surface of
the epiphyses
·Made of hyaline
cartilage
·Decreases friction
at joint surfaces
Figure 5.2a
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· Medullary cavity
·Cavity of the shaft
·Contains yellow
marrow (mostly fat)
in adults
·Contains red marrow
(for blood cell
formation) in infants
Figure 5.2a
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MLNGC, MD, RN
Bone Markings
· Surface features of bones
· Sites of attachments for muscles, tendons,
and ligaments
· Passages for nerves and blood vessels
· Categories of bone markings
·Projections and processes – grow out from the
bone surface
·Depressions or cavities – indentations
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Microscopic Anatomy of Bone
· Osteon (Haversian System)
·A unit of bone
· Central (Haversian) canal
·Opening in the center of an osteon
·Carries blood vessels and nerves
· Perforating (Volkman’s) canal
·Canal perpendicular to the central canal
·Carries blood vessels and nerves
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Figure 5.3
255
MLNGC, MD, RN
· Lacunae
·Cavities containing
bone cells
(osteocytes)
·Arranged in
concentric rings
· Lamellae
· Rings around the
central canal
·Sites of lacunae Figure 5.3
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MLNGC, MD, RN
· Canaliculi
·Tiny canals
·Radiate from the
central canal to
lacunae
·Form a transport
system
Figure 5.3
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Changes in the Human Skeleton
· In embryos, the skeleton is primarily hyaline
cartilage
· During development, much of this cartilage
is replaced by bone
· Cartilage remains in isolated areas
·Bridge of the nose
·Parts of ribs
·Joints
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MLNGC, MD, RN
Bone Growth
· Epiphyseal plates allow for growth of

long bone during childhood
·New cartilage is continuously formed
·Older cartilage becomes ossified
·Cartilage is broken down
·Bone replaces cartilage
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Bone Growth
· Bones are remodeled and lengthened

until growth stops
·Bones change shape somewhat
·Bones grow in width
260
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Long Bone Formation and Growth
Figure 5.4a
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262
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Long Bone Formation and Growth
Figure 5.4b
263
MLNGC, MD, RN
Types of Bone Cells
· Osteocytes
·Mature bone cells
· Osteoblasts
·Bone-forming cells
· Osteoclasts
·Bone-destroying cells
·Break down bone matrix for remodeling and
release of calcium
· Bone remodeling is a process by both
osteoblasts and osteoclasts
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Bone Fractures
· A break in a bone
· Types of bone fractures
·Closed (simple) fracture – break that does not
penetrate the skin
·Open (compound) fracture – broken bone
penetrates through the skin
· Bone fractures are treated by reduction
and immobilization
·Realignment of the bone
265
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Common Types of Fractures
Table 5.2
266
MLNGC, MD, RN
Repair of Bone Fractures
· Hematoma (blood-filled swelling) is
formed
· Break is splinted by fibrocartilage to
form a callus
· Fibrocartilage callus is replaced by a
bony callus
· Bony callus is remodeled to form a
permanent patch
267
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Stages in the Healing of a Bone
Fracture
Figure 5.5
268
MLNGC, MD, RN
AXIAL APPENDICULAR
SKELETON
SKELETON
Limbs
(upper / lower
cranium extremities)
Shoulder (pectoral)
vertebrae girdle
Hip (pelvic) girdle

ribs
269
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The Axial Skeleton
· Forms the longitudinal part of the body

· Divided into three parts
·Skull
·Vertebral column
·Bony thorax
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The Axial Skeleton
Figure 5.6 271

MLNGC, MD, RN
The Skull
· Two sets of bones

·Cranium
·Facial bones
· Bones are joined by sutures
· Only the mandible is attached by a
freely movable joint
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The Skull
Figure 5.7
273
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Bones of the Skull
Figure 5.11
274
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Human Skull, Superior View
Figure 5.8
275
MLNGC, MD, RN
Human Skull, Inferior View
Figure 5.9
276
MLNGC, MD, RN
Paranasal Sinuses
· Hollow portions of bones surrounding
the nasal cavity
Figure 5.10
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MLNGC, MD, RN
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MLNGC, MD, RN
Paranasal Sinuses
· Functions of paranasal sinuses
· Lighten the skull
· Give resonance and amplification to voice
Figure 5.10
279
MLNGC, MD, RN
The Hyoid Bone
· The only bone that

does not articulate
with another bone
· Serves as a
moveable base for
the tongue
Figure 5.12
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The Fetal Skull
· The fetal skull is

large compared
to the infants
total body length
Figure 5.13
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MLNGC, MD, RN
The Fetal Skull
· Fontanelles –
fibrous membranes
connecting the
cranial bones
·Allow the brain
to grow
·Convert to bone
within 24 months
after birth
Figure 5.13
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MLNGC, MD, RN
283
MLNGC, MD, RN
The Vertebral Column
· Vertebrae
separated by
intervertebral discs
· The spine has a
normal curvature
· Each vertebrae is
given a name
according to its
location Figure 5.14
284
MLNGC, MD, RN
Structure of a Typical Vertebrae
Figure 5.16
285
MLNGC, MD, RN
Regional Characteristics of
Vertebrae
Figure 5.17a, b
286
MLNGC, MD, RN
Regional Characteristics of
Vertebrae
Figure 5.17c, d
287
MLNGC, MD, RN
The Cervical Vertebrae
• 7 in number
• C1- atlas
• C2- axis
• C7- cervical prominence
• Atlas and occipital bone=
“yes” motion
• Atlas and Axis=
“no” motion
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The Bony Thorax
· Forms a
cage to
protect
major
organs
Figure 5.19a
289
MLNGC, MD, RN
The Bony Thorax
· Made-up of
three parts
·Sternum
·Ribs
·Thoracic
vertebrae
Figure 5.19a
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MLNGC, MD, RN
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MLNGC, MD, RN
The Appendicular Skeleton
· Limbs (appendages)
· Pectoral girdle
· Pelvic girdle
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The Appendicular Skeleton
Figure 5.6c
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MLNGC, MD, RN
The Pectoral (Shoulder) Girdle
· Composed of two bones

·Clavicle – collarbone
·Scapula – shoulder blade
· These bones allow the upper limb to
have exceptionally free movement
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Bones of the Shoulder Girdle
Figure 5.20a, b
295
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Bones of the Shoulder Girdle
Figure 5.20c, d
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MLNGC, MD, RN
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MLNGC, MD, RN
Bones of the Upper Limb
· The arm is
formed by a
single bone
·Humerus
Figure 5.21a, b 298

MLNGC, MD, RN
• The forearm
has two bones
• Ulna
• Radius
Figure 5.21c 299

MLNGC, MD, RN
· The hand
·Carpals – wrist
·Metacarpals –
palm
·Phalanges –
fingers
Figure 5.22
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MLNGC, MD, RN
Bones of the Pelvic Girdle
· Hip bones
· Composed of three pair of fused bones
· Ilium
· Ischium
· Pubic bone
· The total weight of the upper body rests on the
pelvis
· Protects several organs
· Reproductive organs
· Urinary bladder
· Part of the large intestine
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The Pelvis
Figure 5.23a
302
MLNGC, MD, RN
The Pelvis
Figure 5.23b 303

MLNGC, MD, RN
Gender Differences of the Pelvis
Figure 5.23c
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MLNGC, MD, RN
305
MLNGC, MD, RN
Bones of the Lower Limbs
· The thigh has

one bone
·Femur – thigh
bone
Figure 5.35a, b
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· The leg has

two bones
·Tibia
·Fibula
Figure 5.35c
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· The foot
·Tarsus – ankle
·Metatarsals –
sole
·Phalanges –
toes
Figure 5.25
308
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Arches of the Foot
· Bones of the foot

are arranged to
form three strong
arches
·Two longitudinal
·One transverse
Figure 5.26
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Joints
· Articulations of bones
· Functions of joints
·Hold bones together
·Allow for mobility
· Ways joints are classified
·Functionally
·Structurally
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Functional Classification of Joints
· Synarthroses – immovable joints

· Amphiarthroses – slightly moveable
joints
· Diarthroses – freely moveable joints
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Structural Classification of Joints
· Fibrous joints
·Generally immovable
· Cartilaginous joints
·Immovable or slightly moveable
· Synovial joints
·Freely moveable
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Fibrous Joints
· Bones united by fibrous tissue
· Examples
·Sutures
·Syndesmoses
· Allows more
movement than
sutures
· Example: distal
end of tibia and
fibula
Figure 5.27d, e
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Cartilaginous Joints
· Bones connected by cartilage
· Examples
·Pubic
symphysis
·Intervertebral
joints
Figure 5.27b, c
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Synovial Joints
· Articulating
bones are
separated by a
joint cavity
· Synovial fluid
is found in the
joint cavity
Figure 5.27f–h
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MLNGC, MD, RN
Features of Synovial Joints
· Articular cartilage (hyaline cartilage)

covers the ends of bones
· Joint surfaces are enclosed by a fibrous
articular capsule
· Have a joint cavity filled with synovial
fluid
· Ligaments reinforce the joint
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Structures Associated with the
Synovial Joint
· Bursae – flattened fibrous sacs
·Lined with synovial membranes
·Filled with synovial fluid
·Not actually part of the joint
· Tendon sheath
·Elongated bursa that wraps around a tendon
317
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The Synovial Joint
Figure 5.28
318
MLNGC, MD, RN
Types of Synovial Joints Based on
Shape
Figure 5.29a–c
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MLNGC, MD, RN
Types of Synovial Joints
Based on Shape
Figure 5.29d–f
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MLNGC, MD, RN
Inflammatory Conditions
Associated with Joints
· Bursitis – inflammation of a bursa usually
caused by a blow or friction
· Tendonitis – inflammation of tendon sheaths
· Arthritis – inflammatory or degenerative
diseases of joints
·Over 100 different types
·The most widespread crippling disease in the
United States
327
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Clinical Forms of Arthritis
· Osteoarthritis
·Most common chronic arthritis
·Probably related to normal aging processes
· Rheumatoid arthritis
·An autoimmune disease – the immune system
attacks the joints
·Symptoms begin with bilateral inflammation of
certain joints
·Often leads to deformities
328
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Clinical Forms of Arthritis
· Gouty Arthritis
·Inflammation of joints is caused by a
deposition of urate crystals from the blood
·Can usually be controlled with diet
329
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Developmental Aspects of the
Skeletal System
· At birth, the skull bones are incomplete

· Bones are joined by fibrous membranes
– fontanelles
· Fontanelles are completely replaced
with bone within two years after birth
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Chapter 7
The Muscular System
The Muscular System
· Muscles are responsible for all types of

body movement
· Three basic muscle types are found in
the body
·Skeletal muscle
·Cardiac muscle
·Smooth muscle
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Characteristics of Muscles
· Muscle cells are elongated
(muscle cell = muscle fiber)
· Contraction of muscles is due to the
movement of microfilaments
· All muscles share some terminology
·Prefix myo refers to muscle
·Prefix mys refers to muscle
·Prefix sarco refers to flesh
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A. Skeletal Muscle Characteristics
· Most are attached by
tendons to bones
· Cells are multinucleate
· Striated – have visible
banding
· Voluntary – subject to
conscious control
· Cells are surrounded and
bundled by connective
tissue
334
MLNGC, MD, RN
Connective Tissue Wrappings of
Skeletal Muscle
· Endomysium –
around single
muscle fiber
· Perimysium –
around a
fascicle
(bundle) of
fibers Figure 6.1
335
MLNGC, MD, RN
Connective Tissue Wrappings of
Skeletal Muscle
· Epimysium –
covers the
entire skeletal
muscle
· Fascia – on the
outside of the
epimysium
Figure 6.1
336
MLNGC, MD, RN
Skeletal Muscle Attachments
· Epimysium blends into a connective
tissue attachment
·Tendon – cord-like structure
·Aponeuroses – sheet-like structure
· Sites of muscle attachment
·Bones
·Cartilages
·Connective tissue coverings
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MLNGC, MD, RN
B. Smooth Muscle Characteristics
· Has no striations
· Spindle-shaped
cells
· Single nucleus
· Involuntary – no
conscious control
Figure 6.2a
338
MLNGC, MD, RN
Smooth muscle
· Found mainly in
· the walls of hollow organs
Figure 3.19a
339
MLNGC, MD, RN
C. Cardiac Muscle Characteristics
· Has striations
· Usually has a
single nucleus
· Joined to another
muscle cell at an
intercalated disc
· Involuntary
· Found only in the
heart Figure 6.2b
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MLNGC, MD, RN
Function of Muscles
· Produce movement
· Maintain posture
· Provide shape to the body
· Stabilize joints
· Protect the bones
· Generate heat
341
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Microscopic Anatomy of
Skeletal Muscle
· Cells are multinucleate
· Nuclei are just beneath the sarcolemma
Figure 6.3a
342
MLNGC, MD, RN
Microscopic Anatomy of Skeletal
Muscle
· Sarcolemma – specialized plasma
membrane
· Sarcoplasmic reticulum – specialized
smooth endoplasmic reticulum
Figure 6.3a
343
MLNGC, MD, RN
Muscle
· Myofibril
·Bundles of myofilaments
·Myofibrils are aligned to give distrinct bands
·I band =
light band
·A band =
dark band
Figure 6.3b
344
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Muscle
· Sarcomere
·Contractile unit of a muscle fiber
Figure 6.3b
345
MLNGC, MD, RN
Muscle
· Organization of the sarcomere
·Thick filaments = myosin filaments
·Composed of the protein myosin
·Has ATPase enzymes
Figure 6.3c
346
MLNGC, MD, RN
Muscle
· Organization of the sarcomere
·Thin filaments = actin filaments
·Composed of the protein actin
Figure 6.3c
347
MLNGC, MD, RN
Muscle
· Myosin filaments have heads
(extensions, or cross bridges)
· Myosin and
actin overlap
somewhat
Figure 6.3d
348
MLNGC, MD, RN
Muscle
· At rest, there is a bare zone that lacks
actin filaments
· Sarcoplasmic
reticulum
(SR) – for
storage of
calcium
Figure 6.3d
349
MLNGC, MD, RN
Properties of Skeletal Muscle
Activity
· Irritability – ability to receive and

respond to a stimulus
· Contractility – ability to shorten when an
adequate stimulus is received
350
MLNGC, MD, RN
Nerve Stimulus to Muscles
· Skeletal
muscles must
be stimulated
by a nerve to
contract
· Motor unit
·One neuron
·Muscle cells
stimulated by
that neuron
Figure 6.4a
351
MLNGC, MD, RN
· Neuromuscular
junctions –
association site
of nerve and
muscle
Figure 6.5b
352
MLNGC, MD, RN
· Synaptic cleft –
gap between
nerve and
muscle
·Nerve and
muscle do not
make contact
·Area between
nerve and muscle
is filled with
interstitial fluid Figure 6.5b
353
MLNGC, MD, RN
Transmission of Nerve Impulse to
Muscle
· Neurotransmitter – chemical released
by nerve upon arrival of nerve impulse
·The neurotransmitter for skeletal muscle is
acetylcholine
· Neurotransmitter attaches to receptors
on the sarcolemma
· Sarcolemma becomes permeable to
sodium (Na+)
354
MLNGC, MD, RN
Transmission of Nerve Impulse to
Muscle
· Sodium rushing into the cell generates

an action potential
· Once started, muscle contraction
cannot be stopped
355
MLNGC, MD, RN
The Sliding Filament Theory of
Muscle Contraction
· Activation by nerve
causes myosin
heads
(crossbridges) to
attach to binding
sites on the thin
filament
· Myosin heads then
bind to the next site
of the thin filament
356
MLNGC, MD, RN Figure 6.7
The Sliding Filament Theory of
Muscle Contraction
· This continued
action causes a
sliding of the myosin
along the actin
· The result is that the
muscle is shortened
(contracted)
357
The Sliding Filament Theory
Figure 6.8
358
MLNGC, MD, RN
Contraction of a Skeletal Muscle
· Muscle fiber contraction is “all or none”
· Within a skeletal muscle, not all fibers
may be stimulated during the same
interval
· Different combinations of muscle fiber
contractions may give differing
responses
· Graded responses – different degrees
of skeletal muscle shortening
359
MLNGC, MD, RN
Types of Graded Responses
· Twitch
·Single, brief contraction
·Not a normal muscle function
Figure 6.9a, b
360
MLNGC, MD, RN
Types of Graded Responses3
· Tetanus (summing of contractions)

·One contraction is immediately followed by
another
·The muscle does
not completely
return to a
resting state
·The effects
are added
Figure 6.9a, b
361
MLNGC, MD, RN
· Unfused (incomplete) tetanus
·Some relaxation occurs between
contractions
·The results are summed
Figure 6.9a, b
Figure 6.9c,d 362
MLNGC, MD, RN
· Fused (complete) tetanus
·No evidence of relaxation before the
following contractions
·The result is a sustained muscle contraction
Figure 6.9a, b
Figure 6.9c,d 363
MLNGC, MD, RN
Muscle Response to Strong Stimuli
· Muscle force depends upon the number

of fibers stimulated
· More fibers contracting results in greater
muscle tension
· Muscles can continue to contract unless
they run out of energy
364
MLNGC, MD, RN
Energy for Muscle Contraction
· Initially, muscles used stored ATP for

energy
·Bonds of ATP are broken to release energy
·Only 4-6 seconds worth of ATP is stored by
muscles
· After this initial time, other pathways
must be utilized to produce ATP
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MLNGC, MD, RN
· Direct phosphorylation
· Muscle cells contain creatine
phosphate (CP)
·CP is a high-energy
molecule
· After ATP is depleted, ADP is
left
·CP transfers energy to ADP,
to regenerate ATP
·CP supplies are exhausted in
about 20 seconds
366
MLNGC, MD, RN Figure 6.10a
· Aerobic Respiration
·Series of metabolic
pathways that occur in
the mitochondria
·Glucose is broken down
to carbon dioxide and
water, releasing energy
·This is a slower reaction
that requires continuous
oxygen
Figure 6.10c
367
MLNGC, MD, RN
· Anaerobic glycolysis
·Reaction that breaks
down glucose without
oxygen
·Glucose is broken down
to pyruvic acid to
produce some ATP
·Pyruvic acid is
converted to lactic acid
368
MLNGC, MD, RN Figure 6.10b
· Anaerobic glycolysis
(continued)
·This reaction is not as
efficient, but is fast
·Huge amounts of
glucose are needed
·Lactic acid produces
muscle fatigue
369
Muscle Fatigue and Oxygen Debt
· When a muscle is fatigued, it is unable to
contract
· The common reason for muscle fatigue is
oxygen debt
·Oxygen must be “repaid” to tissue to remove
oxygen debt
·Oxygen is required to get rid of accumulated
lactic acid
· Increasing acidity (from lactic acid) and lack
of ATP causes the muscle to contract less
370
MLNGC, MD, RN
Types of Muscle Contractions
· Isotonic contractions
·Myofilaments are able to slide past each
other during contractions
·The muscle shortens
· Isometric contractions
·Tension in the muscles increases
·The muscle is unable to shorten
371
MLNGC, MD, RN
Muscle Tone
· Some fibers are contracted even in a

relaxed muscle
· Different fibers contract at different
times to provide muscle tone
· The process of stimulating various
fibers is under involuntary control
372
MLNGC, MD, RN
Muscles and Body Movements
· Movement is
attained due to
a muscle
moving an
attached bone
Figure 6.12
373
MLNGC, MD, RN
Muscles and Body Movements
· Muscles are
attached to at
least two points
·Origin –
attachment to a
moveable bone
·Insertion –
attachment to an
immovable bone
Figure 6.12
374
MLNGC, MD, RN
Effects of Exercise on Muscle
· Results of increased muscle use

·Increase in muscle size
·Increase in muscle strength
·Increase in muscle efficiency
·Muscle becomes more fatigue resistant
375
MLNGC, MD, RN
Types of Ordinary Body
Movements
· Flexion
· Extension
· Rotation
· Abduction
· Adduction
376
MLNGC, MD, RN
Body Movements
Figure 6.13
377
MLNGC, MD, RN
Special Movements
· Dorsifelxion
· Plantar flexion
· Inversion
· Eversion
· Supination
· Pronation
378
MLNGC, MD, RN
Types of Muscles
· Prime mover – muscle with the major
responsibility for a certain movement
· Antagonist – muscle that opposes or
reverses a prime mover
· Synergist – muscle that aids a prime
mover in a movement and helps prevent
rotation
· Fixator – stabilizes the origin of a prime
mover
379
MLNGC, MD, RN
Naming of Skeletal Muscles
· Direction of muscle fibers

·Example: rectus (straight)
· Relative size of the muscle
·Example: maximus (largest)
380
MLNGC, MD, RN
· Location of the muscle

·Example: many muscles are named
for bones (e.g., temporalis)
· Number of origins
·Example: triceps (three heads)
381
MLNGC, MD, RN
· Location of the muscles origin and
insertion
·Example: sterno (on the sternum)
· Shape of the muscle
·Example: deltoid (triangular)
· Action of the muscle
·Example: flexor and extensor (flexes or
extends a bone)
382
MLNGC, MD, RN
Head and Neck Muscles
Figure 6.14
383
MLNGC, MD, RN
Trunk Muscles
Figure 6.15
384
MLNGC, MD, RN
Deep Trunk and Arm Muscles
Figure 6.16
385
MLNGC, MD, RN
Muscles of the Pelvis, Hip, and Thigh
Figure 6.18c 386

MLNGC, MD, RN
Muscles of the Lower Leg
Figure 6.19 387

MLNGC, MD, RN
Superficial Muscles: Anterior
Figure 6.20
388
MLNGC, MD, RN
Superficial Muscles: Posterior
Figure 6.21
389
MLNGC, MD, RN
Chapter 8
The Nervous System
Functions of the Nervous System
· Sensory input – gathering information

·To monitor changes occurring inside and
outside the body
·Changes = stimuli
· Integration
·To process and interpret sensory input and
decide if action is needed
391
MLNGC, MD, RN
Functions of the Nervous System
· Motor output
·A response to integrated stimuli
·The response activates muscles or glands
392
MLNGC, MD, RN
Structural Classification of the
Nervous System
· Central nervous system (CNS)

·Brain
·Spinal cord
· Peripheral nervous system (PNS)
·Nerve outside the brain and spinal cord
393
MLNGC, MD, RN
Functional Classification of the
Peripheral Nervous System
· Sensory (afferent) division
·Nerve fibers that carry information to the
central nervous system
Figure 7.1 394

MLNGC, MD, RN
· Motor (efferent) division
·Nerve fibers that carry impulses away from
the central nervous system
Figure 7.1 395

MLNGC, MD, RN
· Motor (efferent) division
·Two subdivisions
· Somatic nervous system = voluntary
· Autonomic nervous system = involuntary
Figure 7.1 396

MLNGC, MD, RN
Organization of the Nervous
System
Figure 7.2
397
MLNGC, MD, RN
Nervous Tissue: Support Cells
(Neuroglia)
· Astrocytes
· Abundant, star-shaped cells
· Brace neurons and anchor
them to their nutrient
supply lines- blood
capillaries
· Form barrier
between capillaries
and neurons
· Control the chemical
environment of
the brain Figure 7.3a
398
MLNGC, MD, RN
· Microglia
·Spider-like phagocytes
·Dispose of debris
· Ependymal cells
·Line cavities of the
brain and spinal cord
·Circulate
cerebrospinal
fluid
Figure 7.3b, c 399

MLNGC, MD, RN
· Oligodendrocytes
·Produce myelin
sheath around
nerve fibers in the
central nervous
system
Figure 7.3d
400
MLNGC, MD, RN
· Satellite cells
·Protect or cushion neuron cell bodies
· Schwann cells
·Form myelin sheath in the peripheral
nervous system
Figure 7.3e
401
MLNGC, MD, RN
Nervous Tissue: Neurons
· Neurons = nerve cells

·Cells specialized to transmit messages
·Major regions of neurons
·Cell body – nucleus and metabolic center
of the cell
·Processes – fibers that extend from the
cell body
402
MLNGC, MD, RN
Neuron Anatomy
· Cell body
·Nissl
substance –
specialized
rough
endoplasmic
reticulum
·Neurofibrils –
intermediate
cytoskeleton
that maintains
cell shape Figure 7.4a
403
MLNGC, MD, RN
Neuron Anatomy
· Cell body
·Nucleus
·Large
nucleolus
Figure 7.4a
404
MLNGC, MD, RN
Neuron Anatomy
· Extensions
outside the cell
body
· Dendrites –
conduct
impulses toward
the cell body
· Axons – conduct
impulses away
from the cell
body
Figure 7.4a
405
MLNGC, MD, RN
Axons and Nerve Impulses
· Axons end in axonal terminals

· Axonal terminals contain vesicles with
neurotransmitters
· Axonal terminals are separated from the
next neuron by a gap
·Synaptic cleft – gap between adjacent
neurons
·Synapse – junction between nerves
406
MLNGC, MD, RN
Nerve Fiber Coverings
· Schwann cells –
produce myelin
sheaths in jelly-roll
like fashion
· Nodes of Ranvier –
gaps in myelin
sheath along the
axon
Figure 7.5
407
MLNGC, MD, RN Slide 7.12
Neuron Cell Body Location
· Most are found in the central nervous

system
·Gray matter – cell bodies and unmyelinated
fibers
·Nuclei – clusters of cell bodies within the
white matter of the central nervous system
· Ganglia – collections of cell bodies
outside the central nervous system
408
MLNGC, MD, RN
Functional Classification of
Neurons
· Sensory (afferent) neurons
·Carry impulses from the sensory receptors
·Cutaneous sense organs
·Proprioceptors – detect stretch or tension
· Motor (efferent) neurons
·Carry impulses from the central nervous
system
409
MLNGC, MD, RN
Functional Classification of
Neurons
· Interneurons (association neurons)

·Found in neural pathways in the central
nervous system
·Connect sensory and motor neurons
410
MLNGC, MD, RN
Structural Classification of Neurons
· Multipolar neurons – many extensions
from the cell body
Figure 7.8a
412
MLNGC, MD, RN
· Bipolar neurons – one axon and one
dendrite
Figure 7.8b
413
MLNGC, MD, RN
· Unipolar neurons – have a short single

process leaving the cell body
Figure 7.8c
414
MLNGC, MD, RN
Functional Properties of Neurons
· Irritability – ability to respond to stimuli

· Conductivity – ability to transmit an
impulse
· The plasma membrane at rest or
inactive is polarized
·Fewer positive ions are inside the cell than
outside the cell
415
MLNGC, MD, RN
Starting a Nerve Impulse
· Depolarization – a
stimulus depolarizes the
neuron’s membrane
· A depolarized
membrane allows
sodium (Na+) to flow
inside the membrane
· The exchange of ions
initiates an action
potential in the neuron
Figure 7.9a–c
416
MLNGC, MD, RN
The Action Potential
· If the action potential (nerve impulse)
starts, it is propagated over the entire
axon
· Potassium ions rush out of the neuron
after sodium ions rush in, which
repolarizes the membrane
· The sodium-potassium pump restores
the original configuration
·This action requires ATP
417
MLNGC, MD, RN
Nerve Impulse Propagation
· The impulse
continues to move
toward the cell body
· Impulses travel
faster when fibers
have a myelin
sheath
Figure 7.9c–e
418
MLNGC, MD, RN
Continuation of the Nerve Impulse
between Neurons
· Impulses are able to cross the synapse
to another nerve
·Neurotransmitter is released from a nerve’s
axon terminal
·The dendrite of the next neuron has
receptors that are stimulated by the
neurotransmitter
·An action potential is started in the dendrite
419
MLNGC, MD, RN
How Neurons Communicate at
Synapses
Figure 7.10
420
MLNGC, MD, RN
The Reflex Arc
· Reflex – rapid, predictable, and
involuntary responses to stimuli
· Reflex arc – direct route from a sensory
neuron, to an interneuron, to an effector
Figure 7.11a
421
MLNGC, MD, RN
Simple Reflex Arc
Figure 7.11b, c
422
MLNGC, MD, RN
Types of Reflexes and Regulation
· Autonomic reflexes
·Smooth muscle regulation
·Heart and blood pressure regulation
·Regulation of glands
·Digestive system regulation
· Somatic reflexes
·Activation of skeletal muscles
423
MLNGC, MD, RN
Central Nervous System (CNS)
· CNS develops from the embryonic

neural tube
·The neural tube becomes the brain and
spinal cord
·The opening of the neural tube becomes
the ventricles
·Four chambers within the brain
·Filled with cerebrospinal fluid
424
MLNGC, MD, RN
Regions of the Brain
· Cerebral
hemispheres
· Diencephalon
· Brain stem
· Cerebellum
Figure 7.12
425
MLNGC, MD, RN
Cerebral Hemispheres (Cerebrum)
· Paired (left
and right)
superior parts
of the brain
· Include more
than half of
the brain
mass
Figure 7.13a
426
MLNGC, MD, RN
Cerebral Hemispheres (Cerebrum)
· The surface
is made of
ridges (gyri)
and grooves
(sulci)
Figure 7.13a
427
MLNGC, MD, RN
Lobes of the Cerebrum
· Fissures (deep grooves) divide the

cerebrum into lobes
· Surface lobes of the cerebrum
·Frontal lobe
·Parietal lobe
·Occipital lobe
·Temporal lobe
428
MLNGC, MD, RN
Lobes of the Cerebrum
Figure 7.15a
429
MLNGC, MD, RN
Specialized Areas of the Cerebrum
· Somatic sensory area – receives

impulses from the body’s sensory
receptors
· Primary motor area – sends impulses to
skeletal muscles
· Broca’s area – involved in our ability to
speak
430
MLNGC, MD, RN
Sensory and Motor Areas of the
Cerebral Cortex
Figure 7.14
431
MLNGC, MD, RN
Specialized Area of the Cerebrum
· Cerebral areas involved in special

senses
·Gustatory area (taste)
·Visual area
·Auditory area
·Olfactory area
432
MLNGC, MD, RN
Specialized Area of the Cerebrum
Figure 7.13c
434
MLNGC, MD, RN
Layers of the Cerebrum
· Gray matter
·Outer layer
·Composed
mostly of neuron
cell bodies
Figure 7.13a
435
MLNGC, MD, RN
· White matter
·Fiber tracts
inside the gray
matter
·Example:
corpus callosum
connects
hemispheres
Figure 7.13a
436
MLNGC, MD, RN
· Basal nuclei –
internal islands
of gray matter
Figure 7.13a
437
MLNGC, MD, RN
Diencephalon
· Sits on top of the brain stem

· Enclosed by the cerebral hemispheres
· Made of three parts
·Thalamus
·Hypothalamus
·Epithalamus
438
MLNGC, MD, RN
Diencephalon
Figure 7.15
439
MLNGC, MD, RN
Thalamus
· Surrounds the third ventricle

· The relay station for sensory impulses
· Transfers impulses to the correct part of
the cortex for localization and
interpretation
440
MLNGC, MD, RN
Hypothalamus
· Under the thalamus

· Important autonomic nervous system
center
·Helps regulate body temperature
·Controls water balance
·Regulates metabolism
441
MLNGC, MD, RN
Hypothalamus
· An important part of the limbic system

(emotions)
· The pituitary gland is attached to the
hypothalamus
442
MLNGC, MD, RN
Epithalamus
· Forms the roof of the third ventricle

· Houses the pineal body (an endocrine
gland)
· Includes the choroid plexus – forms
cerebrospinal fluid
443
MLNGC, MD, RN
Brain Stem
· Attaches to the spinal cord

· Parts of the brain stem
·Midbrain
·Pons
·Medulla oblongata
444
MLNGC, MD, RN
Brain Stem
Figure 7.15a
445
MLNGC, MD, RN
Midbrain
· Mostly composed of tracts of nerve

fibers
· Has two bulging fiber tracts –
cerebral peduncles
· Has four rounded protrusions –
corpora quadrigemina
·Reflex centers for vision and hearing
446
MLNGC, MD, RN
Pons
· The bulging center part of the brain

stem
· Mostly composed of fiber tracts
· Includes nuclei involved in the control of
breathing
447
MLNGC, MD, RN
Medulla Oblongata
· The lowest part of the brain stem
· Merges into the spinal cord
· Includes important fiber tracts
· Contains important control centers
·Heart rate control
·Blood pressure regulation
·Breathing
·Swallowing
·Vomiting
448
MLNGC, MD, RN
Reticular Formation
· Diffuse mass of gray matter along the

brain stem
· Involved in motor control of visceral
organs
· Reticular activating system plays a role
in awake/sleep cycles and
consciousness
449
MLNGC, MD, RN
Reticular Formation
Figure 7.15b
450
MLNGC, MD, RN
Limbic System
• Includes the olfactory cortex, deep cortical
regions, and nuclei. It responds to
olfactory stimulation and is involved with
memory, motivation, mood and other
visceral functions.
451
MLNGC, MD, RN
Cerebellum
· Two hemispheres with convoluted

surfaces
· Provides involuntary coordination of
body movements
452
MLNGC, MD, RN
Cerebellum
Figure 7.15a
453
MLNGC, MD, RN
Protection of the Central Nervous
System
· Scalp and skin
· Skull and vertebral column
· Meninges
Figure 7.16a
454
MLNGC, MD, RN
Protection of the Central Nervous
System
· Cerebrospinal fluid
· Blood brain barrier
Figure 7.16a
455
MLNGC, MD, RN
Meninges
· Dura mater
·Double-layered external covering
·Periosteum – attached to surface of the
skull
·Meningeal layer – outer covering of the
brain
·Folds inward in several areas
456
MLNGC, MD, RN
Meninges
· Arachnoid layer
·Middle layer
·Web-like
· Pia mater
·Internal layer
·Clings to the surface of the brain
457
MLNGC, MD, RN
Cerebrospinal Fluid
· Similar to blood plasma composition

· Formed by the choroid plexus
· Forms a watery cushion to protect the
brain
· Circulated in arachnoid space,
ventricles, and central canal of the
spinal cord
458
MLNGC, MD, RN
Ventricles and Location of the
Cerebrospinal Fluid
Figure 7.17a
459
MLNGC, MD, RN
Ventricles and Location of the
Cerebrospinal Fluid
Figure 7.17b
460
MLNGC, MD, RN
Blood Brain Barrier
· Includes the least permeable capillaries
of the body
· Excludes many potentially harmful
substances
· Useless against some substances
·Fats and fat soluble molecules
·Respiratory gases
·Alcohol
·Nicotine
·Anesthesia
461
MLNGC, MD, RN
• Sensory Functions
The CNS constantly receives sensory input.
We are unaware of much of the input, but it is vital to
survival.
Some sensory input results in sensation.
• Ascending Tracts
Ascending tracts transmit action potentials from the
periphery to the brain.
Each tract carries a specific type of sensory information.
• Sensory Areas of the Cerebral Cortex
Ascending tracts project to primary sensory areas of the
cerebral cortex.
Association areas are involved in recognition of the sensory
input. MLNGC, MD, RN
462
• Motor Functions
Motor functions include involuntary and voluntary movements.
Upper motor neurons in the cerebral cortex connect to lower
motor neurons in the spinal cord or cranial nerve nuclei.
• Motor Areas of the Cerebral Cortex

Upper motor neurons are located in the primary motor cortex.
The premotor and prefrontal areas regulate movements.
• Descending Tracts
Descending tracts project directly from upper motor neurons in
the cerebral cortex to lower motor neurons in the spinal cord
and brainstem, or project indiractly through basal nuclei or
cerebellum.
463
MLNGC, MD, RN
Other Brain Functions
• Speech
Speech involves the sensory speech area, the motor
speech area, and the interactions between them and
other cortical areas.
• Brain Waves
An EEG monitors brain waves, which are a summation of
the electrical activity of the brain.
• Memory
Memory consists of sensory (< 1 second), short term
(lasting a few minutes) and long term (permanent)
memory.
464
MLNGC, MD, RN
Traumatic Brain Injuries
· Concussion
·Slight brain injury
·No permanent brain damage
· Contusion
·Nervous tissue destruction occurs
·Nervous tissue does not regenerate
· Cerebral edema
·Swelling from the inflammatory response
·May compress and kill brain tissue
465
MLNGC, MD, RN
Cerebrovascular Accident (CVA)
· Commonly called a stroke

· The result of a ruptured blood vessel
supplying a region of the brain
· Brain tissue supplied with oxygen from
that blood source dies
· Loss of some functions or death may
result
466
MLNGC, MD, RN
Alzheimer’s Disease
· Progressive degenerative brain disease
· Mostly seen in the elderly, but may
begin in middle age
· Structural changes in the brain include
abnormal protein deposits and twisted
fibers within neurons
· Victims experience memory loss,
irritability, confusion and ultimately,
hallucinations and death
467
MLNGC, MD, RN
Spinal Cord
· Extends from the
medulla oblongata to
the region of ___
· Below ___is the cauda
equina (a collection of
spinal nerves)
· Enlargements occur in
the cervical and lumbar
regions
Figure 7.18
468
MLNGC, MD, RN
Spinal Cord Anatomy
· Exterior white matter – conduction tracts
Figure 7.19
469
MLNGC, MD, RN
Spinal Cord Anatomy
· Internal gray matter - mostly cell bodies
·Dorsal (posterior) horns
·Anterior (ventral) horns
Figure 7.19
470
MLNGC, MD, RN
Spinal Cord Anatomy
· Central canal filled with cerebrospinal
fluid
Figure 7.19
471
MLNGC, MD, RN
Spinal Cord Anatomy
· Meninges cover the spinal cord

· Nerves leave at the level of each
vertebrae
·Dorsal root
· Associated with the dorsal root ganglia –
collections of cell bodies outside the central
nervous system
·Ventral root
472
MLNGC, MD, RN
· Nerves and ganglia outside the central

nervous system
· Nerve = bundle of neuron fibers
· Neuron fibers are bundled by
connective tissue
473
MLNGC, MD, RN
Structure of a Nerve
· Endoneurium
surrounds each fiber
· Groups of fibers are
bound into fascicles
by perineurium
· Fascicles are bound
together by
epineurium
Figure 7.20 474
MLNGC, MD, RN
Classification of Nerves
· Mixed nerves – both sensory and motor

fibers
· Afferent (sensory) nerves – carry
impulses toward the CNS
· Efferent (motor) nerves – carry impulses
away from the CNS
475
MLNGC, MD, RN
Cranial Nerves
· 12 pairs of nerves that mostly serve the

head and neck
· Numbered in order, front to back
· Most are mixed nerves, but three are
sensory only
476
MLNGC, MD, RN
Distribution of Cranial Nerves
Figure 7.21 477

MLNGC, MD, RN
Cranial Nerves
· I Olfactory nerve – sensory for smell

· II Optic nerve – sensory for vision
· III Oculomotor nerve – motor fibers to
eye muscles
· IV Trochlear – motor fiber to eye
muscles
478
MLNGC, MD, RN
Cranial Nerves
· V Trigeminal nerve – sensory for the
face; motor fibers to chewing muscles
· VI Abducens nerve –
motor fibers to eye muscles
· VII Facial nerve – sensory for taste;
motor fibers to the face
· VIII Vestibulocochlear nerve –
sensory for balance and hearing
479
MLNGC, MD, RN
Cranial Nerves
· IX Glossopharyngeal nerve – sensory
for taste; motor fibers to the pharynx
· X Vagus nerves – sensory and motor
fibers for pharynx, larynx, and viscera
· XI Accessory nerve – motor fibers to
neck and upper back
· XII Hypoglossal nerve – motor fibers to
tongue
480
MLNGC, MD, RN
CN
I O S
II O S
III O M
IV T M
V T B
VI A M
VII F B
VIII A/Vc S
IX G B
X V B
XI A M
XII H M
481
MLNGC, MD, RN
Spinal Nerves
· There is a pair of spinal nerves at the

level of each vertebrae for a total of 31
pairs
· Spinal nerves are formed by the
combination of the ventral and dorsal
roots of the spinal cord
· Spinal nerves are named for the region
from which they arise
482
MLNGC, MD, RN
Spinal Nerves
Figure 7.22a 483

MLNGC, MD, RN
Anatomy of Spinal Nerves
· Spinal nerves
divide soon after
leaving the spinal
cord
· Dorsal rami – serve
the skin and muscles
of the posterior trunk
·Ventral rami – forms
a complex of
networks (plexus) for
the anterior
Figure 7.22b
484
MLNGC, MD, RN
Examples of Nerve Distribution
Figure 7.23
485
MLNGC, MD, RN
Autonomic Nervous System
· The involuntary branch of the nervous

system
· Consists of only motor nerves
· Divided into two divisions
·Sympathetic division
·Parasympathetic division
486
MLNGC, MD, RN
Differences Between Somatic and
Autonomic Nervous Systems
· Nerves
·Somatic – one motor neuron
·Autonomic – preganglionic and
postganglionic nerves
· Effector organs
·Somatic – skeletal muscle
·Autonomic – smooth muscle, cardiac
muscle,and glands
487
MLNGC, MD, RN
Differences Between Somatic and
· Nerurotransmitters
·Somatic – always use acetylcholine
·Autominic – use acetylcholine, epinephrine,
or norepinephrine
488
MLNGC, MD, RN
Comparison of Somatic and
489
Anatomy of the Sympathetic
Division
· Originates from T1 through L2
· Ganglia are at the sympathetic trunk
(near the spinal cord)
· Short pre-ganglionic neuron and long
postganglionic neuron transmit impulse
from CNS to the effector
· Norepinephrine and epinephrine are
neurotransmitters to the effector organs
490
MLNGC, MD, RN
Sympathetic Pathways
Figure 7.26
491
MLNGC, MD, RN
Anatomy of the Parasympathetic
Division
· Originates from the brain stem and S1

through S4
· Terminal ganglia are at the effector
organs
· Always uses acetylcholine as a
neurotransmitter
492
MLNGC, MD, RN
Anatomy of the Autonomic Nervous
System
Figure 7.25
493
MLNGC, MD, RN
Autonomic Functioning
· Sympathetic – “fight-or-flight”
·Response to unusual stimulus
·Takes over to increase activities
·Remember as the “E” division = exercise,
excitement, emergency, and
embarrassment
494
MLNGC, MD, RN
Autonomic Functioning
· Parasympathetic – housekeeping
activites
·Conserves energy
·Maintains daily necessary body functions
·Remember as the “D” division - digestion,
defecation, and diuresis
495
MLNGC, MD, RN
Development Aspects of the
Nervous System
· The nervous system is formed during

the first month of embryonic
development
· Any maternal infection can have
extremely harmful effects
· The hypothalamus is one of the last
areas of the brain to develop
496
MLNGC, MD, RN
Development Aspects of the
Nervous System
· No more neurons are formed after birth,

but growth and maturation continues for
several years
· The brain reaches maximum weight as
a young adult
497
MLNGC, MD, RN
Chapter 9
Senses
The Senses
· General senses of touch
·Temperature
·Pressure
·Pain
· Special senses
·Smell
·Taste
·Sight
·Hearing
·Equilibrium
499
MLNGC, MD, RN
The Eye and Vision
· 70 percent of all sensory receptors are

in the eyes
· Each eye has over a million nerve fibers
· Protection for the eye
·Most of the eye is enclosed in a bony orbit
·A cushion of fat surrounds most of the eye
500
MLNGC, MD, RN
Accessory Structures of the Eye
· Eyelids
· Eyelashes
Figure 8.1b
501
MLNGC, MD, RN
· Meibomian glands –
modified
sebacious
glands
produce an
oily secretion
to lubricate
the eye
Figure 8.1b
502
MLNGC, MD, RN
· Ciliary glands –
modified
sweat glands
between the
eyelashes
Figure 8.1b
503
MLNGC, MD, RN
· Conjunctiva
·Membrane that lines the eyelids
·Connects to the surface of the eye
·Secretes mucus to lubricate the eye
504
MLNGC, MD, RN
· Lacrimal
apparatus
·Lacrimal gland –
produces lacrimal
fluid
·Lacrimal canals –
drains lacrimal
fluid from eyes
Figure 8.1a
505
MLNGC, MD, RN
·Lacrimal sac –
provides
passage of
lacrimal fluid
towards nasal
cavity
Figure 8.1a
506
MLNGC, MD, RN
·Nasolacrimal
duct – empties
lacrimal fluid into
the nasal cavity
Figure 8.1a
507
MLNGC, MD, RN
Function of the Lacrimal Apparatus
· Properties of lacrimal fluid

·Dilute salt solution (tears)
·Contains antibodies and lysozyme
· Protects, moistens, and lubricates the
eye
· Empties into the nasal cavity
508
MLNGC, MD, RN
Extrinsic Eye Muscles
· Muscles attach to the outer surface of
the eye
· Produce eye movements
Figure 8.2
509
MLNGC, MD, RN
Structure of the Eye
· The wall is composed of three tunics
·Fibrous tunic –
outside layer
·Choroid –
middle
layer
·Sensory
tunic –
inside
layer
Figure 8.3a
510
MLNGC, MD, RN
The Fibrous Tunic
· Sclera
·White connective tissue layer
·Seen anteriorly as the “white of the eye”
· Cornea
·Transparent, central anterior portion
·Allows for light to pass through
·Repairs itself easily
·The only human tissue that can be
transplanted without fear of rejection
511
MLNGC, MD, RN
Choroid Layer
· Blood-rich nutritive tunic

· Pigment prevents light from scattering
· Modified interiorly into two structures
·Cilliary body – smooth muscle
·Iris
·Pigmented layer that gives eye color
·Pupil – rounded opening in the iris
512
MLNGC, MD, RN
Sensory Tunic (Retina)
· Contains receptor cells (photoreceptors)
·Rods
·Cones
· Signals pass from photoreceptors via a
two-neuron chain
·Bipolar neurons
·Ganglion cells
· Signals leave the retina toward the brain
through the optic nerve
513
MLNGC, MD, RN
Neurons of the Retina
Figure 8.4
514
MLNGC, MD, RN
Neurons of the Retina and Vision
· Rods
·Most are found towards the edges of the
retina
·Allow dim light vision and peripheral vision
·Perception is all in gray tones
515
MLNGC, MD, RN
Neurons of the Retina and Vision
· Cones
·Allow for detailed color vision
·Densest in the center of the retina
·Fovea centralis – area of the retina with
only cones
· No photoreceptor cells are at the
optic disk, or blind spot
516
MLNGC, MD, RN
Cone Sensitivity
· There are three
types of cones
· Different cones
are sensitive to
different
wavelengths
· Color blindness is
the result of lack
of one cone type
517
MLNGC, MD,Figure
RN 8.6
Lens
· Biconvex crystal-like structure
· Held in place by a suspensory ligament
attached to the ciliary body
Figure 8.3a 518

MLNGC, MD, RN
Internal Eye Chamber Fluids
· Aqueous humor
·Watery fluid found in chamber between the
lens and cornea
·Similar to blood plasma
·Helps maintain intraocular pressure
·Provides nutrients for the lens and cornea
·Reabsorbed into venous blood through the
canal of Schlemm
519
MLNGC, MD, RN
Internal Eye Chamber Fluids
· Vitreous humor
·Gel-like substance behind the lens
·Keeps the eye from collapsing
·Lasts a lifetime and is not replaced
520
MLNGC, MD, RN
Lens Accommodation
· Light must be
focused to a point
on the retina for
optimal vision
· The eye is set for
distance vision
(over 20 ft away)
· The lens must
change shape to
focus for closer
objects
521
MLNGC, MD, Figure
RN 8.9
Images Formed on the Retina
Figure 8.10
522
MLNGC, MD, RN
Visual Pathway
· Photoreceptors of
the retina
· Optic nerve
· Optic nerve crosses
at the optic chiasma
523
Visual Pathway
· Optic tracts
· Thalamus (axons
form optic radiation)
· Visula cortex of the
occipital lobe
524
Eye Reflexes
· Internal muscles are controlled by the
autonomic nervous system
·Bright light causes pupils to constrict
through action of radial and ciliary muscles
·Viewing close objects causes
accommodation
· External muscles control eye movement
to follow objects
· Viewing close objects causes
convergence (eyes moving medially)
525
MLNGC, MD, RN
The Ear
· Houses two senses

·Hearing
·Equilibrium (balance)
· Receptors are mechanoreceptors
· Different organs house receptors for
each sense
526
MLNGC, MD, RN
Anatomy of the Ear
· The ear is divided into three areas
·Outer
(external)
ear
·Middle
ear
·Inner
ear
Figure 8.12
527
MLNGC, MD, RN
The External Ear
· Involved in
hearing only
· Structures of
the external
ear
·Pinna
(auricle)
·External
auditory canal
Figure 8.12
528
MLNGC, MD, RN
The External Auditory Canal
· Narrow chamber in the temporal bone

· Lined with skin
· Ceruminous (wax) glands are present
· Ends at the tympanic membrane
529
MLNGC, MD, RN
The Middle Ear or Tympanic Cavity
· Air-filled cavity within the temporal bone

· Only involved in the sense of hearing
530
MLNGC, MD, RN
The Middle Ear or Tympanic Cavity
· Two tubes are associated with the inner

ear
·The opening from the auditory canal is
covered by the tympanic membrane
·The auditory tube connecting the middle ear
with the throat
·Allows for equalizing pressure during yawning
or swallowing
·This tube is otherwise collapsed
531
MLNGC, MD, RN
Bones of the Tympanic Cavity
· Three bones
span the cavity
·Malleus
(hammer)
·Incus (anvil)
·Stapes (stirrip)
Figure 8.12
532
MLNGC, MD, RN
Bones of the Tympanic Cavity
· Vibrations from
eardrum move
the malleus
· These bones
transfer sound
to the inner ear
Figure 8.12
533
MLNGC, MD, RN
Inner Ear or Bony Labyrinth
· Includes sense organs for hearing and
balance
· Filled with
perilymph
Figure 8.12 534

MLNGC, MD, RN
Inner Ear or Bony Labrynth
· A maze of bony chambers within the
temporal bone
·Cochlea
·Vestibule
·Semicircular
canals
Figure 8.12 535

MLNGC, MD, RN
Organs of Hearing
· Organ of Corti
·Located within the cochlea
·Receptors = hair cells on the basilar
membrane
·Gel-like tectorial membrane is capable of
bending hair cells
·Cochlear nerve attached to hair cells
transmits nerve impulses to auditory cortex
on temporal lobe
536
MLNGC, MD, RN
Organs of Hearing
Figure 8.13
537
MLNGC, MD, RN
Mechanisms of Hearing
· Vibrations from sound waves move

tectorial membrane
· Hair cells are bent by the membrane
· An action potential starts in the cochlear
nerve
· Continued stimulation can lead to
adaptation
538
MLNGC, MD, RN
Mechanisms of Hearing
Figure 8.14
539
MLNGC, MD, RN
Organs of Equilibrium
· Receptor cells are in two structures
·Vestibule
·Semicircular canals
Figure 8.16a, b
540
MLNGC, MD, RN
Organs of Equilibrium
· Equilibrium has two functional parts
·Static equilibrium
·Dynamic equilibrium
Figure 8.16a, b
541
MLNGC, MD, RN
Static Equilibrium
· Maculae – receptors in the vestibule
·Report on the position of the head
·Send information via the vestibular nerve
· Anatomy of the maculae
·Hair cells are embedded in the otolithic
membrane
·Otoliths (tiny stones) float in a gel around
the hair cells
·Movements cause otoliths to bend the hair
cells
542
MLNGC, MD, RN
Function of Maculae
Figure 8.15
543
MLNGC, MD, RN
Dynamic Equilibrium
· Crista ampullaris –
receptors in the
semicircular canals
·Tuft of hair cells
·Cupula (gelatinous cap)
covers the hair cells
Figure 8.16c
544
MLNGC, MD, RN
Dynamic Equilibrium
· Action of angular head

movements
·The cupula stimulates the
hair cells
·An impulse is sent via the
vestibular nerve to the
cerebellum
Figure 8.16c
545
MLNGC, MD, RN
Chemical Senses – Taste and
Smell
· Both senses use chemoreceptors
·Stimulated by chemicals in solution
·Taste has four types of receptors
·Smell can differentiate a large range of
chemicals
· Both senses complement each other
and respond to many of the same
stimuli
546
MLNGC, MD, RN
Olfaction – The Sense of Smell
· Olfactory receptors are in the roof of the
nasal cavity
·Neurons with long cilia
·Chemicals must be dissolved in mucus for
detection
· Impulses are transmitted via the
olfactory nerve
· Interpretation of smells is made in the
cortex
547
MLNGC, MD, RN
Olfactory Epithelium
Figure 8.17
548
MLNGC, MD, RN
The Sense of Taste
· Taste buds
house the
receptor
organs
· Location of
taste buds
·Most are on
the tongue
·Soft palate
·Cheeks
Figure 8.18a, b
549
MLNGC, MD, RN
The Tongue and Taste
· The tongue is covered with projections
called papillae
·Filiform papillae – sharp with no taste buds
·Fungifiorm papillae – rounded with taste
buds
·Circumvallate papillae – large papillae with
taste buds
· Taste buds are found on the sides of
papillae
550
MLNGC, MD, RN
Structure of Taste Buds
· Gustatory cells are the receptors

·Have gustatory hairs (long microvilli)
·Hairs are stimulated by chemicals
dissolved in saliva
551
MLNGC, MD, RN
Structure of Taste Buds
· Impulses are carried to the gustatory

complex by several cranial nerves
because taste buds are found in
different areas
·Facial nerve
·Glossopharyngeal nerve
·Vagus nerve
552
MLNGC, MD, RN
Anatomy of Taste Buds
Figure 8.18
553
MLNGC, MD, RN
Taste Sensations
· Sweet receptors
·Sugars
·Saccharine
·Some amino acids
· Sour receptors
·Acids
· Bitter receptors
·Alkaloids
· Salty receptors
·Metal ions
554
MLNGC, MD, RN
Special Senses
· Formed early in embryonic development

· Eyes are outgrowths of the brain
· All special senses are functional at birth
555
MLNGC, MD, RN
Chapter 10
Endocrine System
The Endocrine System
· Second messenger system of the body
· Uses chemical messages (hormones)
that are released into the blood
· Hormones control several major
processes
·Reproduction
·Growth and development
·Mobilization of body defenses
·Maintenance of much of homeostasis
·Regulation of metabolism
557
MLNGC, MD, RN
Hormone Overview
· Hormones are produced by specialized

cells
· Cells secrete hormones into
extracellular fluids
· Blood transfers hormones to target sites
· These hormones regulate the activity of
other cells
558
MLNGC, MD, RN
The Chemistry of Hormones
· Amino acid-based hormones

·Proteins
·Peptides
·Amines
· Steroids – made from cholesterol
· Prostaglandins – made from highly
active lipids
559
MLNGC, MD, RN
Mechanisms of Hormone Action
· Hormones affect only certain tissues or

organs (target cells or organs)
· Target cells must have specific protein
receptors
· Hormone binding influences the working
of the cells
560
MLNGC, MD, RN
Effects Caused by Hormones
· Changes in plasma membrane

permeability or electrical state
· Synthesis of proteins, such as enzymes
· Activation or inactivation of enzymes
· Stimulation of mitosis
561
MLNGC, MD, RN
Steroid Hormone Action
· Diffuse through the plasma membrane
of target cells
· Enter the nucleus
· Bind to a specific protein within the
nucleus
· Bind to specific sites on the cell’s DNA
· Activate genes that result in synthesis of
new proteins
562
MLNGC, MD, RN
Steroid Hormone Action
Figure 9.1a
563
MLNGC, MD, RN
Nonsteroid Hormone Action
· Hormone binds to a membrane receptor
· Hormone does not enter the cell
· Sets off a series of reactions that
activates an enzyme
· Catalyzes a reaction that produces a
second messenger molecule
· Oversees additional intracellular
changes to promote a specific response
564
MLNGC, MD, RN
Nonsteroid Hormone Action
Figure 9.1b
565
MLNGC, MD, RN
Control of Hormone Release
· Hormone levels in the blood are

maintained by negative feedback
· A stimulus or low hormone levels in the
blood triggers the release of more
hormone
· Hormone release stops once an
appropriate level in the blood is reached
566
MLNGC, MD, RN
Hormonal Stimuli of Endocrine
Glands
· Endocrine glands
are activated by
other hormones
Figure 9.2a
567
MLNGC, MD, RN
Humoral Stimuli of Endocrine
Glands
· Changing blood
levels of certain
ions stimulate
hormone release
Figure 9.2b
568
MLNGC, MD, RN
Neural Stimuli of Endocrine Glands
· Nerve impulses
stimulate hormone
release
· Most are under
control of the
sympathetic nervous
system
Figure 9.2c
569
MLNGC, MD, RN
Location of Major Endrocrine Organs
Figure 9.3
570
MLNGC, MD, RN
Pituitary Gland
· Size of a grape
· Hangs by a stalk from the hypothalamus
· Protected by the sphenoid bone
· Has two functional lobes
·Anterior pituitary – glandular tissue
·Posterior pituitary – nervous tissue
571
MLNGC, MD, RN
Hormones of the Anterior Pituitary
· Six anterior pituitary hormones
·Two affect non-endocrine targets
·Four stimulate other endocrine glands
(tropic hormones)
· Characteristics of all anterior pituitary
hormones
·Proteins (or peptides)
·Act through second-messenger systems
·Regulated by hormonal stimuli, mostly
negative feedback
572
MLNGC, MD, RN
Hormones of the Anterior Pituitary
Figure 9.4
573
MLNGC, MD, RN
Growth Hormone (GH)
· General metabolic hormone

· Major effects are directed to growth of
skeletal muscles and long bones
· Causes amino acids to be built into
proteins
· Causes fats to be broken down for a
source of energy
574
MLNGC, MD, RN
Functions of Other Anterior
Pituitary Hormones
· Prolactin (PRL)
·Stimulates and maintains milk production
following childbirth
·Function in males is unknown
· Adrenocorticotropic hormone (ACTH)
·Regulates endocrine activity of the adrenal
cortex
· Thyroid-stimulating hormone (TSH)
·Influences growth and activity of the thyroid
575
MLNGC, MD, RN
Pituitary Hormones
· Gonadotropic hormones
·Regulate hormonal activity of the gonads
·Follicle-stimulating hormone (FSH)
·Stimulates follicle development in
ovaries
·Stimulates sperm development in
testes
576
MLNGC, MD, RN
Pituitary Hormones
·Gonadotropic hormones (continued)
·Luteinizing hormone (LH)
·Triggers ovulation
·Causes ruptured follicle to become the
corpus luteum
·Stimulates testosterone production in
males
·Referred to as interstitial cell-stimulating
hormone (ICSH)
577
MLNGC, MD, RN
Pituitary - Hypothalamus
Relationship
· Release of hormones is controlled by
releasing and inhibiting hormones
produced by the hypothalamus
· Hypothlamus produces two hormones
that are transorted to neurosecretory
cells of the posterior pituitary
· The poterior pituitary is not strictly an
endocrine gland, but does release
hormones
578
MLNGC, MD, RN
Hormones of the Posterior Pituitary
· Oxytocin
·Stimulates contractions of the uterus during
labor
·Causes milk ejection
· Antidiuretic hormone (ADH)
·Can inhibit urine production
·In large amounts, causes vasoconstriction
leading to increased blood pressure
(vasopressin)
579
MLNGC, MD, RN
Hormones of the Posterior Pituitary
Figure 9.5
580
MLNGC, MD, RN
Thyroid Gland
· Found at the base of the throat

· Consists of two lobes and a connecting
isthmus
· Produces two hormones
·Thyroid hormone
·Calcitonin
581
MLNGC, MD, RN
Thyroid Gland
Figure 9.6
582
MLNGC, MD, RN
Thyroid Hormone
· Major metabolic hormone

· Composed of two active iodine-
containing hormones
·Thyroxine (T4) – secreted by thyroid
follicles
·Triiodothyronine (T3) – conversion of T4 at
target tissues
583
MLNGC, MD, RN
Calcitonin
· Decreases blood
calcium levels by
causing its
deposition on bone
· Antagonistic to
parathyroid
hormone
· Produced by C
(parafollicular)
cells
Figure 9.9 584
MLNGC, MD, RN
Parathyroid Glands
· Tiny masses on the posterior of the

thyroid
· Secrete parathyroid hormone
·Stimulate osterclasts to remove calcium
from bone
·Stimulate the kidneys and intestine to
absorb more calcium
·Raise calcium levels in the blood
585
MLNGC, MD, RN
Adrenal Glands
· Two glands
·Cortex – outer glandular region in three
layers
·Medulla – inner neural tissue region
· Sits on top of the kidneys
586
MLNGC, MD, RN
Hormones of the Adrenal Cortex
· Mineralocorticoids (mainly aldosterone)
·Produced in outer adrenal cortex
·Regulate mineral content in blood, water,
and electrolyte balance
·Target organ is the kidney
·Production stimulated by renin and
aldosterone
·Production inhibited by atrial natriuretic
peptide
587
MLNGC, MD, RN
Figure 9.10
588
MLNGC, MD, RN
· Glucocorticoids (including cortisone and

cortisol)
·Produced in the middle layer of the adrenal
cortex
·Promote normal cell metabolism
·Help resist long-term stressors
·Released in response to increased blood
levels of ACTH
589
MLNGC, MD, RN
· Sex hormones
·Produced in the inner layer of the adrenal
cortex
·Androgens (male) and some estrogen
(female)
590
MLNGC, MD, RN
Hormones of the Adrenal Medulla
· Produces two similar hormones

(catecholamines)
·Epinephrine
·Norepinephrine
· These hormones prepare the body to
deal with short-term stress
591
MLNGC, MD, RN
Roles of the Hypothalamus and
Adrenal Glands in the Stress
Response
Figure 9.12
592
MLNGC, MD, RN
Pancreatic Islets
· The pancreas is a mixed gland
· The islets of the pancreas produce
hormones
·Insulin – allows glucose to cross plasma
membranes into cells from beta cells
·Glucagon – allows glucose to enter the
blood from alpha cells
·These hormones are antagonists that
maintain blood sugar homeostasis
593
MLNGC, MD, RN
Pancreatic Islets
Figure 9.13
594
MLNGC, MD, RN
Pancreatic Hormones and Blood Sugar
Figure 9.14
595
MLNGC, MD, RN
Pineal Gland
· Found on the third ventricle of the brain

· Secretes melatonin
·Helps establish the body’s wake and sleep
cycles
·May have other as-yet-unsubstantiated
functions
596
MLNGC, MD, RN
Thymus
· Located posterior to the sternum

· Largest in infants and children
· Produces thymosin
·Matures some types of white blood cells
·Important in developing the immune system
597
MLNGC, MD, RN
Hormones of the Ovaries
· Estrogens
·Produced by Graafian follicles or the placenta
·Stimulates the development of secondary
female characteristics
·Matures female reproductive organs
·Helps prepare the uterus to receive a fertilized
egg
·Helps maintain pregnancy
·Prepares the breasts to produce milk
598
MLNGC, MD, RN
Hormones of the Ovaries
· Progesterone
·Produced by the corpus luteum
·Acts with estrogen to bring about the
menstrual cycle
·Helps in the implantation of an embryo in
the uterus
599
MLNGC, MD, RN
Hormones of the Testes
· Interstitial cells of testes are hormone-
producing
· Produce several androgens
· Testosterone is the most important
androgen
·Responsible for adult male secondary sex
characteristics
·Promotes growth and maturation of male
reproductive system
·Required for sperm cell production
600
MLNGC, MD, RN
Other Hormone-Producing Tissues
and Organs
· Parts of the small intestine

· Parts of the stomach
· Kidneys
· Heart
· Many other areas have scattered
endocrine cells
601
MLNGC, MD, RN lide 9.39
Endocrine Function of the Placenta
· Produces hormones that maintain the

pregnancy
· Some hormones play a part in the
delivery of the baby
· Produces HCG in addition to estrogen,
progesterone, and other hormones
602
MLNGC, MD, RN
Endocrine System
· Most endocrine organs operate smoothly
until old age
·Menopause is brought about by lack of
efficiency of the ovaries
·Problems associated with reduced estrogen
are common
·Growth hormone production declines with age
·Many endocrine glands decrease output with
age
603
MLNGC, MD, RN
Chapter 11
Blood
Blood
· The only fluid tissue in the human body

· Classified as a connective tissue
·Living cells = formed elements
·Non-living matrix = plasma
605
MLNGC, MD, RN
Blood
Figure 10.1
606
MLNGC, MD, RN
Physical Characteristics of Blood
· Color range
·Oxygen-rich blood is scarlet red
·Oxygen-poor blood is dull red
· pH must remain between 7.35–7.45
· Blood temperature is slightly higher than
body temperature
607
MLNGC, MD, RN
Blood Plasma
· Composed of approximately 90 percent
water
· Includes many dissolved substances
·Nutrients
·Salts (metal ions)
·Respiratory gases
·Hormones
·Proteins
·Waste products
608
MLNGC, MD, RN
Plasma Proteins
· Albumin – regulates osmotic pressure

· Clotting proteins – help to stem blood
loss when a blood vessel is injured
· Antibodies – help protect the body from
antigens
609
MLNGC, MD, RN
Formed Elements
· Erythrocytes = red blood cells

· Leukocytes = white blood cells
· Platelets = cell fragments
610
MLNGC, MD, RN
611
MLNGC, MD, RN
612
MLNGC, MD, RN
Erythrocytes (Red Blood Cells)
· The main function is to carry oxygen

· Anatomy of circulating erythrocytes
·Biconcave disks
·Essentially bags of hemoglobin
·Anucleate (no nucleus)
·Contain very few organelles
· Outnumber white blood cells 1000:1
613
MLNGC, MD, RN
Hemoglobin
· Iron-containing protein
· Binds strongly, but reversibly, to oxygen
· Each hemoglobin molecule has four
oxygen binding sites
· Each erythrocyte has 250 million
hemoglobin molecules
614
MLNGC, MD, RN
Leukocytes (White Blood Cells)
· Crucial in the body’s defense against
disease
· These are complete cells, with a
nucleus and organelles
· Able to move into and out of blood
vessels (diapedesis)
· Can move by ameboid motion
· Can respond to chemicals released by
damaged tissues
615
MLNGC, MD, RN
Leukocyte Levels in the Blood
· Normal levels are between 4,000 and
11,000 cells per millimeter
· Abnormal leukocyte levels
·Leukocytosis
·Above 11,000 leukocytes/ml
·Generally indicates an infection
·Leukopenia
·Abnormally low leukocyte level
·Commonly caused by certain drugs
616
MLNGC, MD, RN
Types of Leukocytes
· Granulocytes
·Granules in their
cytoplasm can be
stained
·Include
neutrophils,
eosinophils, and
basophils
Figure 10.4
617
MLNGC, MD, RN
Types of Leukocytes
· Agranulocytes
·Lack visible
cytoplasmic
granules
·Include
lymphocytes and
monocytes
Figure 10.4
618
MLNGC, MD, RN
Granulocytes
· Neutrophils
·Multilobed nucleus with fine granules
·Act as phagocytes at active sites of infection
· Eosinophils
·Large brick-red cytoplasmic granules
·Found in repsonse to allergies and parasitic
worms
619
MLNGC, MD, RN
Granulocytes
· Basophils
·Have histamine-containing granules
·Initiate inflammation
620
MLNGC, MD, RN
Agranulocytes
· Lymphocytes
·Nucleus fills most of the cell
·Play an important role in the immune
response
· Monocytes
·Largest of the white blood cells
·Function as macrophages
·Important in fighting chronic infection
621
MLNGC, MD, RN
Platelets
· Derived from ruptured multinucleate

cells (megakaryocytes)
· Needed for the clotting process
· Normal platelet count = 300,000/mm3
622
MLNGC, MD, RN
Hematopoiesis
· Blood cell formation

· Occurs in red bone marrow
· All blood cells are derived from a
common stem cell (hemocytoblast)
· Hemocytoblast differentiation
·Lymphoid stem cell produces lymphocytes
·Myeloid stem cell produces other formed
elements
623
MLNGC, MD, RN
Fate of Erythrocytes
· Unable to divide, grow, or synthesize

proteins
· Wear out in 100 to 120 days
· When worn out, are eliminated by
phagocytes in the spleen or liver
· Lost cells are replaced by division of
hemocytoblasts
624
MLNGC, MD, RN
Control of Erythrocyte Production
· Rate is controlled by a hormone

(erythropoietin)
· Kidneys produce most erythropoietin as
a response to reduced oxygen levels in
the blood
· Homeostasis is maintained by negative
feedback from blood oxygen levels
625
MLNGC, MD, RN
Control of Erythrocyte Production
Figure 10.5
626
MLNGC, MD, RN
Hemostasis
· Stoppage of blood flow

· Result of a break in a blood vessel
· Hemostasis involves three phases
·Platelet plug formation
·Vascular spasms
·Coagulation
627
MLNGC, MD, RN
Platelet Plug Formation
· Collagen fibers are exposed by a break

in a blood vessel
· Platelets become “sticky” and cling to
fibers
· Anchored platelets release chemicals to
attract more platelets
· Platelets pile up to form a platelet plug
628
MLNGC, MD, RN
Vascular Spasms
· Anchored platelets release serotonin

· Serotonin causes blood vessel muscles
to spasm
· Spasms narrow the blood vessel,
decreasing blood loss
629
MLNGC, MD, RN
Coagulation
· Injured tissues release thromboplastin

· PF3 (a phospholipid) interacts with
thromboplastin, blood protein clotting
factors, and calcium ions to trigger a
clotting cascade
· Prothrombin activator converts
prothrombin to thrombin (an enzyme)
630
MLNGC, MD, RN
Coagulation
· Thrombin joins fibrinogen proteins into

hair-like fibrin
· Fibrin forms a meshwork
(the basis for a clot)
631
MLNGC, MD, RN
Blood Clotting
· Blood usually clots within 3 to 6 minutes

· The clot remains as endothelium
regenerates
· The clot is broken down after tissue
repair
632
MLNGC, MD, RN
Undesirable Clotting
· Thrombus
·A clot in an unbroken blood vessel
·Can be deadly in areas like the heart
· Embolus
·A thrombus that breaks away and floats
freely in the bloodstream
·Can later clog vessels in critical areas such
as the brain
633
MLNGC, MD, RN
Bleeding Disorders
· Thrombocytopenia
·Platelet deficiency
·Even normal movements can cause
bleeding from small blood vessels that
require platelets for clotting
· Hemophilia
·Hereditary bleeding disorder
·Normal clotting factors are missing
634
MLNGC, MD, RN
Blood Groups and Transfusions
· Large losses of blood have serious
consequences
·Loss of 15 to 30 percent causes weakness
·Loss of over 30 percent causes shock,
which can be fatal
· Transfusions are the only way to
replace blood quickly
· Transfused blood must be of the same
blood group
635
MLNGC, MD, RN
Human Blood Groups
· Blood contains genetically determined

proteins
· A foreign protein (antigen) may be
attacked by the immune system
· Blood is “typed” by using antibodies that
will cause blood with certain proteins to
clump (agglutination)
636
MLNGC, MD, RN
Human Blood Groups
· There are over 30 common red blood

cell antigens
· The most vigorous transfusion reactions
are caused by ABO and Rh blood group
antigens
637
MLNGC, MD, RN
ABO Blood Groups
· Based on the presence or absence of two

antigens
·Type A
·Type B
· The lack of these antigens is called
type O
638
MLNGC, MD, RN
ABO Blood Groups
· The presence of both A and B is called

type AB
· The presence of either A or B is called
types A and B, respectively
639
MLNGC, MD, RN
Rh Blood Groups
· Named because of the presence or

absence of one of eight Rh antigens
(agglutinogen D)
· Most Americans are Rh+
· Problems can occur in mixing Rh+ blood
into a body with Rh– blood
640
MLNGC, MD, RN
Rh Dangers During Pregnancy
· Danger is only when the mother is Rh–

and the father is Rh+, and the child
inherits the Rh+ factor
641
MLNGC, MD, RN
Rh Dangers During Pregnancy
· The mismatch of an Rh– mother carrying
an Rh+ baby can cause problems for the
unborn child
·The first pregnancy usually proceeds without
problems
·The immune system is sensitized after the
first pregnancy
·In a second pregnancy, the mother’s immune
system produces antibodies to attack the Rh+
blood (hemolytic disease of the newborn)
642
MLNGC, MD, RN
Blood Typing
· Blood samples are mixed with anti-A and
anti-B serum
· Coagulation or no coagulation leads to
determining blood type
· Typing for ABO and Rh factors is done in
the same manner
· Cross matching – testing for
agglutination of donor RBCs by the
recipient’s serum, and vice versa
643
MLNGC, MD, RN
Developmental Aspects of Blood
· Sites of blood cell formation

·The fetal liver and spleen are early sites of
blood cell formation
·Bone marrow takes over hematopoiesis by
the seventh month
· Fetal hemoglobin differs from
hemoglobin produced after birth
644
MLNGC, MD, RN
Chapter 12
Heart
The Cardiovascular System
· A closed system of the heart and blood

vessels
·The heart pumps blood
·Blood vessels allow blood to circulate to all
parts of the body
· The function of the cardiovascular
system is to deliver oxygen and
nutrients and to remove carbon dioxide
and other waste products
646
MLNGC, MD, RN
The Heart
· Location
·Thorax between the lungs
·Pointed apex directed toward left hip
· About the size of your fist
647
MLNGC, MD, RN
The Heart
Figure 11.1
648
MLNGC, MD, RN
The Heart: Coverings
· Pericardium – a double serous

membrane
·Visceral pericardium
·Next to heart
·Parietal pericardium
·Outside layer
· Serous fluid fills the space between the
layers of pericardium
649
MLNGC, MD, RN
The Heart: Heart Wall
· Three layers
·Epicardium
· Outside layer
· This layer is the parietal pericardium
· Connective tissue layer
·Myocardium
· Middle layer
· Mostly cardiac muscle
·Endocardium
· Inner layer
· Endothelium
650
MLNGC, MD, RN
External Heart Anatomy
651
MLNGC, MD, RN Figure 11.2a
The Heart: Chambers
· Right and left side act as separate pumps
· Four chambers
·Atria
·Receiving chambers
· Right atrium
· Left atrium
·Ventricles
·Discharging chambers
· Right ventricle
· Left ventricle
652
MLNGC, MD, RN
Chapter 13
Blood Vessels
and Circulation
Blood Circulation
Figure 11.3
654
MLNGC, MD, RN
The Heart: Valves
· Allow blood to flow in only one direction
· Four valves
·Atrioventricular valves – between atria and
ventricles
· Bicuspid valve (left)
· Tricuspid valve (right)
·Semilunar valves between ventricle and
artery
· Pulmonary semilunar valve
· Aortic semilunar valve
655
MLNGC, MD, RN
The Heart: Valves
· Valves open as blood is pumped

through
· Held in place by chordae tendineae
(“heart strings”)
· Close to prevent backflow
656
MLNGC, MD, RN
Operation of Heart Valves
Figure 11.4 657

MLNGC, MD, RN
The Heart: Associated Great Vessels
· Aorta
·Leaves left ventricle
· Pulmonary arteries
·Leave right ventricle
· Vena cava
·Enters right atrium
· Pulmonary veins (four)
·Enter left atrium
658
MLNGC, MD, RN
Coronary Circulation
· Blood in the heart chambers does not

nourish the myocardium
· The heart has its own nourishing
circulatory system
·Coronary arteries
·Cardiac veins
·Blood empties into the right atrium via the
coronary sinus
659
MLNGC, MD, RN
The Heart: Conduction System
· Intrinsic conduction system

(nodal system)
·Heart muscle cells contract, without nerve
impulses, in a regular, continuous way
660
MLNGC, MD, RN
The Heart: Conduction System
·Special tissue sets the pace

·Sinoatrial node
·Pacemaker
·Atrioventricular node
·Atrioventricular bundle
·Bundle branches
·Purkinje fibers
661
MLNGC, MD, RN
Heart Contractions
· Contraction is initiated by the sinoatrial

node
· Sequential stimulation occurs at other
autorhythmic cells
662
MLNGC, MD, RN
Heart Contractions
Figure 11.5
663
MLNGC, MD, RN
Filling of Heart Chambers –
the Cardiac Cycle
Figure 11.6
664
MLNGC, MD, RN
The Heart: Cardiac Cycle
· Atria contract simultaneously

· Atria relax, then ventricles contract
· Systole = contraction
· Diastole = relaxation
665
MLNGC, MD, RN
The Heart: Cardiac Cycle
· Cardiac cycle – events of one complete

heart beat
·Mid-to-late diastole – blood flows into
ventricles
·Ventricular systole – blood pressure builds
before ventricle contracts, pushing out
blood
·Early diastole – atria finish re-filling,
ventricular pressure is low
666
MLNGC, MD, RN
The Heart: Cardiac Output
· Cardiac output (CO)

·Amount of blood pumped by each side of
the heart in one minute
·CO = (heart rate [HR]) x (stroke volume
[SV])
· Stroke volume
·Volume of blood pumped by each ventricle
in one contraction
667
MLNGC, MD, RN
Cardiac Output Regulation
Figure 11.7
668
MLNGC, MD, RN
The Heart: Regulation of Heart
Rate
· Stroke volume usually remains relatively
constant
·Starling’s law of the heart – the more that
the cardiac muscle is stretched, the
stronger the contraction
· Changing heart rate is the most
common way to change cardiac output
669
MLNGC, MD, RN
Rate
· Increased heart rate
·Sympathetic nervous system
·Crisis
·Low blood pressure
·Hormones
·Epinephrine
·Thyroxine
·Exercise
·Decreased blood volume
670
MLNGC, MD, RN
Rate
· Decreased heart rate

·Parasympathetic nervous system
·High blood pressure or blood volume
·Dereased venous return
671
MLNGC, MD, RN
Blood Vessels: The Vascular
System
· Taking blood to the tissues and back

·Arteries
·Arterioles
·Capillaries
·Venules
·Veins
672
MLNGC, MD, RN
The Vascular System
Figure 11.8b
673
MLNGC, MD, RN
Blood Vessels: Anatomy
· Three layers (tunics)
·Tunic intima
·Endothelium
·Tunic media
·Smooth muscle
·Controlled by sympathetic nervous
system
·Tunic externa
·Mostly fibrous connective tissue
674
MLNGC, MD, RN
Differences Between Blood Vessel
Types
· Walls of arteries are the thickest
· Lumens of veins are larger
· Skeletal muscle “milks” blood in veins
toward the heart
· Walls of capillaries are only one cell
layer thick to allow for exchanges
between blood and tissue
675
MLNGC, MD, RN
Movement of Blood Through
Vessels
· Most arterial blood is

pumped by the heart
· Veins use the milking
action of muscles to
help move blood
Figure 11.9
676
MLNGC, MD, RN
Capillary Beds
· Capillary beds
consist of two
types of vessels
·Vascular shunt –
directly connects an
arteriole to a venule
677
MLNGC, MD, RN
Figure 11.10
Capillary Beds
·True capillaries –
exchange vessels
·Oxygen and
nutrients cross to
cells
·Carbon dioxide
and metabolic
waste products
cross into blood
678
MLNGC, MD, RN
Figure 11.10
Diffusion at Capillary Beds
Figure 11.20
679
MLNGC, MD, RN
Major Arteries of Systemic Circulation
Figure 11.11
680
MLNGC, MD, RN
Major Veins of Systemic Circulation
Figure 11.12
681
MLNGC, MD, RN
Arterial Supply of the Brain
Figure 11.13
682
MLNGC, MD, RN
Hepatic Portal Circulation
Figure 11.14
683
MLNGC, MD, RN
Circulation to the Fetus
Figure 11.15
684
MLNGC, MD, RN
Pulse
· Pulse –
pressure wave
of blood
· Monitored at
“pressure
points” where
pulse is easily
palpated
Figure 11.16
685
MLNGC, MD, RN
Blood Pressure
· Measurements by health professionals
are made on the pressure in large
arteries
·Systolic – pressure at the peak of
ventricular contraction
·Diastolic – pressure when ventricles relax
· Pressure in blood vessels decreases as
the distance away from the heart
increases
686
MLNGC, MD, RN
Measuring Arterial Blood Pressure
Figure 11.18
687
MLNGC, MD, RN
Comparison of Blood Pressures in
Different Vessels
Figure 11.17
688
MLNGC, MD, RN
Blood Pressure: Effects of Factors
· Neural factors
·Autonomic nervous system adjustments
(sympathetic division)
· Renal factors
·Regulation by altering blood volume
·Renin – hormonal control
689
MLNGC, MD, RN
Blood Pressure: Effects of Factors
· Temperature
·Heat has a vasodilation effect
·Cold has a vasoconstricting effect
· Chemicals
·Various substances can cause increases or
decreases
· Diet
690
MLNGC, MD, RN
Factors Determining Blood Pressure
Figure 11.19 691

MLNGC, MD, RN
Variations in Blood Pressure
· Human normal range is variable
·Normal
·140–110 mm Hg systolic
·80–75 mm Hg diastolic
·Hypotension
·Low systolic (below 110 mm HG)
·Often associated with illness
·Hypertension
·High systolic (above 140 mm HG)
·Can be dangerous if it is chronic
692
MLNGC, MD, RN
Capillary Exchange
· Substances exchanged due to

concentration gradients
·Oxygen and nutrients leave the blood
·Carbon dioxide and other wastes leave the
cells
693
MLNGC, MD, RN
Capillary Exchange: Mechanisms
· Direct diffusion across plasma
membranes
· Endocytosis or exocytosis
· Some capillaries have gaps (intercellular
clefts)
·Plasma membrane not joined by tight
junctions
· Fenestrations of some capillaries
·Fenestrations = pores
694
MLNGC, MD, RN
Cardiovascular System
· A simple “tube heart” develops in the

embryo and pumps by the fourth week
· The heart becomes a four-chambered
organ by the end of seven weeks
· Few structural changes occur after the
seventh week
695
MLNGC, MD, RN
Chapter 14
The Lymphatic System
and Immunity
The Lymphatic System
· Consists of two semi-independent parts

·Lymphatic vessels
·Lymphoid tissues and organs
· Lymphatic system functions
·Transport fluids back to the blood
·Play essential roles in body defense and
resistance to disease
697
MLNGC, MD, RN
Lymphatic Characteristics
· Lymph – excess tissue fluid carried by
lymphatic vessels
· Properties of lymphatic vessels
·One way system toward the heart
·No pump
·Lymph moves toward the heart
·Milking action of skeletal muscle
·Rhythmic contraction of smooth muscle
in vessel walls
698
MLNGC, MD, RN
Lymphatic Vessels
· Lymph Capillaries
·Walls overlap to form flap-like minivalves
·Fluid leaks into lymph capillaries
·Capillaries are anchored to connective
tissue by filaments
·Higher pressure on the inside closes
minivalves
699
MLNGC, MD, RN
Lymphatic Vessels
Figure 12.1
700
MLNGC, MD, RN
Lymphatic Vessels
· Lymphatic
collecting vessels
·Collects lymph
from lymph
capillaries
·Carries lymph to
and away from
lymph nodes
701
MLNGC, MD,Figure
RN 12.2
Lymphatic Vessels
· Lymphatic
collecting vessels
(continued)
·Returns fluid to
circulatory veins
near the heart
·Right lymphatic
duct
·Thoracic duct
702
MLNGC, MD,Figure
RN 12.2
Lymph
· Materials returned to the blood

·Water
·Blood cells
·Proteins
703
MLNGC, MD, RN
Lymph
· Harmful materials that enter lymph

vessels
·Bacteria
·Viruses
·Cancer cells
·Cell debris
704
MLNGC, MD, RN
Lymph Nodes
· Filter lymph before it is returned to the

blood
· Defense cells within lymph nodes
·Macrophages – engulf and destroy foreign
substances
·Lymphocytes – provide immune response to
antigens
705
MLNGC, MD, RN
Lymph Nodes
Figure 12.3
706
MLNGC, MD, RN
Lymph Node Structure
· Most are kidney-shaped, less than 1 inch
long
· Cortex
·Outer part
·Contains follicles – collections of
lymphocytes
· Medulla
·Inner part
·Contains phagocytic macrophages
707
MLNGC, MD, RN
Lymph Node Structure
Figure 12.4
708
MLNGC, MD, RN
Flow of Lymph Through Nodes
· Lymph enters the convex side through

afferent lymphatic vessels
· Lymph flows through a number of
sinuses inside the node
· Lymph exits through efferent lymphatic
vessels
· Fewer efferent than afferent vessels
causes flow to be slowed
709
MLNGC, MD, RN
Other Lymphoid Organs
· Several other
organs contribute
to lymphatic
function
·Spleen
·Thymus
·Tonsils
·Peyer’s patches
Figure 12.5
710
MLNGC, MD, RN
The Spleen
· Located on the left side of the abdomen

· Filters blood
· Destroys worn out blood cells
· Forms blood cells in the fetus
· Acts as a blood reservoir
711
MLNGC, MD, RN
The Thymus
· Located low in the throat, overlying the

heart
· Functions at peak levels only during
childhood
· Produces hormones (like thymosin) to
program lymphocytes
712
MLNGC, MD, RN
Tonsils
· Small masses of lymphoid tissue

around the pharynx
· Trap and remove bacteria and other
foreign materials
· Tonsillitis is caused by congestion with
bacteria
713
MLNGC, MD, RN
Peyer’s Patches
· Found in the wall of the small intestine

· Resemble tonsils in structure
· Capture and destroy bacteria in the
intestine
714
MLNGC, MD, RN
Mucosa-Associated Lymphatic
Tissue (MALT)
· Includes:
·Peyer’s patches
·Tonsils
·Other small accumulations of lymphoid
tissue
· Acts as a sentinal to protect respiratory
and digestive tracts
715
MLNGC, MD, RN
Body Defenses
· The body is constantly in contact with
bacteria, fungi, and viruses
· The body has two defense systems for
foreign materials
·Nonspecific defense system
·Mechanisms protect against a variety of
invaders
·Responds immediately to protect body
from foreign materials
716
MLNGC, MD, RN
Body Defenses
·Specific defense system

·Specific defense is required for each type
of invader
·Also known as the immune system
717
MLNGC, MD, RN
Nonspecific Body Defenses
· Body surface coverings

·Intact skin
·Mucous membranes
· Specialized human cells
· Chemicals produced by the body
718
MLNGC, MD, RN
Surface Membrane Barriers –
First Line of Defense
· The skin
·Physical barrier to foreign materials
·pH of the skin is acidic to inhibit bacterial
growth
·Sebum is toxic to bacteria
·Vaginal secretions are very acidic
719
MLNGC, MD, RN
Surface Membrane Barriers –
First Line of Defense
· Stomach mucosa
·Secretes hydrochloric acid
·Has protein-digesting enzymes
· Saliva and lacrimal fluid contain
lysozyme
· Mucus traps microogranisms in
digestive and respiratory pathways
720
MLNGC, MD, RN
Defensive Cells
· Phagocytes
(neutrophils and
macrophages)
·Engulfs foreign
material into a
vacuole
·Enzymes from
lysosomes digest
the material
721
MLNGC, MD, RN12.6b
Figure
Defensive Cells
· Natural killer cells

·Can lyse and kill
cancer cells
·Can destroy virus-
infected cells
722
MLNGC, MD, RN12.6b
Figure
Inflammatory Response -
Second Line of Defense
· Triggered when body tissues are injured
· Produces four cardinal signs
·Redness
·Heat
·Swelling
·Pain
· Results in a chain of events leading to
protection and healing
723
MLNGC, MD, RN
Functions of the Inflammatory
Response
· Prevents spread of damaging agents

· Disposes of cell debris and pathogens
· Sets the stage for repair
724
MLNGC, MD, RN
Steps in the Inflammatory Response
Figure 12.7 725

MLNGC, MD, RN
Antimicrobial Chemicals
· Complement
·A group of at
least 20
plasma
proteins
·Activated when
they encounter
and attach to
cells
(complement
fixation) Figure 12.8
726
MLNGC, MD, RN
· Complement
(continued)
·Damage
foreign cell
surfaces
·Has
vasodilators,
chemotaxis,
and
opsonization
Figure 12.8
727
MLNGC, MD, RN
· Interferon
·Secreted proteins of virus-infected cells
·Bind to healthy cell surfaces to inhibit viruses
binding
728
MLNGC, MD, RN
Fever
· Abnormally high body temperature
· Hypothalmus heat regulation can be
reset by pyrogens (secreted by white
blood cells)
· High temperatures inhibit the release of
iron and zinc from liver and spleen
needed by bacteria
· Fever also increases the speed of
tissue repair
729
MLNGC, MD, RN
Specific Defense: The Immune
System – Third Line of Defense
· Antigen specific – recognizes and acts

against particular foreign substances
· Systemic – not restricted to the initial
infection site
· Has memory – recognizes and mounts
a stronger attack on previously
encountered pathogens
730
MLNGC, MD, RN
Types of Immunity
· Humoral immunity
·Antibody-mediated immunity
·Cells produce chemicals for defense
· Cellular immunity
·Cell-mediated immunity
·Cells target virus infected cells
731
MLNGC, MD, RN
Antigens (Nonself)
· Any substance capable of exciting the
immune system and provoking an immune
response
· Examples of common antigens
·Foreign proteins
·Nucleic acids
·Large carbohydrates
· Some lipids
·Pollen grains
·Microorganisms
732
MLNGC, MD, RN
Self-Antigens
· Human cells have many surface

proteins
· Our immune cells do not attack our own
proteins
· Our cells in another person’s body can
trigger an immune response because
they are foreign
·Restricts donors for transplants
733
MLNGC, MD, RN
Allergies
· Many small molecules (called haptens
or incomplete antigens) are not
antigenic, but link up with our own
proteins
· The immune system may recognize and
respond to a protein-hapten
combination
· The immune response is harmful rather
than protective because it attacks our
own cells
734
MLNGC, MD, RN
Cells of the Immune System
· Lymphocytes
·Originate from hemocytoblasts in the red bone
marrow
·B lymphocytes become immunocompetent in
the bone marrow
· T lymphocytes become immunocompetent in
the thymus
· Macrophages
· Arise from monocytes
· Become widely distributed in lymphoid organs
735
MLNGC, MD, RN
Activation of Lymphocytes
Figure 12.9
736
MLNGC, MD, RN
Humoral (Antibody-Mediated)
Immune Response
· B lymphocytes with specific receptors

bind to a specific antigen
· The binding event activates the
lymphocyte to undergo clonal selection
· A large number of clones are produced
(primary humoral response)
737
MLNGC, MD, RN
Humoral (Antibody Mediated)
Immune Response
· Most B cells become plasma cells

·Produce antibodies to destroy antigens
·Activity lasts for four or five days
· Some B cells become long-lived memory
cells (secondary humoral response)
738
MLNGC, MD, RN
Humoral Immune Response
Figure 12.10
739
MLNGC, MD, RN
Secondary Response
· Memory cells
are long-lived
· A second
exposure
causes a rapid
response
· The secondary
response is
stronger and
longer lasting
Figure 12.11
740
MLNGC, MD, RN
Active Immunity
· Your B cells
encounter
antigens and
produce
antibodies
· Active immunity
can be naturally
or artificially
acquired
Figure 12.12
741
MLNGC, MD, RN
Passive Immunity
· Antibodies are obtained from someone

else
·Conferred naturally from a mother to her
fetus
·Conferred artificially from immune serum or
gamma globulin
· Immunological memory does not occur
· Protection provided by “borrowed
antibodies”
742
MLNGC, MD, RN
Monoclonal Antibodies
· Antibodies prepared for clinical testing
or diagnostic services
· Produced from descendents of a single
cell line
· Examples of uses for monoclonal
antibodies
·Diagnosis of pregnancy
·Treatment after exposure to hepatitis and
rabies
743
MLNGC, MD, RN
Antibodies (Immunoglobulins) (Igs)
· Soluble proteins secreted by B cells

(plasma cells)
· Carried in blood plasma
· Capable of binding specifically to an
antigen
744
MLNGC, MD, RN
Antibody Structure
· Four amino acid

chains linked by
disulfide bonds
· Two identical
amino acid
chains are linked
to form a heavy
chain
745
MLNGC, MD, RN
Figure 12.13b
Antibody Structure
· The other two

identical chains
are light chains
· Specific antigen-
binding sites are
present
746
MLNGC, MD, RN
Figure 12.13b
Antibody Classes
· Antibodies of each class have slightly
different roles
· Five major immunoglobulin classes
·IgM – can fix complement
·IgA – found mainly in mucus
·IgD – important in activation of B cell
·IgG – can cross the placental barrier
·IgE – involved in allergies
747
MLNGC, MD, RN
Antibody Function
· Antibodies inactivate antigens in a

number of ways
·Complement fixation
·Neutralization
·Agglutination
·Precipitation
748
MLNGC, MD, RN
Antibody Function
Figure 12.14
749
MLNGC, MD, RN
Cellular (Cell-Mediated) Immune
Response
· Antigens must be presented by
macrophages to an immunocompetent
T cell (antigen presentation)
· T cells must recognize nonself and self
(double recognition)
· After antigen binding, clones form as
with B cells, but different classes of cells
are produced
750
MLNGC, MD, RN
Cellular (Cell-Mediated) Immune
Response
Figure 12.15
751
MLNGC, MD, RN
T Cell Clones
· Cytotoxic T cells
·Specialize in killing infected cells
·Insert a toxic chemical (perforin)
· Helper T cells
·Recruit other cells to fight the invaders
·Interact directly with B cells
752
MLNGC, MD, RN
T Cell Clones
· Suppressor T cells
·Release chemicals to suppress the activity
of T and B cells
·Stop the immune response to prevent
uncontrolled activity
· A few members of each clone are
memory cells
753
MLNGC, MD, RN
Summary of the Immune Response
Figure 12.16 754

MLNGC, MD, RN
Organ Transplants and Rejection
· Major types of grafts
·Autografts – tissue transplanted from one
site to another on the same person
·Isografts – tissue grafts from an identical
person (identical twin)
·Allografts – tissue taken from an unrelated
person
·Xenografts – tissue taken from a different
animal species
755
MLNGC, MD, RN
Organ Transplants and Rejection
· Autografts and isografts are ideal

donors
· Xenografts are never successful
· Allografts are more successful with a
closer tissue match
756
MLNGC, MD, RN
Disorders of Immunity: Allergies
(Hypersensitivity)
· Abnormal, vigorous immune responses
· Types of allergies
·Immediate hypersensitivity
·Triggered by release of histamine from IgE
binding to mast cells
·Reactions begin within seconds of contact with
allergen
·Anaphylactic shock – dangerous, systemic
response
757
MLNGC, MD, RN
Disorders of Immunity: Allergies
(Hypersensitivity)
· Types of allergies (continued)

·Delayed hypersensitivity
·Triggered by the release of lymphokines
from activated helper T cells
·Symptoms usually appear 1–3 days after
contact with antigen
758
MLNGC, MD, RN
Allergy Mechanisms
Figure 12.17
759
MLNGC, MD, RN
Disorders of Immunity:
Immunodeficiencies
· Production or function of immune cells

or complement is abnormal
· May be congenital or acquired
· Includes AIDS – Acquired Immune
Deficiency Syndrome
760
MLNGC, MD, RN
Autoimmune Diseases
· The immune system does not

distinguish between self and nonself
· The body produces antibodies and
sensitized T lymphocytes that attack its
own tissues
761
MLNGC, MD, RN
Autoimmune Diseases
· Examples of autoimmune diseases
·Multiple sclerosis – white matter of brain
and spinal cord are destroyed
·Myasthenia gravis – impairs
communication between nerves and
skeletal muscles
·Juvenile diabetes – destroys pancreatic
beta cells that produce insulin
·Rheumatoid arthritis – destroys joints
762
MLNGC, MD, RN
Autoimmune Diseases
· Examples of autoimmune diseases

(continued)
·Systemic lupus erythematosus (SLE) –
affects kidney, heart, lung and skin
·Glomerulonephritis – impairment of renal
function
763
MLNGC, MD, RN
Self Tolerance Breakdown
· Inefficient lymphocyte programming

· Appearance of self-proteins in the
circulation that have not been exposed
to the immune system
·Eggs
·Sperm
·Eye lens
764
MLNGC, MD, RN
Self Tolerance Breakdown
· Cross-reaction of antibodies produced

against foreign antigens with self-
antigens
·Rheumatic fever
765
MLNGC, MD, RN
Lymphatic System and Body
Defenses
· Except for thymus and spleen, the
lymphoid organs are poorly developed
before birth
· A newborn has no functioning
lymphocytes at birth; only passive
immunity from the mother
· If lymphatics are removed or lost, severe
edema results, but vessels grow back in
time 766
MLNGC, MD, RN
Chapter 15
The Respiratory System
Organs of the Respiratory system
· Nose
· Pharynx
· Larynx
· Trachea
· Bronchi
· Lungs –
alveoli
768
Function of the Respiratory System
· Oversees gas exchanges between the

blood and external environment
· Exchange of gasses takes place within
the lungs in the alveoli
· Passageways to the lungs purify, warm,
and humidify the incoming air
769
MLNGC, MD, RN
The Nose
· The only externally visible part of the

respiratory system
· Air enters the nose through the external
nares (nostrils)
· The interior of the nose consists of a
nasal cavity divided by a nasal septum
770
MLNGC, MD, RN
Upper Respiratory Tract
Figure 13.2
771
MLNGC, MD, RN
Anatomy of the Nasal Cavity
· Olfactory receptors are located in the

mucosa on the superior surface
· The rest of the cavity is lined with
respiratory mucosa
·Moistens air
·Traps incoming foreign particles
772
MLNGC, MD, RN
Anatomy of the Nasal Cavity
· Lateral walls have projections called
conchae
·Increases surface area
·Increases air turbulence within the nasal
cavity
· The nasal cavity is separated from the
oral cavity by the palate
·Anterior hard palate (bone)
·Posterior soft palate (muscle)
773
MLNGC, MD, RN
Paranasal Sinuses
· Cavities within bones surrounding the

nasal cavity
·Frontal bone
·Sphenoid bone
·Ethmoid bone
·Maxillary bone
774
MLNGC, MD, RN
Paranasal Sinuses
· Function of the sinuses

·Lighten the skull
·Act as resonance chambers for speech
·Produce mucus that drains into the nasal
cavity
775
MLNGC, MD, RN
Pharynx (Throat)
· Muscular passage from nasal cavity to
larynx
· Three regions of the pharynx
·Nasopharynx – superior region behind
nasal cavity
·Oropharynx – middle region behind mouth
·Laryngopharynx – inferior region attached
to larynx
· The oropharynx and laryngopharynx are
common passageways for air and food
776
MLNGC, MD, RN
Structures of the Pharynx
· Auditory tubes enter the nasopharynx

· Tonsils of the pharynx
·Pharyngeal tonsil (adenoids) in the
nasopharynx
·Palatine tonsils in the oropharynx
·Lingual tonsils at the base of the tongue
777
MLNGC, MD, RN
Larynx (Voice Box)
· Routes air and food into proper

channels
· Plays a role in speech
· Made of eight rigid hyaline cartilages
and a spoon-shaped flap of elastic
cartilage (epiglottis)
778
MLNGC, MD, RN
Structures of the Larynx
· Thyroid cartilage
·Largest hyaline cartilage
·Protrudes anteriorly (Adam’s apple)
· Epiglottis
·Superior opening of the larynx
·Routes food to the larynx and air toward
the trachea
779
MLNGC, MD, RN
Structures of the Larynx
· Vocal cords (vocal folds)

·Vibrate with expelled air to create sound
(speech)
· Glottis – opening between vocal cords
780
MLNGC, MD, RN
Trachea (Windpipe)
· Connects larynx with bronchi

· Lined with ciliated mucosa
·Beat continuously in the opposite direction of
incoming air
·Expel mucus loaded with dust and other
debris away from lungs
· Walls are reinforced with C-shaped
hyaline cartilage
781
MLNGC, MD, RN
Primary Bronchi
· Formed by division of the trachea

· Enters the lung at the hilus
(medial depression)
· Right bronchus is wider, shorter,
and straighter than left
· Bronchi subdivide into smaller
and smaller branches
782
MLNGC, MD, RN
Lungs
· Occupy most of the thoracic cavity

·Apex is near the clavicle (superior portion)
·Base rests on the diaphragm (inferior
portion)
·Each lung is divided into lobes by fissures
·Left lung – two lobes
·Right lung – three lobes
783
MLNGC, MD, RN
Lungs
Figure 13.4b
784
MLNGC, MD, RN
Coverings of the Lungs
· Pulmonary (visceral) pleura covers the

lung surface
· Parietal pleura lines the walls of the
thoracic cavity
· Pleural fluid fills the area between layers
of pleura to allow gliding
785
MLNGC, MD, RN
Respiratory Tree Divisions
· Primary bronchi
· Secondary bronchi
· Tertiary bronchi
· Bronchioli
· Terminal bronchioli
786
MLNGC, MD, RN
Bronchioles
· Smallest
branches of
the bronchi
Figure 13.5a
787
MLNGC, MD, RN
Bronchioles
· All but the smallest

branches have
reinforcing cartilage
Figure 13.5a
788
MLNGC, MD, RN
Bronchioles
· Terminal
bronchioles end
in alveoli
Figure 13.5a
789
MLNGC, MD, RN
Respiratory Zone
· Structures
·Respiratory bronchioli
·Alveolar duct
·Alveoli
· Site of gas exchange
790
MLNGC, MD, RN
Alveoli
· Structure of alveoli
·Alveolar duct
·Alveolar sac
·Alveolus
· Gas exchange takes place within the alveoli
in the respiratory membrane
791
MLNGC, MD, RN
Respiratory Membrane
(Air-Blood Barrier)
· Thin squamous epithelial layer lining

alveolar walls
· Pulmonary capillaries cover external
surfaces of alveoli
792
MLNGC, MD, RN
Respiratory Membrane
(Air-Blood Barrier)
Figure 13.6
793
MLNGC, MD, RN
Gas Exchange
· Gas crosses the respiratory membrane

by diffusion
·Oxygen enters the blood
·Carbon dioxide enters the alveoli
· Macrophages add protection
· Surfactant coats gas-exposed alveolar
surfaces
794
MLNGC, MD, RN
Events of Respiration
· Pulmonary ventilation – moving air in and

out of the lungs
· External respiration – gas exchange
between pulmonary blood and alveoli
795
MLNGC, MD, RN
Events of Respiration
· Respiratory gas transport – transport of

oxygen and carbon dioxide via the
bloodstream
· Internal respiration – gas exchange
between blood and tissue cells in
systemic capillaries
796
MLNGC, MD, RN
Mechanics of Breathing
(Pulmonary Ventilation)
· Completely mechanical process

· Depends on volume changes in the
thoracic cavity
· Volume changes lead to pressure
changes, which lead to the flow of
gases to equalize pressure
797
MLNGC, MD, RN
Mechanics of Breathing
(Pulmonary Ventilation)
· Two phases
·Inspiration – flow of air into lung
·Expiration – air leaving lung
798
MLNGC, MD, RN
Inspiration
· Diaphragm and intercostal muscles

contract
· The size of the thoracic cavity increases
· External air is pulled into the lungs due to
an increase in intrapulmonary volume
799
MLNGC, MD, RN
Inspiration
Figure 13.7a
800
MLNGC, MD, RN
Exhalation
· Largely a passive process which depends

on natural lung elasticity
· As muscles relax, air is pushed out of the
lungs
· Forced expiration can occur mostly by
contracting internal intercostal muscles to
depress the rib cage
801
MLNGC, MD, RN
Exhalation
Figure 13.7b
802
MLNGC, MD, RN
Pressure Differences in the
Thoracic Cavity
· Normal pressure within the pleural

space is always negative (intrapleural
pressure)
· Differences in lung and pleural space
pressures keep lungs from collapsing
803
MLNGC, MD, RN
Nonrespiratory Air Movements
· Can be caused by reflexes or voluntary
actions
· Examples
·Cough and sneeze – clears lungs of debris
·Laughing
·Crying
·Yawn
·Hiccup
804
MLNGC, MD, RN
Respiratory Volumes and Capacities
· Normal breathing moves about 500 ml of air
with each breath (tidal volume [TV])
· Many factors that affect respiratory capacity
·A person’s size
·Sex
·Age
·Physical condition
· Residual volume of air – after exhalation,
about 1200 ml of air remains in the lungs
805
MLNGC, MD, RN
· Inspiratory reserve volume (IRV)

·Amount of air that can be taken in forcibly
over the tidal volume
·Usually between 2100 and 3200 ml
· Expiratory reserve volume (ERV)
·Amount of air that can be forcibly exhaled
·Approximately 1200 ml
806
MLNGC, MD, RN
· Residual volume
·Air remaining in lung after expiration
·About 1200 ml
807
MLNGC, MD, RN
· Vital capacity
·The total amount of exchangeable air
·Vital capacity = TV + IRV + ERV
·Dead space volume
· Air that remains in conducting zone and
never reaches alveoli
· About 150 ml
808
MLNGC, MD, RN
· Functional volume
·Air that actually reaches the respiratory
zone
·Usually about 350 ml
· Respiratory capacities are measured
with a spirometer
809
MLNGC, MD, RN
Respiratory Capacities
Figure 13.9
810
MLNGC, MD, RN
Respiratory Sounds
· Sounds are monitored with a

stethoscope
· Bronchial sounds – produced by air
rushing through trachea and bronchi
· Vesicular breathing sounds – soft
sounds of air filling alveoli
811
MLNGC, MD, RN
External Respiration
· Oxygen movement into the blood

·The alveoli always has more oxygen than
the blood
·Oxygen moves by diffusion towards the
area of lower concentration
·Pulmonary capillary blood gains oxygen
812
MLNGC, MD, RN
External Respiration
· Carbon dioxide movement out of the

blood
·Blood returning from tissues has higher
concentrations of carbon dioxide than air in
the alveoli
·Pulmonary capillary blood gives up carbon
dioxide
· Blood leaving the lungs is oxygen-rich
and carbon dioxide-poor
813
MLNGC, MD, RN
Gas Transport in the Blood
· Oxygen transport in the blood

·Inside red blood cells attached to
hemoglobin (oxyhemoglobin [HbO2])
·A small amount is carried dissolved in the
plasma
814
MLNGC, MD, RN
Gas Transport in the Blood
· Carbon dioxide transport in the blood

·Most is transported in the plasma as
bicarbonate ion (HCO3–)
·A small amount is carried inside red blood
cells on hemoglobin, but at different binding
sites than those of oxygen
815
MLNGC, MD, RN
Internal Respiration
· Exchange of gases between blood and

body cells
· An opposite reaction to what occurs in
the lungs
·Carbon dioxide diffuses out of tissue to
blood
·Oxygen diffuses from blood into tissue
816
MLNGC, MD, RN
Figure 13.11
817
MLNGC, MD, RN
External Respiration,
Gas Transport, and
Summary
Figure 13.10
818
MLNGC, MD, RN
Neural Regulation of Respiration
· Activity of respiratory muscles is transmitted
to the brain by the phrenic and intercostal
nerves
· Neural centers that control rate and depth are
located in the medulla
· The pons appears to smooth out respiratory
rate
· Normal respiratory rate (eupnea) is 12–15
respirations per minute
· Hypernia is increased respiratory rate often
due to extra oxygen needs
819
MLNGC, MD, RN
Neural Regulation of Respiration
Figure 13.12 820

MLNGC, MD, RN
Factors Influencing Respiratory
Rate and Depth
· Physical factors
·Increased body temperature
·Exercise
·Talking
·Coughing
· Volition (conscious control)
· Emotional factors
821
MLNGC, MD, RN
Rate and Depth
· Chemical factors
·Carbon dioxide levels
·Level of carbon dioxide in the blood is the
main regulatory chemical for respiration
·Increased carbon dioxide increases
respiration
·Changes in carbon dioxide act directly on
the medulla oblongata
822
MLNGC, MD, RN
Rate and Depth
· Chemical factors (continued)

·Oxygen levels
·Changes in oxygen concentration in the
blood are detected by chemoreceptors in
the aorta and carotid artery
·Information is sent to the medulla oblongata
823
MLNGC, MD, RN
Respiratory Disorders: Chronic
Obstructive Pulmonary Disease
(COPD)
· Exemplified by chronic bronchitis and

emphysema
· Major causes of death and disability in
the United States
824
MLNGC, MD, RN
(COPD)
· Features of these diseases
·Patients almost always have a history of
smoking
·Labored breathing (dyspnea) becomes
progressively more severe
·Coughing and frequent pulmonary
infections are common
825
MLNGC, MD, RN
(COPD)
· Features of these diseases (continued)

·Most victimes retain carbon dioxide, are
hypoxic and have respiratory acidosis
·Those infected will ultimately develop
respiratory failure
826
MLNGC, MD, RN
Emphysema
· Alveoli enlarge as adjacent chambers break
through
· Chronic inflammation promotes lung fibrosis
· Airways collapse during expiration
· Patients use a large amount of energy to
exhale
· Overinflation of the lungs leads to a
permanently expanded barrel chest
· Cyanosis appears late in the disease
827
MLNGC, MD, RN
Chronic Bronchitis
· Mucosa of the lower respiratory
passages becomes severely inflamed
· Mucus production increases
· Pooled mucus impairs ventilation and
gas exchange
· Risk of lung infection increases
· Pneumonia is common
· Hypoxia and cyanosis occur early
828
MLNGC, MD, RN
Chronic Obstructive Pulmonary Disease
(COPD)
Figure 13.13
829
MLNGC, MD, RN
Lung Cancer
· Accounts for 1/3 of all cancer deaths in
the United States
· Increased incidence associated with
smoking
· Three common types
·Squamous cell carcinoma
·Adenocarcinoma
·Small cell carcinoma
830
MLNGC, MD, RN
Sudden Infant Death syndrome
(SIDS)
· Apparently healthy infant stops
breathing and dies during sleep
· Some cases are thought to be a
problem of the neural respiratory control
center
· One third of cases appear to be due to
heart rhythm abnormalities
831
MLNGC, MD, RN
Asthma
· Chronic inflamed hypersensitive

bronchiole passages
· Response to irritants with dyspnea,
coughing, and wheezing
832
MLNGC, MD, RN
Respiratory System
· Lungs are filled with fluid in the fetus

· Lungs are not fully inflated with air until
two weeks after birth
· Surfactant that lowers alveolar surface
tension is not present until late in fetal
development and may not be present in
premature babies
833
MLNGC, MD, RN
Respiratory System
· Important birth defects

·Cystic fibrosis – oversecretion of thick
mucus clogs the respiratory system
·Cleft palate
834
MLNGC, MD, RN
Aging Effects
· Elasticity of lungs decreases

· Vital capacity decreases
· Blood oxygen levels decrease
· Stimulating effects of carbon dioxide
decreases
· More risks of respiratory tract infection
835
MLNGC, MD, RN
Respiratory Rate Changes
Throughout Life
· Newborns – 40 to 80 respirations per
minute
· Infants – 30 respirations per minute
· Age 5 – 25 respirations per minute
· Adults – 12 to 18 respirations per
minute
· Rate often increases somewhat with old
age
836
MLNGC, MD, RN
Chapter 16
Digestive System
The Digestive System and Body
Metabolism
· Digestion
·Breakdown of ingested food
·Absorption of nutrients into the blood
· Metabolism
·Production of cellular energy (ATP)
·Constructive and degradative cellular
activities
838
MLNGC, MD, RN
Organs of the Digestive System
· Two main groups

· Alimentary canal – continuous coiled hollow
tube
· Accessory digestive organs
839
MLNGC, MD, RN
Organs of the Digestive System
Figure 14.1
840
MLNGC, MD, RN
Organs of the Alimentary Canal
· Mouth
· Pharynx
· Esophagus
· Stomach
· Small intestine
· Large intestine
· Anus
841
MLNGC, MD, RN
Mouth (Oral Cavity) Anatomy
· Lips (labia) – protect
the anterior opening
· Cheeks – form the
lateral walls
· Hard palate – forms
the anterior roof
· Soft palate – forms
the posterior roof
· Uvula – fleshy
projection of the Figure 14.2a
soft palate
842
MLNGC, MD, RN
· Vestibule – space
between lips
externally and teeth
and gums internally
· Oral cavity – area
contained by the
teeth
· Tongue – attached at
hyoid and styloid
processes of the
skull, and by the
lingual frenulum Figure 14.2a
843
MLNGC, MD, RN
· Tonsils
·Palatine tonsils
·Lingual tonsil
Figure 14.2a
844
MLNGC, MD, RN
Processes of the Mouth
· Mastication (chewing) of food

· Mixing masticated food with saliva
· Initiation of swallowing by the tongue
· Allowing for the sense of taste
845
MLNGC, MD, RN
Pharynx Anatomy
· Nasopharynx –
not part of the
digestive system
· Oropharynx –
posterior to oral
cavity
· Laryngopharynx –
below the oropharynx
and connected to
the esophagus
Figure 14.2a
846
MLNGC, MD, RN
Pharynx Function
· Serves as a passageway for air and
food
· Food is propelled to the esophagus by
two muscle layers
·Longitudinal inner layer
·Circular outer layer
· Food movement is by alternating
contractions of the muscle layers
(peristalsis)
847
MLNGC, MD, RN
Esophagus
· Runs from pharynx to stomach through

the diaphragm
· Conducts food by peristalsis
(slow rhythmic squeezing)
· Passageway for food only (respiratory
system branches off after the pharynx)
848
MLNGC, MD, RN
Layers of Alimentary Canal Organs
· Mucosa
·Innermost layer
·Moist membrane
·Surface epithelium
·Small amount of connective tissue
(lamina propria)
·Small smooth muscle layer
849
MLNGC, MD, RN
· Submucosa
·Just beneath the mucosa
·Soft connective tissue with blood vessels,
nerve endings, and lymphatics
850
MLNGC, MD, RN
· Muscularis externa – smooth muscle

·Inner circular layer
·Outer longitudinal layer
· Serosa
·Outermost layer – visceral peritoneum
·Layer of serous fluid-producing cells
851
MLNGC, MD, RN
Figure 14.3
852
MLNGC, MD, RN
Alimentary Canal Nerve Plexuses
· All are part of the autonomic nervous

system
· Three separate networks of nerve fibers
·Submucosal nerve plexus
·Myenteric nerve plexus
·Subserous plexus
853
MLNGC, MD, RN
Stomach Anatomy
· Located on the left side of the

abdominal cavity
· Food enters at the cardioesophageal
sphincter
854
MLNGC, MD, RN
Stomach Anatomy
· Regions of the stomach

·Cardiac region – near the heart
·Fundus
·Body
·Phylorus – funnel-shaped terminal end
· Food empties into the small intestine at
the pyloric sphincter
855
MLNGC, MD, RN
Stomach Anatomy
· Rugae – internal folds of the mucosa

· External regions
·Lesser curvature
·Greater curvature
856
MLNGC, MD, RN
Stomach Anatomy
· Layers of peritoneum attached to the

stomach
·Lesser omentum – attaches the liver to the
lesser curvature
·Greater omentum – attaches the greater
curvature to the posterior body wall
·Contains fat to insulate, cushion, and
protect abdominal organs
857
MLNGC, MD, RN
Stomach Anatomy
Figure 14.4a
858
MLNGC, MD, RN
Stomach Functions
· Acts as a storage tank for food

· Site of food breakdown
· Chemical breakdown of protein begins
· Delivers chyme (processed food) to the
small intestine
859
MLNGC, MD, RN
Specialized Mucosa of the
Stomach
· Simple columnar epithelium
·Mucous neck cells – produce a sticky
alkaline mucus
·Gastric glands – secrete gastric juice
·Chief cells – produce protein-digesting
enzymes (pepsinogens)
·Parietal cells – produce hydrochloric acid
·Endocrine cells – produce gastrin
860
MLNGC, MD, RN
Structure of the Stomach Mucosa
· Gastric pits formed by folded mucosa

· Glands and specialized cells are in the
gastric gland region
861
MLNGC, MD, RN
Structure of the Stomach Mucosa
Figure 14.4b, c
862
MLNGC, MD, RN
Small Intestine
· The body’s major digestive organ

· Site of nutrient absorption into the blood
· Muscular tube extending form the
pyloric sphincter to the ileocecal valve
· Suspended from the posterior
abdominal wall by the mesentery
863
MLNGC, MD, RN
Subdivisions of the Small Intestine
· Duodenum
·Attached to the stomach
·Curves around the head of the pancreas
· Jejunum
·Attaches anteriorly to the duodenum
· Ileum
·Extends from jejunum to large intestine
864
MLNGC, MD, RN
Chemical Digestion in the Small
Intestine
· Source of enzymes that are mixed with

chyme
·Intestinal cells
·Pancreas
· Bile enters from the gall bladder
865
MLNGC, MD, RN
Chemical Digestion in the Small
Intestine
Figure 14.6
866
MLNGC, MD, RN
Villi of the Small Intestine
· Fingerlike
structures formed
by the mucosa
· Give the small
intestine more
surface area
Figure 14.7a
867
MLNGC, MD, RN
Microvilli of the Small Intestine
· Small projections of the

plasma membrane
· Found on absorptive cells
Figure 14.7c
868
MLNGC, MD, RN
Structures Involved in Absorption of
Nutrients
· Absorptive cells
· Blood capillaries
· Lacteals (specialized
lymphatic capillaries)
Figure 14.7b
869
MLNGC, MD, RN
Folds of the Small Intestine
· Called circular folds or plicae circulares

· Deep folds of the mucosa and
submucosa
· Do not disappear when filled with food
· The submucosa has Peyer’s patches
(collections of lymphatic tissue)
870
MLNGC, MD, RN
Large Intestine
· Larger in diameter, but shorter than the

small intestine
· Frames the internal abdomen
871
MLNGC, MD, RN
Large Intestine
Figure 14.8
872
MLNGC, MD, RN
Functions of the Large Intestine
· Absorption of water
· Eliminates indigestible food from the
body as feces
· Does not participate in digestion of food
· Goblet cells produce mucus to act as a
lubricant
873
MLNGC, MD, RN
Structures of the Large Intestine
· Cecum – saclike first part of the large

intestine
· Appendix
·Accumulation of lymphatic tissue that
sometimes becomes inflamed
(appendicitis)
·Hangs from the cecum
874
MLNGC, MD, RN
Structures of the Large Intestine
· Colon
·Ascending
·Transverse
·Descending
·S-shaped sigmoidal
· Rectum
· Anus – external body opening
875
MLNGC, MD, RN
Modifications to the Muscularis
Externa in the Large Intestine
· Smooth muscle is reduced to three

bands (teniae coli)
· Muscle bands have some degree of
tone
· Walls are formed into pocketlike sacs
called haustra
876
MLNGC, MD, RN
Accessory Digestive Organs
· Salivary glands
· Teeth
· Pancreas
· Liver
· Gall bladder
877
MLNGC, MD, RN
Salivary Glands
· Saliva-producing glands
·Parotid glands – located anterior to ears
·Submandibular glands
·Sublingual glands
878
MLNGC, MD, RN
Saliva
· Mixture of mucus and serous fluids

· Helps to form a food bolus
· Contains salivary amylase to begin
starch digestion
· Dissolves chemicals so they can be
tasted
879
MLNGC, MD, RN
Teeth
· The role is to masticate (chew) food

· Humans have two sets of teeth
·Deciduous (baby or milk) teeth
·20 teeth are fully formed by age two
880
MLNGC, MD, RN
Teeth
· Permanent teeth
·Replace deciduous teeth beginning
between the ages of 6 to 12
·A full set is 32 teeth, but some people do
not have wisdom teeth
881
MLNGC, MD, RN
Classification of Teeth
· Incisors
· Canines
· Premolars
· Molars
882
MLNGC, MD, RN
Classification of Teeth
Figure 14.9
883
MLNGC, MD, RN
Regions of a Tooth
· Crown – exposed
part
· Outer enamel
· Dentin
· Pulp cavity
· Neck
·Region in contact
with the gum
·Connects crown to
root
884
Regions of a Tooth
· Root
·Periodontal
membrane
attached to the
bone
·Root canal carrying
blood vessels and
nerves
885
Pancreas
· Produces a wide spectrum of digestive
enzymes that break down all categories of food
· Enzymes are secreted into the duodenum
· Alkaline fluid introduced with enzymes
neutralizes acidic chyme
· Endocrine products of pancreas
·Insulin
·Glucagons
886
MLNGC, MD, RN
Liver
· Largest gland in the body
· Located on the right side of the body
under the diaphragm
· Consists of four lobes suspended from
the diaphragm and abdominal wall by
the falciform ligament
· Connected to the gall bladder via the
common hepatic duct
887
MLNGC, MD, RN
Bile
· Produced by cells in the liver

· Composition
·Bile salts
·Bile pigment (mostly bilirubin from the
breakdown of hemoglobin)
·Cholesterol
·Phospholipids
·Electrolytes
888
MLNGC, MD, RN
Gall Bladder
· Sac found in hollow fossa of liver

· Stores bile from the liver by way of the
cystic duct
· Bile is introduced into the duodenum in
the presence of fatty food
· Gallstones can cause blockages
889
MLNGC, MD, RN
Chapter 17
Nutrition, Metabolism
and Body Temperature
Processes of the Digestive System
· Ingestion – getting food into the mouth

· Propulsion – moving foods from one
region of the digestive system to
another
891
MLNGC, MD, RN
·Peristalsis – alternating
waves of contraction
·Segmentation – moving
materials back and forth
to aid in mixing
Figure 14.12 892

MLNGC, MD, RN
· Mechanical digestion
·Mixing of food in the mouth by the tongue
·Churning of food in the stomach
·Segmentation in the small intestine
893
MLNGC, MD, RN
· Chemical Digestion
·Enzymes break down food molecules into
their building blocks
·Each major food group uses different
enzymes
·Carbohydrates are broken to simple sugars
·Proteins are broken to amino acids
·Fats are broken to fatty acids and alcohols
894
MLNGC, MD, RN
· Absorption
·End products of digestion are absorbed in
the blood or lymph
·Food must enter mucosal cells and then
into blood or lymph capillaries
· Defecation
·Elimination of indigestible substances as
feces
895
MLNGC, MD, RN
Figure 14.11 896

MLNGC, MD, RN
Control of Digestive Activity
· Mostly controlled by reflexes via the

parasympathetic division
· Chemical and mechanical receptors are
located in organ walls that trigger
reflexes
897
MLNGC, MD, RN
Control of Digestive Activity
· Stimuli include:
·Stretch of the organ
·pH of the contents
·Presence of breakdown products
· Reflexes include:
·Activation or inhibition of glandular
secretions
·Smooth muscle activity
898
MLNGC, MD, RN
Digestive Activities of the Mouth
· Mechanical breakdown
·Food is physically broken down by chewing
· Chemical digestion
·Food is mixed with saliva
·Breaking of starch into maltose by salivary
amylase
899
MLNGC, MD, RN
Activities of the Pharynx and
Esophagus
· These organs have no digestive function

· Serve as passageways to the stomach
900
MLNGC, MD, RN
Deglutition (Swallowing)
· Buccal phase
·Voluntary
·Occurs in the mouth
·Food is formed into a bolus
·The bolus is forced into the pharynx by the
tongue
901
MLNGC, MD, RN
· Pharyngeal-esophageal phase
·Involuntary transport of the bolus
·All passageways except to the stomach are
blocked
·Tongue blocks off the mouth
·Soft palate (uvula) blocks the
nasopharynx
·Epiglottis blocks the larynx
902
MLNGC, MD, RN
· Pharyngeal-esophogeal phase
(continued)
·Peristalsis moves the bolus toward the
stomach
·The cardioesophageal sphincter is opened
when food presses against it
903
MLNGC,
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings MD, RN
Figure 14.13
904
MLNGC,
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings MD, RN
Food Breakdown in the Stomach
· Gastric juice is regulated by neural and

hormonal factors
· Presence of food or falling pH causes
the release of gastrin
· Gastrin causes stomach glands to
produce protein-digesting enzymes
· Hydrocholoric acid makes the stomach
contents very acidic
905
MLNGC, MD, RN
Necessity of an Extremely Acid
Environment in the Stomach
· Activates pepsinogen to pepsin for

protein digestion
· Provides a hostile environment for
microorganisms
906
MLNGC, MD, RN
Digestion and Absorption in the
Stomach
· Protein digestion enzymes

·Pepsin – an active protein digesting
enzyme
·Rennin – works on digesting milk protein
· The only absorption that occurs in the
stomach is of alcohol and aspirin
907
MLNGC, MD, RN
Propulsion in the Stomach
· Food must first be well mixed
· Rippling peristalsis occurs in the lower
stomach
Figure 14.14
908
MLNGC, MD, RN
Propulsion in the Stomach
· The pylorus meters out chyme into the
small intestine (30 ml at a time)
· The stomach empties in four to six
hours
Figure 14.14
909
MLNGC, MD, RN
Digestion in the Small Intestine
· Enzymes from the brush border
·Break double sugars into simple sugars
·Complete some protein digestion
· Pancreatic enzymes play the major
digestive function
·Help complete digestion of starch
(pancreatic amylase)
·Carry out about half of all protein digestion
(trypsin, etc.)
910
MLNGC, MD, RN
Digestion in the Small Intestine
· Pancreatic enzymes play the major

digestive function (continued)
·Responsible for fat digestion (lipase)
·Digest nucleic acids (nucleases)
·Alkaline content neutralizes acidic chyme
911
MLNGC, MD, RN
Stimulation of the Release of
Pancreatic Juice
· Vagus nerve
· Local hormones
·Secretin
·Cholecystokinin
912
MLNGC,Figure
MD, 14.15
RN
Absorption in the Small Intestine
· Water is absorbed along the length of
the small intestine
· End products of digestion
·Most substances are absorbed by active
transport through cell membranes
·Lipids are absorbed by diffusion
· Substances are transported to the liver
by the hepatic portal vein or lymph
913
MLNGC, MD, RN
Propulsion in the Small Intestine
· Peristalsis is the major means of

moving food
· Segmental movements
·Mix chyme with digestive juices
·Aid in propelling food
914
MLNGC, MD, RN
Food Breakdown and Absorption in
the Large Intestine
· No digestive enzymes are produced
· Resident bacteria digest remaining
nutrients
·Produce some vitamin K and B
·Release gases
· Water and vitamins K and B are absorbed
· Remaining materials are eliminated via
feces
915
MLNGC, MD, RN
Propulsion in the Large Intestine
· Sluggish peristalsis
· Mass movements
·Slow, powerful movements
·Occur three to four times per day
· Presence of feces in the rectum causes
a defecation reflex
·Internal anal sphincter is relaxed
·Defecation occurs with relaxation of the
voluntary (external) anal sphincter
916
MLNGC, MD, RN
Nutrition
· Nutrient – substance used by the body
for growth, maintenance, and repair
· Categories of nutrients
·Carbohydrates
·Lipids
·Proteins
·Vitamins
·Mineral
·Water
917
MLNGC, MD, RN
Dietary Sources of Major Nutrients
· Carbohydrates
·Most are derived from plants
·Exceptions: lactose from milk and small
amounts of glycogens from meats
· Lipids
·Saturated fats from animal products
·Unsaturated fats from nuts, seeds, and
vegetable oils
·Cholesterol from egg yolk, meats, and milk
products
918
MLNGC, MD, RN
· Proteins
·Complete proteins – contain all essential
amino acids
·Most are from animal products
·Legumes and beans also have proteins,
but are incomplete
· Vitamins
·Most vitamins are used as cofactors and
act with enzymes
·Found in all major food groups
919
MLNGC, MD, RN
· Minerals
·Play many roles in the body
·Most mineral-rich foods are vegetables,
legumes, milk, and some meats
920
MLNGC, MD, RN
Metabolism
· Chemical reactions necessary to

maintain life
·Catabolism – substances are broken down
to simpler substances
·Anabolism – larger molecules are built from
smaller ones
·Energy is released during catabolism
921
MLNGC, MD, RN
Carbohydrate Metabolism
· The body’s preferred source to produce

cellular energy (ATP)
· Glucose (blood sugar) is the major
breakdown product and fuel to make
ATP
Figure 14.16
922
MLNGC, MD, RN
Cellular Respiration
· Oxygen-using events take place within the
cell to create ATP from ADP
· Carbon leaves cells as carbon dioxide (CO2)
· Hydrogen atoms are combined with oxygen
to form water
· Energy produced by these reactions adds a
phosphorus to ADP to produce ATP
· ATP can be broken down to release energy
for cellular use
923
MLNGC, MD, RN
Metabolic Pathways Involved in
· Glycolysis – energizes a glucose

molecule so that it can be split into two
pyruvic acid molecules and yield ATP
924
MLNGC, MD, RN
Figure 14.17
925
MLNGC, MD, RN
· Krebs cycle
·Produces virtually all the carbon dioxide
and water resulting from cell respiration
·Yields a small amount of ATP
926
MLNGC, MD, RN
· Electron transport chain
·Hydrogen atoms
removed during
glycolysis and
the Krebs cycle
are delivered to
protein carriers
Figure 14.18 927

MLNGC, MD, RN
· Electron transport chain (continued)
·Hydrogen is
split into
hydrogen ions
and electrons
in the
mitochondria
Figure 14.18 928

MLNGC, MD, RN
· Electron transport chain (continued)
·Electrons give
off energy in a
series of steps
to enable the
production of
ATP
Figure 14.18 929

MLNGC, MD, RN
Fat Metabolism
· Handled mostly by the liver

·Use some fats to make ATP
·Synthesize lipoproteins, thromboplastin,
and cholesterol
·Release breakdown products to the blood
· Body cells remove fat and cholesterol to
build membranes and steroid hormones
930
MLNGC, MD, RN
Use of Fats for ATP Synthesis
· Fats must first be broken down to acetic

acid
· Within mitochondira, acetic acid is
completely oxidized to produce water,
carbon dioxide, and ATP
931
MLNGC, MD, RN
Protein Metabolism
· Proteins are conserved by body cells

because they are used for most cellular
structures
· Ingested proteins are broken down to
amino acids
932
MLNGC, MD, RN
Protein Metabolism
· Cells remove amino acids to build

proteins
·Synthesized proteins are actively
transported across cell membranes
· Amino acids are used to make ATP only
when proteins are overabundant or
there is a shortage of other sources
933
MLNGC, MD, RN
Production of ATP from Protein
· Amine groups are removed from

proteins as ammonia
· The rest of the protein molecule enters
the Krebs cycle in mitochondria
· The liver converts harmful ammonia to
urea which can be eliminated in urine
934
MLNGC, MD, RN
Role of the Liver in Metabolism
· Several roles in digestion

· Detoxifies drugs and alcohol
· Degrades hormones
· Produce cholesterol, blood proteins
(albumin and clotting proteins)
· Plays a central role in metabolism
935
MLNGC, MD, RN
Metabolic Functions of the Liver
· Glycogenesis
·Glucose molecules are converted to
glycogen
·Glycogen molecules are stored in the liver
· Glycogenolysis
·Glucose is released from the liver after
conversion from glycogen
· Gluconeogenesis
·Glucose is produced from fats and proteins
936
MLNGC, MD, RN
Figure 14.20
937
MLNGC, MD, RN
· Fats and fatty acids are picked up by

the liver
·Some are oxidized to provide energy for
liver cells
·The rest are broken down into simpler
compounds and released into the blood
938
MLNGC, MD, RN
Cholesterol Metabolism
· Functions of cholesterol
·Serves as a structural basis of steroid
hormones and vitamin D
·Is a major building block of plasma
membranes
· Most cholesterol is produced in the liver
and is not from diet
939
MLNGC, MD, RN
Cholesterol Transport
· Cholesterol and fatty acids cannot freely

circulate in the bloodstream
· They are transported by lipoproteins
(lipid-protein complexes)
·Low-density lipoproteins (LDLs) transport to
body cells
·High-density lilpoproteins (HDLs) transport
from body cells to the liver
940
MLNGC, MD, RN
Body Energy Balance
· Energy intake = total energy output

(heat + work + energy storage)
·Energy intake is liberated during food
oxidation
·Energy output
·Heat is usually about 60%
·Storage energy is in the form of fat or
glycogen
941
MLNGC, MD, RN
Regulation of Food Intake
· Body weight is usually relatively stable
·Energy intake and output remain about
equal
· Mechanisms that may regulate food
intake
·Levels of nutrients in the blood
·Hormones
·Body temperature
·Psychological factors
942
MLNGC, MD, RN
Metabolic Rate and Body Heat
Production
· Basic metabolic rate (BMR) – amount of

heat produced by the body per unit of
time at rest
· Factors that influence BMR
·Surface area – small body usually has
higher BMR
·Gender – males tend to have higher BMR
943
MLNGC, MD, RN
Metabolic Rate and Body Heat
Production
· Factors that influence BMR (continued)

·Age – children and adolescents have a
higher BMR
·The amount of thyroxine produced is the
most important control factor
·More thyroxine means higher metabolic
rate
944
MLNGC, MD, RN
Total Metabolic Rate (TMR)
· Total amount of kilocalories the body

must consume to fuel ongoing activities
· TMR increases with an increase in body
activity
· TMR must equal calories consumed to
maintain homeostasis and maintain a
constant weight
945
MLNGC, MD, RN
Body Temperature Regulation
· Most energy is released as foods are

oxidized
· Most energy escapes as heat
946
MLNGC, MD, RN
Body Temperature Regulation
· The body has a narrow range of

homeostatic temperature
·Must remain between 35.6° to 37.8°C
(96° to 100° F)
·The body’s thermostat is in the
hypothalamus
·Initiates heat-loss or heat-promoting
mechanisms
947
MLNGC, MD, RN
Heat Promoting Mechanisms
· Vasoconstriction of blood vessels

·Blood is rerouted to deeper, more vital body
organs
· Shivering – contraction of muscles
produces heat
948
MLNGC, MD, RN
Heat Loss Mechanisms
· Heat loss from the skin via radiation and

evaporation
·Skin blood vessels and capillaries are
flushed with warm blood
·Evaporation of perspiration cools the skin
949
MLNGC, MD, RN
Body
Temperature
Regulation
Figure 14.21
950
MLNGC, MD, RN
Digestive System
· The alimentary canal is a continuous tube
by the fifth week of development
· Digestive glands bud from the mucosa of
the alimentary tube
· The developing fetus receives all
nutrients through the placenta
· In newborns, feeding must be frequent,
peristalsis is inefficient, and vomiting is
common
951
MLNGC, MD, RN
Digestive System
· Teething begins around age six months

· Metabolism decreases with old age
· Middle age digestive problems
·Ulcers
·Gall bladder problems
952
MLNGC, MD, RN
Digestive System
· Activity of digestive tract in old age

·Fewer digestive juices
·Peristalsis slows
·Diverticulosis and cancer are more
common
953
MLNGC, MD, RN
Chapter 18
Urinary System
and Fluid Balance
Functions of the Urinary System
· Elimination of waste products

·Nitrogenous wastes
·Toxins
·Drugs
955
MLNGC, MD, RN
Functions of the Urinary System
· Regulate aspects of homeostasis

·Water balance
·Electrolytes
·Acid-base balance in the blood
·Blood pressure
·Red blood cell production
·Activation of vitamin D
956
MLNGC, MD, RN
Organs of the Urinary system
· Kidneys
· Ureters
· Urinary bladder
· Urethra
Figure 15.1a 957

MLNGC, MD, RN
Location of the Kidneys
· Against the dorsal body wall

· At the level of T12 to L3
· The right kidney is slightly lower than
the left
· Attached to ureters, renal blood vessels,
and nerves at renal hilus
· Atop each kidney is an adrenal gland
958
MLNGC, MD, RN
Coverings of the Kidneys
· Renal capsule
·Surrounds each kidney
· Adipose capsule
·Surrounds the kidney
·Provides protection to the kidney
·Helps keep the kidney in its correct location
959
MLNGC, MD, RN
Regions of the Kidney
· Renal cortex –
outer region
· Renal medulla –
inside the cortex
· Renal pelvis –
inner collecting
tube
960
Kidney Structures
· Medullary pyramids – triangular regions

of tissue in the medulla
· Renal columns – extensions of cortex-
like material inward
· Calyces – cup-shaped structures that
funnel urine towards the renal pelvis
961
MLNGC, MD, RN
Blood Flow in the Kidneys
Figure 15.2c
962
MLNGC, MD, RN
Nephrons
· The structural and functional units of the

kidneys
· Responsible for forming urine
· Main structures of the nephrons
·Glomerulus
·Renal tubule
963
MLNGC, MD, RN
Glomerulus
· A specialized
capillary bed
· Attached to
arterioles on both
sides (maintains
high pressure)
·Large afferent
arteriole
·Narrow efferent
arteriole
Figure 15.3c
964
MLNGC, MD, RN
Glomerulus
· Capillaries are
covered with
podocytes from
the renal tubule
· The glomerulus
sits within a
glomerular capsule
(the first part of the
renal tubule) Figure 15.3c
965
MLNGC, MD, RN
Renal Tubule
· Glomerular
(Bowman’s)
capsule
· Proximal
convoluted
tubule
· Loop of Henle
· Distal
convoluted
tubule
966
Types of Nephrons
· Cortical nephrons
·Located entirely in the cortex
·Includes most nephrons
Figure 15.3a 967

MLNGC, MD, RN
Types of Nephrons
· Juxtamedullary nephrons
·Found at the boundary of the cortex and
medulla
Figure 15.3a 968

MLNGC, MD, RN
Peritubular Capillaries
· Arise from efferent arteriole of the

glomerulus
· Normal, low pressure capillaries
· Attached to a venule
· Cling close to the renal tubule
· Reabsorb (reclaim) some substances
from collecting tubes
969
MLNGC, MD, RN
Urine Formation Processes
· Filtration
· Reabsorption
· Secretion
Figure 15.4
970
MLNGC, MD, RN
Filtration
· Nonselective passive process

· Water and solutes smaller than proteins
are forced through capillary walls
· Blood cells cannot pass out to the
capillaries
· Filtrate is collected in the glomerular
capsule and leaves via the renal tubule
971
MLNGC, MD, RN
Reabsorption
· The peritubular capillaries reabsorb several
materials
· Some water
· Glucose
· Amino acids
·Ions
· Some reabsorption is passive, most is active
· Most reabsorption occurs in the proximal
convoluted tubule
972
MLNGC, MD, RN
Materials Not Reabsorbed
· Nitrogenous waste products

·Urea
·Uric acid
·Creatinine
· Excess water
973
MLNGC, MD, RN
Secretion – Reabsorption in
Reverse
· Some materials move from the
peritubular capillaries into the renal
tubules
·Hydrogen and potassium ions
·Creatinine
· Materials left in the renal tubule move
toward the ureter
974
MLNGC, MD, RN
Formation of Urine
Figure 15.5 975

MLNGC, MD, RN
Characteristics of Urine Used for
Medical Diagnosis
· Colored somewhat yellow due to the
pigment urochrome (from the
destruction of hemoglobin) and solutes
· Sterile
· Slightly aromatic
· Normal pH of around 6
· Specific gravity of 1.001 to 1.035
976
MLNGC, MD, RN
Ureters
· Slender tubes attaching the kidney to

the bladder
·Continuous with the renal pelvis
·Enter the posterior aspect of the bladder
· Runs behind the peritoneum
· Peristalsis aids gravity in urine transport
977
MLNGC, MD, RN
Urinary Bladder
· Smooth, collapsible, muscular sac
· Temporarily stores urine
Figure 15.6 978

MLNGC, MD, RN
Urinary Bladder
· Trigone – three openings
·Two from the ureters
·One to the urethrea
Figure 15.6 979

MLNGC, MD, RN
Urinary Bladder Wall
· Three layers of smooth muscle

(detrusor muscle)
· Mucosa made of transitional epithelium
· Walls are thick and folded in an empty
bladder
· Bladder can expand significantly without
increasing internal pressure
980
MLNGC, MD, RN
Urethra
· Thin-walled tube that carries urine from

the bladder to the outside of the body by
peristalsis
· Release of urine is controlled by two
sphincters
·Internal urethral sphincter (involuntary)
·External urethral sphincter (voluntary)
981
MLNGC, MD, RN
Urethra Gender Differences
· Length
·Females – 3–4 cm (1 inch)
·Males – 20 cm (8 inches)
· Location
·Females – along wall of the vagina
·Males – through the prostate and penis
982
MLNGC, MD, RN
Urethra Gender Differences
· Function
·Females – only carries urine
·Males – carries urine and is a passageway
for sperm cells
983
MLNGC, MD, RN
Micturition (Voiding)
· Both sphincter muscles must open to

allow voiding
·The internal urethral sphincter is relaxed
after stretching of the bladder
·Activation is from an impulse sent to the
spinal cord and then back via the pelvic
splanchnic nerves
·The external urethral sphincter must be
voluntarily relaxed
984
MLNGC, MD, RN
Maintaining Water Balance
· Normal amount of water in the human
body
·Young adult females – 50%
·Young adult males – 60%
·Babies – 75%
·Old age – 45%
· Water is necessary for many body
functions and levels must be maintained
985
MLNGC, MD, RN
Distribution of Body Fluid
· Intracellular fluid
(inside cells)
· Extracellular
fluid (outside
cells)
·Interstitial fluid
·Blood plasma
Figure 15.7
986
MLNGC, MD, RN
The Link Between Water and Salt
· Changes in electrolyte balance causes

water to move from one compartment to
another
·Alters blood volume and blood pressure
·Can impair the activity of cells
987
MLNGC, MD, RN
· Water intake must equal water output
· Sources for water intake
·Ingested foods and fluids
· Water produced from metabolic processes
· Sources for water output
· Vaporization out of the lungs
· Lost in perspiration
· Leaves the body in the feces
· Urine production
988
MLNGC, MD, RN
· Dilute urine is produced if water intake

is excessive
· Less urine (concentrated) is produced if
large amounts of water are lost
· Proper concentrations of various
electrolytes must be present
989
MLNGC, MD, RN
Regulation of Water and Electrolyte
Reabsorption
· Regulation is primarily by hormones
·Antidiuretic hormone (ADH) prevents
excessive water loss in urine
·Aldosterone regulates sodium ion content of
extracellular fluid
· Triggered by the rennin-angiotensin
mechanism
· Cells in the kidneys and hypothalamus
are active monitors
990
MLNGC, MD, RN
Maintaining Water and Electrolyte
Balance
Figure 15.9
991
MLNGC, MD, RN
Maintaining Acid-Base Balance in
Blood
· Blood pH must remain between 7.35

and 7.45 to maintain homeostasis
·Alkalosis – pH above 7.45
·Acidosis – pH below 7.35
· Most ions originate as byproducts of
cellular metabolism
992
MLNGC, MD, RN
Maintaining Acid-Base Balance in
Blood
· Most acid-base balance is maintained

by the kidneys
· Other acid-base controlling systems
·Blood buffers
·Respiration
993
MLNGC, MD, RN
Blood Buffers
· Molecules react to prevent dramatic
changes in hydrogen ion (H+)
concentrations
·Bind to H+ when pH drops
·Release H+ when pH rises
· Three major chemical buffer systems
·Bicarbonate buffer system
·Phosphate buffer system
·Protein buffer system
994
MLNGC, MD, RN
The Bicarbonate Buffer System
· Mixture of carbonic acid (H2CO3) and

sodium bicarbonate (NaHCO3)
· Bicarbonate ions (HCO3–) react with
strong acids to change them to weak
acids
· Carbonic acid dissociates in the presence
of a strong base to form a weak base and
water 995
MLNGC, MD, RN
Respiratory System Controls of
Acid-Base Balance
· Carbon dioxide in the blood is converted to
bicarbonate ion and transported in the
plasma
· Increases in hydrogen ion concentration
produces more carbonic acid
· Excess hydrogen ion can be blown off with
the release of carbon dioxide from the lungs
· Respiratory rate can rise and fall depending
on changing blood pH
996
MLNGC, MD, RN
Renal Mechanisms of Acid-Base
Balance
· Excrete bicarbonate ions if needed

· Conserve or generate new bicarbonate
ions if needed
· Urine pH varies from 4.5 to 8.0
997
MLNGC, MD, RN
Urinary System
· Functional kidneys are developed by the

third month
· Urinary system of a newborn
·Bladder is small
·Urine cannot be concentrated
998
MLNGC, MD, RN
Urinary System
· Control of the voluntary urethral

sphincter does not start until age 18
months
· Urinary infections are the only common
problems before old age
999
MLNGC, MD, RN
Aging and the Urinary System
· There is a progressive decline in urinary

function
· The bladder shrinks with aging
· Urinary retention is common in males
1000
MLNGC, MD, RN
Chapter 19
Reproductive System
The Reproductive System
· Gonads – primary sex organs

·Testes in males
·Ovaries in females
· Gonads produce gametes (sex cells) and
secrete hormones
·Sperm – male gametes
·Ova (eggs) – female gametes
1002
MLNGC, MD, RN
Male Reproductive System
· Testes
· Duct system
·Epididymis
·Ductus deferens
·Urethra
1003
MLNGC, MD, RN
· Accessory organs
·Seminal vesicle
·Prostate gland
·Bulbourethral gland
· External genitalia
·Penis
·Scrotum
1004
MLNGC, MD, RN
Figure 16.2
1005
MLNGC, MD, RN
Testes
· Coverings of
the testes
·Tunica
albuginea –
capsule that
surrounds
each testis
Figure 16.1
1006
MLNGC, MD, RN
Testes
· Coverings of
the testes
(continued)
·Septa –
extensions of
the capsule that
extend into the
testis and divide
it into lobules
Figure 16.1
1007
MLNGC, MD, RN
Testes
· Each lobule contains one to four
seminiferous tubules
·Tightly coiled structures
·Function as sperm-forming factories
·Empty sperm into the rete testis
· Sperm travels through the rete testis to
the epididymis
· Interstitial cells produce androgens such
as testosterone
1008
MLNGC, MD, RN lide 16.4
Epididymis
· Comma-shaped, tightly coiled tube

· Found on the superior part of the testis
and along the posterior lateral side
· Functions to mature and store sperm
cells (at least 20 days)
· Expels sperm with the contraction of
muscles in the epididymis walls to the
vas deferens
1009
MLNGC, MD, RN
Ductus Deferens (Vas Deferens)
· Carries sperm from the epididymis to the

ejaculatory duct
· Passes through the inguinal canal and
over the bladder
· Moves sperm by peristalsis
· Spermatic cord – ductus deferens, blood
vessels, and nerves in a connective
tissue sheath
1010
MLNGC, MD, RN
Ductus Deferens (Vas Deferens)
· Ends in the ejaculatory duct which

unites with the urethra
· Vasectomy – cutting of the ductus
deferens at the level of the testes to
prevent transportation of sperm
1011
MLNGC, MD, RN
Urethra
· Extends from the base of the urinary

bladder to the tip of the penis
· Carries both urine and sperm
· Sperm enters from the ejaculatory duct
1012
MLNGC, MD, RN
Urethra
· Regions of the urethra

·Prostatic urethra –surrounded by
prostate
·Membranous urethra – from prostatic
urethra to penis
·Spongy (penile) urethra – runs the
length of the penis
1013
MLNGC, MD, RN
Seminal Vesicles
· Located at the base of the bladder

· Produces a thick, yellowish secretion
(60% of semen)
·Fructose (sugar)
·Vitamin C
·Prostaglandins
·Other substances that nourish and activate
sperm
1014
MLNGC, MD, RN
Prostate Gland
· Encircles the upper part of the urethra

· Secretes a milky fluid
·Helps to activate sperm
·Enters the urethra through several small
ducts
1015
MLNGC, MD, RN
Bulbourethral Glands
· Pea-sized gland inferior to the prostate

· Produces a thick, clear mucus
·Cleanses the urethra of acidic urine
·Serves as a lubricant during sexual
intercourse
·Secreted into the penile urethra
1016
MLNGC, MD, RN
Semen
· Mixture of sperm and accessory gland
secretions
· Advantages of accessory gland
secretions
·Fructose provides energy for sperm cells
·Alkalinity of semen helps neutralize the
acidic environment of vagina
·Semen inhibits bacterial multiplication
·Elements of semen enhance sperm motility
1017
MLNGC, MD, RN
External Genitalia
· Scrotum
·Divided sac of skin outside the abdomen
·Maintains testes at 3°C lower than normal
body temperature to protect sperm viability
1018
MLNGC, MD, RN
External Genitalia
· Penis
·Delivers sperm into the female reproductive
tract
·Regions of the penis
·Shaft
·Glans penis (enlarged tip)
·Prepuce (foreskin)
·Folded cuff of skin around proximal end
·Often removed by circumcision
1019
MLNGC, MD, RN
External Genitalia
· Internally there are three areas of spongy

erectile tissue around the urethra
1020
MLNGC, MD, RN
Spermatogenesis
· Production of sperm cells

· Begins at puberty and continues
throughout life
· Occurs in the seminiferous tubules
1021
MLNGC, MD, RN
Processes of Spermatogenesis
· Spermatogonia (stem cells) undergo

rapid mitosis to produce more stem cells
before puberty
· Follicle stimulating hormone (FSH)
modifies spermatogonia division
·One cell produced is a stem cell
·The other cell produced becomes a
primary spermatocyte
1022
MLNGC, MD, RN
· Primary spermatocytes undergo meiosis

· Haploid spermatids are produced
1023
MLNGC, MD, RN
· Spermiogenesis
·Late spermatids are produced with distinct
regions
· Head – contains DNA covered by the
acrosome
· Midpiece
· Tail
·Sperm cells result after maturing of
spermatids
· Spermatogenesis takes 64 to 72 days
1024
MLNGC, MD, RN
Processes of
Spermatogenesis
Figure 16.3
1025
MLNGC, MD, RN
Anatomy of a Mature Sperm Cell
· The only
human
flagellated cell
· DNA is found
in the head
Figure 16.5
1026
MLNGC, MD, RN
Testosterone Production
· The most important hormone of the testes

· Produced in interstitial cells
1027
MLNGC, MD, RN
Testosterone Production
· Functions of testosterone
·Stimulates reproductive organ development
·Underlies sex drive
·Causes secondary sex characteristics
·Deepening of voice
·Increased hair growth
·Enlargement of skeletal muscles
·Thickening of bones
1028
MLNGC, MD, RN
Regulation
of Male
Androgens
(Sex
Hormones)
Figure 16.6
1029
MLNGC, MD, RN
Female Reproductive System
· Ovaries
· Duct System
·Uterine tubes (fallopian tubes)
·Uterus
·Vagina
· External genitalia
1030
MLNGC, MD, RN
Female Reproductive System
Figure 16.8a
1031
MLNGC, MD, RN
Ovaries
· Composed
of ovarian
follicles
(sac-like
structures)
· Structure of
an ovarian
follicle
·Oocyte
·Follicular cells Figure 16.7
1032
MLNGC, MD, RN
Ovarian Follicle Stages
· Primary follicle – contains an immature
oocyte
· Graafian (vesicular) follicle – growing
follicle with a maturing oocyte
· Ovulation – when the egg is mature the
follicle ruptures
·Occurs about every 28 days
· The ruptured follicle is transformed into a
corpus luteum
1033
MLNGC, MD, RN
Support for Ovaries
· Suspensory ligaments – secure ovary to

lateral walls of the pelvis
· Ovarian ligaments – attach to uterus
· Broad ligament – a fold of the
peritoneum, encloses suspensory
ligament
1034
MLNGC, MD, RN
Support for Ovaries
Figure 16.8b
1035
MLNGC, MD, RN
Uterine (Fallopian) Tubes
· Receive the ovulated oocyte

· Provide a site for fertilization
· Attaches to the uterus
· Does not physically attach to the ovary
· Supported by the broad ligament
1036
MLNGC, MD, RN
Uterine Tube Function
· Fimbriae – finger-like projections at the

distal end that receive the oocyte
· Cilia inside the uterine tube slowly move
the oocyte towards the uterus
(takes 3–4 days)
· Fertilization occurs inside the uterine
tube
1037
MLNGC, MD, RN
Uterus
· Located between the urinary bladder

and rectum
· Hollow organ
· Functions of the uterus
·Receives a fertilized egg
·Retains the fertilized egg
·Nourishes the fertilized egg
1038
MLNGC, MD, RN
Support for the Uterus
· Broad ligament – attached to the pelvis

· Round ligament – anchored interiorly
· Uterosacral ligaments – anchored
posteriorly
1039
MLNGC, MD, RN
Support for the Uterus
Figure 16.8b
1040
MLNGC, MD, RN
Regions of the Uterus
· Body – main portion

· Fundus – area where uterine tube
enters
· Cervix – narrow outlet that protrudes
into the vagina
1041
MLNGC, MD, RN
Walls of the Uterus
· Endometrium
·Inner layer
·Allows for implantation of a fertilized egg
·Sloughs off if no pregnancy occurs
(menses)
· Myometrium – middle layer of smooth
muscle
· Serous layer – outer visceral
peritoneum
1042
MLNGC, MD, RN
Vagina
· Extends from cervix to exterior of body

· Behind bladder and in front of rectum
· Serves as the birth canal
· Receives the penis during sexual
intercourse
· Hymen – partially closes the vagina until
it is ruptured
1043
MLNGC, MD, RN
External Genitalia (Vulva)
· Mons pubis
·Fatty area
overlying the
pubic symphysis
·Covered with
pubic hair after
puberty
Figure 16.9
1044
MLNGC, MD, RN
External Genitalia (Vulva)
· Labia – skin folds

·Labia majora
·Labia minora
Figure 16.9
1045
MLNGC, MD, RN
External Genitalia
· Vestibule
·Enclosed by labia majora
·Contains opening of the urethra and the
greater vestibular glands (produce mucus)
· Clitoris
·Contains erectile tissue
·Corresponds to the male penis
1046
MLNGC, MD, RN
Oogenesis
· The total supply of eggs are present at

birth
· Ability to release eggs begins at puberty
· Reproductive ability ends at menopause
· Oocytes are matured in developing
ovarian follicles
1047
MLNGC, MD, RN
Oogenesis
· Oogonia – female stem cells found in a

developing fetus
· Oogonia undergo mitosis to produce
primary oocytes
· Primary oocytes are surrounded by cells
that form primary follicles in the ovary
· Oogonia no longer exist by the time of
birth
1048
MLNGC, MD, RN
Oogenesis
· Primary oocytes are inactive until puberty
· Follicle stimulating hormone (FSH)
causes some primary follicles to mature
·Meiosis starts inside maturing follicle
·Produces a secondary oocyte and the first
polar body
·Meiosis is completed after ovulation only if
sperm penetrates
·Two additional polar bodies are produced
1049
MLNGC, MD, RN
Oogenesis
Figure 16.10
1050
MLNGC, MD, RN
Menstrual (Uterine) Cycle
· Cyclic changes of the endometrium
· Regulated by cyclic production of
estrogens and progesterone
· Stages of the menstrual cycle
·Menses – functional layer of the
endometrium is sloughed
·Proliferative stage – regeneration of
functional layer
·Secretory stage – endometrium increases
in size and readies for implantation
1051
MLNGC, MD, RN
Hormonal Control of the Ovarian and
Uterine Cycles
Figure 16.12a, b
1052
MLNGC, MD, RN
Hormonal Control of the Ovarian and
Uterine Cycles
Figure 16.12c, d
1053
MLNGC, MD, RN
Hormone Production by the
Ovaries
· Estrogens
·Produced by follicle cells
·Cause secondary sex characteristics
· Enlargement of accessory organs
· Development of breasts
· Appearance of pubic hair
· Increase in fat beneath the skin
· Widening and lightening of the pelvis
· Onset of menses MLNGC, MD, RN
1054
Hormone Production by the
Ovaries
· Progesterone
·Produced by the corpus luteum
·Production continues until LH diminishes in
the blood
·Helps maintain pregnancy
1055
MLNGC, MD, RN
Mammary Glands
· Present in both sexes, but only function

in females
·Modified sweat glands
· Function is to produce milk
· Stimulated by sex hormones (mostly
estrogens) to increase in size
1056
MLNGC, MD, RN
Anatomy of Mammary Glands
· Areola – central pigmented area
· Nipple – protruding central area of
areola
· Lobes – internal structures that radiate
around nipple
· Alveolar glands – clusters of milk
producing glands within lobules
· Lactiferous ducts – connect alveolar
glands to nipple
1057
MLNGC, MD, RN
Thank you.
REFERENCES
• Essentials of Anatomy and Physiology
- Seeley, Stephens and Tate
• Essentials of Anatomy and Physiology
- Valerie Scanlon and Tina Sanders
• Essentials of Human Anatomy and Physiology
- Elaine Marieb
• Pearson Education, Inc. Publishing
Benjamin Cummings
1059
MLNGC, MD, RN

Anatomy and Physiology

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Anatomy and Physiology

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“Dispel from your mind the

thought that an understanding

• Anatomy – study of the structure and

• Maintenance of a stable internal

• The body communicates through neural

• Special terminology is used to prevent

Table 1.1 (cont)

· Carry out all chemical activities needed

· Material outside the nucleus and inside

· Not found in all cells

· Membrane Transport – movement of

· The plasma membrane allows some

Passive Active 115

- high to low concentration

· Gene – DNA segment that carries a

· Gene – DNA segment that carries a

· Found in different areas

· 1. Number of cell layers

capillaries MLNGC, MD, RN

· Found everywhere in the body

· Variations in blood supply

joint (jaw) MLNGC, MD, RN

· Function is to produce movement

than one nucleusMLNGC, MD, RN 181

by serous fluid MLNGC, MD, RN

· Cells divide more slowly as people age.

· Skin (cutaneous membrane)

· 1. Protects deeper tissues from:

· Pigment (melanin) produced by

· Infections and allergies

·Way to determine the extent of burns

· Burns are considered critical if:

· Support of the body

· Epiphyseal plates allow for growth of

· Bones are remodeled and lengthened

Hip (pelvic) girdle

· Forms the longitudinal part of the body

Figure 5.6 271

· Two sets of bones

· The only bone that

· The fetal skull is

· Composed of two bones

Figure 5.21a, b 298

Figure 5.21c 299

Figure 5.23b 303

· The thigh has

· The leg has

· Bones of the foot

· Synarthroses – immovable joints

· Articular cartilage (hyaline cartilage)

· At birth, the skull bones are incomplete

· Muscles are responsible for all types of

· Irritability – ability to receive and

· Sodium rushing into the cell generates

· Tetanus (summing of contractions)

· Muscle force depends upon the number

· Initially, muscles used stored ATP for

· Some fibers are contracted even in a

· Results of increased muscle use

· Direction of muscle fibers

· Location of the muscle

Figure 6.18c 386

Figure 6.19 387

· Sensory input – gathering information