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Epithelium: Types of simple epithelium

Squamous

Squamous means scale-like.

simple squamous epithelium is a single layer of flat

scale-shaped cells.

Both the endothelial lining(lapisan) of blood vessels

and the mesothelial lining(lapisan) of the body
cavities(rongga) are simple squamous
epithelium. Vein simple squamous epithelium.

Cuboidal

Lines small ducts, tubules.

It can have an excretory, secretory or absortive function - i.e. in salivary glands.

This image opposite is of ducts in the kidney, which are lined by simple cuboidal epithelium.

Simple Cuboidal
Virtual slides: Thyroid gland and Kidney

Thyroid follicles Renal tubules

Kidney - distal and collecting tubule. (Stain - Haematoxylin Eosin)

Columnar
This picture shows columnar cells from the stomach. A few of the cells are outlined, to help
you identify them.

This is a single layer of cells, and the cells are all tall columnar.

Tall columnar epithelium lines the ducts of many exocrine glands.

Simple Columnar
Virtual slides: Fallopian tube-isthmus and Duodenum
Duodenum (Stain - Haematoxylin Eosin) Ileum (Stain - Haematoxylin Eosin)

This type of epithelium is adapted for secretion and/or absorption, and can also be protective.
Simple secretory columnar epithelium lines(melapisi) the stomach and uterine cervix.The
simple columnar epithelium that lines the intestine also contains a few goblet cells.
In histological slides of pseudostratified epithelium, it looks as though some of the cells are
not in contact with the basal lamina, and the nuclei are at different levels. So it looks as
though there is more than one layer of cells.

However EM shows that all the cells contact the basal lamina, so this is a 'simple' epithelium.
But it is called pseudostratified, because of its appearance.

Pseudostratified ciliated columnar epithelium containing goblet cells lines most of the major
airways.
Pseudostratified Columnar
This type is categorized as simple because all the epithelial cells make contact with the basement
membrane, but not all cells reach the surface of the epithelium.
Virtual slides: Epididymis and Trachea
Epididymis

Trachea
Stratified Epithelium
Stratified Squamous Non-Keratinising
Virtual slides: Tongue-Foliate papillae and Cervix of uterus/vaginal canal

Stratified Squamous Keratinising

Virtual slide: Skin
See more in the Skin histology notes section below.

Stratified Cuboidal / Stratified Columnar

Virtual slides: Skin and Submandibular Gland
Parotid gland epithelium is an example of a stratified columnar epithelium.

Transitional
Located only in the urinary system, this epithelium is composed of 5 or more cell layers. Those located
basally are either low columnar or cuboidal.
Virtual slides: Urinary bladder (relaxed) and Urinary bladder (partly distended)
Glands are classified as :
ENDOCRINE and EXOCRINE depending on their route of secretion
ENDOCRINE GLANDS
Secretory products
called hormones, are
secreted directly into
the blood

No ducts

Exocrine glands can be classified according to the

A) Number of cells
Uni- or multicellular
B) Mode of secretion
holocrine, apocrine, merocrine
D) Shape
tubular, alveolar (acinar), tubuloalveolar

C) Secretory products
mucous and serous
releasetheir products onto the free surface of the skin or
mucous membranes

mucouos membranes of tubular organs of the digestive,
respiratory or reproductive tracts.
Classification according to the number of the cells
1. Unicellular
2. Multicellular
A.) simple (one unbranched duct)- sweat gland
B.) compound (branched ducts) parotid gland

Unicellular glands
They are scattered among other
non-secretory epithelial cells
They have no ducts, but they

secrete their products directly on

the free surface
The most common unicellular

exocrine glands are the goblet

cells (mucus secreting cells)
Multicellular glands

a) intraepithelial gland
gland is entirely within the epithelium.

b) extraepithelial gland
below epithelium

Multicellular endoepithelial glands

In the epithelium of the

male urethra

Modes of Secretion
(how products leave the cell)
1)merocrine

- secretion does not affect the well-being of the cell

sweat glands, salivary glands, pancreas etc.

apocrine

- small part of the cell cytoplasm is lost with the secretion;

mammary glands

3)holocrine

- great deal of cytoplasm is lost with the secretion; the cell

dies. sebaceous glands
 MEROCRINE SECRETION

Sero-mucous gland (submandibular gland)

APOCRINE SECRETION

mammary gland
HOLOCRINE SECRETION

SEBACEAUOS GLAND

Composition of the secretum

A) mucous B) serous C) sero-mucous D) lipid

B) Mucous gland

- basally located nuclei

- viscous secretory product

- well-seen, wide lumen

- pale-stained, foamy citoplasm with H.E.

 Esophagus

Serous glands

- centrally located nucleus

- basophil
Salivary gland HE
cytoplasm
- narrow lumen
- protein-reach
fluidy secretum
 Exocrine pancreas HE

Mixed sero-mucous gland

nn
 j

Bowstring Sign is
often used to apply
pressure on the sciatic
nerve and reproduce
radicular pain,
indicating lumbar root
compression or sciatic
nerve tension
(sciatica).
Procedure
1. Patient supine(telentang),
examiner (pemeriksa)
flexes patient’s hip with
knee slightly flexed;
examiner then applies
pressure with thumbs on
hamstring muscles
2. If no pain is elicited,
examiner then proceeds to
apply pressure to the popliteal fossa (traction on the sciatic nerve).
3. Patient is instructed to repeat motion of touching toes.
Interpretation
Bowstring Sign can be used to differentiate between radiculopathy, sciatica and local
muscular and/or ligamentous sprain(keseleo).
Positive Bowstring Sign
There are two signs to show a positive Bowstring test.

1. Leg pain: Radiculopathy, interventricular foramen encroachment(gangguan), space-

occupying lesion, nerve root tension(ketegangan), sciatica
2. Local Back(nyeri punggung) or Hamstring Pain: Consider local muscle strain or
ligamentous sprain

Examiner flexes patient’s hip with knee slightly flexed. Exam then applied pressure on
hamstrings muscles & then the popliteal fossa. The Bowstring sign is used to evaluate for
lumbar disc herniation. After a positive straight leg raise, slightly flex the knee and apply pressure
to the Tibial Nerve in the patient’s popliteal fossa. The test is positive if this reproduces the
patient’s sciatic pain.

The bulbocavernosus reflex (BCR), bulbospongiosus reflex (BSR) or "Osinski reflex" is a

polysynaptic reflex that is useful in testing for spinal shock and gaining information about the
state of spinal cord injuries (SCI).[1] Bulbocavernosus is an older term for bulbospongiosus,
thus this reflex may also be referred to as the bulbospongiosus reflex. Procedure
 The test involves
monitoring(pemantauan)
internal/external anal sphincter
contraction in response to
squeezing(tekanan) the glans penis
or clitoris, or tugging(menarik) on
an indwelling( yg ada dalam tubuh)
Foley catheter.[1] This reflex can
also be tested
electrophysiologically, by
stimulating the penis or vulva and
recording from the anal sphincter.
This test modality is used in
intraoperative neurophysiology
monitoring to verify function of
sensory and motor sacral roots as
well as the conus medullaris.[2]

Refeks Fisologis

Refleks Fisiologis adalah reflex regang otot (muscle stretch reflex) yang muncul
sebagai akibat rangsangan terhadap tendon atau periosteum atau kadang - kadang terhadap
tulang, sendi, fasia atau aponeurosis. Refleks yang muncul pada orang normal disebut sebagai
refleks fisiologis. Kerusakan pada sistem syaraf dapat menimbulkan refleks yang seharusnya
tidak terjadi atau refleks patologis. Keadaan inilah yang dapat dimanfaatkan praktisi agar dapat
mengetahui ada atau tidaknya kelainan sistem syaraf dari refleks.
Pemeriksaan reflek fisiologis merupakan satu kesatuan dengan pemeriksaan neurologi
lainnya, dan terutama dilakukan pada kasus-kasus mudah lelah, sulit berjalan,
kelemahan/kelumpuhan, kesemutan, nyeri otot anggota gerak, gangguan trofi otot anggota
gerak, nyeri punggung/pinggang gangguan fungsi otonom. Interpretasi pemeriksaan refleks
fisiologis tidak hanya menentukan ada/tidaknya tapi juga tingkatannya.
A. Dasar pemeriksaan refleks

1. Pemeriksaan menggunakan alat refleks hammer

2. Penderita harus berada dalam posisi rileks dan santai. Bagian tubuh yang akan diperiksa harus
dalam posisi sedemikian rupa sehingga gerakan otot yang nantinya akan terjadi dapat muncul
secara optimal
3. Rangsangan harus diberikan secara cepat dan langsung;keras pukulan harus dalam batas nilai
ambang, tidak perlu terlalu keras
4. Oleh karena sifat reaksi tergantung pada tonus otot, maka otot yang diperiksa harus dalam
keadaan sedikit kontraksi.
B. Jenis Refleks fisiologis

1. Refleks Biceps (BPR) : ketukan pada jari pemeriksa yang ditempatkan pada tendon
m.biceps brachii, posisi lengan setengah diketuk pada sendi siku. Respon : fleksi lengan pada
sendi siku.
2. Refleks Triceps (TPR) : ketukan pada tendon otot triceps, posisi lengan fleksi pada sendi
siku dan sedikit pronasi. Respon : ekstensi lengan bawah pada sendi siku.
3. Refleks Periosto Radialis : ketukan pada periosteum ujung distal os symmetric posisi
lengan setengah fleksi dan sedikit pronasi. Respon : fleksi lengan bawah di sendi siku dan
supinasi karena kontraksi m.brachiradialis.
4. Refleks Periostoulnaris : ketukan pada periosteum prosesus styloid ilna, posisi lengan
setengah fleksi dan antara pronasi supinasi. Respon : pronasi tangan akibat kontraksi
m.pronator quadrates.
5. Refleks Patela (KPR) : ketukan pada tendon patella dengan hammer. Respon : plantar
fleksi longlegs karena kontraksi m.quadrises femoris.
6. Refleks Achilles (APR) : ketukan pada tendon achilles. Respon : plantar fleksi longlegs
karena kontraksi m.gastroenemius.
7. Refleks Klonus Lutut : pegang dan dorong os patella ke arah distal. Respon : kontraksi
reflektorik m.quadrisep femoris selama stimulus berlangsung.
8. Refleks Klonus Kaki : dorsofleksikan longlegs secara maksimal, posisi tungkai fleksi di sendi
lutut. Respon : kontraksi reflektorik otot betis selama stimulus berlangsung.
9. Reflek kornea : Dengan cara menyentuhkan kapas pada limbus, hasil positif bila mengedip
(N IV & VII )
10. Reflek faring : Faring digores dengan spatel, reaksi positif bila ada reaksi muntahan ( N IX
&X)
11. Reflek Abdominal : Menggoreskan dinidng perut dari lateral ke umbilicus, hasil negative
pada orang tua, wanita multi para, obesitas, hasil positif bila terdapat reaksi otot.
12. Reflek Kremaster : Menggoreskan paha bagian dalam bawah, positif bila skrotum sisi yang
sama naik / kontriksi ( L 1-2 )
13. Reflek Anal : Menggores kulit anal, positif bila ada kontraksi spincter ani ( S 3-4-5 )
14. Reflek Bulbo Cavernosus : Tekan gland penis tiba-tiba jari yang lain masukkan kedalam
anus, positif bila kontraksi spincter ani (S3-4 / saraf spinal )
15. Reflek Moro : Refleks memeluk pada bayi saat dikejutkan dengan tangan
16. Reflek Babinski : Goreskan ujung reflak hammer pada lateral telapak kaki mengarah ke
jari, hasil positif pada bayi normal sedangkan pada orang dewasa abnormal ( jari kaki
meregang / aduksi ektensi )
17. Sucking reflek : Reflek menghisap pada bayi
18. Grasping reflek : Reflek memegang pada bayi
19. Rooting reflek : Bayi menoleh saat tangan ditempelkan ke sisi pipi.
Refleks Patologis

Refleks patologis merupakan respon yang tidak umum dijumpai pada individu normal. Refleks
patologis pada ekstemitas bawah lebih konstan, lebih mudah muncul, lebih reliable dan lebih
mempunyai korelasi secara klinis dibandingkan pada ekstremitas atas.

A. Dasar pemeriksaan refleks

1. Selain dengan jari - jari tangan untuk pemeriksaan reflex ekstremitas atas,bisa juga dengan
menggunakan reflex hammer.
2. Pasien harus dalam posisi enak dan santai
3. Rangsangan harus diberikan dengan cepat dan langsung

B. Jenis Refleks Patologis

 Jenis Refleks Patologis Untuk Ekstremitas Superior adalah sebagai berikut :
1. Refleks Tromner
Cara: pada jari tengah gores pada bagian dalam
+ : bila fleksi empat jari yang lain
2. Refleks Hoffman
Cara : pada kuku jari tengah digoreskan
+ : bila fleksi empat jari yang lain
3. Leri : fleksi maksimal tangan pada pergelangan tangan, sikap lengan diluruskan dengan
bagian ventral menghadap ke atas. Respon : tidak terjadi fleksi di sendi siku.
4. Mayer : fleksi maksimal jari tengah pasien ke arah telapak tangan. Respon : tidak terjadi
oposisi ibu jari.
 Jenis RefleksPatologis Untuk Ekstremitas Inferior adalah sebagai berikut :
1. Babinski : gores telapak kaki di lateral dari bawah ke atas ==> + bila dorsofleksi ibu jari,
dan abduksi ke lateral empat jari lain
2. 2. Chaddok : gores bagian bawah malleolus medial ==> + sama dengan babinski
3. Oppenheim : gores dengan dua sendi interfalang jari tengah dan jari telunjung di sepanjang
os tibia/cruris==> + sama dgn babinski
4. Gordon : pencet/ remas m.gastrocnemeus/ betis dengan keras==> + sama dengan babinski
5. Schaeffer : pencet/ remas tendo achilles ==> + sama dengan babinski
6. Gonda : fleksi-kan jari ke 4 secara maksimal, lalu lepas ==> + sama dengan babinski
7. Bing : tusuk jari kaki ke lima pada metacarpal/ pangkal ==> + sama dengan babinski
8. Stransky : penekukan (lateral) jari longlegs ke-5. Respon : seperti babinsky.
9. Rossolimo : pengetukan ada telapak kaki. Respon : fleksi jari-jari longlegs pada sendi
interfalangeal.
10. Mendel-Beckhterew : pengetukan dorsum pedis pada daerah os coboideum. Respon :
seperti rossolimo.

Indikasi CT Scan
Berikut ini contoh penerapan metode CT scan pada sejumlah organ tubuh, di
antaranya adalah:

 Dada, untuk melihat adanya infeksi, emboli paru, kanker paru,

penyebaran kanker dari organ lain ke daerah dada, atau masalah pada
jantung, kerongkongan (esofagus), dan pembuluh darah besar (aorta).
 Perut, untuk mendeteksi terjadinya infeksi, kista, abses, tumor,
perdarahan, aneurisma, benda asing, dan pembesaran kelenjar getah bening,
atau melihat adanya divertikulitisserta radang usus buntu.
 Saluran kemih, untuk mendeteksi adanya infeksi di dalam saluran
kemih, batu ginjal, batu kandung kemih, penyakit terkait lainnya.
 Panggul, untuk mendeteksi adanya gangguan pada rahim, indung telur,
saluran tuba, atau kelenjar prostat.
 Tungkai atau lengan, misalnya untuk melihat kondisi lengan, bahu, siku,
pergelangan tangan, tangan, paha, tungkai, lutut, pergelangan kaki, atau kaki.
 Kepala, untuk melihat tumor dan infeksi, atau perdarahan dan keretakan
tulang tengkorak setelah cedera kepala.
 Tulang belakang, untuk melihat struktur dan celah tulang belakang, serta
melihat keadaan saraf tulang belakang.
Indikasi MRI
Pencitraan MRI dapat dilakukan pada sejumlah organ tubuh guna mendeteksi
kondisi tertentu, misalnya:

 Otak dan saraf tulang belakang, untuk mendeteksi cedera kepala,

kanker, stroke, kerusakan pembuluh darah pada otak, cedera saraf tulang
belakang, tumor, kelainan pada mata atau telinga bagian dalam,
serta multiple sclerosis.
 Jantung dan pembuluh darah, untuk mendeteksi gangguan aliran darah
atau peradangan pada pembuluh darah, penyakit jantung, kerusakan jantung
pasca serangan jantung, kelainan struktur aorta seperti diseksi
atau aneurisma aorta, serta kelainan struktur organ jantung yang meliputi
ukuran dan fungsi bilik jantung, ketebalan dan pergerakan dinding jantung.
 Tulang dan sendi, untuk mendeteksi infeksi tulang, kanker tulang, dan
cedera sendi.

Selain organ tersebut, MRI juga bisa dilakukan pada organ tubuh lainnya, seperti
payudara, rahim dan indung telur, hati, saluran empedu, limpa, ginjal, pankreas, atau
prostat.
Untuk kasus tertentu, seperti penyakit epilepsi, tumor otak, dan stroke, dapat
dilakukan tes bernama functional magnetic resonance imaging (fMRI), yaitu melihat
gambaran keadaan otak dan aliran darah otak saat penderita melakukan kegiatan.
Kalau MRI itu untuk melihat (tubuh, red) sampai ke sel, sedangkan CT scan hanya
mengamati anatomi kasarnya. Kondisi yang dapat diperiksa dengan MRI di
antaranya tumor atau perubahan pada otak yang mengarah ke indikasi pikun,
sedangkan CT Scan lebih banyak dipergunakan untuk mengecek ada tidaknya
pendarahan atau benturan.

Indications for when to get an MRI scan include:

After 4 to 6 weeks of leg pain, if the pain is severe enough to warrant surgery
After 3 to 6 months of low back pain, if the pain is severe enough to warrant surgery
If the back pain is accompanied by constitutional symptoms (such as loss of appetite, weight
loss, fever, chills, shakes, or severe pain when at rest) that may indicate that the pain is due to
a tumor or an infection
For patients who may have lumbar spinal stenosis and are considering an epidural injection to
alleviate painful symptoms
For patients who have not done well after having back surgery, specifically if their pain
symptoms do not get better after 4 to 6 weeks.

MR imaging is performed to:

assess spinal anatomy and alignment.

detect congenital anomalies of vertebrae or the spinal cord.
detect bone, disc, ligament or spinal cord injury after spine trauma.
assess intervertebral disk disease (degenerated, bulging or herniated) and intervertebral joint
disease, both frequent causes of severe lower back pain and sciatica (back pain radiating into
lower leg).
explore other possible causes of back pain (compression fracture or bone swelling, such as
edema).
assess compression of spinal cord and nerves.
assess inflammation of the spinal cord or nerves.
assess infection involving the spine, disks and spinal contents including spinal cord or its
coverings (meninges).
assess tumors that arise from or have spread to the vertebrae, spinal cord, nerves or the
surrounding soft tissues.
help plan spinal surgical procedures, such as decompression of a pinched nerve, spinal
fusion, or the injection of steroids to relieve spinal pain. Such injections are usually...
CT scanning of the spine is also performed to:

assess spine fractures due to injury.

evaluate the spine before and after surgery.
help diagnose spinal pain. One of the most common causes of spinal pain that may be
diagnosed by CT is a herniated intervertebral disk. Occasionally, this diagnosis is made using
CT myelography.
accurately measure bone density in the spine and predict whether vertebral fractures are
likely to occur in patients who are at risk of osteoporosis.
assess for congenital anomalies of the spine or scoliosis.
detect various types of tumors in the vertebral column, including those that have spread there
from another area of the body. Some tumors that arise elsewhere are first identified by
finding deposits of malignant cells (metastases) in the vertebrae; prostate cancer is an
example.
guide diagnostic procedures such as the biopsy of a suspicious area to detect cancer, or the
removal of fluid from a localized infection (abscess).

the steps in the mechanism of muscle contraction

1. A Muscle Contraction Is Triggered When an

Action Potential Travels Along the Nerves to the
Muscles
Muscle contraction begins when the nervous system generates a signal. The
signal, an impulse called an action potential, travels through a type of nerve
cell called a motor neuron. The neuromuscular junction is the name of the
place where the motor neuron reaches a muscle cell. Skeletal muscle tissue is
composed of cells called muscle fibers. When the nervous system signal
reaches the neuromuscular junction a chemical message is released by the
motor neuron. The chemical message, a neurotransmitter called acetylcholine,
binds to receptors on the outside of the muscle fiber. That starts a chemical
reaction within the muscle.
2. Acetylcholine Is Released and Binds to Receptors
on the Muscle Membrane
A multistep molecular process within the muscle fiber begins when
acetylcholine binds to receptors on the muscle fiber membrane. The proteins
inside muscle fibers are organized into long chains that can interact with each
other, reorganizing to shorten and relax. When acetylcholine reaches
receptors on the membranes of muscle fibers, membrane channels open and
the process that contracts a relaxed muscle fibers begins:
• Open channels allow an influx of sodium ions into the cytoplasm of the
muscle fiber.
• The sodium influx also sends a message within the muscle fiber to trigger
the release of stored calcium ions.
• The calcium ions diffuse into the muscle fiber.
• The relationship between the chains of proteins within the muscle cells
changes, leading to the contraction.
3. Muscle Fibers Relax When the Nervous System
Signal Is No Longer Present
When the stimulation of the motor neuron providing the impulse to the muscle
fibers stops, the chemical reaction that causes the rearrangement of the
muscle fibers' proteins is stopped. This reverses the chemical processes in
the muscle fibers and the muscle relaxes.