Final Exam Thyroid Gland Thyroid hormones - T3 and T4 for maintaining metabolism Calcitonin (CT) for maintaining blood

calcium level Location and Anatomy: - Located anterior to trachea and inferior to larynx - Made of two lobes connected by isthmus - Each lobe consists of numerous sacs called follicles - Follicles store large amounts of hormones - Has a rich blood supply for quick delivery of hormones in the blood stream Thyroid hormones T3 and T4 T3 (Triiodothyroxine): tyrosine with 3 iodines T4 (Thyroxine): tyrosine with 4 iodines Similar structure and function Made by follicular cells Modified and stored inside the follicles with the help of thyroglubulin (TGB) Function: Regulate carbohydrate and lipid metabolism Affect growth and development Increase blood pressure, heart beat, body temperature, and GI tract movement Regulation: - Low Metabolic rate --> stimulates TRH or TIH release from hypothalamus --> regulates release of TSH from anterior pituitary --> increased or decreased release of T 3 and T 4 from follicular cells in thyroids. Clinical application: Cretinism: hyposecretion of T 3 and T 4 in infants --> physical and mental retardation, yellow skin, fat pads, protruding tongue, enlarged belly; hormone therapy

Myxedema: hyposecretion of T 3 and T 4 in adults --> low metabolism, lethargy, increased weight, decreased body temperature and heart rate, enlarged heart Exophthalmic goiter/Graves disease: hypersecretion of T 3 and T 4 in adults --> high metabolism, decreased weight, increased body temperature and heart rate, bulging eyes Calcitonin (CT) Made by parafollicular cells also known as the C sells, located between the follicles. Function: Helps regulate concentrations of Ca2+ in body fluids Inhibits osteoclasts, which slows the rate of Ca2+ release from bone Stimulates Ca2+ excretion by the kidneys Gonadocorticoids Located in the adrenal cortex. Zona Reticularis: secrete androgens and gonadocorticoids (small amount of sex hormones). Insignificant in males (main source is testis). Main source in females. Clinical application: Hirsuitism: hypersecretion of androgens --> excessive hair growth Hormones - Types & Characteristics Functions of Hormones: Help maintain homeostasis (water, pH, blood sugar, temperature, minerals). Help regulate metabolism (making/breaking organic chemicals, energy production). Help regulate growth, development and reproduction. Based on their chemical structure, hormones can be divided into three groups: Amino acid derivatives: also known as biogenic amines, are derived from amino acids, e.g. thyroid hormones, epinephrine, norepinephrine and melatonin. Peptide hormones: are chains of amino acids, e.g. TSH, LH, FSH, ADH, Oxytocin, GH and PRL.

Lipid derivatives: are divided into two classes - eicosanoids (signaling molecules, e.g. prostaglandins) and steroid hormones (derived from cholesterol, e.g. estrogen and androgens). Secretion and Distribution of Hormones Some hormones circulate freely in the blood, e.g peptide hormones. These hormones remain functional for a short period of time, minutes to hours. Taken as shots/injections. Examples - insulin, growth hormone. Thyroid hormones and steroid hormones travel in the blood bound to a special transport proteins and therefore remain in circulation much longer. Can be administered orally. Measurement of Hormones: Hormones are released in blood and transported by blood. Most hormones are measured by taking a blood sample. Some hormones are produced in excess and excreted in urine and can be measured in urine sample. Based on the location of the receptor, mechanism of hormone action can be divided into two groups: Hormones and Plasma Membrane Receptors Hormone diffuses out of the blood capillary to go to its target cell --> Peptide hormones cannot pass phospholipid bilayer of the plasma membrane --> Hormone binds to specific receptor present on plasma membrane --> Hormone receptor (HR) complex is formed on the outer surface of the plasma membrane --> G protein on the inside of the membrane is activated -> leads to the appearance of a second messenger (cAMP/cGMP/Ca) --> second messenger acts as an enzyme activator, inhibitor, or cofactor --> results in a change in the rate of metabolic reactions. Down Regulation: Presence of a hormone triggers decrease in number of hormone receptors. When levels of particular hormone are high, cells become less sensitive to it. Up Regulation: Absence of a hormone triggers increase in number of hormone receptors. When levels of particular hormone are low, cells become more sensitive to it. Hormones and Intracellular Receptors Hormone diffuses out of the blood capillary to go to its target cell --> Lipid soluble hormone diffuses through the phospholipid bilayer of the plasma membrane --> Hormone binds to the specific cytoplasmic receptor --> OR ->

Hormone diffuses through the nuclear membrane to enter the nucleus and bind to nuclear receptor --> Hormone-receptor (HR) complex is formed --> HR complex binds to specific locations on DNA --> Specific genes are activated --> new mRNA and proteins are made --> These proteins could be enzymes or transport proteins needed for specific hormone action. ls become more sensitive to it. Insulin A hormone that stimulates glucose uptake and utilization. Beta cells - secrete insulin, which stimulates glucose uptake by body cells and increased conversion of glucose to glycogen in liver. Adrenal Medulla Secrete epinephrine and norepinephrine - Similar structure and function - Released in response to sympathetic nerve - Involved in "Fight or flight response" - Increase heart rate, BP, breathing rate , blood sugar, metabolism, and muscle contraction Pituitary Gland Pituitary Gland (hypophysis): sits in the sella turcica of sphenoid bone. Made of two lobes - anterior and posterior. Anterior lobe (also known as adenohypophysis) is an endocrine tissue which secretes a variety of hormones. These hormones are regulated by releasing and inhibitory tropic hormones made by hypothalamus. Anterior lobe can be divided into 3 regions: pars distalis, pars tuberalis and pars intermedia. Posterior pituitary (also known as neurohypophysis) is a nervous tissue which does not make hormones. Houses axon terminals of neurosecretory cells located in hypothalamus. Stores and releases hypothalamic hormones in response to nerve impulses. Anterior lobe of the pituitary makes a total of seven hormones, thyroid stimulating hormones (TSH), adrenocorticotropic hormones (ACTH), follicle stimulating hormone (FSH), leutinizing hormone (LH), prolactin (PRL), growth hormone (GH) and melanocyte stimulating hormone (MSH).

The hormones of the anterior lobe are also called tropic hormones, since they "turn on" other endocrine glands to release hormones. Growth hormone stimulates cell growth and replication by increasing the rate of protein synthesis, fat metabolism, blood sugar level and ATP production. Skeletal muscle cells and bone cells of the body are more sensitive to GH. Most actively secreted in early childhood years, its secretion goes down during puberty. Secretion of GH is regulated by growth hormone releasing hormone (GHRH) and growth hormone inhibiting hormone (GHIH) from the hypothalamus in the following manner: Decreased blood sugar level (hypoglycemia) --> stimulates GHRH secretion by hypothalamus --> stimulates anterior pituitary --> increased hGH secretion - Increased blood sugar level (hyperglycemia) --> stimulates GHIH secretion by hypothalamus --> inhibits anterior pituitary --> decreased hGH secretion. Thyroid stimulating hormones (TSH or thyrotropin): causes the thyroid gland to release the thyroid hormones. TSH is released from anterior pituitary in response to thyroid releasing hormone (TRH) from the hypothalamus. Regulation: Decreased metabolism --> stimulates Thyrotropin Releasing Hormone (TRH) secretion by hypothalamus --> increased TSH secretion by anterior pituitary --> Increased metabolism --> decreased TRH secretion by hypothalamus --> decreased TSH secretion by anterior pituitary Adrenocorticotropic hormone (ACTH): Stimulates adrenal cortex to secrete cortisols. Regulation: Corticotropin Releasing Hormone (CRH) secretion by hypothalamus --> increased ACTH secretion by anterior pituitary --> increased cortisol secretion by adrenal cortex.

Gonadotropins: regulate the activity of gonads, ovaries and testes. Two types: Follicle stimulating hormone (FSH): stimulate development of follicles in ovary and secretion of estrogen. In males, FSH stimulate differentiation of sperms. Leutinising hormone (LH): In females, LH stimulates the process of ovulation and secretion of estrogen and progesterone. In males LH stimulates the secretion of testosterone.

Regulation: Decreased sex hormones --> increased Gonadotropin Releasing Hormone (GnRH) secretion by hypothalamus --> increased FSH and LH secretion by anterior pituitary --> increased sex hormones by ovaries and testis Prolactin (PRL): Stimulates mammary gland to produce milk. Regulation: - Decreased estrogen during the later part of menstrual cycle OR infant sucking after delivery --> increased Prolactin Releasing Hormone (PRLRH) secretion by hypothalamus --> increased prolactin secretion by anterior pituitary --> tenderness of mammary gland - Increased estrogen during the earlier part of menstrual cycle --> increased Prolactin Inhibiting Hormone (PRLIH) secretion by hypothalamus --> decreased Prolactin secretion by anterior pituitary Melanocyte Stimulating Hormone (MSH): Stimulates melanin synthesis by melanocytes. Results in darkening of skin color. Posterior lobe of Pituitary secretes two hormones listed below: Antidiuretic Hormone (ADH): also known as vasopresin. ADH causes water reabsorption at the distal convoluted tubule and collecting duct thereby increasing blood volume, and vasoconstriction thereby increasing blood pressure. Regulation: Low water intake --> hypothalamus detects osmolarity of blood --> neurosecretory cells in hypothalamus generate impulses --> stimulates release of ADH from axon terminals located in posterior pituitary --> ADH stimulates water reabsorption in kidneys --> less urine formed --> water is conserved. Clinical note: hyposecretion of ADH --> symptoms similar to diabetes mellitus (large amounts of urine formed, dehydration, thirst). Oxytocin (OT): OT causes release of milk by contraction of smooth muscles in the mammary duct. OT released during labor results in the delivery of the baby. It is regulated by the contraction of smooth muscles in the wall of the uterus. Regulation: OT works on a positive feedback system Infant suckles --> nerve impulses are generated --> impulses reach hypothalamus --> stimulates release of OT from axon terminals located in posterior pituitary --> smooth muscle contraction in mammary gland and uterus --> milk release and toning of uterus

Leukocytes (WBCs) Less than 1% of the formed elements 5,000 to 10,000 WBC / ml of blood Many different types of WBC - Neutrophils, Lymphocytes, Eosinophils, Basophils and Monocytes. Have a distinct nucleus - serves as a distinguishing feature Do not have hemoglobin Functions - defend against pathogens, remove toxins and wastes, and attack abnormal cells. Plasma membrane has histocompatibility antigens used to match cells, tissues and organs during donation procedures Granular leukocytes : have lobed nucleus and granules in the cytoplasm. Neutrophils make up 60-70% of the WBCs have 2-6 lobed nucleus Pale lilac granules in the cytoplasm Phagocytic cells for bacterial infections and injuries. Eosinophils make up 2-4 % of the WBCs have bilobed nucleus orange-red granules in the cytoplasm. Allergic reactions and phagocytic cells for infectious worms. Basophils make up 0.5 - 1% of the WBCs have bi-lobed nucleus dark blue-black granules in the cytoplasm. Release histamine in allergic reactions --> modify --> mast cells

Agranular leukocytes : have a dented nucleus and no prominent granules Lymphocytes make up 20% of the WBCs Smaller cells with relatively large nucleus and very little cytoplasm Involved in antigen-antibody immunity against viral infections Monocytes 3-8% of the total WBC Larger cells with large dented nucleus and a lot of foamy cytoplasm Phagocytic cells --> modify --> macrophages Lymphopoiesis: is defined as the formation of Leukocytes Hematopoietic stem cells in red bone marrow --> divide to form proerythroblast, myeloblast, monoblast, lymphoblast and megakaryoblast --> Myeloblasts form neutrophils, eosinophils, basophils; Monoblasts form monocytes; Lymphoblasts form lymphocytes (T and B cells) WBC disorders Leukocytosis: when leukocyte number goes above 10,000/cu mm of blood Leukopenia: when leukocyte number goes below 5,000/cu mm of blood Leukemia: cancer of leukocytes; accumulation of immature (acute) or mature leukocytes (chronic). Blood Groups

on the type of surface antigen (protein) found on the outside of RBC Blood group A B AB O

Antigen on RBC (Agglutinogen)

antibodies in plasma (Agglutinin)

A antigen B antigen A&B antigen neither A or B antigen

b antibody a antibody neither a or b antibody both a& b antibody

The O blood type is Universal donor - has no antigen

The AB blood type is Universal recipient- has no antibodies Blood type A can receive from A & O B can receive from B & O AB can receive from A, B, AB, and O O can receive from O Blood type A can donate to A & AB B to B & AB AB to AB O can donate to A, B, AB, and O Plasma Makes up 50-60% of the blood volume 91.5% water 7% protein: Three main proteins in the blood plasma are Albumin (60% of the total proteins): made by liver, helps to maintain blood viscosity, helps to transport water-insoluble chemicals (fats and hormones) Globulins (35% of the total proteins): made by liver and WBC, Protects against disease, Transport water-insoluble chemicals (fats and hormones) Fibrinogen (4% of the total proteins): produced by live, used for blood clotting 1.5% other solute: Electrolytes, Nutrients and Gases Platelets Cytoplasmic fragments 250,000 to 400,000 platelets / mL of blood Involved in blood clotting Circulate for 5-9 days in the blood stream

Formation: Hematopoietic stem cells in red bone marrow --> divide to form proerythroblast, myeloblast, monoblast, lymphoblast and megakaryoblast --> megakaryoblast forms megakaryocyte --> cytoplasm of megakaryocyte breaks up --> platelets are formed Platelet disorders Thrombocytosis: when number of platelets goes up --> excessive clots formed Thrombocytopenia: when number of platelets goes down --> excessive internal bleeding Heart sounds Auscultation: Act of listening to sounds within the body with the help of stethoscope. It is due to turbulence created by the closure of heart valves. Each cardiac cycle has 4 heart sounds, although only the first 2 are heard clearly. First sound is the lubb sound: louder and longer. Is due to closure of AV valves during ventricular systole. Second sound is the dupp sound: shorter and not so loud, is due to the closure of semilunar valves as the ventricles begin to relax. Heart murmurs: is abnormal sound that is heard before, between, or after normal sound. Some heart murmurs are innocent, i.e. do not suggest a heart problem. But most often a murmur indicates a valve disorder. Heart Chambers Heart is divided into 4 chambers. The two superior chambers are the right atrium and left atrium. Each atrium has a flap like extension called an auricle, which increases the size of the atria. The two inferior chambers are the ventricles: right and the left ventricle. Externally, a groove known as coronary sulcus separates atria from the ventricles. Anterior and Posterior inter ventricular sulcus are shallow grooves separating the right and left ventricles.

Electrocardiogram (ECG) ELECTROCARDIOGRAM (ECG or EKG): is a recording of the sum of all action potentials generated by the heart muscle fibers during a single heart beat. The instrument used to record these changes is called an electrocardiograph. A normal ECG consists of: P wave (atrial depolarization - spread of impulse from SA node to the atria), QRS complex (ventricular depolarization - spread of impulse through the ventricles) and T wave (ventricular repolarization - ventricles begriming to relax). PQ interval represents the conduction time from the begriming of atrial excitation to the begriming of ventricular excitation. ST segment represents the plateau phase of the impulse. With the ECG it is possible to determine if the conduction pathway is abnormal, if the heart is enlarged, or if certain regions are damaged. Clinical problems: Arrythmia: is an irregularity in the normal rhythm or force of the heartbeat. Pulmonary Veins Hepato portal Papillary Muscles Valves have 2-3 flaps or cusps. The cusps of the AV valve are connected to tendon like cords called chordae tendinae which in turn are connected to the traberculae carnae by papillary muscles. Chordae tendinae and papillary muscle are regulate opening and closing of AV valves Angina Pectoris chest discomfort due to decreased blood supply to heart The Conducting System Specialized cardiac muscle cells are called auto rhythmic cells since they are selfexcitable. They generate spontaneous action potentials that trigger heart contractions. These specialized cells are present in two nodes in the heart: Sinoatrial (SA) node and Atrioventricular (AV) node. The action potential generated here travels through the conduction system in the following sequence:

SA node (located in the right atrium- also known as the pacemaker)--> AV node (located in the interatrial septum) --> AV bundle (bundle of His) --> right and left bundle branches (located in the interventricular septum) --> Purkinjee fibers. On their own the auto rhythmic cells in the pacemaker are capable of initiating an action potential every 0.6 sec or 100 times per minute. Signals from the autonomic nervous system and hormones, such as epinephrine, can modify the rate of heartbeat. Clinical problems: Tachycardia: faster than normal heart rate. > 100 bpm. Badycardia: slower than normal heart rate < 60 bpm. Ectopic pacemaker: are ventricular muscle cells generating action potentials at a higher rate. These impulses can override those of the SA or AV node, resulting in the pumping efficiency of the heart. Heart Rate-Factors Regulation of Heart Rate: is the body's principal mechanism for controlling the cardiac output and blood pressure. The bodys need for blood varies under different conditions. Autonomic regulation of heart rate: Cardiovascular center in the medulla oblongata receives input from a variety of receptors. Receptors sending information to medulla oblongata include proprioceptors, baroreceptors, or chemoreceptors.ad Information coming out of the medulla oblongata, travels via two routes - Sympathetic impulses increase heart rate and force of contraction whereas parasympathetic impulses decrease heart rate. Factors affecting the Stroke Volume: Stroke volume is measured as the difference between end diastolic volume and end systolic volume. Therefore any changes in either EDV or ESV will have an impact on stroke volume. Some of these factors that impact stroke volume are: EDV: is the amount of blood in a ventricle after diastole. Two factors influence this volume: Filling time: is the duration of the ventricular diastole, which is entirely dependent on heart rate.

Venous return: varies in response to changes in cardiac output, blood volume, patterns of peripheral circulation etc. Preload: the degree of stretch in the heart before it contracts. Greater the preload on fibers just before they contract greater is the force of contraction (Frank-Starling law of the heart). This law equalizes the volume of blood flowing to both systemic and pulmonary circulations. ESV: is the amount of blood left behind in the ventricle after ventricular systole. Three factors affect ESV: Preload: discussed earlier. Contractility: is the forcefulness of myocardial contraction. Substances that increase contractility are positive inotropic agents (e.g. epinephrine, norepinephrine, stimulation of sympathetic nervous system) and those that decrease contractility are negative inotropic agents (e.g. inhibition of sympathetic division, acidosis and anesthetics). Afterload: the pressure that must be overcome before a semilunar valve can open. An increase in afterload causes the stroke volume to decrease. Arteries Two types: Elastic or Conducting arteries: found closer to the heart. Contain more elastic fibers and less smooth muscle tissue. Can receive blood under pressure and propel it forward. Muscular or Distributing arteries: away from the heart and closer to the organs and tissues. Have large amounts of smooth muscle tissue. Help to distribute blood to different parts of the body. Arteries are blood vessels carrying blood away from heart. Made up of 3 layers or tunics - tunica interna, tunica media and tunica externa Tunica interna - innermost layer surrounding the lumen. Made up of a simple squamous epithelium (endothelium) and elastic tissue (internal elastic lamina). Tunica media: middle layer, thickest, made up of elastic fibers and smooth muscles. Capable of exhibiting vasoconstriction (decrease in the diameter of the lumen) and vasodilation (increase in the diameter of the lumen) to regulate blood flow and blood pressure. Tunica externa: outermost made up of mainly elastic and collagen fibers.

Artery (red) 1. transports oxygenated blood (exception : pulmonary artery) 2. always transport blood away from heart 3. deeper in location 4. thicker wall 5. do not have valves 6. pulsations felt 7. used to check pulse , BP Vein (blue) 1. transport deoxygenated blood (exception :pulmonary veins) 2. always transport blood towards heart 3. superficial in location 4. thin wall 5. have valves 6. no pulsations felt 7. used to obtain blood samples and for transfusions( infusion- IVs) CIRCULATION OF BLOOD: With each beat of the heart, the blood is pumped into two closed circuits the systemic circulation and the pulmonary circulation. Systemic circulation: left side of the heart is the pump for systemic circulation. It receives oxygenated blood from the lungs and distributes it into the vessels of the body. Pulmonary circulation: involves the right side of the heart. It receives deoxygenated blood from the body and sends it to lungs for oxygenation. Superior vena cava, Inferior vena cava, coronary sinus --> Right Atrium --> Tricuspid valve --> Right Ventricle --> Pulmonary semilunar valve --> pulmonary trunk --> left and right pulmonary artery --- > lungs --- > coronary circulation :The flow of the blood through the many vessels that supply the heart.

left ventricle -- > aorta --> left and right coronary arteries --> blood delivers oxygen and nutrients, and collects carbon dioxide and waste from the walls of the atrium and the ventricle--- > cardiac veins large coronary sinus --- > which empties into right atrium. blood looses carbon dioxide and picks up oxygen--- > pulmonary veins --- > left atrium -- > bicuspid valve--> left ventricle --- > aortic semilunar valves --- > Aorta and systemic arteries --> blood looses oxygen and picks up carbon dioxide. Venous return Facilitated by: 1. muscle contraction 2. deep breathing Defective valves can cause veins to distend, engorge with blood varicose Vein varicosities of rectal veins called hemorrhoids Pulse Pressure Arterial blood Pressure: arterial blood pressure is needed to insure blood flow in the capillaries. Arterial blood pressure peaks at 110-120 mm Hg during ventricular systole and is referred to as the systolic pressure. Arterial blood pressure drops to 70-80 mm Hg during ventricular diastole and is referred to as the diastolic pressure. Pulse pressure is the difference between the systolic and the diastolic pressure. Mean arterial pressure (MAP) is calculated as follows: MAP = diastolic pressure +pulse pressure/3 Lymph Nodes Oval or bean shaped structures located along lymphatic vessels Function to filter lymph. Structure: A dense connective tissue capsule surround each lymph node. Capsule extends in the lymph node as trabeculae. Outer part of the node is called cortex which is made up of lymphatic nodules containing lymphocytes and macrophages. Inner medulla is made up of irregular strands of lymphatic tissue called medullary cords. Lymph enters the nodes via the afferent lymphatic vessel and after filtration in the cortex and medulla, leaves via the efferent lymphatic vessel.

FUNCTIONS OF THE LYMPHATIC SYSTEM Fluid Balance: To maintain homeostasis the fluid left behind by the circulatory system (approx 3L) is returned back via the Lymphatic System. Fat Absorption: Lymphatic system helps to absorb fat and other substances from the digestive system with the help of specialized vessels called lacteals. Defense: Lymphocytes residing in the lymphatic tissues of the body, protect the body against microorganisms and foreign substances. Tonsils: large groups of nodules in the mucosa of the pharynx. Provide protection against bacteria entering the body through the mouth or nasal cavities.e.g. palatine, pharyngeal and lingual tonsils. When the tonsils become infected and inflammed, the condition is referred to as tonsilitis. Lymph - fluid found within lymphatic vessels - do not have RBCs - high in fats and proteins Lymphatic vessels Flow of lymph through the lymphatic vessels Interstitial Fluid --> Lymphatic Capillaries --> Lymphatic vessels --> Lymph nodes --> lymphatic trunk --> Lymphatic duct --> Drain into large veins of the body. Lymphatic capillaries: Very similar to blood capillaries in structure with 2 modifications. First Lymphatic capillaries have endothelial cells which are loosely attached and are therefore more permeable. Secondly the lymphatic capillaries have one way valves to prevent back flow of lymph into interstitial space. Large Lymphatic vessels/trunks: Each lymphatic trunk drains fluid from a certain area of the body. e.g. jugular trunks drain from the head and neck, subclavian trunks drain from the upper arms and superficial thoracic wall. Lymphatic ducts: formed by joining a few lymphatic trunks. e.g. on the left side of the body, jugular trunk, subclavian trunk and bronchomediastinal trunks join to form

thoracic duct which drains into the Left Subclavian vein. Lymph is collected from the upper right side of the body by the right jugular, right subclavian and right bronchomediastinal trunks which drain in the right lymphatic duct. This duct drains lymph in the right subclavian vein. Thymus Gland bi-lobed gland located in the mediastinum. Gland atrophies with age. Structure: Outer connective tissue called Capsule, Extensions of capsule called Trabeculae divide each lobe into smaller compartments called Lobules. Each lobule has outer region called cortex (has more lymphocytes) and inner medulla (fewer lymphocytes). Immunity Active: body makes its own antibodies Passive: prepared antibodies (immunoglobulins) given to individuals Four characteristic features of the immune system are:Specificity: - recognition of a specific pathogen or toxin and then destroying it. Each lymphocyte is highly specific in responding to a particular pathogen or toxin. Verstality/Diversity: - Immune system on the whole has the ability to respond to millions of different kind of invaders. Memory:- Immune system has the ability to remember pathogens or toxins it encounters. This property is carried out by specialized cells termed the memory cells. Tolerance OR Self/Nonself recognition: - Immune system distinguishes the body's own molecules (self) from foreign molecules (nonself). Voice: Volume amount of air breathed in Pitch tension within cords. Lung volumes: 1. Tidal volume amount of air breathed in / out during respiration 2. Inspiratory reserve volume amount of air breathed in during forceful inspiration 3. Expiratory reserve volume amount of air breathed out during forceful Expiration

4. Residual volume amount of air left behind in lungs after forceful expiration Nose: Air enters the respiratory system Through nostrils or external nares Into nasal vestibule Nasal hairs Are in nasal vestibule Are the first particle filtration system - made of bone and cartilage - external nostrils lead into nasal cavity - nasal cavity divided into 2 compartments by nasal septum - internal nostrils connect nasal cavity into throat Nose: warms, moistens and filters air breathed in Breathing centers Apneustic center cessation of breathing Pneumotaxic center stimulates breathing Apnea stop breathing Eupnea normal breathing Dyspnea difficult, labored breathing Factors affecting diffusion 1. Partial pressure difference of the gases The greater the difference between partial pressures of alveoli and blood, the greater the rate of diffusion. During exercise, partial pressure difference is greater, so diffusion rate is greater. At high altitude, lower % of oxygen in air is less, so difference between alveolar and blood PO 2 is less: low diffusion rate, high altitude sickness 2. Surface area available for gas exchange

Numerous smaller alveoli increase surface area for diffusion. If due to a pulmonary disorder, functional area decreases, then rate of exchange also decreases. 3. Respiratory membrane thickness Total thickness of alveolar capillary membranes accounts for the distance the gases have to diffuse. Thicker membranes would slow down diffusion. Also build up of fluid due to edema can also slow down diffusion. 4. Solubility and molecular weight of the gases Oxygen has lower molecular weight as compared to carbon dioxide, but the solubility of carbon dioxide is much higher as compared to oxygen and hence overall diffusion of carbon dioxide is faster that oxygen. Net outward CO 2 diffusion is 20 times greater than inward diffusion of O 2 In emphysema or pulmonary edema, hypoxia occurs before hypercapnia (high CO 2 in blood). Right Lung (3 lobes) - Superior - Middle - Inferior The right lung has three lobes separated by two fissures (Oblique & horizontal fissure ): no cardiac notch Digestion includes six basic processes: Ingestion is taking food into the mouth (eating). Secretion is the release, by cells within the walls of the GI tract and accessory organs, of water, acid, buffers, and enzymes into the lumen of the tract. Mixing and propulsion result from the alternating contraction and relaxation of the smooth muscles within the walls of the GI tract. Digestion proper is the breakdown of large food molecules into simple molecules. It includes: Mechanical digestion: consists of movements of the GI tract that mix, soften, and liquefy the food. Chemical digestion: a series of enzymatic reactions that break down polysaccharides, lipids, proteins, and nucleic acids into smaller molecules.

 Absorption is the passage of nutrients generated by digestion from the lumen of the GI tract into blood or lymph. Defecation is the release of solid waste (generated by digestion) from the rectum. Layers of Digestive Tract The basic layers of the GI tract from the inside to the outside are : 1. Mucosa 2.Submucosa 3. Muscularis 4. Serosa Submucosa The submucosa is made of areolar connective tissue housing a large number of glands, nerves, blood vessels, and lymphatic tissue. the numerous nerves are part of the submucosal plexus or Plexus of Meissner which is part of the autonomic nervous system. This plexus regulates movements of the mucosa, vasoconstriction of blood vessels, and controls secretory cells of mucosal glands. Muscularis The muscularis is made of at least two layers of smooth muscle fibers (involuntary): the innermost layer is the circular layer the outermost layer is the longitudinal layer Together the two layers contract rhythmically during a process called peristalsis to mix, crush, and propel the food through the GI tract. The muscularis is highly vascular and houses the myenteric plexus or plexus of Auerbach . This vast network of nerves, neurons, and ganglia controls both parasympathetic and sympathetic innervation of circular and longitudinal muscle layers

Serosa The serosa is made of two layers: An inner connective tissue layer which is made of areolar connective tissue: it covers the other layers, and lead blood vessels and nerves into them. An outer epithelial layer which attaches the GI tract to the peritoneum folds. Saliva Saliva is a watery secretion from the salivary glands. A small portion of saliva comes from buccal glands located in the mucous epithelium of the oral cavity. There are two types of salivary gland cells called salivary acini : serous acini , and mucous acini . Water makes up 99.5% of saliva, and the remaining 0.5% is a mixture of mucus, solutes such as salts, various organic substances, and enzymes. Salivamoistens and dissolves food and starts the enzymatic digestion of carbohydratesand lipids. It also moistens the mouth and throat. Functions of Saliva: Chemical digestion of food starts in the mouth: in fact saliva contains salivary amylase, an enzyme that begins the hydrolysis of starch (a polysachaccharide ) into glucose (amonosaccharide). Saliva also contains lingual lipase, an enzyme secreted by serous salivary glands of the tongue called Ebners glands (minor salivary glands). Lingual lipase begins lipid hydrolysis by breaking down triglycerides (fats) into glycerol and three(3) fatty acids. Lysozyme , an antibacterial enzyme, is also found in saliva. Bicarbonate ions in saliva act as buffers to neutralize acidic foods and beverages. Saliva has also a rinsing function. Salivation: Salivation is the secretion of saliva. Salivation is a nearly constant phenomenon that helps cleanse the mouth and keep it moist.

 Salivation can be triggered by a number of stimuli including the smell, taste, sight, or even the thought of food. It can be interrupted by emotions such as fear (dry mouth). Salivation is under sympathetic and parasympathetic control. Chyme semiliquid food that moves from stomach to small intestine is called chime Gastric Glands Cells There are 4 main types of gastric gland cells in gastric pits: Chief cells (exocrine) secrete the inactive enzymes pepsinogen and gastric lipase (zymogens). Parietal cells (exocrine) secrete hydrochloric acid ( HCl ), and a glycoprotein called intrinsic factor Mucous neck cells (exocrine) secrete mucus. G cells (endocrine) secrete gastrin. Exocrine gland cells release their secretions into the lumen of the stomach, while endocrine gland cells release their secretion into the blood. Peristalisis: alternate waves of contraction and relaxation Pancreas The pancreas is a leaf-shaped organ with three main parts: the head, the body, and the tail. The head of the pancreas is attached to the lesser curvature of the C-shaped duodenum via the pancreatic duct (duct of Wirsung ) and the accessory pancreatic duct (duct of Santorini ). It has both endocrine and exocrine functions: its endocrine cells secrete hormones (insulin, glucagon, somatostatin ), and its exocrine cells secrete pancreatic juice which contains digestive enzymes and bicarbonate ions. Pancreatic Islet (Islet of Langerhans) Pancreatic acini : secrete pancreatic juice

Pancreatic islet cells: secrete hormones During digestion, the pancreas secrets pancreatic juice which is a mixture of digestive enzymes and bicarbonate ions. The digestive enzymes are secreted by basophilic acinar cells. Pancreatic amylase for starch digestion. Trypsinogen , chymotrypsinogen , procarboxypeptidase , and proelastase for protein digestion. Pancreatic lipase for lipid digestion. Deoxyribonuclease and ribonuclease for nucleic acid digestion. Bicarbonate ions are produced by centroacinar cells. Pancreatic enzymes are secreted as zymogens (inactive form of the enzyme). Most of these zymogen are activated by trypsin . Trypsin itself is activated by enterokinase which is secreted by the absorptive cells of the small intestine. Pancreatic juice is slightly alkaline, due to the presence of bicarbonate ions. It neutralizes acid chyme in the duodenum. Secretion of Pancreatic Juice Pancreatic juice is collected by the pancreatic duct through a network of tubes called the pancreatic ductal system. The duct of Wirsung joins the common bile duct to form the hepatopancreatic ampulla . There, bile and pancreatic juice mix. They are released into the duodenum through the major duodenal papilla. Pancreatic juice can be released alone into the duodenum via the accessory pancreatic duct. Secretion and release of pancreatic juice are regulated by 2 duodenal hormones: secretin and CCK ( cholecystokinin ). Hormonal Regulation of the Pancreas Presence of fatty acids and amino acids in the duodenum triggers the release of secretin and CCK by the duodenal glands ( enteroendocrine glands).

 Secretin and CCK have different effects on the pancreas: Secretin stimulates secretion of bicarbonate ions. CCK stimulates secretion of digestive enzymes. Duodenal glands release also Gastric Inhibitory Polypeptide (GIP). It inhibits stomach acid secretion, and is now believed to also induce the secretion of insulin in presence of glucose. Liver The liver is the largest organ in the abdominopelvic cavity. It is located in the upper abdominal cavity, right underneath the diaphragm. The gallbladder is attached to the posterior surface of the right hepatic lobe. Right and left lobes of the liver are unequally separated by the falciform ligament: the right lobe is significantly larger than the left lobe. The liver is an important, multitasking organ in the body. However its main contribution to digestion is the secretion of bile. Made of cells hepatocytes (produce bile) Enzymes-Substrates The digestive enzymes are secreted by basophilic acinar cells. Pancreatic amylase for starch digestion. Trypsinogen , chymotrypsinogen , procarboxypeptidase , and proelastase for protein digestion. Pancreatic lipase for lipid digestion. Deoxyribonuclease and ribonuclease for nucleic acid digestion. Bicarbonate ions are produced by centroacinar cells. Pancreatic enzymes are secreted as zymogens (inactive form of the enzyme). Most of these zymogen are activated by trypsin. The reactants in enzymatic reactions are called substrates. Small Intestine About 21 ft in length Digestion is completed and all food and water absorbed into bloodstream from here

Structure of the Small Intestine The small intestine is a very long tube subdivided into three regions: the duodenum (.25 m), the jejunum (2.4 m), and the ileum (3.6m). Function of the Small Intestine Duodenum: digestion and some absorption. Jejunum and Ileum: absorption but also the finishing stages of digestion. The structure of the intestinal mucosa as well as the long length of the small intestine combine to form a very large surface area ideal for absorption. Since the duodenum receives all the digestive juices, it is the place where most of digestion occurs. The enzymes of the intestinal mucosa finish the digestive process. Small intestine wall layers - mucosa has intestinal glands/ crypts of Lieberkuln - submucosa has folds called villi and increase surface area for food absorption - muscularis - serosa Large Intestine Unique land marks Haustra pouches Taenia coli 3 longitudinal muscle bands Function: - formation of stools - normal bacteria that reside in colon ferment food and produce gas The large intestine or colon is shorter in length than the small intestine, but larger in diameter. The colon is made of haustrae , pouches which increase the surface area of the colon for absorption of water and electrolytes.

 The first part of the colon is a blind pouch called the cecum which is connected to the ileum of the small intestine. The ileocecal sphincter (valve) separates the cecum from the ileum. The vermiform (wormlike) appendix is attached to the cecum : it may have a function in colic defense, but appendectomy (removal of the appendix) does not appear to have serious effect on the colon. Regions of the Colon ADH Antidiuretic Hormone (ADH): also known as vasopresin. ADH causes water reabsorption at the distal convoluted tubule and collecting duct thereby increasing blood volume, and vasoconstriction thereby increasing blood pressure. Regulation: Low water intake --> hypothalamus detects osmolarity of blood --> neurosecretory cells in hypothalamus generate impulses --> stimulates release of ADH from axon terminals located in posterior pituitary --> ADH stimulates water reabsorption in kidneys --> less urine formed --> water is conserved. Clinical note: hyposecretion of ADH --> symptoms similar to diabetes mellitus (large amounts of urine formed, dehydration, thirst). Renal Corpuscle Bowmans capsule and glomerulus Filtration unit of the nephron The glomerulus is a condensed mass of capillaries which allows substances to escape by filtration. Glomerular capillaries are surrounded by specialized cells called podocytes . Podocytes form the inner (visceral) layer of Bowman's capsule. cecum ascending colon transverse colon descending colon sigmoid colon rectum anal canal anus

Podocytes have processes called pedicels which interdigitate to produce openings called filtration slits. Glomerular capillaries are fenestrated in order to allow filtration. The outer (parietal) layer of Bowman's capsule consists of epithelial cells with tight junctions and serves to contain the filtrate in the capsular space. The Nephron Nephrons filter blood and remove wastes The Nephron consists of renal tubule and renal corpuscle Renal tubule Long tubular passageway Begins at renal corpuscle Renal corpuscle Spherical structure consisting of: Glomerular capsule (Bowmans capsule) Cup-shaped chamber Capillary network ( glomerulus ) Glomerulus Consists of 50 intertwining capillaries Blood delivered via afferent arteriole Blood leaves in efferent arteriole Flows into peritubular capillaries Which drain into small venules And return blood to venous system Filtration Occurs in renal corpuscle Blood pressure

Forces water and dissolved solutes out of glomerular capillaries into capsular space Produces protein-free solution ( filtrate ) similar to blood plasma Three Functions of the Renal Tubule 1. Reabsorb useful organic nutrients that enter filtrate 2. Reabsorb more than 90% of water in filtrate 3. Secrete waste products that failed to enter renal corpuscle through filtration at glomerulus Segments of the Renal Tubule Located in cortex Proximal convoluted tubule (PCT) Distal convoluted tubule (DCT) Separated by nephron loop (loop of Henle ) U-shaped tube Extends partially into medulla Body Fluids Body Fluids Compartments Body fluids are located in two places: Inside cells: intracellular fluid (ICF) Outside cells: extracellular fluid (ECF) ICF represents 2/3 of body fluids. ECF represents 1/3 of body fluids. ECF is made of two main fluids: Interstitial fluid (80%) (found between cells, lymph, CSF, GI tract, synovial cavities, pericardial cavity, pleural cavity, peritoneal cavity, etc) Blood plasma (20%) within blood vessels

Electrolytes Electrolytes are charged atoms or molecules located within body fluids. Cations are positively charged: Na + , Ca +2 , K + , Mg +2 , H + . Anions are negatively charged: HCO 3 - , Cl - , PO 4 -3 Electrolytes play a crucial role in osmotic balance, electrochemical gradient, acid balance of cells. They are also important enzyme cofactors. Electrolytes Concentration in Body Fluids Sodium Ions Sodium (Na + ) ions are the dominant ECF cations . They are mainly responsible for osmotic pressure Hypernatremia is an excess of Na + in blood plasma Hyponatremia is deficit of Na + the in blood plasma Small quantities of Na + are lost in sweat Regulation of Na + ions: ANP promotes elimination of Na + ( natriuriesis ) Aldosterone promotes Na + reabsorption ADH secretion is sensitive to Na + concentration Chloride Ions Chloride ions are the most abundant anions in the ECF. They form a natural association with Na + ions and are therefore indirectly regulated by aldosterone. They balance the negative charge of many anions, particularly which of bicarbonate ions during the chloride shift. They are used by gastric glands to make hydrochloric acid in the stomach. Potassium Ions K + ions are the predominant ions in the ICF. Affect a number of mechanisms such as resting membrane potentials, membrane repolarization and hyperpolarization.

 Aldosterone regulates the amount of K + secreted into urine. Aldosterone maintains K + ions in a narrow range in blood plasma. Hyperkalemia occurs when the level of potassium in the bloodstream is higher than normal. Hypokalemia occurs when the level of potassium in the bloodstream is lower than normal. It is also known as potassium deficiency. Both conditions may affect cardiac function, blood pressure, and neuromuscular interaction. Bicarbonate (HCO 3 - ) Ions Bicarbonate (HCO 3 - ) ions are the main buffer in the ECF. It is present in a number of ECF fluids such as blood plasma and pancreatic juice, HCO 3 - is the main form of transport of CO 2 in blood plasma: when carbon dioxide reacts with water in red blood cells in presence of the enzyme carbonic anhydrase, carbonic acid forms, and then breaks down into bicarbonate ions and hydrogen ion: CO 2 + H 2 O H 2 CO 3 HCO 3 - + H + HCO 3 - ions are then exchanged for Cl - ions during the chloride shift. Scrotum: Made of skin and muscle: 1. Dartos muscle cause wrinkling of scrotal skin conserve heat 2. Cremaster muscle: Contraction causes elevation of testis toward abdominal cavity Exposure to cold Sexual stimulation Pouch formed by the abdominal wall divided into two sacs by a septum Skin with dartos muscle contraction during sexual arousal causes tightening and wrinkling of the

skin Closer to birth testes descend into the scrotum through the inguinal canal inguinal canal then closes testes are suspended in the scrotal sac by a spermatic cord and cremaster muscles Sex Glands-Male Sperms are made in seminiferous tubules in the testes released and mature in epididymis as they are released; they are mixed with seminal fluid, secretions from 3 exocrine glands: (1) Seminal vesicle (2) Prostate gland (3) Bulbourethral / Cowpers gland Uterus Supports embryo development Consists of fundus, body and cervix Wall of the uterus: Endometrium inner layer; shed during menstruation; embryo implantation Myometrium middle smooth muscle layer; contraction delivery Perimetrium outer serosa layer Cervix: opens into the vagina: secretes mucus to plug the opening during pregnancy Corpus luteum Menstrual phase lasts about 4-5 days - secondary oocyte degenerates - corpus luteum degenerates - endometrium breaks down menstruation occurs After ovulation, secondary oocyte enters the uterine/fallopian tube LH stimulates the leftover follicular jacket Corpus luteum develops Secretes large amounts of estrogen and progesterone Progesterone maintains the lining of the uterus for potential implantation Increased estrogens and progesterone inhibit hypothalamus Hypothalamus shuts off GnRH secretion No FSH and LH secretion No additional follicular development

Gametes Producing, storing, nourishing, and transporting functional male and female reproductive cells are called gametes Gonads are organs that produce gametes and hormones

Male and Female Reproductive Systems Are functionally different Female produces one gamete per month Retains and nurtures zygote Male produces large quantities of gametes Produces 1/2 billion sperm per day Fertilization: - fusion of sperm and egg - takes place in fallopian tube Fertilized egg called zygote Sperms penetrate corona radiata layer Acrosomal enzymes digest their way through zona pellucida One sperm fuses with the secondary oocyte ( syngamy ) Oocyte membrane depolarizes Intracellular release of calcium causes zona pellucida to harden (cortical reaction) Blocks fusion of any other sperm ( polyspermy is prevented) Syngamy triggers secondary oocyte to undergo meiosis II Ovum and second polar body are formed Male pronucleus and female pronucleus fuse (fertilization) Diploid zygote (44XX or 44XY) is formed

IUD Intrauterine device (IUDs): prevents implantation of fertilized egg Identical twins (monozygotic from one zygote) Release of 1 oocyte fertilized by 1 sperm --> one zygote is formed --> zygote divides to form 2 blastomeres --> blastomeres separate to independently develop into 2 embryos Genetically identical & always the same sex Sperms: have the following structure Head with haploid nucleus (22X or 22Y) and acrosome Midpiece with mitochondria for producing energy (ATP) Flagella tail for swimming About 300-500 million sperms are deposited in the vagina They undergo changes and develop the capacity to fertilize (capacitation) They move through the uterus and uterine tube with the help of their flagella and muscular contractions of the uterus. Spermatogenesis/Oogenesis Spermatogenesis: Sperm formation Diploid spermatogonia in the periphery of seminiferous tubules divide by mitosis to form diploid primary spermatocytes divide by meiosis to form 4 haploid spermatids Oogenesis Formation of an egg/ovum Process begins in the fetus

continues after puberty Starts with a diploid oogonium (44XX) divides by mitosis to form diploid primary oocytes (44XX) primary oocyte divides by meiosis I to form 2 haploid cells (22X): : secondary oocyte : first polar body (non-functional cell) secondary oocyte is released during ovulation after syngamy (fusion with sperm), sec. oocyte undergoes meiosis II to form: : a functional ovum : second polar body Seminiferous tubules Developing germ cells. - begin their development near the periphery of the tubules - get released as spermatozoa in the lumen of the tubule Sertoli or sustentacular or nurse cells that - support developing germ cells- nourish, protect - phagocytize germ cell debris - secrete hormone ( inhibin ) to regulate FSH release - secrete androgen binding protein (ABP) that concentrates testosterone

Between seminiferous tubules are Leydig or interstitial cells - endocrine cells secrete hormones help regulate spermatogenesis Uterine / menstrual cycle Events that take place inside uterus over a 28 day period Day 1 day 5 Menstruation; periodic discharge of blood tissue and mucus through vagina Day 6 day 14 Proliferative phase: repair of endometrium Day 15 day 28 Secretony phase: thickening of endometrium in anti apation of receiving a fertilized egg
Germ layers:

- outer ectoderm - middle mesoderm - inner endoderm all organs and structures of offspring develop from RBCs or Erythrocytes - most numerous of blood cells - about 5 million in number - do not have nucleus - appear as biconcave disks - have red pigment called hemoglobin - strong affinity for O2 - life span 120 days - old RBCs destroyed in spleen 99% of the formed elements 4.8 to 5.4 million RBC / cu mm of blood Biconcave (disc) shaped - 3 important effects of shape: high surface to volume ratio - allows greater absorption

Stacked discs allow blood to flow smoothly. Disc can flex and pass through the capillary wall. Enucleated - lack nucleus Lack mitochondria - roduce ATP by anaerobic respiration Cytoplasm has a red protein - hemoglobin Plasma membrane has ABO and Rh antigens Function: Transport O2 a. blood doping b. neonatal jaundice as a result of breakdown of increase number of RBCs and increased blood levels of bilirubin ( yellow pigment breakdown product of hemoglobin) c. higher number of RBCs when above sea level 2. gives blood its red color Leukemia: cancer of leukocytes; accumulation of immature (acute) or mature leukocytes (chronic). pathological (abnormal) increase in number of WBCs Pap smear (removal of a sample of cervical cells Urethra The urethra is a tubular organ that allows drainage of the urinary bladder. In females it is a short tubule. Its external orifice is located within the vulva. In males the urethra is subdivided into 3 regions: prostatic, membranous, and spongy regions. exam)

Near the bladder the urethra is lined with transitional epithelium and near the external os it is stratified squamous, while in the middle it is pseudostratified columnar epithelium. Small mucous cells of the urethral mucosa secrete mucous to protect the urethral lining from acidic urine. The Male Urethra

Extends from neck of urinary bladder to tip of penis (1820 cm; 78 in.) Prostatic urethra passes through center of prostate gland Membranous urethra includes short segment that penetrates the urogenital diaphragm Spongy urethra (penile urethra) extends from urogenital diaphragm to external urethral orifice.

The Female Urethra Is very short (35 cm; 12 in.) Extends from bladder to vestibule External urethral orifice is near anterior wall of vagina

Erectile dysfunction-Impotence : Inability to maintain erection : Due to - Reduced testosterone level (hypothalamus, pituitary or testes disorder) - Nerve disorder (unable to stimulate blood sinuses in erectile tissue) - Blood vessel disorder (nerve impulses stimulate endothelial cells release of nitric oxide *Viagra increases NO levels relaxation of smooth muscle in the wall of blood sinuses vasodilation erection) Ovarian cycle Events that take place in ovary over a 28 days period Day 1 - day 13 Follicular phase - 1 follicle in 1 ovary begin to mature - Maturing follicle secretes estrogen Day 14 Ovulation - release of egg from ovary

- mature follicle that release the egg is called graafian follicle Day 15 day 28 Luteal phase - empty follicle begins to shrink - shrinking follicle called corpus luteum: secrete progesterone Day 28 If egg is fertilized missed period If egg is not fertilized next period Pregnancy test (presence of human chrionic gonadotropin HCG) Episiotomy: Surgical incision at the vaginal outlet to facilitate child birth Blood vessels-Layers Network of tubes that transport blood to and form the heart wall- layers Central opening - lumen Wall - 3 layers Outer tunica externa connective tissue Middle tunica media smooth muscle Inner tunica interna- epithelial tissue (endothelium) Respiration: happens in 3 stages 1. Pulmonary ventilation gas exchange between atmosphere and lung 2. External respiration: gas exchange between lung and blood 3. Internal respiration: gas exchange between blood and body cells.