Anatomy and Physiology

Heart, Lungs, Pancreas,

Liver, Kidneys and Skin

B. Paul White, MD
HOD ID#: 2078

HODS - November 2006 1

HODS - November 2006 2
 HEART

HODS - November 2006 3

 HEART

• Hollow, muscular organ

• 300 grams (size of a fist)
• 4 chambers
• found in chest between lungs
• surrounded by membrane called
Pericardium
• Pericardial space is fluid-filled to nourish
and protect the heart.

HODS - November 2006 4

 HEART ANATOMY

• The heart is a complex

muscular pump that
maintains blood
pressure and flow
through the lungs and
the rest of the body.
• The heart pumps about
100,000 times and
moves 7200 liters
(1900 gallons) of blood
every day.

HODS - November 2006 5

 HEART ANATOMY
 The heart has four chambers.
 Two atria act as collecting
reservoirs.

 Two ventricles act as pumps.

 The heart has four valves for:

 Pumping action of the heart.
 Maintaining unidirectional
blood flow.

HODS - November 2006 6

 Functions of the Heart

• Generates blood pressure

• Routes blood
– Heart separates pulmonary and systemic
circulation
• Ensures one-way blood flow
– Heart valves ensure one-way flow

HODS - November 2006 7

 Functions of the Heart

• Regulates blood supply

– Changes in contraction rate and force
match blood delivery to changing metabolic
needs
– Most healthy people can increase cardiac
output by 300–500%
• Heart failure is the inability of the heart
to provide enough blood flow to
maintain normal metabolism

HODS - November 2006 8

 Cardiac Cycle
• The heart is two pumps that work
together, right (pulmonary) and left
(systemic) half
• Repetitive, sequential contraction
(systole) and relaxation (diastole) of
heart chambers
• Blood moves through circulatory system
from areas of higher to lower pressure.
– Contraction of heart produces the pressure
HODS - November 2006 9
 Cardiac Cycle

HODS - November 2006 10

 HEART
 Deoxygenated blood returns
to the heart via the superior
and inferior vena cava,
enters the right atrium,
passes into the right
ventricle, and from here it is
ejected to the pulmonary
artery.
 Oxygenated blood returning
from the lungs enters the left
atrium via the pulmonary
veins, passes into the left
ventricle, and is then ejected
to the aorta.
HODS - November 2006 11
 Blood Vessels

• Blood vessels are divided into a pulmonary

circuit and systemic circuit.
• Artery - vessel that carries blood away from
the heart. Usually oxygenated
• Vein - vessel that carries blood towards the
heart. Usually deoxygenated.
• Capillary - a small blood vessel that allow
diffusion of gases, nutrients and wastes
between plasma and interstitial fluid.

HODS - November 2006 12

 Blood Vessels
• Systemic vessels
– Transport blood through the body part from
left ventricle and back to right atrium
• Pulmonary vessels
– Transport blood from right ventricle through
lungs and back to left atrium
• Blood vessels and heart are regulated to
ensure blood pressure is high enough for
blood flow to meet metabolic needs of tissues

HODS - November 2006 13

 Blood Flow

HODS - November 2006 14

 LUNGS

• Lungs comprised of
– Airways
– Alveoli

http://www.aduk.org.uk/gfx/lungs.jpg
HODS - November 2006 15
 What do the lungs do?

• Primary function is gas exchange

• Let oxygen move in
• Let carbon dioxide move out

HODS - November 2006 16

 How do the lungs do this?

• First, air has to move to the region

where gas exchange occurs.

• For this, you need a normal ribcage and

respiratory muscles that work properly
(among other things).

HODS - November 2006 17

 Conducting Airways

• Air travels via laminar

flow through the
conducting airways
comprised of the
following: trachea,
lobar bronchi,
segmental bronchi,
subsegmental bronchi,
small bronchi,
bronchioles, and
terminal bronchioles.

HODS - November 2006 18

 How do the lungs do this?

• The airways then branch further to

become transitional/respiratory
bronchioles.
• The transitional/respiratory zones are
made up of respiratory bronchioles,
alveolar ducts, and alveoli.

HODS - November 2006 19

 The Airways
• Conducting zone: no
gas exchange occurs
– Anatomic dead
space
• Transitional zone:
alveoli appear, but are
not great in number
• Respiratory zone:
contain the alveolar
sacs
Weibel ER: Morphometry of the Human • Over 8 million branches
Lung. Berlin and New York: Springer-
Verlag, 1963
HODS - November 2006 20
 How does gas exchange
occur?
• Numerous capillaries are wrapped
around alveoli.
• Gas diffuses across this alveolar-
capillary barrier.
• This barrier is as thin as 0.3 μm in some
places and has a surface area of 50-
100 square meters!

HODS - November 2006 21

 Gas Exchange
• Diffusion Barrier crossed by O2 moving
from air to blood and CO2 from blood to
air is made up of:
• 1. an aqueous surface film
• 2. epithelial cells of alveolus
• 3. interstitial layer
• 4. endothelial cells of capillaries
• 5. blood plasma
• 6. membrane of RBCs
HODS - November 2006 22
 Alveoli
• Approximately 300
million alveoli
• 1/3 mm diameter
• Total surface area
about 85 sq. meters
(size of a tennis
court)

HODS - November 2006 23

 Gas Exchange

From
Netter
Atlas of
Human
Anatomy,
1989
HODS - November 2006 24
 Control of Ventilation
• Arterial PO2
– When PO2 is VERY low, ventilation increases
• Arterial PCO2
– The most important regulator of ventilation, small
increases in PCO2, greatly increases ventilation
• Arterial pH
– As hydrogen ions increase, alveolar ventilation
increases, but hydrogen ions cannot diffuse into
CSF as well as CO2

HODS - November 2006 25

PANCREAS
 Anatomy of the Pancreas
• 5" long by 1" thick
• Head close to curve in C-
shaped duodenum
• Main duct joins common
bile duct from liver
• Sphincter of Oddi on
major duodenal papilla
• Opens 4" below pyloric
sphincter

HODS - November 2006 27

 Anatomy of the Pancreas

Gray’s Anatomy of the Human Body

HODS - November 2006 28

 Anatomy of the Pancreas
Exocrine glands have ducts that carry their secretions to specific locations.

Gray’s Anatomy of the Human Body

Robbins Basic Pathology Digestive gland that secretes digestive enzymes
http://faculty.clintoncc.suny.edu/faculty/Michael.Gregory/default.htm
into the duodenum through the pancreatic duct.
HODS - November 2006 29
Histology of the Pancreas
 Histology of the Pancreas
• Acini- dark clusters
– 99% of gland
– produce pancreatic
juice
• Islets of Langerhans
– 1% of gland
– pale staining cells
– produce hormones

HODS - November 2006 31

Bicarbonate Ion Production
 Functions of the Pancreas

• Anatomy • Secretions
– Endocrine – Pancreatic juice
• Pancreatic islets (exocrine)
produce insulin and • Trypsin
glucagon • Chymotrypsin
• Carboxypeptidase
– Exocrine
• Pancreatic amylase
• Acini produce
• Pancreatic lipases
digestive enzymes
• Enzymes that reduce
– Regions: Head, DNA and ribonucleic
body, tail acid
Bicarbonate Ion Production
LIVER
 LIVER
• Largest gland in the body (1.4 kg – 3 lbs.)
• Produces bile
– Stored in GB
– Emulsifies fats
• Involved in metabolism
• Diaphramatic and visceral surface
• Right and left lobes
• Porta hepatis = major vessels and nerves
• Right and left hepatic ducts, common bile,
common

HODS - November 2006 36

 Histology of the Liver

• Hepatocytes arranged in lobules

• Sinusoids in between
hepatocytes are blood-filled
spaces
• Kupffer cells phagocytize
HODS - November 2006
microbes & foreign matter 37
 Histology of the Liver

HODS - November 2006 38

 Histology of the Liver

HODS - November 2006 39

 Functions of the Liver
• Bile production
– Salts emulsify fats, contain pigments as bilirubin
• Storage
– Glycogen, fat, vitamins, copper and iron
• Nutrient interconversion
• Detoxification
– Hepatocytes remove ammonia and convert to urea
• Phagocytosis
– Kupffer cells phagocytize worn-out and dying red and white
blood cells, some bacteria
• Synthesis
– Albumins, fibrinogen, globulins, heparin, clotting factors

HODS - November 2006 40

 Bile
• About 600 ml of bile is produced daily
– Bile acid
– Phospholipids
– Cholesterol
– Bilirubin
– Waste products
– Electrolytes
– Mucin

HODS - November 2006 41

 KIDNEYS

HODS - November 2006 42

 KIDNEYS
• Play a major role in maintaining homeostasis
• Maintain water balance
• Regulate the quantity and concentration of
ECF ions
• Regulate the plasma volume
• Regulate pH by controlling elimination of acid
and base in urine
• Maintain osmolarity
• Regulate the concentration of plasma
constituents (e.g. electrolytes and water)

HODS - November 2006 43

 KIDNEYS
• Kidneys have excellent blood supply: 0.5% total
body weight but ~20% of Cardiac Output.
• Kidneys process plasma portion of blood by
removing substances from it, and in a few cases,
by adding substances to it.
• Works with cardiovascular system (and others!)
in integrated manner

HODS - November 2006 44

 Functions of the kidneys
• Regulation of H2O and inorganic ion balance – most
important function!
• Removal of metabolic waste products from blood and
excretion in urine.
• Removal of foreign chemicals in the blood (e.g.
drugs) and excretion in urine.
• Gluconeogenesis
• Endocrine functions (e.g. renin, erythropoetin, 1,25-
dihydroxyvitamin D)
• In kidney disease, build-up of waste serious, but not
a bad as ECF volume and composition disturbances.

HODS - November 2006 45

 Functions of the kidneys
• Water balance
• Electrolyte balance
• Plasma volume
• Acid-base balance
• Osmolarity balance
• Excretion
• Hormone secretion

HODS - November 2006 46

 Acid-Base Balance
• Kidneys VERY important for acid-base balance, along
with respiratory system.
• Important because all biochemical processes must occur
within an optimal pH window.
• Prevent ACIDOSIS or ALKALOSIS.
• Although the lungs excrete a large amount of CO2, a
potential acid formed by metabolism, the kidneys are
crucial for excreting non-volatile acids.
• To maintain acid-base balance, kidney must not only
reabsorb virtually all filtered HCO3-, but must also
secrete into the urine the daily production of non-volatile
acids.

HODS - November 2006 47

 KIDNEY

HODS - November 2006 48

 Internal Anatomy of
Kidneys
• Cortex: Outer area
– Renal columns
• Medulla: Inner area
– Renal pyramids
• Calyces
– Major: Converge to form
pelvis
– Minor: Papillae extend
• Nephron: Functional
unit of kidney
– Juxtamedullary
– Cortical
HODS - November 2006 49
 Kidney Failure

• at age 49 years, the expected duration

of life of a patient with end-stage renal
disease on hemodialysis is 7 additional
years compared with approximately 30
additional years for a person of the
same age from the general population.

HODS - November 2006 50

 Dialysis and Transplant

Hemo-
dialysis

Peritoneal
dialysis

HODS - November 2006 51

 SKIN

HODS - November 2006 52

 SKIN
• Largest organ of the body.
• Surface area 1.5 - 2 m2.
• Average adult weight 9 kg.
• Functions - protection, defence,
sensation, thermoregulation, vit D
synthesis, excretion, storage.

HODS - November 2006 53

 SKIN
2 Principal portions

• Epidermis - epithelium

• Dermis – areolar &

dense irregular
connective tissue

• Hypodermis
– “beneath the dermis”
– the subcutaneous layer
next to:
• adipose layer or
• muscle or
• bone
HODS - November 2006 54
 Functions of the Skin
• Protection
– Prevents invasion of environmental toxins and microorganisms

• Immunologic
– Sebum has antibacterial properties which helps shed topical
bacteria

• Thermoregulation
– Insulates from heat loss and controls loss of heat through
evaporation

HODS - November 2006 55

 Functions of the Skin
• Fluid and Electrolyte Balance
– Controls sodium excretion
– Sebum retards fluid loss from skin

• Metabolism
– Produces Vitamin D
– Prevents excessive fluid loss

• Neurosensory
– Nerve endings and receptors process environmental stimuli for pain,
touch, heat and cold

• Social and Interactive

– Provides body image and personal identity

HODS - November 2006 56

 Epidermis
• Provides barrier function.
• Multilayered structure, continually
regenerating.
• Thickness dependent on exposure to friction.
• Stratified squamous epithelium, organised in
five layers.
– Stratum basale; Stratum spinosum, Stratum
granulosum, Stratum lucidum, Stratum corneum.

HODS - November 2006 57

 Epidermis
• First layer of defense
• Composed of dead, keratinized
cells and surrounded by a lipid
monolayer
• There are no blood vessels. It is
fed by capillaries in the dermis.
• If the epidermis is destroyed but
the appendages of the dermis
remain, a new epidermis is
formed when the epithelial grow
out of the hair follicles.

HODS - November 2006 58

• EPIDERMIS
• 4 cell types
– Keratinocytes - 90%
• filled with keratin (protein)
• waterproof barrier
– Melanocytes - 8%
• produce melanin (pigment)
• pass melanin to
keratinocytes
– Langerhans cells
• phagocytes (from immune
system)
• easily damaged by UV light
– Merkel cells
• in deepest layer of hairless
skin
• sensory transduction -
touch
HODS - November 2006 59
 Epidermis

SC

SG

SS

HODS - November 2006 60

 Dermis
• Varies in thickness across body.
• 1 mm on face , 4 mm on back.
• Responsible for most major functions of
the skin.
• Two distinct layers:
Papillary dermis,
Reticular dermis.

HODS - November 2006 61

 Dermis
• Few cells present - fibroblasts,
macrophages, adipocytes
• Intracellular matrix thick with many
protein fibers: collagen, elastin,
reticular
• The location for blood vessels, nerves
and sensory receptors, glands, hair
follicles

HODS - November 2006 62

 Dermis
• Collagen and fibrous connective tissue
• Contains capillaries and arterioles
• Has special sensory nerve fibers and
lymph system
– Meissner Corpuscle: light touch, just
beneath epidermis
– Vater Pacini Corpuscles: pressure
sensors, deep in subq
– Ruffini Corpuscles: heat sensors, deep
in subq tissue
– Krause Corpuscles: cold sensors,
deep in subcutaneous tissue

HODS - November 2006 63

 Dermis
• Papillary region -
outer layer - 20%
– areolar connective
tissue, elastic fibers
– dermal papillae –
mound-like
projections to
increase the
surface area for
nutrition from
capillaries
– some papillae
contain Meissner's
corpuscles (for light
touch)
HODS - November 2006 64
 Dermis
• Reticular region-
80%
– dense, irregular
connective tissue
– collagen, elastic
fibers in a network
surrounding the
various cells
– fibers give strength,
elasticity,
extensibility
– tears in reticular
region - "stretch
marks“ - long
straight red or white
streaks
HODS - November 2006 65
 Layers of the Dermis.

HODS - November 2006 66

 Subcutaneous Tissue
• Connective tissue
• Fat cells in most areas
• Blood vessels
• Nerves
• Base of hair follicles
• Function:
• Insulation
• Storage of nutrients

HODS - November 2006 67

 Skin Blood Vessels
Superficial
dermal plexus.

Cutaneous plexus

Subcutaneous
plexus.

HODS - November 2006 68

 Types of Burns

• Superficial
• Superficial partial thickness
• Deep partial thickness
• Full thickness

HODS - November 2006 69

 Partial Thickness Burn

• Can be superficial or deep

• Involves epidermis and dermis
• Has blister formation
• Moist appearance
• Tactile and pain sensors intact
• Will usually heal on own but will scar

HODS - November 2006 70

 Full Thickness Burn
• Involves all layer of skin
• Has waxy and dry appearance
• Elasticity destroyed
• Painless
• Does not heal without intervention
– Autologous skin graft or banked skin

HODS - November 2006 71