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Physiology lecture 5 – 6/10/2010 Done By: Lamees Nimri

Blood is a connective mobile tissue which has cell compounds (45%) & liquid parts (55%). The
majority of cell compounds are RBCs which have a major function in carrying oxygen from lungs to
the tissues. The liquid part is plasma which consists of 90% of water , 10% different substances
mainly proteins (6-8%) that perform many valuable functions; some proteins like gamma globulins
are antibodies ,other proteins share in the colloid osmotic pressure ,some of them carry insoluble
substances like cholesterol & vitamins. the number of RBCs is 5 million/μL and the life span for
them is 120 days so they must be replaced at the rate of 2-3million/sec. the factory for RBCs
production is the bone marrow which can be stimulated by a special hormone or chemical called
erythropoietin that secreted form the kidneys by the lacking of oxygen. In the stem cell the mother
cell is one but it can be RBC, WBC or platelet.. the red bone marrow produce RBCs and
agranulocytes WBCs like momocytes and all types of granulocytes WBCs . The other type of WBCs
is the lymphocytes ,they're produced in the lymph nods but their stem cells are produces in the bone
marrow after that they will be migrated from the bone marrow to the lymph nods then it'll be located
there and start to produce the lymphocyte cells for the blood circulation.

Platelets are the other part of blood ,they aren't complete cells but small cell fragments. The big cell
is called the megakkaryocyte which is located in the bone marrow ,It's the differentiated cell for
platelets that came from the mother stem cell,it has a large volume after that it will be fragmented
into pieces which migrate form the bone marrow to the blood circulation we call them "Platelets" or
thromocytes. The number of platelets in blood is about 150-350thousand/mm
They live only 10 days then the bone marrow will produce more and more.

*Hemostasis:
Is the process by which you prevent bleeding from a broken blood vessel. It has 3 steps :
-Step 1: spasm to the vessel which cause the muscles to contract in order to reduce blood flow and
prevent blood lose also the endothelial surfaces of the vessel are pressed together when
the contraction happens and this speeds the process of healing.

-step 2 : platelet plug formation

Platelet Adenosine
Adenosine
Adenosine
diphosphate
diphosphate
diphosphate
(ADP)
(ADP)
(ADP)

Inhibits platelet
Vessel aggregation
lumen Prostacyclin
Prostacyclin
Prostacyclin Prostacyclin
Prostacyclin
Prostacyclin
and
and nitric
and nitric and
and nitric
and nitric
nitric
acid
acid
acid acid
acid
acid

Normal
Normal Normal
Normal
Normal
Normal
endothelium
endothelium endothelium
endothelium
endothelium
endothelium
Vessel
wall

Aggregating
Aggregating Collagen
Collagen
Collagen
platelet plug
platelet plug Exposed collagen
Exposed
Exposed collagen
collagen
at site
at
at site of
site of
of
vessel
vessel injury
vessel injury
injury

Fig. 11-7, p. 322

Whenever there's a damage in the endothelial structure in the blood vessel will cause an
exposure of a special protein called collagen in the interstitial compartment that stimulates
a huge number of platelets to be adherent to each other as shown in the figure above.

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These platelets are flowing in the blood circulation normal but if there is a cut or damage
the collagen will attract these platelets together to form platelet plug, this plug will produce
different chemicals the main one is Adenoslne diphosphate (ADP) which will cause more
aggregation of platelets so if we have 1 million platelets together ADP will be produced and
that will cause another million to be in that area and the plug will be more and more through
positive-feedback mechanism. If the plug will continue to develop it will block the whole
capillaries,to prevent that there're another chemicals to released from the adjacent area of
endothelial cells ,these chemicals are: prostacyclin and nitric oxide.

So In the local area of the wound there're chemicals to increase the plug but aside that
area there're chemicals to prevent the plug. If plug formation is enough to close the wound
and form a new endothelial tissue the third step will not occur, but if the bleeding continue
the third step will occur which is called " clot formation " .

-step 3 : Clot Formation

The ultimate step of that series of reaction is to change fibrinogen (soluble plasma protein)
to fibrin which is like needle network of threads and it'll form a clot. There're 12 plasma
clotting factors that circulating in the plasma in inactive form but if there's any damage in
the endothelial cells or the smooth muscles or the tissue that will produce chemicals from
the damaged area that will activate factor number 12 which will activate factor number 11
and so on through the positive-feedback mechanism .

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 Inside our vascular system there're 2 major pathways to clot formation: the intrinsic pathway & the
extrinsic pathway.

The intrinsic pathway: occurs inside the vessels or outside the body for example if we took blood
sample and put it in a tube if we don't add anticoagulant factor to that tube it'll be clotted through the
intrinsic pathway even it's outside the body. Inside our body if there's a cut wound or any damage in
the endothelial structure that will activate the intrinsic pathway. When the area has a damage but the
blood leaves outside to the interstitial compartment (under the skin ) which is called hematoma it'll
follow the other pathway which is the extrinsic pathway because it's outside the vessel.

 The intrinsic pathway:

This pathway is set off when factor XII (factor number twelve) is activated by either exposed
collagen in an injured vessel or a foreign surface such as a glass test tube after that factor 12 will
activate factor 11 and factor 11 will activate 10 and factor 10 will activate factor 9 ,this positive-
feedback will lead to the conversion of prothrombin to thrombin this is the major protein which is
able to cut the fibrinogen and form the fibrin after that factor XIII ( factor thirteen) which is called
fibrin stabilizing factor will solidify the clot.

For example, when we have a wound and the clot forms at first it'll look yellow a little bit but after a
while it'll be brown .when fibrin forms in the wounded area it'll collect within it different things
mainly RBCs and a serum which has no clotting factors that makes the clot soft and not dry and
fixed that's why when kids play with there wounds they would take it back again which cause
another bleeding but after a while factor 13 will make the clot solid and by the contraction of elastin
and other proteins this will cause to squeeze the serum out so we will end with a dry clot and that
will be the solid fixed brown clot.

After the bleeding stop there're some chemicals to contract that clot (the contraction starts from the
peripheral to the central part to close the wounded edges together which speed the healing process of
producing connective tissue and a scar is formed ).

There're two ways by which the colt is taken off from the wounded area :
- phagocytic cells which eat the dead cells

- cutting the fibrin by another chemical called plasmin which is in inactive form (plasminogen) in
the plasma when there's a need to it the plasminogen will convert to plasmin that will dissolve the
clot.

Under normal condition there is another system inside blood vessels which is called antigoagulant
mainly the plasminogen all the time plasmin fights and forms clot inside the body but under
ubnormal conditions like thromboembolism ; thrombus means the clot which blocks the whole
vessel for example infarction in the heart, stroke in the brain, Deep vein thrombosis (DVT) in the
lower limbs. embolism is a free-floating clot that moves with the blood but it's small and doesn't clot
the whole vessel, both situation are dangerous for the life but if there is a good antigoagulant system
they sould not be exist.

The main causes for thromboembolism:

1-rough surface for the endothelial layer which is so smooth so the blood slips over it without any
trouble but by aging or by being very fat that will create a lot of cholesterol inside the plasma which
cause a very rough surface for the endothelial layer and make disturbance of the blood flow which
might cause infarction or stork.

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2- imbalance between clotting and anti-clotting system: if there's more activation in fibrin,thrombin
and factor 13 and there's less plasmin effect that will cause clotting formation inside the vessel

3-slow blood flow: if it's normal the platelet won't be aggregated if it's slow the platelets will be
adherent to each other and the plug will be formed and this will activate the positive-feedback
mechanism and this will cause the clotting formation.

4- thromboplastin is the triggering point of the extrinsic pathway for clot formation,whenever the
tissue is damage the thromboplastin will be released when it's released in the tissue it will cause the
clotting outside the vessels through the extrinsic pathway but if it's caused by a huge damage of the
tissue it'll be distributed inside the vascular system which might cause a clot inside the vessels which
cause thrombus or emboli.

*leukocytes (WBCs) :

There are two groups of them: granulocytes with granules and agranulocytes without granules.
-Agranulocytes are 2 types: monocytes (the biggest one) and lymphocytes which are mononuclear
-granulocytes are 3 types : basophils, eosinophils, neutrophis ( the major amount 60-70%)

WBCs is colorless so in order to distinguish them we use special stains ,basophils will be blue in
color because it's basic and eosinophils will be red and neutrophile will be in between.
All of them play a major roll in the defense mechanism in different ways either by releasing toxins
that makes holes in the viruses and bacteria or by producing antibodies or by killing invader itself.

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*Respiratory System :

Our life is started by the fist inspiration, if the new born doesn't cry we don't conseder that new born is
alive so the first cry is the first respiratory movement which is the first sign in our life and the last
movement in our life is the last expiration Respiratory sysyem is one of the most efficient system in
our body but it doesn't need a lot of energy to achieve its function (2-3 % of the total energy
consumption in the normal condition.) this small percentage is for gas exchange, breathing(ventilation)
and so on.

There're 4 steps in respiration the first one is called respiratory cycle which has 2 phases; inspiration
and expiration , inspiration to take the air from the atmosphere to the lungs and expiration to take off
carbon dioxide form the lungs to outside the body.the second step is to conduct gas exchange
between the alveoli in the lungs and the blood (take oxygen from lungs to the blood and remove
CO2 from the blood to the lung) .the third one is called gas transport in which O2 and CO2 is
transported by the blood between the lungs and the tissues. The final step is the diffusion of gases
through the capillaries to the tissues. These 4 steps are for external respiration but the internal
respiration "cellular respiration" refers to the intracellular metabolic processes carried out within the
mitochondria when the O2 is inside the cells which use nutrients and O2 to get energy and CO2.

Atmosphere Steps of external respiration

1 Ventilation or gas exchange between

the atmosphere and air sacs (alveoli)
in the lungs

O2 CO2
Alveoli of lungs
2 Exchange of O2 and CO2 between air
CO2 in the alveoli and the blood
O2

Pulmonary
circulation

3 Transport of O2 and CO2 between the

lungs and the tissues

Systemic
circulation

CO2
O2
4 Exchange of O2 and CO2 between the
blood and the tissues
Food + O2 CO2 + HO2 + HTP Internal respiration

Tissue cell Fig. 12-1, p. 366

There're many non-respiratory functions for this system like:

- when the breathing occurs water vapor will get inside and outside the body so the temperature is
regulated plus the body compartment will remain constant ( we will keep the alveoli wet )

- enhances venous return: the heart pumps the blood out and this blood should go back to the
heart but this isn't easy because the veins don't have enough muscle to pump the blood back so
there're some other structures and other functions from other systems like the negative pressure
inside the chest which cause a suction for the blood to flow inside the veins and get back to the
heart.

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- acid-base balance

- enables speech: without the respiratory system the vocal cords (which give sounds by
flowing in and out the air) will not work .

- defends against foreign inhaled matters ( dust, smoke, viruses, bacteria) by phagocytes .

- smelling: without breathing we can't smell because the movement of air will cause particles
to dissolve in special receptor to smell them.

- Shape of the chest

- Protects heats and vessels :the lungs protect the hearts and vessels in addition to the chest
bones

- Aireate the blood between respiratory phases.

The respiratory system includes: the respiratory airways leading "conducting channels" which
conduct air into the lungs where gas exchange occurs and the chest which involves in producing
movement of air through the airways into and out of the lungs.

The lungs consist mainly of alveoli ( 300 million of them each about 300 micrometer in diameter) in
order to increase the surface area (75 meter square).

Terminal
bronchiole Smooth
muscle

Branch of Branch of
pulmonary pulmonary
artery vein

Respiratory
bronchiole

Alveolus Pulmonary
capillaries

Alveolar
Pores of Kohn sac

Fig. 12-2b, p. 367

The Alveoli are clusters of thin-walled, inflatable, grapelike sacs which are connected with each
other . The alveolar walls consist of single layer of flattened type 1 alveolar cells. The alveolar

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epithelium also contains type 2 alveolar cells which secrete surfactant a chemical complex, there are
also the phagocytes which take off invaders.
The blood circulation around alveoli is very efficient to take the O2 the red one is the venous part
which takes oxygen-rich blood from lung to the heart and the blue one is the arterial part which is
CO2-rich blood.

Airway conducting channels start with a big trachea (the cartilaginous structure with some muscle in
it) then it goes to the right bronchus and left bronchus, the 2 bronchus will be divided into 4 and the
4 to 8 ….until 25 divisions occur after that we reach to the final parts of the airway conducting
channels which are called the bronchioles, they're small and have smooth muscles (the brownish
structure) ,if the muscles contract the airway channels will be squeezed if the muscles relax the
airway channels will be dilated.

For the protection of the lungs there's another special structure surrounding the lunges which is
called the pleural that has double layers outside layer which is connected to the internal surface of
the chest (to the ribs and muscles), inside layer connected to the alveoli .in between there's a pleural
space and it isn't open neither to the lungs nor to outside the chest ,it contains a small amount of
pleural liquid it's like plasma and it lubricates the movement of the lungs .because of the liquid the
separation of the two layers won't be easy but they can slide over each other .if there's a deficiency in
that liquid the breathing will be painful.

Respiratory mechanism :

Atmospheric pressure
(the pressure Atmosphere
exerted by the 760 mm Hg
weight of the gas in the
atmosphere on objects on Airways
the Earth’s surface—760
mm
Hg at sea level)

Thoracic wall

Intra-alveolar
pressure (the
pressure within
the alveoli—760 mm Plural wall
Hg when equilibrated
with atmospheric
pressure)

Lungs

Intrapleural pressure (the 756 mm Hg

pressure within the pleural
sac—the pressure exerted
outside the lungs within the
thoracic cavity, usually less
than atmospheric pressure at
756 mm Hg) Fig. 12-5, p. 370

Air tends to move from a region of higher pressure to a region of lower pressure .there are three
different pressures which are :
1- the atmospheric pressure: the normal pressure at the sea level is 760mm Hg if we go up it
will decrease and if we go down it will increase
2- intra-alveolar pressure is the pressure within the alveoli
3- the intrapleural pressure it's within the pleural sac.

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Because the lungs is connected wit the conducting channels so when these channels is opened to the
outside there will be a communication between the atmosphere and the alveolar space and the air
will flow from higher to the lower pressure .without doing inspiration and expiration the alveolar
pressure will be equaled to the atmospheric pressure (760mm Hg) . but when inspiration occurs the
pressure inside the lungs is less than the atmospheric pressure. Through expiration opposite thing
occurs the air moves from lungs to outside so the alveolar pressure is higher than the atmospheric
one.

 760mm Hg is considered as zero line ( 0 pressure = 760mm Hg ). Through inspiration

inside the lung the pressure will be negative ( not negative in the absolute but in the concept) .for
example if the alveolar pressure is 757mm Hg and the atmospheric pressure is 760mm Hg this
means -3 ,
Inside 762 and outside 760 it means +2 .
The intra-alveolar pressure could be zero, + ,- depending on the movement of the air but the
intrapleural pressure it's about -4 (less than atmospheric pressure ) it could be changed (more
negative).

*Respiratory Muscles:
In inspiration to increase the chest cavity there're special muscles called inspiratory muscles the
main are the diaphragm which is under the lungs in the chest cavity when it's contracted it will go
down and it will increase the space of the chest. The other main muscle is the external intercostals
between the ribs these muscles when contract it will raise the ribs up. that will increase the chest's
dimension in all directions (up and down) and anterio-posterior.
The accessory inspiration muscles are: sternocloidomastoid and scalenus which located in the neck
these kind of muscles is used in exercising and in stressful situation.

Elevation of ribs causes sternum

External Elevated to move upward and outward,
intercostal rib cage which increases front-to-back
muscles dimension of thoracic cavity
(relaxed)
Contraction
of external
intercostal
muscles

Sternum

Contraction
of diaphragm
Diaphragm
(relaxed)
Lowering of diaphragm on
contraction increases vertical
dimension of thoracic cavity
Before inspiration Inspiration

Contractions of external intercostal

muscles causes elevation of ribs,
which increases side-to-side
dimension of thoracic cavity Fig. 12-11a, p. 374

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In expiration the muscles are relaxed so it pushes the air outside .the expiration musles are the
internal intercostals and the abdominal muscles.
in forceful breathing huge contraction will occurs during inspiration so the relaxation of the muscles
during expiration isn't enough so the expiration musles will contract.

Relaxation Contraction of internal intercostal

of external muscles flattens ribs and
intercostal sternum, further reducing
muscles Contraction side-to-side and front-to-back
of internal dimensions of thoracic cavity
intercostal
muscles

Contraction
of diaphragm

Position of relaxed
Relaxation of
abdominal muscles
diaphragm
Contractions of abdominal
muscles cause diaphragm to
be pushed upward, further
Passive expiration reducing vertical dimension
of thoracic cavity
Return of diaphragm, ribs, and sternum
to resting position on relaxation of Active expiration
inspiratory muscles restores thoracic
cavity to preinspiratory size
Fig. 12-11bc, p. 375

Best of luck all ….study well 

Done By : Lamees Nimri

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