M. I .A.

SOOJEEDE

HUMAN
ANATOMY &
PHYSIOLOGY
Lecture note

Dr-Mohamed Ibrahim Abdi “Soojeede”

BSC. Veterinary medicine & Animal husbandry
BSC. Public health
 Master of HSM at KU

Year - 2015

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 Dedication
I dedicate this book to my mother: FADUMO DAHIR

ALASOW, she equipped and encourage me to the skills of all

my life starting when I was child up to now, she gave me her

role and the role of my father when my father died.

MY MOM: FADUMO DAHIR ALASOW

ANATOMY AND PHYSIOLOGY

Copyright of this book © [email protected]

2014-02-10 first Printed at Mogadishu-Somalia

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 Acknowledgment

First I would like to thank Allah who gives me the ability to complete
this task, Praise due to Allah who created the creation and much thanks
to him for allowing me to be one of his creations, and make this book
possible to be completed in a time.

By: Mohamed Ibrahim Abdi “Soojeede”

 Bsc. Veterinary Medicine and Animal Husbandry
 Bsc. Public Health
 Master of HSM at KU

Please keep copy right of this textbook of anatomy and

physiology, take permission if you need hard copy.
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 Table contents
Dedication ............................................................................................................... II

Acknowledgment ................................................................................................... III

Table contents ........................................................................................................ IV

CHAPTER ONE ......................................................................................................1

INTRODUCTION....................................................................................................1

CHAPTER TWO .....................................................................................................8

CELL, TISSUE AND MEMBRANES ...................................................................8

CHAPTER THREE ...............................................................................................19

BLOOD ...................................................................................................................19

CHAPTER FOUR CARDIOVASCULAR SYSTEM........................................29

CHAPTER FIVE....................................................................................................37

THE LYMPHATIC SYSTEM ..............................................................................37

CHAPTER SIX ......................................................................................................44

THE NERVOUS SYSTEM ...................................................................................44

CHAPTER SEVEN ................................................................................................64

ENDOCRINE SYSTEM ........................................................................................64

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CHAPTER EIGHT ................................................................................................78

SKELETAL AND JOINT SYSTEM ....................................................................78

CHAPTER NINE ...................................................................................................93

THE SPECIAL SENSES .......................................................................................93

CHAPTER TEN ...................................................................................................100

RESISTANCE AND IMMUNITY ......................................................................100

CHAPTER ELVEN ..............................................................................................108

THE URINARY SYSTEM ..................................................................................108

Reference...............................................................................................................113

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 CHAPTER ONE
INTRODUCTION
Definitions

Anatomy is the study of the structure of the body and the physical relationships

involved between body parts.

Physiology is the study of how the parts of the body work, and the ways in which

they cooperate together to maintain life and health of the individual.

Anatomy

Anatomy can be divided into microscopic or macroscopic (gross) anatomy.

 Microscopic anatomy deals with structures that cannot be seen without

magnification.

Microscopic anatomy can be subdivided into specialties.

a. Cytology- analyzes the internal structure of individual cells.

b. Histology- examines tissues and organs.

 Gross anatomy, or macroscopic anatomy studies features visible to the naked

eye.

Anatomy has another division

a. Surface anatomy- refers to the study of general form and superficial

markings.

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 b. Regional anatomy – considers all of the superficial and internal features in a

specific region of the body; such as head, neck or trunk.

c. Systemic anatomy considers the structures of major organ systems; example-

circulatory system.

Physiology

Physiology examines the function of anatomical structures; it considers the

physical and chemical processes responsible.

a. Human physiology is the study of the functions of the human body.

b. Cell physiology is the study of the functions of living cells.

c. Special physiology is the study of the physiology of specific organs.

d. System physiology considers all aspects of the function of specific organ

systems.

Levels of organization

A. Chemical or Molecular level- Atoms

1. Cellular – red blood cell

2. Tissue- arter

3. Organ- heart

4. System- circulatory system

5. Organism level – human

Each level of organization depends on the others.

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All living things perform the same basic functions.

1. Responsiveness- Organisms respond to changes in their immediate

environment, this is called irritability.

2. Growth- Organisms grow larger, increasing in size through an increase in the

size or number of their cells.

3. Reproduction- Organisms must reproduce to pass on their genetic information.

4. Movement- Organisms are capable of movement of food, blood or other

materials inside the body, also moving in the environment.

5. Metabolism- Organisms rely on complex chemical reactions to provide the

energy for responsiveness

THE INTERNAL ENVIRONMENT AND HOMEOSTASIS

The external environment surrounds the body and provides the oxygen and

nutrients required by all the cells of the body. Waste products of cellular activity

are eventually excreted into the external environment. The skin provides a barrier

between the dry external environment and the watery environment of most body

cells.

The internal environment is the water-based medium in which body cells exist.

Cells are bathed in fluid called interstitial or tissue fluid.

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Homeostasis and System Integration

Homeostasis (homeo= unchanging; stasis= standing) keeping a stable environment.

(Example body temp)

Homeostasis is maintained by control systems which detect and respond to changes

in the internal environment. Homeostatic regulation refers to the adjustments that

are met to keep homeostasis. (Example when to hot body will seat to cool down.)

Homeostatic regulation usually involves 3 things.

A. Receptor- that is sensitive to a particular environmental change or stimulus.

b. A control center, or integration center, which receives and processes the

information from the receptor.

c. An effector - responds to the commands of the control center and whose

activity opposes or enhances the stimulus.

Negative Feedback

The method of homeostatic regulation is called negative feedback because the

effector that is activated by the control center opposes or eliminates the stimulus.

Most homeostatic mechanisms in the body involve negative feedback.

Body temperature is a physiological variable controlled by negative feedback.

When body temperature falls below the preset level, this is detected by specialised

temperature sensitive nerve endings. They transmit this information as an input to

groups of cells in the hypothalamus of the brain which form the control centre. The

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output from the control centre activates mechanisms that raise body temperature

(effectors). These include:

• Stimulation of skeletal muscles causing shivering

• Narrowing of the blood vessels in the skin reducing the blood flow to, and heat

loss from, the peripheries

• Behavioural changes, e.g. we put on more clothes or curl up.

Positive Feedback

In positive feedback the initial stimulus produces a response that reinforces the

stimulus. In positive feedback mechanisms, the stimulus progressively increases

the response, so that as long as the stimulus is continued the response is

progressively being enlarged.

Homeostasis and Disease

When homeostatic regulation fails, organ systems begin to malfunction and the

individual experiences the symptoms of illness or disease.

D. Body Cavities

Two body cavities form during embryonic development- the dorsal body and

ventral body cavity.

a) The dorsal body cavity is contains two cavities such as cranial cavity and

spinal cavity.

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 b) Ventral cavity is contains three cavities such as Thoracic, Abdominal and

Pelvic cavity.

The organs that make up the systems of the body are contained in five cavities:

 Cranial

 Spinal

 Thoracic

 Abdominal

 Pelvic.

Organ system

 Integumentary system

 Skeletal system

 Muscular system

 Nervous system

 Endocrine system

 Cardiovascular system

 Lymphatic/immune system

 Respiratory system

 Digestive system

 Urinary system

 Reproductive system
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Body cavity

 Body cavities and membranes

 Dorsal cavity divided into cranial and vertebral

 Ventral cavity containing viscera (visceral organs) divided into two

main cavities

 Thoracic cavity

 2 lateral pleural cavities

 Central mediastinum containing pericardial cavity

 Abdominopelvic cavity

 Abdominal cavity

 Pelvic cavity

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 CHAPTER TWO
CELL, TISSUE AND MEMBRANES
CELL

Cellsare the smallest functional units of the body. Theyare grouped together to

form tissues, each of which has aspecialised function, e.g. blood, muscle, bone.

Differenttissues are grouped together to form organs, e.g. heart,stomach, brain.

Organs are grouped together to form systems,each of which performs a particular

function.

The human body develops from a single cell called thezygote

Plasma membranes

A cell consists of a plasma membrane,The plasma membrane consists of two

layersof phospholipids with someprotein molecules embedded in them. that allow

the passage of materials, for example,

The membrane proteins perform several functions: to transport carbohydrate.

Cytoplasm

Cytoplasm is a matrix or ground substance in which various cellular components

are found. It is thick semi transparent, elastic fluid containing suspended particles

and a series of minute tubules and filaments that form cytoskeleton.

Water constitutes 75-90% of the cytoplasm. It also contains solid components,

proteins, carbohydrates, lipids and inorganic substances.

Organelles
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Organelles are small structureswith highly specialised functions, They include: the

 Nucleus,

 Mitochondria,

 Ribosomes,

 Endoplasmic reticulum,

 Golgi apparatus,

 Lysosomes,

 Centrioles

 Microfilaments and microtubules

Organelles

Nucleus

Every cell in the body has a nucleus, with the exceptionof mature erythrocytes (red

blood cells). Skeletal muscleand some other cells contain several nuclei.

The nucleusis the largest organelle and is contained within a membranesimilar to

the plasma membrane but it has tinypores through which some substances can pass

betweenit and the cytoplasm, i.e. the cell contents excluding thenucleus.

The nucleus contains the body's genetic material,which directs the activities of the

cell.

This is built fromDNA and proteins called histones coiled togetherforming a fine

network of threads called chromatin.Chromatin resembles tiny strings of beads.

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During celldivision the chromatin replicates and becomes moretightly coiled

forming chromosomes.

Mitochondria

Mitochondria are sausage-shaped structures in the cytoplasm, sometimes described

as the 'power house of energy' of the cell.

They are involved in aerobic respiration, the processes by which chemical energy

is made available in the cell.

Synthesis of ATP is most efficient in the final stages of aerobic respiration, a

process requiring oxygen.

Ribosomes

These are tiny granules composed of RNA and protein. They synthesize proteins

from amino acids, the ribosomes make proteins for use within the cell.

Ribosomes are found on free units or attached in the outer surface of rough

endoplasmic reticulum.

Endoplasmic reticulum (ER)

Endoplasmic reticulum is a series of interconnecting membranous canals in the

cytoplasm. There are two types: smooth and rough.

Smooth ER synthesizes lipids and steroid hormones, and is also associated with the

detoxification of some drugs.

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Rough ER is studded with ribosomes. These are the site of synthesis of proteins

that are 'exported from cells, i.e. enzymes and hormones that pass out of their

parent cell to be used by other cells in the body.

Golgi apparatus

The Golgi apparatus consists of stacks of closely foldedflattened membranous sacs.

It is present in all cells but islarger in those that synthesise and export proteins.

Theproteins move from the endoplasmic reticulum to theGolgi apparatus where

they are 'packaged' into membrane-bound vesicles called secretory granules.

Lysosomes

Lysosomes are one type of secretory vesicle formed bythe Golgi apparatus. They

contain a variety of enzymesinvolved in breaking down fragments of organelles

andlarge molecules (e.g. RNA, DNA, carbohydrates, proteins).Lysosomes in white

blood cells contain enzymes thatdigest foreign material such as microbes.

Microfilaments and microtubules

 Microfilaments. These are tiny strands of protein thatprovide structural

support and maintain the characteristicshape of the cell.

 Microtubules. These are contractile protein structures inthe cytoplasm

involved in the movement of the cell andof organelles within the cell,

Cell division

 There are two types of cell division: mitosis and meiosis.

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  Mitosis: Is a somatic cell division which beginning with the fertilised egg, or

zygote, cell divisionis an on-going process.

 Mitosis occurs in two stages: replication of DNA, in the form of 23 pairs of

chromosomes, then division of the cytoplasm. The frequency with which

cell division occurs varies with different types of cell.

Meiosis

This is the process of cell division that occurs in the formationof reproductive cells

(gametes — the ova and spermatozoa).

Inmeiosis four daughter cells are formed after two divisions.

When it divides, each of the 'daughter' cellshas only 23 chromosomes, called the

haploid number.

zygotehas the full complement of 46 chromosomes (thediploid number), half from

the father and half from themother.

Mutation

Cells are said to mutate when their genetic make-up isaltered in any way. Mutation

may cause:

 modification of cell function that may causephysiological abnormality.

 The death of the cell.

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Transport of substances across cell membranes

Passive transport

This occurs when substances can cross plasma andorganelle (semipermeable)

membranes and move downthe concentration gradient (downhill) without

usingenergy.

 Diffusion

Small substances diffuse down the concentration gradient crossing membranes by:

 dissolving in the lipid part of the membrane,

 passing through water-filled channels, or pores in the membrane,

Facilitated diffusion

This passive process is utilised by some substances thatare unable to diffuse

through the semipermeable membraneunaided, e.g. glucose, amino acids.

Specialisedprotein carrier molecules in the membrane have specificsites that attract

and bind substances to be transferred,

Osmosis

Osmosis is passive movement of water down its concentrationgradient towards

equilibrium across a semipermeable “the passage of solvent from a less

concentrated solution”.

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Active transport

This is the transport of substances up their concentrationgradient (uphill), i.e. from

a lower to a higher concentration, and it is energy dependable process.

Tissue and membranes

Tissues are groups of cells similar in structure, arranged in a characteristic pattern,

and specialized for the performance of specific tasks. The study of tissues is known

as histology (his-TOL-o-je).

Tissue Classification

The four main groups of tissue are the following:

 Epithelial (ep-ih-THE-le-al) tissue covers surfaces, lines cavities, and

forms glands.

 Connective tissue supports and forms the framework of all parts of the

body.

 ◗ Muscle tissue contracts and produces movement.

 ◗ Nervous tissue conducts nerve impulses.

Epithelial Tissue

Epithelial tissue, or epithelium (ep-ih-THE-le-um), forms a protective covering

for the body. It is the main tissue of the skin’s outer layer. It also forms membranes,

ducts, and the lining of body cavities and hollow organs, such as the organs of the

digestive, respiratory, and urinary tracts.

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Epithelial tissue is classified on the basis of these characteristics. In shape, the cells

may be described as follows:

 ◗ Squamous (SKWA-mus)—flat and irregular

 ◗ Cuboidal—square

 ◗ Columnar—long and narrow

Connective Tissue

The supporting fabric of all parts of the body is connective tissue. we will

categorize them according to these physical properties:

 Liquid connective tissue—blood and lymph.

 Soft connective tissue—loosely held together with semi-liquid material

between the cells; includes adipose (fat) tissue and areolar (loose)

connective tissue.

 Fibrous connective tissue—most connective tissue contains some fibers, but

this type is densely packed with them. Cells called fibroblasts. Examples of

structures composed of fibrous connective tissue are ligaments, tendons, and

the capsules (coverings) around certain organs.

 Hard connective tissue—has a very firm consistency, as in cartilage, or is

hardened by minerals in the matrix, as in bone.

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Muscle Tissue

Muscle tissue is designed to produce movement by contraction of its cells, which

are called muscle fibers because most of them are long and threadlike. Muscle

tissue is usually classified as follows:

 Skeletal muscle, which works with tendons and bones to move the body.

This type of tissue is described as voluntary muscle, The cells in skeletal

muscle are very large and are remarkable in having multiple nuclei and a

pattern of dark and light banding described as striations.

 Cardiac muscle, which forms the bulk of the heart wall and is known also as

myocardium (mi-o-KAR-deum). This is the muscle that produces the

regular, contractions known as heartbeats. Cardiac muscle is described as

involuntary muscle, Cardiac muscle has branching cells and specialized

membranes between the cells that appear as dark lines under the microscope.

Their technical name is intercalated (in-TERcal- a-ted) disks.

 Smooth muscle is also involuntary muscle. It forms the walls of the hollow

organs in the ventral body cavities, including the stomach, intestines,

gallbladder, and urinary bladder. Together these organs are known as viscera

(VIS-ehrah), so smooth muscle is sometimes referred to as visceral muscle.

Smooth muscle cells are of a typical size and taper at each end. They are not

striated and have only one nucleus per cell.

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  Nervous Tissue The human body is made up of countless structures, both

large and small, each of which contributes something to the action of the

whole organism.

 The Neuron The basic unit of nervous tissue is the neuron (NU-ron), or

nerve cell A neuron consists of a nerve cell body plus small branches from

the cell called fibers

Membranes

Membranes are thin sheets of tissue. Their properties vary: some are fragile, others

tough; some are transparent, others opaque (i.e., they cannot be seen through).

Membranes may cover a surface, may serve as a dividing partition, may line a

hollow organ or body cavity,

Epithelial membranes are of several types:

 Serous (SE-rus), membranes line the walls of body cavities and are folded

back onto the surface of internal organs, forming their outermost layer.

 Mucous (MU-kus) membranes line tubes and other spaces that open to the

outside of the body.

 The cutaneous (ku-TA-ne-us) membrane, commonly known as the skin,

has an outer layer of epithelium.

Serous Membranes

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Serous membranes line the closed ventral body cavities and do not connect with

the outside of the body. There are three serous membranes:

 The pleurae (PLU-re), or pleuras (PLU-rahs), line the thoracic cavity and

cover each lung.

 The serous pericardium (per-ih-KAR-de-um) forms part of a sac that

encloses the heart, which is located in the chest between the lungs.

 The peritoneum (per-ih-to-NE-um) is the largest serous membrane. It lines

the walls of the abdominal cavity, covers the organs of the abdomen,

Connective Tissue Membranes

The following list is an overview of membranes that consist of connective tissue

with no epithelium.

 Synovial (sin-O-ve-al) membranes are thin connective tissue membranes

that line the joint cavities.

 The meninges (men-IN-jeze) are several layers of membranes covering the

brain and the spinal cord.

 Superficial fascia is the continuous sheet of tissue that underlies the skin

and contains adipose (fat) tissue that insulates the body and protects the skin.

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 CHAPTER THREE
BLOOD
Blood is a connective tissue. It provides one of the means of communication

between the cells of different parts of the body and the external environment, e.g. it

carries:

 Oxygen and carbon dioxide.

 Nutrients and cell wastes,

 Hormones secreted by glands

 Heat produced in active tissues

 Protective substances, e.G. Antibodies,

 Clotting factors that coagulate blood.

Blood makes up about 7% of body weight (about 5.6 litres in a 70 kg man

COMPOSITION OF BLOOD

Blood is composed of in two types:

a) Plasma

b) Cellular content of blood

Plasma

The constituents of plasma are water (90 to 92%) and dissolved substances,

including:

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  Plasma proteins: albumins, globulins (including antibodies), fibrinogen,

clotting factors

 Inorganic salts (mineral salts): sodium chloride, sodium bicarbonate,

potassium, magnesium, phosphate, iron, calcium, copper, iodine, cobalt

 Nutrients, principally from digested foods, e.g. Monosaccharide's (mainly

glucose), amino acids, fatty acids, glycerol and vitamins

 Organic waste materials, e.g. Urea, uric acid,

 Hormones

 Enzymes, e.g. Certain clotting factors

 Gases, e.g. Oxygen, carbon dioxide, nitrogen.

Cellular content of blood

There are three types of blood cells.

• Erythrocytes or red cells

• Thrombocytes or platelets

• Leukocytes or white cells.

• Erythrocytes or red cells

These are circular biconcave non-nucleated discs with a diameter of about 7

microns.

Development and life span of erythrocytes

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Erythrocytes are formed in red bone marrow, which is present in the ends of long

bones and in flat and irregular bones. They pass through several stages of

development before entering the blood. Their life span in the circulation is about

120 days.

Development of erthrocytes

The process of development of red blood cells from pluripotent stem cells takes

about 7 days and is called erythropoiesis. It is characterized by two main features:

 maturation of the cell

 formation of hemoglobin inside the cell.

Maturation of the cell.During this process the cell decreases in size and loses its

nucleus. These changes depend on a number of factors, especially the presence of

vitamin B12 and folic acid.

Formation of Haemoglobin.Haemoglobin is a complex protein, consisting of

globin and an iron-containing substance called haem, and is synthesized inside

developing erythrocytes in red bone marrow.

Haemoglobin in mature erythrocytes combines with oxygen to form

oxyhaemoglobin, giving arterial blood its characteristic red colour.

Control of erythropoiesis

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The number of red cells remains fairly constant, which means that the bone

marrow produces erythrocytes at the rate at which they are destroyed. This is due

to a homeostatic negative feedback mechanism.

The primary stimulus to increased erythropoiesis is hypoxia, i.e. deficient oxygen

supply to body cells,

Hypoxia increases erythrocyte formation by stimulating the production of the

hormone erythropoietin, mainly by the kidneys. Erythropoietin stimulates an

increase in the production

Destruction of erythrocytes

Destruction of erythrocytes

The life span of erythrocytes is about 120 days and theirbreakdown, or haemolysis,

is carried out by phagocytic reticuloendothelial cells. These cells are found in

many tissues but the main sites of haemolysis are the spleen, bone marrow and

liver.

Blood groups

Individuals have different types of antigen on the surfaces of their red blood cells.

These antigens, which are inherited, determine the individual's blood group.

The ABO system

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About 55% of the population has either A-type antigens (blood group A), B-type

antigens (blood group B) or both (blood group AB) on their red cell surface. The

remaining 45% have neither A nor B type antigens (blood group O).

The Rhesus system

The red blood cell membrane antigen important here is the Rhesus (Rh) antigen, or

Rhesus factor. About 85% of people have this antigen; they are Rhesus positive

(Rh+) and do not therefore make anti-Rhesus antibodies.

The remaining 15% have no Rhesus antigen (they are Rhesus negative, or Rh~).

Rh~ individuals are capable of making anti-Rhesus antibodies,

Leukocytes (white blood cells)

These cells have an important function in defending the body against microbes and

other foreign materials.

Leukocytes are the largest blood cells and they account for about 1% of the blood

volume. They contain nuclei and some have granules in their cytoplasm. There are

two main types:

• Granulocytes (polymorphonuclear leukocytes) — neutrophils, eosinophil's

and basophils

• Agranulocytes — monocytes and lymphocytes.

Granulocytes (polymorphonuclear leukocytes) During their formation,

granulopoiesis,

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Neutrophils

Their main function is to protect against any foreign material that gains entry to the

body mainly microbes, and to remove waste materials, e.g. cell debris.

They are attracted in large numbers to any area of infection by chemical

substances, released by damaged cells, called chemotaxins.Neutrophils pass

through the capillary walls in the affected area by amoeboid movement

Number of neutrophils

There is a physiological increase in circulating neutrophils following active

exercise and in the later stages of normal pregnancy.

Numbers are also increased in a pathological change occurs in the body:

• Microbial infection

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 • Tissue damage, e.g. Inflammation, myocardial infarction, burns, crush

injuries

• Metabolic disorders, e.g. Diabetic ketoacidosis, acute gout

• Leukaemia

• Heavy smoking

• Use of oral contraceptives

Eosinophil's

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Eosinophil's, although capable of phagocytosis, are less active in this than

neutrophils; their specialized role appears to be in the elimination of parasites, such

as worms, which are too big to be phagocytized.

They are equipped with certain toxic chemicals, stored in their granules, which

they release when the eosinophil binds an infecting organism.

Eosinophil's are often found at sites of allergic inflammation, such as the asthmatic

airway and skin allergies.

Basophils

Basophils, which are closely associated with allergic reactions, contain

cytoplasmic granules packed with heparin (an anticoagulant), histamine (an

inflammatory agent) and other substances that promote inflammation.

Agranulocytes

The types of leukocyte with a large nucleus and no granules in their cytoplasm are

monocytes and lymphocytes and they make up 25% to 50% of all leukocytes.

Monocytes

These are large mononuclear cells that originate in red bone marrow. Some

circulate in the blood and are actively motile and phagocytic while others migrate

into the tissues where they develop into macrophages.

The monocyte-macrophage system

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The monocyte-macrophage system.This system, which is sometimes called the

reticuloendothelial system, Some macrophages are mobile whereas others are

fixed. These include:

• Histiocytes in connective tissues

• Microglia in the brain

• Kupffer cells in the liver

• Alveolar macrophages in the lungs

• Osteoclasts in bone.

Lymphocytes

Lymphocytes are smaller than monocytes and have large nuclei. They circulate in

the blood and are present in great numbers in lymphatic tissue such as lymph nodes

and the spleen. Lymphocytes develop from pluripotent stem cells in red bone

marrow.

Although all lymphocytes originate from one type of stem cell, when they are

activated in lymphatic tissue, two distinct types of lymphocyte are produced — T-

lymphocytes and B-lymphocytes.

Thrombocytes (platelets)

These are very small non-nucleated discs, 2 to 4 um in diameter, derived from the

cytoplasm of megakaryocytes in red bone marrow. They contain a variety of

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substances that promote blood clotting, which causes haemostasis(cessation of

bleeding).

Haemostasis

When a blood vessel is damaged, loss of blood is stopped and healing occurs in a

series of overlapping processes, in which platelets play a vital part.

1. Vasoconstriction

2. Platelet plug formation.

3. Coagulation (blood clotting).

4. Fibrinolysis.

Anaemias

In anaemia there is not enough Haemoglobin available to carry sufficient oxygen

from the lungs to supply the needs of the tissues. It occurs when the rate of

production of mature cells entering the blood from the red bone marrow does not

keep pace with the rate of haemolysis. The classification of anaemia is based on

the cause:

1. Impaired erythrocyte production .e.g. Iron deficiency

2. Increased erythrocyte loss .e.g. Haemolyticanaemias

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 CHAPTER FOUR
CARDIOVASCULAR SYSTEM
The cardiovascular system is divided for descriptive purposes into two main parts.

1. The circulatory system, consisting of the heart, which acts as a pump, and the

blood vessels through which the blood circulates

2. The lymphatic system, consisting of lymph nodes and lymph vessels, through

which colourlesslymph flows.

The two systems communicate with one another and are intimately associated. The

heart pumps blood into two anatomically separate systems of blood vessels.

 the pulmonary circulation

 the systemic circulation.

 The right side of the heart pumps blood to the lungs (the pulmonary

circulation) where gas exchange occurs; i.e. CO2 leaves the blood and enters

the lungs, and O2 leaves the lungs and enters the blood.

 The left side of the heart pumps blood into the systemic circulation, which

supplies the rest of the body. Here, tissue wastes are passed into the blood

for excretion, and body cells extract nutrients and O2.

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  Figure 5.1 The relationship between the pulmonary and the systemic

circulations

 BLOOD VESSELS

 The heart pumps blood into vessels that vary in structure, size and function,

and there are several types: arteries, arterioles, capillaries, venules and veins.

Arteries and arterioles

 These are the blood vessels that transport blood away from the heart. They

vary considerably in size and their walls consist of three layers of tissue.

 Arteries have thicker walls than veins and this enables them to withstand the

high pressure of arterial blood. The smallest arteries are called arterioles.

 Figure 5.2 The relationship between the heart and the different types of

blood vessel.

 Veins and venules

 The veins are the blood vessels that return blood at low pressure to the heart.

The walls of the veins are thinner than those of arteries but have the same

three layers of tissue

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  Some veins possess valves, which prevent backflow of blood, ensuring that

it flows towards the heart, The smallest veins are called venules.

 Capillaries and sinusoids

 The smallest arterioles break up into a number of minute vessels called

capillaries. Capillary walls consist of a single layer of endothelial cells

through which water and other small-molecule substances can pass. Blood

cells and large-molecule substances such as plasma proteins do not normally

pass through capillary walls.

 Sinusoids are wider than capillaries and have extremely thin walls separating

blood from the neighboring cells

HEART

 The heart is a roughly cone-shaped hollow muscular organ. The heart lies in

the thoracic cavity in the mediastinum between the lungs, The heart is

composed of three layers of tissue: pericardium, myocardium and

endocardium.

Pericardium

The pericardium is made up of two sacs. The outer sac consists of fibrous tissue

and the inner of a continuous double layer of serous membrane.

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In health the two layers are in close association, with only the thin film of serous

fluid between them.

 Myocardium

 The myocardium is composed of specialised cardiac muscle found only in

the heart. It is not under voluntary control but, like skeletal muscle, cross-

stripes are seen on microscopic examination. Microscopically these 'joints',

or intercalated discs,

Endocardium

 This forms the lining of the myocardium and the heart valves. It is a thin,

smooth, glistening membrane which permits smooth flow of blood inside the

heart.

 Figure 5.12 Cardiac muscle, with fibres separated.

Figure 5.13 The heart and the great vessels, viewed from the front.

Flow of blood through the heart

The two largest veins of the body, the superior and inferior venae cavae, empty

their contents into the right atrium. This blood passes via the right atrioventricular

valve into the right ventricle, and from there it is pumped into the pulmonary

artery or trunk (the only artery in the body which carries deoxygenated blood).
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The opening of the pulmonary artery is guarded by the pulmonary valve, After

leaving the heart the pulmonary artery divides into left and right pulmonary

arteries, which carry the venous blood to the lungs where exchange of gases takes

place: carbon dioxide is excreted and oxygen is absorbed.

Two pulmonary veins from each lung carry oxygenated blood back to the left

atrium. Blood then passes through the left atrioventricular valve into the left

ventricle, and from there it is pumped into the aorta, the

Blood supply to the heart

Arterial supplyThe heart is supplied with arterial blood by the right and left

coronary arteries which branch from the aorta immediately distal to the aorta.

Venous drainage.Most of the venous blood is collected into several small veins

that join to form the coronary sinus which opens into the right atrium.

Conducting system of the heart

Sinoatrial node (SA node)

This small mass of specialised cells is in the wall of the right atrium near the

opening of the superior vena cava.

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The SA node is the 'pace-maker' of the heart because it normally initiates impulses

more rapidly than other groups of neuromuscular cells.

Atrioventricular node (AV node)

This small mass of neuromuscular tissue is situated in the wall of the atrial septum

near the atrioventricular valves. Normally the AV node is stimulated by impulses

that sweep over the atrial myocardium.

Atrioventricular bundle

This is a mass of specialisedfibres that originate from the AV node

The cardiac cycle

The function of the heart is to maintain a constant circulation of blood throughout

the body. The heart acts as a pump and its action consists of a series of events

known as the cardiac cycle.

During each heartbeat, or cardiac cycle, the heart contracts and then relaxes. The

period of contraction is called systole and that of relaxation, diastole.

Heart sounds: The individual is not usually conscious of his heartbeat, but if the

ear or the diaphragm of a stethoscope is placed on the chest wall a little below the

left nipple and slightly nearer the midline the heartbeat can be heard.

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Two sounds, separated by a short pause, can be clearly distinguished. They are

described in words as 'lub dup'. The first sound, 'lub', is fairly loud and is due to

the closure of the atrioventricular valves. This corresponds with ventricular systole.

The second sound, 'dup', is softer and is due to the closure of the aortic and

pulmonary valves. This corresponds with atrial systole

Electrical changes in the heart

The pattern of electrical activity may be displayed on an oscilloscope screen or

traced on paper. The apparatus used is an electrocardiograph and the tracing is an

electrocardiogram.

The normal ECG tracing shows five waves which, by convention, have been

named P, Q, R, S and T. The P wave arises when the impulse from the SA node

sweeps over the atria.

The QRS complex represents the very rapid spread of the impulse from the AV

node through the AV bundle and the Purkinje fibres and the electrical activity of

the ventricular muscle. The T wave represents the relaxation of the ventricular

muscle.

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The ECG described above originates from the SA node and is known as sinus

rhythm. The rate of sinus rhythm is 60 to 100 beats per minute. A faster heart rate

is called tachycardia and a slower heart rate, bradycardia.

PULSE

The pulse is a wave of distension, the nine superficial arteries are as follow:

1) Temporal artery

2) Facial artery

3) Carotid artery

4) Brachial artery

5) Radial artery

6) Femoral artery

7) Popliteal artery

8) Posterior tibia artery

9) Dorsalis Pedi's artery

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 CHAPTER FIVE
THE LYMPHATIC SYSTEM
All body tissues are covered in tissue fluid, consisting of the diffusible constituents

of blood and waste materials from cells. Some tissue fluid returns to the capillaries

at their venous end and other remainder diffuses through intracellular spaces.

Lymph passes through vessels of increasing size and a varying number of lymph

nodes before returning to the blood. The lymphatic system consists of:

 lymph

 lymph vessels

 lymph nodes

 lymph organs, e.g. spleen and thymus etc.

Functions of the lymphatic system

Functions of the lymphatic system include the following.

 Tissue drainage. Every day, around 21 litres of plasma fluid, carrying

dissolved substances and some plasma protein, escape from the arterial end

of the capillaries and into the tissues.

Most of this fluid is returned directly to the bloodstream via the capillary at its

venous end, but 3-4 liters of fluid are drained away by the lymphatic vessels.

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  Absorption in the small intestine. Fat and fat-soluble materials, e.g. the fat-

soluble vitamins, are absorbed into the central lacteals (lymphatic vessels) of

the villi.

 Immunity. The lymphatic organs are concerned with the production and

maturation of lymphocytes, the white blood cells that are primarily

responsible for provision of immunity. Bone marrow is therefore considered

to be lymphatic tissue,

LYMPH

Lymph is a clear watery fluid, similar in composition to plasma, with the important

exception of plasma proteins, and identical in composition to interstitial fluid.

It also carries away larger particles, e.g. bacteria and cell debris from damaged

tissues, which can then be filtered out and destroyed by the lymph nodes.

LYMPH VESSELS

Lymph capillaries

These originate as blind-end tubes in the interstitial spaces (Fig. 6.2). They have

the same structure as blood capillaries, i.e. a single layer of endothelial cells, but

their walls are more permeable to all interstitial fluid constituents, including

proteins and cell debris.

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All tissues of the body have a network of lymphatic vessels, with the exception of

the central nervous system, the bones and the most superficial layers of the skin.

Larger lymph vessels

The walls of lymph vessels are about the same thickness as those of small veins

and have the same layers of tissue,

There is no 'pump', like the heart, involved in the onward movement of lymph but

the muscle tissue in the walls of the large lymph vessels has an intrinsic ability to

contract rhythmically (the lymphatic pump).

Lymph vessels become larger as they join together, eventually forming two large

ducts, the thoracic duct and right lymphatic duct, that empty lymph into the

subclavian veins.

Lymph nodes

Lymph nodes are oval or bean-shaped organs that lie, often in groups, along the

length of lymph vessels. The lymph drains through a number of nodes, usually 8 to

10, before returning to the venous circulation.

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Structure of lymph nodes

Lymph nodes have an outer capsule of fibrous tissue which dips down into the

node substance forming partitions, or tmbeculae. The main substance of the node

consists of reticular and lymphatic tissue containing many lymphocytes and

macrophages.

As many as four or five afferent lymph vessels may enter a lymph node while only

one efferent vessel carries lymph away from the node.

Functions of lymph nodes

Filtering and phagocytosis

Lymph is filtered by the reticular and lymphoid tissue as it passes through lymph

nodes. Particulate matter may include microbes, dead and live phagocytes

containing ingested microbes, cells from malignant tumours, worn out and

damaged tissue cells and inhaled particles.

Proliferation of lymphocytes

Activated T- and B-lymphocytes multiply in lymph nodes.

LYMPHATIC ORGANS AND TISSUES

Spleen

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The spleen is formed by reticular and lymphatic tissue and is the largest lymph

organ.

The spleen lies in the left hypochondriac region of the abdominal cavity between

the fundus of the stomach and the diaphragm.

Structure of spleen

The spleen is slightly oval in shape with the hilum on the lower medial border. The

anterior surface is covered with peritoneum.

The structures entering and leaving the spleen at the hilum are:

 Splenic artery,

 Splenic vein,

 Lymph vessels (efferent only)

 Nerves.

Functions of spleen

Phagocytosis

As described previously, old and abnormal erythrocytes are destroyed in the spleen

and the breakdown products, bilirubin and iron, are passed to the liver via the

splenic and portal veins.

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Storage of blood

The spleen contains up to 350 ml of blood, and in response to sympathetic

stimulation can rapidly return a large part of this volume to the circulation.

Immune response

The spleen contains T- and B-lymphocytes, which are activated by the presence of

antigens, e.g. in infection.

Erythropoiesis

The spleen and liver are important sites of fetal blood cell production,

Thymus gland

The thymus gland lies in the upper part of the mediastinum behind the sternum and

extends upwards into the root of the neck.

Function

Lymphocytes originate from pluripotent stem cells in red bone marrow. Those that

enter the thymus develop into activated T-lymphocytes.

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Mucosa-associated lymphoid tissue (MALT)

Throughout the body, at strategically placed locations, are collections of lymphoid

tissue which unlike the spleen and thymus, are not enclosed in a capsule. They

contain B- and T-lymphocytes.

The main groups of MALT are the tonsils and Peyer's patches.

Tonsils. These are located in the mouth and throat, and will therefore destroy

swallowed and inhaled antigens

Peyer's patches. These large collections of lymphoid tissue are found in the small

intestine, and intercept swallowed antigens.

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CHAPTER SIX
THE NERVOUS SYSTEM

The nervous system detects and responds to changes inside and outside the body.

Together with the endocrine system it controls important aspects of body function

and maintains homeostasis.

The nervous system consists of the brain, the spinal cord and peripheral nerves.

Organisation of nervous tissue within the body enables rapid communication

between different parts of the body.

For descriptive purposes the parts of the nervous system are grouped as follows:

1. the central nervous system (CNS), consisting of the brain and the spinal cord

2. the peripheral nervous system (PNS) consisting of all the nerves outside the

brain and spinal cord.

PNS

The PNS comprises paired cranial and sacral nerves — some of these are sensory

(afferent), some are motor (efferent) and some mixed. It is useful to consider two

functional parts within the PNS:

 The sensory division

 The motor division.

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The motor division

In the motor division is involved in activities that are:

 Voluntary —the somatic nervous system (movement of voluntary muscles)

 Involuntary — the autonomic nervous system (functioning of smooth and

cardiac muscle and glands). The autonomic nervous system has two parts:

sympathetic and parasympathetic

Sensory receptors

Specialized endings of sensory neurones respond to different stimuli (changes)

inside and outside the body.

a) Somatic, cutaneous or common senses. These originate in the skin. They are:

pain, touch, heat and cold. Sensory nerve endings in the skin are fine branching

filaments without myelin sheaths

b) Proprioceptor senses. These originate in muscles and joints and contribute to

the maintenance of balance and posture.

c) Special senses. These are sight, hearing, smell, touch and taste.

d) Autonomic afferent nerves. These originate in internal organs, glands and

tissues, e.g. baroreceptors, chemoreceptors, and are associated with reflex

regulation of involuntary activity and visceral pain.

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Mixed nerves

In the spinal cord, sensory and motor nerves are arranged in separate groups, or

tracts. Outside the spinal cord, when sensory and motor nerves are enclosed within

the same sheath of connective tissue they are called mixed nerves.

Properties of neurons

The Neuron is the Principal Functional Unit of the Nervous System. The CNS is

made up of two main types of cell: nerve cells or neurons, and glial cells or

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 neuroglia. The cell bodies of the neurons are found throughout the gray matter of

the brain and spinal cord.

Neurons

Each neuron consists of three parts: a main part called the neuron cell body, one or

more branching projections called dendrites, and one elongated projection known

as an axon.

The nerve impulse

An impulse is initiated by stimulation of sensory nerve endings. Transmission of

the impulse, or action potential, is due to movement of ions across the nerve cell

membrane. The principal ions involved are:

i. Sodium (na+) the main extracellular cation

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ii. Potassium (K+) the main intracellular cation

The synapse and neurotransmitters

There is always more than one neurone involved in the transmission of a nerve

impulse from its origin. whether it is sensory or motor.

There is no physical contact between these neurones. The point at which the nerve

impulse passes from one to another is the synapse

The neurotransmitters in the brain and spinal cord and their modes of action are not

yet fully understood. It is believed however that nor adrenaline, gamma ammo -

butyric acid (GABA) and acetylcholine act as neurotransmitters.

Neurons of brain

Neuroglia

The neurones of the central nervous system are supported by four types of non-

excitable glial cells that make up a quarter to a half of the volume of brain tissue.

Unlike nerve cells these continue to replicate throughout life. They are astrocytes,

oligodendrocytes, microglia and ependymal cells.

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 Astrocytes

These cells form the main supporting tissue of the central nervous system. They are

star-shaped with fine branching processes and they lie in a mucopolysaccharide

ground substance. At the free ends of some of the processes there are small

swellings called foot processes

Their functions are blood-brain barrier and same to those of fibroblasts elsewhere

in the body.

Oligodendrocytes

These cells are smaller than astrocytes and are found:

I. In clusters round nerve cell bodies, the grey matter

II. Adjacent to, and along the length of, myelinated nerve fibres.

The oligodendrocytes form and maintain myelin, having the same functions as

Schwann cells in peripheral nerves.

Microglia

These cells are derived from monocytes that migrate from the blood into the

nervous system before birth.

They are found mainly in the area of blood vessels. They enlarge and become

phagocytic in areas of inflammation and cell destruction.

Ependymal cells: These cells form the epithelial lining of the ventricles of the

brain and the central canal of the spinal cord.

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Membranes covering the brain and spinal cord (the meninges)

The brain and spinal cord are completely surrounded by three membranes, the

meninges, lying between the skull and the brain and between the vertebrae and the

spinal cord. Named as follow:

 Dura mater

 Arachnoid mater

 Pia mater.

The dura and arachnoid maters are separated by a potential space, the subdural

space. The arachnoid and pia maters are separated by the subarachnoid space,

containing cerebrospinal fluid

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Dura mater

The cerebral dura mater consists of two layers of dense fibrous tissue.

Arachnoid mater

This delicate serous membrane lies between the dura and pia maters. It is separated

from the dura mater by the subdural space, and from the pia mater by the

subarachnoid space, containing cerebrospinal fluid.

It continues downwards to envelop the spinal cord and ends by merging with the

dura mater at the level of the 2nd sacral vertebra.

Pia mater

This is a fine connective tissue containing many minute blood vessels. It adheres to

the brain, completely covering the convolutions and dropping into each fissure.

Ventricles of the brain and the cerebrospinal fluid

Within the brain there are four irregular-shaped cavities, or ventricles, containing

cerebrospinal fluid (CSF). They are:

 Right and left lateral ventricles

 Third ventricle

 Fourth ventricle.

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Cerebrospinal fluid (CSF)

Cerebrospinal fluid is secreted into each ventricle of the brain by choroid plexuses.

These are vascular areas where there is a proliferation of blood vessels surrounded

by ependymal cells in the lining of ventricle walls.

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 BRAIN

The brain constitutes about one-fiftieth of the body weight and lies within the

cranial cavity. The parts are:

i. Cerebrum

ii. The brain stem(midbrain, pons, medulla oblongata)

iii. Cerebellum.

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Cerebrum

This is the largest part of the brain and it occupies the anterior and middle cranial

fossae.

It is divided by a deep cleft, the longitudinal cerebral fissure, into right and left

cerebral hemispheres, each containing one of the lateral ventricles.

The superficial (peripheral) part of the cerebrum is composed of nerve cell bodies

or grey matter, forming the cerebral cortex, and the deeper layers consist of nerve

fibres or white matter.

For descriptive purposes each hemisphere of the cerebrum is divided into lobes

which take the names of the bones of the cranium under which they lie:

a) Frontal

b) Parietal

c) Temporal

d) Occipital.

The boundaries of the lobes are marked by deep sulci (fissures). These are the

central, lateral and parieto-occipital sulci

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 Functions of the cerebrum

There are three main varieties of activity associated with the cerebral cortex:

 Mental activities involved in memory, intelligence, sense of responsibility,

thinking, reasoning, moral sense and learning are attributed to the higher

centres

 Sensory perception, including the perception of pain, temperature, touch, sight,

hearing, taste and smell

 Initiation and control of skeletal (voluntary) muscle contraction.

Other areas of the cerebrum

Deep within the cerebral hemispheres there are groups of cell bodies called nuclei

(previously called ganglia) which act as relay stations where impulses are passed

from one neurone to the next in a chain. Important masses of grey matter include:

i. Basal nuclei

ii. Thalamus

iii. Hypothalamus.

Brain stem

Midbrain

The midbrain is the area of the brain situated around the cerebral channel between

the cerebrum above and the pons below. It consists of groups of cell bodies and

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 nerve fibres (tracts) which connect the cerebrum with lower parts of the brain and

with the spinal cord.

Pons

The pons is situated in front of the cerebellum, below the midbrain and above the

medulla oblongata. It consists mainly of nerve fibres which form a bridge between

the two hemispheres of the cerebellum,

Medulla oblongata

The medulla oblongata extends from the pons above and is continuous with the

spinal cord below.

The vital centres, consisting of groups of cells associated with autonomic reflex

activity, lie in its deeper structure. These are the:

 Cardiac centre

 Respiratory centre

 Vasomotor centre

 Reflex centres of vomiting, coughing, sneezing and Swallowing.

Cerebellum

i. The cerebellum is situated behind the pons and immediately below the posterior

portion of the cerebrum occupying the posterior cranial fossa.

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ii. It is ovoid in shape and has two hemispheres, separated by a narrow median

strip called the vermis. Grey matter forms the surface of the cerebellum, and the

white matter lies deeply.

Functions

The cerebellum is concerned with the coordination of voluntary muscular

movement, posture and balance. Damage to the cerebellum results in

uncoordinated muscular movement

SPINAL CORD

The spinal cord is the elongated, almost cylindrical part of the central nervous

system, which is suspended in the vertebral canal surrounded by the meninges and

cerebrospinal fluid.

Grey matter: The arrangement of grey matter in the spinal cord resembles the

shape of the letter H,

Sensory nerve tracts (afferent or ascending) in the spinal cord

There are two main sources of sensation transmitted to the brain via the spinal

cord.

1. The skin. Sensory receptors (nerve endings) in the skin, called cutaneous

receptors, are stimulated by pain, heat, cold and touch, including pressure.

2. The tendons, muscles and joints. Sensory receptors are nerve endings in these

structures, called proprioceptors, and they are stimulated by stretch.

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 Spinal reflexes.

These consist of three elements:

1. Sensory neurones

2. Connector neurones in the spinal cord

3. Lower motor neurones.

PERIPHERAL NERVOUS SYSTEM

This part of the nervous system consists of:

I. 31 pairs of spinal nerves

II. 12 pairs of cranial nerves

III. The autonomic part of the nervous system.

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Most of the nerves of the peripheral nervous system are composed of sensory nerve

fibres conveying afferent impulses from sensory end organs to the brain, and

motor nerve fibres conveying efferent impulses from the brain through the

spinal cord to the effector organs, e.g. skeletal muscles, smooth muscle and

glands.

Each nerve consists of numerous nerve fibres collected into bundles. Each bundle

has several coverings of protective connective tissue . Endoneurium, Perineurium

and Epineurium

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Spinal nerves

There are 31 pairs of spinal nerves that leave the vertebral canal by passing

through the intervertebral foramina formed by adjacent vertebrae. They are named

and grouped according to the vertebrae with which they are associated:

 8 cervical

 12 thoracic

 5 lumbar

 5 sacral

 1 coccygeal.

 Cranial nerves

There are 12 pairs of cranial nerves originating from nuclei in the inferior

surface of the brain, some sensory, some motor and some mixed. Their names

and numbers are:

I. Olfactory: sensory “These are the nerves of the sense of smell”

II. Optic: sensory “These are the nerves of the sense of sight”

III. Oculomotor: motor “They supply four extraocular muscles e.g. eyeball, ciliary

muscles, circular muscles of the iris and levator palpebrae muscle which

raises the upper eyelid.

IV. Trochlear: motor “They supply the superior oblique muscles of the eyes.

V. Trigeminal: mixed “sensory nerves for the face and head”

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VI. Abducent: motor “They supply the lateral rectus muscles of the eyeballs.

VII. Facial: mixed “supply the muscles of facial expression”.

VIII. Vestibulocochlear (auditory): sensory “vestibular nerves and cochlear

nerves”

IX. Glossopharyngeal: mixed “stimulate the muscles of the tongue and pharynx

and the secretory cells of the parotid (salivary) glands.

X. Vagus: mixed “supply the smooth muscles and secretory glands of the pharynx,

larynx, trachea, heart, oesophagus, stomach, intestines, pancreas, gall bladder,

bile ducts, spleen, kidneys, ureter and blood vessels in the thoracic and

abdominal cavities.

XL Accessory: motor “supply the phanyngeal and laryngeal muscles”

XII. Hypoglossal: motor “They supply the muscles of the tongue and muscles

surrounding the hyoid bone”

AUTONOMIC NERVOUS SYSTEM

The autonomic or involuntary part of the nervous system controls the functions of

the body carried out 'automatically‘. The autonomic nervous system is divided into

two divisions:

1. Sympathetic

2. Parasympathetic

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Each division has two efferent neurones in its peripheral pathways between the

central nervous system and effector organs. These are:

 The preganglionic neurone

 The postganglionic neurone.

The cell body of the preganglionic neurone is in the brain or spinal cord. Its axon

terminals synapse with the cell body of the postganglionic neurone in an

autonomic ganglion outside the central nervous system.

Sympathetic nervous system

Neurones convey impulses from their origin in the hypothalamus, The sympathetic

nervous system prepares the body for activity and has effects that are similar to the

effects of the hormone adrenalin. This is the fight or flight response.The

sympathetic system arises from the spinal cord but with a ganglion(lump) of

nervous tissue found near the root of the nerves.

Parasympathetic system

The parasympathetic nervous system relaxes the body. Its effects are antagonistic

to the sympathetic system.Parasympathetic nerves arise directly from the spinal

cord without any ganglia. The most important parasympathetic nerve in the body is

the vagus nerve, which connects to awide range of organs in the chest and

abdominal areas.

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RESPONSE OF NERVOUS TISSUE TO INJURY

Neurone damage

Damage to the nerve cells or their processes can lead to rapid necrosis with sudden

acute functional failure, or to slow atrophy with gradually increasing dysfunction.

These changes are associated with:

 Hypoxia and anoxia

 Nutritional deficiencies

 Poisons, e.G. Organic lead

 Trauma

 Infections

 Ageing

 Hypoglycaemia.

Neurone regeneration

Neurones of the brain, spinal cord and ganglia reach maturity a few weeks after

birth and are not replaced when they are damaged or die.

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 CHAPTER SEVEN
ENDOCRINE SYSTEM
Introduction

The endocrine system consists of glands widely separated from each other with no

direct anatomical links.

A hormone is formed in one organ or gland and carried in the blood to another

organ (target organ or tissue). Most hormones are synthesised from amino acids

(amines, polypeptides and proteins; or are cholesterol-based lipids (steroids).

Homeostasis of the internal environment is maintained partly by the autonomic

nervous system and partly by the endocrine system.

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The endocrine system consists of a number of distinct glands and some tissues in

other organs. Although the hypothalamus is classified as a part of the brain and not

as an endocrine gland it controls the pituitary gland and has an indirect effect on

many others. The endocrine glands are:

 1 pituitary gland

 1 thyroid gland

 4 parathyroid glands

 2 adrenal (suprarenal) glands

 the pancreatic islets (islets of Langerhans)

 1 pineal gland or body

 1 thymus gland

 2 ovaries in the female

 2 testes in the male.

PITUITARY GLAND AND HYPOTHALAMUS

The pituitary gland (hypophysis) and the hypothalamus act as a unit, regulating the

activity of most of the other endocrine glands. The pituitary gland lies in the

hypophyseal fossa of the sphenoid bone below the hypothalamus,

The influence of the hypothalamus on the pituitary gland

The influence of the hypothalamus on the release of hormones is different in the

anterior and posterior lobes of the pituitary gland.

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1. The anterior pituitary. This is supplied indirectly with arterial blood that has

already passed through a capillary bed in the hypothalamus. This network of

blood vessels forms part of the pituitary portal system,

This blood transports releasing and inhibiting hormones secreted by the

hypothalamus. These hormones influence secretion and release of other hormones

formed in the anterior pituitary.

2. The posterior pituitary. This is formed from nervous

tissue and consists of nerve cells surrounded by supporting cells called pituicytes.

Posterior pituitary hormones are synthesised in the nerve cell bodies, transported

along the axons and then stored in vesicles within the axon terminals

Anterior pituitary hormones

 Growth hormone (GH)

 Thyroid stimulating hormone (TSH)

 Adrenocorticotrophic hormone (corticotrophin, ACTH)

 Prolactin

 Gonadotrophins

Posterior pituitary

 Oxytocin

 Antidiuretic hormone (ADH) or vasopressin

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Growth hormone (GH)

This is the most abundant hormone synthesised by the anterior pituitary. It

stimulates growth and division of most body cells but especially those in the bones

and skeletal muscles.

Its release is stimulated by growth hormone releasing hormone (GHRH) and

suppressed by growth hormone release inhibiting hormone (GHRIH) both of

which are secreted by the hypothalamus. Secretion of GH is greater at night during

sleep.

Thyroid stimulating hormone (TSH)

This hormone is synthesised by the anterior pituitary and its release is stimulated

by TRH from the hypothalamus. It stimulates growth and activity of the thyroid

gland, which secretes the hormones thyroxine (T4) and triiodothyronine (T3).

Release is lowest in the early evening and highest during the night.

Adrenocorticotrophic hormone (corticotrophin, ACTH)

Corticotrophin releasing hormone (CRH) from the hypothalamus promotes the

synthesis and release of ACTH by the anterior pituitary. This increases the

concentration of cholesterol and steroids within the adrenal context and the output

of steroid hormones.

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Prolactin

This hormone stimulates lactation (milk production) and has a direct effect on the

breasts immediately after parturition (childbirth). The blood level of prolactin is

stimulated by prolactin releasing hormone (PRH) released from the hypothalamus

and it is lowered by prolactin inhibiting hormone (PIH, dopamine) and by an

increased blood level of prolactin. After birth, suckling stimulates prolactin

secretion and lactation.

Gonadotrophins

After puberty two gonadotrophins (sex hormones) are secreted by the anterior

pituitary in response to luteinising hormone releasing hormone (LHRH), also

known as gonadotrophin releasing hormone (GnRH). In both males and females

these are:

 follicle stimulating hormone (FSH)

 luteinising hormone (LH). In both sexes. FSH stimulates production of

gametes (ova or spermatozoa).

In females, LH and FSH are involved in secretion of the hormones oestrogen and

progesterone during the menstrual cycle. As the levels of oestrogen and

progesterone rise secretion of LH and FSH is suppressed.

In males, LH, also called interstitial cell stimulating hormone (ICSH) stimulates

the interstitial cells of the testes to secrete the hormone testosterone.

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Posterior pituitary

Oxytocin

Oxytocin stimulates two target tissues during and after parturition (childbirth):

uterine smooth muscle and the muscle cells of the lactating breast.

Antidiuretic hormone (ADH) or vasopressin

The main effect of antidiuretic hormone is to reduce urine output (diuresis is the

production of a large volume of urine). ADH increases the permeability to water of

the distal convoluted and collecting tubules of the nephrons of the kidneys. As a

result the reabsorption of water from the glomerular filtrate is increased.

THYROID GLAND

The thyroid gland is situated in the neck in front of the larynx and trachea at the

level of the 5th, 6th and 7th cervical and 1st thoracic vertebrae. It resembles a

butterfly in shape, consisting of two lobes, one on either side of the thyroid.

Thyroxine and triiodothyronine

Iodine is essential for the formation of the thyroid gland hormones, thyroxine (T4)

and triiodothyronine (T3). The body's main sources of iodine are seafood,

vegetables grown in iodine-rich soil and iodinated table salt in the diet. The thyroid

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gland selectively takes up iodine from the blood, a process called iodine trapping.

T3 and T4 affect most cells of the body by:

o Increasing the basal metabolic rate and heat production

o Regulating metabolism of carbohydrates, proteins and fats.

Calcitonin

This hormone is secreted by the parafollicular or C-cells in the thyroid gland. It

acts on bone and the kidneys to reduce the blood calcium (Ca2+) level when it is

raised.

This hormone is important during childhood when bones undergo considerable

changes in size and shape.

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PARATHYROID GLANDS

There are four small parathyroid glands, two embedded in the posterior surface of

each lobe of the thyroid gland. They are surrounded by fine connective tissue

capsules.

Function

The parathyroid glands secrete parathyroid hormone (PTH, parathormone).

Secretion is regulated by the blood level of calcium. The main function of PTH is

to increase the blood calcium level when it is low. Parathormone and calcitonin

from the thyroid gland act in a complementary manner to maintain blood calcium

levels within the normal range.

ADRENAL (SUPRARENAL) GLANDS

The glands are composed of two parts which have different structures and

functions. The outer part is the cortex and the inner part the medulla. The adrenal

cortex is essential to life but the medulla is not.

Adrenal cortex

The adrenal cortex produces three groups of steroid hormones from cholesterol.

They are collectively called adrenocorticocoids (corticosteroids, corticoids). They

are:

 Glucocorticoids

 Mineralocorticoids
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  Sex hormones (androgens).

Glucocorticoids

Cortisol (hydrocortisone), corticosterone and cortisone are the main

glucocorticoids. They are essential for life, regulating metabolism and responses to

stress. Secretion is stimulated by ACTH from the anterior pituitary and by stress.

In pathological and pharmacological quantities glucocorticoids:

 Have an anti-inflammatory action

 Suppress the immune response

 Suppress the response of tissues to injury

 Delay wound healing.

Mineralocorticoids (aldosterone)

Aldosterone is the main mineralocorticoid. Its functions are associated with the

maintenance of water and electrolyte balance in the body.

It stimulates the reabsorption of sodium (Na+) by the renal tubules and excretion of

potassium (K+) in the urine.

Sex hormones

Sex hormones secreted by the adrenal cortex are mainly androgens (male sex

hormones) and the amounts produced are insignificant compared with those

secreted by the testes and ovaries in late puberty and adulthood.

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Adrenal medulla

The medulla is completely surrounded by the cortex. It develops from nervous

tissue in the embryo and is part of the sympathetic division of the autonomic

nervous system. It is stimulated by its extensive sympathetic nerve supply to

produce the hormones adrenaline and nor adrenaline.

PANCREATIC ISLETS

The cells which make up the pancreatic islets (islets of Langerhans) are found in

clusters irregularly distributed throughout the substance of the pancreas. Unlike the

exocrine pancreas, which produces pancreatic juice, there are no ducts leading

from the clusters of islet cells.

Pancreatic hormones are secreted directly into the bloodstream and circulate

throughout the body. There are three main types of cells in the pancreatic islets:

 (Alpha) cells that secrete glucagon

 (Beta) cells that secrete insulin

 (Delta) cells that secrete somatostatin.

PINEAL GLAND OR BODY

The pineal gland is a small body attached to the roof of the third ventricle and is

connected to it by a short stalk containing nerves, many of which terminate in the

hypothalamus.

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The pineal gland is about 10 mm long, is reddish brown in colour and is

surrounded by a capsule.

Melatonin

This is the hormone secreted by the pineal gland. Secretion is influenced by the

amount of light entering the eye stimulating the optic pathways.

THYMUS GLAND

Thymosin

This is the hormone secreted by the thymus gland and is required for the

development of T-lymphocytes for cellmediated immunity.

LOCAL HORMONES

A number of body tissues not normally described as endocrine glands secrete

substances that act locally.

Histamine

This hormone is synthesised by mast cells in the tissues and basophils in blood. It

is released as part of the inflammatory process, increasing capillary permeability

and dilatation. It also causes contraction of smooth muscle of the bronchi and

alimentary tract and stimulates the secretion of gastric juice.

Serotonin (5-hydroxytryptamine, 5-HT)

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This is present in platelets, in the brain and in the intestinal wall. It causes

intestinal secretion and contraction of smooth muscle and its role in haemostasis

(blood clotting).

Prostaglandins (PGs)

These are lipid substances that act as local hormones and have wide-ranging

physiological effects in:

 The inflammatory response

 Potentiating pain

 Fever

 Regulating blood pressure

 Blood clotting

 Uterine contractions during labour.

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Erythropoietin

This hormone is synthesised by the kidneys and

increases erythropoiesis (the rate of red blood cell formation,

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 CHAPTER EIGHT
SKELETAL AND JOINT SYSTEM
Bone

Bone is a strong and durable type of connective tissue. It consists of:

 Water (25%)

 Organic constituents including osteoid (the carbon containing) and bone

cells (25%)

 Inorganic constituents, mainly calcium phosphate (50%)

Types of bones

Bones are classified as long, short, irregular, flat and sesamoid.

Long bones

These consist of a shaft and two extremities. As the name suggests the length is

much greater than the width. Examples include the femur, tibia and fibula.

Short, irregular, flat and sesamoid bones.

These have no shafts or extremities and are diverse in shape and size. Examples

include:

 Short bones — carpals (wrist)

 Irregular bones—vertebrae and some skull bones

 Flat bones — sternum, ribs and most skull bones

 Sesamoid bones — patella (knee cap).

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Bone structure (General structure of a long bone)

These have a diaphysis or shaft and two epiphyses or extremities. The diaphysis is

composed of compact bone with a central medullary canal, containing fatty yellow

bone marrow. The epiphyses consist of an outer covering of compact bone with

cancellous bone inside.

Bone cells

The cells responsible for bone formation are osteoblasts (these later mature into

osteocytes). Osteoblasts and chondrocytes (cartilage-forming cells) develop from

the same parent fibrous tissue cells.

Osteoblasts

These are the bone-forming cells that secrete collagen and other constituents of

bone tissue.

Hormonal regulation of bone growth

Hormones that regulate the growth and consistency of size and shape of bones

include the following.

Growth hormone and the thyroid hormones, thyroxine and triiodothyronine, are

especially important during infancy and childhood;

Testosterone and oestrogens influence the physical changes that occur at puberty,

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Functions of bones

Bones have a variety of functions. They:

 Provide the framework of the body

 Give attachment to muscles and tendons

 Permit movement of the body as a whole and of parts of the body, by forming

joints that are moved by muscles

 Form the boundaries of the cranial, thoracic and pelvic cavities, protecting the

organs they contain

 Contain red bone marrow in which blood cells develop: haematopoiesis.

 Provide a reservoir of minerals, especially calcium phosphate.

Skeletal system part

The bones of the skeleton are divided into two groups: the axial skeleton and the

appendicular skeleton.

AXIAL SKELETON

This part consists of the skull, vertebral column, ribs and sternum.

Skull

The skull rests on the upper end of the vertebral column and its bony structure is

divided into two parts: the cranium and the face.

Cranium

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The cranium is formed by a number of flat and irregular bones that provide a bony

protection for the brain.

The bones of the cranium are:

1 frontal bone,

2 parietal bones

2 temporal bones

1 occipital bone

1 sphenoid bone

1 ethmoid bone.

Face

The skeleton of the face is formed by 13 bones in addition to the frontal bone.

2 zygomatic or cheek bones

1 maxilla (originated as 2)

2 nasal bones

2 lacrimal bones

1 mandible (originated as 2

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Hyoid bone

This is an isolated horse-shoe-shaped bone lying in the soft tissues of the neck just

above the larynx and below the mandible.

Vertebral column

The vertebral column consists of 24 separate movable, irregular bones, the sacrum

(five fused bones) and the coccyx (four fused bones). The 24 separate bones are in

three groups: 7 cervical, 12 thoracic and 5 lumbar.

Characteristics of a typical vertebra

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Functions of the vertebral column

These include the following.

 Collectively the vertebral foramina form the vertebral canal which provides

a strong bony protection for the spinal cord lying within it.

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  The adjacent vertebrae form intervertebral foramina, one on each side,

providing access to the spinal cord for spinal nerves, blood vessels and

lymph vessels.

 The numerous individual bones enable a certain amount of movement.

 It supports the skull.

 It forms the axis of the trunk, giving attachment to the ribs, shoulder girdle

and upper limbs, and the pelvic girdle and lower limbs.

Thoracic cage

The bones of the thorax or thoracic cage are:

 1 sternum

 12 pairs of ribs

 12 thoracic vertebrae.

Sternum or breast bone

This flat bone can be felt just under the skin in the middle of the front of the chest.

Ribs

There are 12 pairs of ribs which form the bony lateral walls of the thoracic cage

and articulate posteriorly with the thoracic vertebrae. The first 10 pairs are attached

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anteriorly to the sternum by costal cartilages, some directly and some indirectly.

The last two pairs (floating ribs] have no anterior attachment.

APPENDICULAR SKELETON

The appendicular skeleton consists of the shoulder girdle with the upper limbs and

the pelvic girdle with the lower limbs.

Shoulder girdle and upper limb Each shoulder girdle consists of:

 1 clavicle

 1 scapula.

Each upper limb consists of the following bones:

 1 humerus

 1 radius

 1 ulna

 8 carpal bones

 5 metacarpal bones

 14 phalanges.

Pelvic girdle and lower limb

The bones of the pelvic girdle are:

 2 innominate bones

 1 sacrum.

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The bones of the lower limb are:

i. 1 femur • 7 tarsal bones

ii. 1 tibia • 5 metatarsal bones

iii. 1 fibula • 14 phalanges.

iv. 1 patella

Innominate or hip bones.

Each hip bone consists of three fused bones, the ilium,

ischium and pubis.

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JOINT

A joint is the site at which any two or more bones articulate or come together.

Some joints have no movement (fibrous), some only slight movement

(cartilaginous) and some are freely movable (synovial).

TYPES OF JOINT

Fibrous or fixed joints

These immovable joints have fibrous tissue between the bones, e.g. joints between

the bones of the skull (sutures) and those between the teeth and the maxilla and

mandible.

Cartilaginous or slightly movable joints

There is a pad of fibrocartilage between the ends of the bones that form the joint

which allows for very slight movement where the pad of cartilage is compressed.

Synovial or freely movable joints

Synovial joints have characteristic features that enable a wide range of movements.

They are classified according to the range of movement possible or to the shape of

the articulating parts of the bones involved.

Ball and socket. The head or ball of one bone articulates with a socket of another

and the shape of the bones allows for a wide range of movement.

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Hinge joints. These allow the movements of flexion and extension only. They are

the elbow, knee, ankle,

Gliding joints. The articular surfaces glide over each other, e.g. joints between the

carpal bones and those between the tarsal bones.

Characteristics of a synovial joint

 Articular or hyaline cartilage

 Capsule or capsular ligament

 Synovial membrane

 Synovial fluid.

Shoulder joint Muscles

 Coracobrachialis muscle.

 Deltoid muscle.

 Pectoralis major.

 Latissimus dorsi.

Elbow joint muscles

 Biceps muscle.

 Brachialis muscle.

 Triceps muscle.

PROXIMAL AND DISTAL RADIOULNAR JOINTS MUSCLES

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 Pronator teres.

 Supinator muscle.

HIP JOINT MUSCLES

o Psoas muscle.

o Iliacus muscle.

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o Quadriceps femoris.

o Gluteal muscles.

o Sartorius.

o Adductor group.

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Knee joint muscles

 Hamstring muscles.

 Gastrocnemius.

Ankle joint muscles

 Anterior tibialis muscle.

 Soleus.

 Gastrocnemius.
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 CHAPTER NINE
THE SPECIAL SENSES
INTRODUCTION
The special senses of hearing, sight, smell and taste all have specialised sensory
receptors (nerve endings) outside the brain. These are found in the ears, eyes, nose
and mouth. The ear is also involved in the maintenance of balance.
HEARING AND THE EAR
The ear is the organ of hearing. It is supplied by the 8 th cranial nerve, i.e. the
cochlear part of the vestibulocochlear nerve which is stimulated by vibrations
caused by sound waves.
STRUCTURE
The ear is divided into three distinct parts :
 Outer ear
 Middle ear (tympanic cavity)
 Inner ear.
OUTER EAR
The outer ear consists of the auricle (pinna) and the external acoustic meatus.
a. The auricle (pinna): The auricle is the expanded portion projecting from
the side of the head. It is composed of fibroelastic cartilage covered with
skin.
b. External acoustic meatus (auditory canal): This is a slightly 'S'-shaped
tube about 2.5 cm long extending from the auricle to the tympanic
membrane (eardrum). And containing hairs and glands e.g. Ceruminous
glands are modified sweat glands that secrete cerumen (wax), a sticky
material containing lysozyme and immunoglobulins.
c. The tympanic membrane (eardrum) completely separates the external
acoustic meatus from the middle ear.
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MIDDLE EAR (TYMPANIC CAVITY)
This is an irregular-shaped air-filled cavity within the portion of the temporal bone.
The medial wall is a thin layer of temporal bone in which there are two openings:
 Oval window
 Round window.
The oval window is occluded by part of a small bone called the stapes and the
round window, by a fine sheet of fibrous tissue.
Air reaches the cavity through the pharyngotympanic (auditory or Eustachian)
tube which extends from the nasopharynx. The presence of air at atmospheric
pressure on both sides of the tympanic membrane is maintained by the
pharyngotympanic tube and enables the membrane to vibrate when sound waves
strike it
Auditory ossicles
These are three very small bones that extend across the middle ear from the
tympanic membrane to the oval window, They form a series of movable joints,
They are named according to their shapes.
 Malleus.
 Incus
 Stapes.
INNER EAR
The inner ear is a fluid-filled cavity connected to the middle ear by the oval
window. It consists of a series of chambers and canals embedded in the bone of the
skull-It has three cavities: the vestibule, the cochlea and the semi-circular canals.
The vestibule and semi-circular canals are the structures for balance while the
cochlea is for hearing.

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The cavities in the inner ear are filled with fluids called perilymph and endolymph.
The fluids conduct sound vibrations transmitted from the middle ear to the cochlea
for hearing.
PHYSIOLOGY OF HEARING
Every sound produces sound waves or vibrations in the air, which travel at about
332 metres (1088 feet) per second. The auricle, because of its shape, concentrates
the waves and directs them along the auditory meatus causing the tympanic
membrane to vibrate and enlarged through the middle ear by movement of the
ossicles in the oval window, setting up fluid waves in the perilymph of the scala
vestibuli and then the pressure is transmitted into the cochlear duct.
The nerve impulses generated pass to the brain in the cochlear (auditory) portion of
the vestibulocochlear nerve.

SIGHT AND THE EYE

The eye is the organ of the sense of sight situated in the orbital cavity and it is
supplied by the optic nerve (2nd cranial nerve). There are three layers of tissue in
the walls of the eye. They are:
1. The outer fibrous layer: sclera and cornea
2. The middle vascular layer or uveal tract: choroid, ciliary body and iris
3. The inner nervous tissue layer: retina.

SCLERA AND CORNEA

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The sclera, or white of the eye, forms the outermost layer of tissue of the posterior
and lateral aspects of the eyeball and is continuous anteriorly with the transparent
cornea.
Conjunctiva
This is a fine transparent membrane which lines the eyelids and the front of the
eyeball. Where it lines the eyelids it consists of highly vascular columnar
epithelium. Corneal conjunctiva consists of less-vascular stratified epithelium.
Choroid
The choroid lines the posterior of the inner surface of the sclera. It is very rich in
blood vessels, Light enters the eye through the pupil, stimulates the nerve endings
in the retina and is then absorbed by the choroid.
CILIARY BODY
The ciliary body is the anterior continuation of the choroid consisting of ciliary
muscle (smooth muscle fibres) and secretory epithelial cells. It gives attachment to
the suspensory ligament, Contraction and relaxation of the ciliary muscle changes
the thickness of the lens.
IRIS
The iris is the visible coloured part of the eye and extends anteriorly from the
ciliary body, lying behind the cornea in front of the lens. It is a circular body
composed of pigment cells and two layers of smooth muscle fibres, one circular
and the other radiating (Fig. 8.9). In the centre there is an aperture called the pupil.
LENS
The lens is a highly elastic circular biconvex body, lying immediately behind the
pupil. Its thickness is controlled by the ciliary muscle through the suspensory
ligament.
RETINA

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The retina is the innermost layer of the wall of the eye, In the centre of the area
there is a little depression called the fovea centralis, The rods and cones contain
photosensitive pigments that convert light rays into nerve impulses, The rods are
more sensitive than the cones. They are stimulated by low-intensity or dim light,
and The cones are sensitive to bright light and colour.
PHYSIOLOGY OF SIGHT
Light from the object is refracted by cornea aqueous humour and the lens through
the vitreous humour and focused onto the fovea centralis on the retina.
The image is recorded as real, inverted and small. See figure 1.15. The
photoreceptor cells become stimulated and nerve impulse is generated and
transmitted by the optic nerve to the cerebrum part of the brain for interpretation.
In the brain the impulses are interpreted and the object appears real, upright and
normal. The images from the left eye are interpreted by the right cerebral
hemisphere and those from the right eye by the left cerebral hemisphere.

EXTRAOCULAR MUSCLES OF THE EYE

The eyeballs are moved by six extrinsic muscles, attached at one end to the eyeball
and at the other to the walls of the orbital cavity. There are four straight (rectus)
muscles and two oblique muscles (Fig. 8.20). They are:
 Medial rectus
 Lateral rectus
 Superior rectus
 Inferior rectus
 Superior oblique
 Inferior oblique.
ACCESSORY ORGANS OF THE EYE

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The eye is a delicate organ which is protected by several structures:
 Eyebrows
 Eyelids and eyelashes
 Lacrimal apparatus.
SENSE OF SMELL
The nasal cavity has a dual function: a passageway for Respiration and sense of
smell.
Olfactory nerves (first cranial nerves)
These are the sensory nerves of smell. They originate as specialised olfactory nerve
endings (chemoreceptors) in the mucous membrane of the roof of the nasal cavity
above the superior nasal conchae.
Physiology of smell
All odorous materials give off volatile molecules, which are carried into the nose
with the inhaled air and stimulate the olfactory chemoreceptors when dissolved in
mucus. This increases the number of olfactory receptors stimulated and thus occurs
the perception of the smell. And interpretate in the brain.

SENSE OF TASTE
Taste buds contain sensory receptors (chemoreceptors) that are found in the
papillae of the tongue and widely distributed in the epithelia of the tongue, soft
palate, pharynx and epiglottis. They consist of small sensory nerve endings of th
glossopharyngeal, facial and vagus nerves (cranial nerves VII, IX and X).
Physiology of taste
Four fundamental sensations of taste have been described — sweet, sour, bitter and
salt. The taste buds in specific parts of the tongue:
 Sweet and salty, mainly at the tip

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  Sour, at the sides
 Bitter, at the back.
The sense of taste triggers salivation and the secretion of gastric juice. It also has a
protective function, The sense of taste is impaired when the mouth is dry because
substances can be 'tasted' only if they are in solution.

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 CHAPTER TEN
RESISTANCE AND IMMUNITY
Introduction

An individual is under constant attack from an enormous range of potentially

harmful invaders, These invaders include such diverse entities as bacteria,
viruses, cancer cells, parasites and foreign (non-self) cells. The body therefore
has developed a wide selection of protective measures, which can be divided
into two categories.

Non-specific defence mechanisms. These protect against any of an enormous

range of possible dangers.

Specific defence mechanisms. These are grouped together under the term
immunity. Resistance is directed against only one particular invader. In addition,
immunological memory develops,

NON-SPECIFIC DEFENCE MECHANISMS

These are the first lines of general defence; they prevent entry and minimise
further passage of microbes and other foreign material into the body.

There are four main non-specific defence mechanisms:

 Defence at body surfaces

 Phagocytosis
 Natural antimicrobial substances
 The inflammatory response.

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 DEFENCE AT BODY SURFACES

When skin and mucous membrane are intact and healthy they provide an
efficient physical barrier to invading microbes.

The outer layer of skin can be penetrated by only a few microbes and the mucus
secreted by mucous membranes traps microbes and other foreign material on its
sticky surface. Sebum and sweat secreted on to the skin surface contain
antibacterial and antifungal substances.

Hairs in the nose act as a coarse filter and the sweeping action of cilia in the
respiratory tract moves mucus and inhaled foreign materials towards the throat.
Then it is expectorated or swallowed.

The one-way flow of urine from the bladder minimises the risk of microbes
ascending through the urethra into the bladder.

PHAGOCYTOSIS

The process of phagocytosis (cell eating) is shown in. Phagocytic defence cells
such as macrophages and neutrophils are attracted to sites of inflammation and
infection by chemotaxis, when chemoattractants are released by injured cells
and invading microbes. Phagocytes trap particles either by engulfing.

Macrophages have an important role as a link between the non-specific and

specific defence mechanisms.

NATURAL ANTIMICROBIAL SUBSTANCES

Hydrochloric acid. This is present in high concentrations in gastric juice, and

kills the majority of ingested microbes.

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 Lysosyme. This is a small molecule protein with antibacterial properties present
in granulocytes, tears, and other body secretions.

Antibodies. These are present in nasal secretions and saliva and are able to
inactivate some microbes.

Saliva. This is secreted into the mouth and washes away food debris that may
serve as culture medium for microbes.

Interferons. These are substances produced by T-lymphocytes and by cells that

have been invaded by viruses. They prevent viral replication within cells and
spread of viruses to other cells.

THE INFLAMMATORY RESPONSE

This is the physiological response to tissue damage and is accompanied by a

characteristic series of local changes, Inflammatory conditions are recognised
by their Latin suffix '-itis'; for example, appendicitis is inflammation of the
appendix and laryngitis is inflammation of the larynx.

CAUSES OF INFLAMMATION

The numerous causes of inflammation may be classified as follows:

Microbes, e.G. Bacteria, viruses, protozoa, fungi

Physical agents, e.G. Heat, cold, mechanical injury,

Chemical agents e.G. Organic, and— inorganic,

Antigens that stimulate immunological responses.

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 ACUTE INFLAMMATION

The occurrence of acute inflammation are usually of short duration, e.g. days to
a few weeks, and may range from mild to very severe. The cardinal signs of
inflammation are:

 Redness
 Heat
 Pain
 Swelling
 Loss of function.

The acute inflammatory response is described in a series of overlapping stages:

increased blood flow, increased formation of tissue fluid, Increased
permeability of small blood vessel walls and migration of leukocytes.

HARMFUL EFFECTS OF ACUTE INFLAMMATION

Tissue swelling. This is the result of the increased blood flow and exudation
and is often accompanied by loss of function. The effects can be harmful,
depending on the site:

Pain. This occurs when local swelling compresses sensory nerve endings. It is
improved by chemical mediators of the inflammatory process,

Suppuration (pus formation): Pus consists of dead phagocytes, dead cells,

cell debris, fibrin, inflammatory exudate and living and dead microbes. The
most common causative pyogenic microbes are Staphylococcus aureus and
Streptococcus pyogenes.

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 OUTCOMES OF ACUTE INFLAMMATION

Resolution. This occurs when the cause has been successfully overcome. The
inflammatory process is reversed

Chronic inflammation

The processes involved are very similar to those of acute inflammation but,
because the process is of longer duration, considerably more tissue is likely to
be destroyed.

The inflammatory cell types are mainly lymphocytes instead of neutrophils, and
fibroblasts are activated, leading to the laying down of collagen, and fibrosis. If
the body defences are unable to clear the infection,

Fibrosis (scar formation)

Fibrous tissue is formed during healing when there is loss of tissue or the cells
destroyed do not regenerate,

IMMUNITY

The cell type involved in immunity is the lymphocyte. This white blood cell is
manufactured in the bone marrow, and has a characteristically large, single
nucleus.

T-lymphocytes. These are processed by the thymus gland, which lies

between the heart and the sternum. The hormone thymosin, produced by the
thymus, is responsible for promoting the processing, which leads to the
formation of fully specialised (differentiated), mature, functional T-
lymphocytes.

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 It is important to recognise that a mature T-lymphocyte has been programmed
to recognise only one type of antigen, T-lymphocytes provide cell-mediated
immunity.

B-lymphocytes. These are processed in the bone marrow. Their role is in

production of antibodies (immunoglobulins), which are proteins designed to
bind to, and cause the destruction of, an antigen. As with Tlymphocytes, each
B-lymphocyte targets one specific antigen; the antibody released reacts with
one type of antigen and no other.

B-lymphocytes provide antibodymediated immunity

CELL-MEDIATED IMMUNITY

T-lymphocytes that have been activated in the thymus gland are released into
the circulation. When they encounter(meet) their antigen for the first time, they
become sensitised to it. If the antigen has come from outside the body, it needs
to be 'presented' to the T-lymphocyte on the surface of an antigen-presenting
cell.

On their movement around the body, still displaying the antigen fragment, they
eventually come into contact with the T-lymphocyte that has been processed to
target that particular antigen.

Three main types of specialised T-lymphocyte are produced, each of which is

still directed against the original antigen, Memory T-cells, Cytotoxic T-cells
and Helper T-cells.

Memory T-cells

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 These provide cell-mediated immunity by responding rapidly to another
encounter with the same antigen.

Cytotoxic T-cells

These directly inactivate any cells carrying antigens. They attach themselves to
the target cell and release powerful toxins, which are very effective because the
two cells are so close together. The main role of cytotoxic T-lymphocytes is in
destruction of abnormal body cells, e.g. infected cells and cancer cells.

Helper T-cells

These are essential for correct functioning of not only cell-mediated immunity,
but also antibody-mediated immunity. Their central role in immunity is
highlight in situations where they are destroyed, their main functions include:

production of special chemicals called cytokines,

cooperating with B-lymphocytes to produce antibodies; although B-

lymphocytes are responsible for antibody manufacture.

ANTIBODY-MEDIATED (HUMORAL) IMMUNITY

B-lymphocytes, unlike T-lymphocytes, which are free to circulate around the

body, are fixed in lymphoid tissue (e.g. the spleen and lymph nodes).

B-lymphocytes, Once its antigen has been detected and bound, and with the
help of a helper T-lymphocyte, the B-lymphocyte enlarges and begins to divide.
It produces two functionally distinct types of cell, plasma cells and memory B-
cells.

Plasma cells

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 These secrete antibodies into the blood. Antibodies are carried throughout the
tissues, while the B-lymphocytes themselves remain fixed in lymphoid tissue.
Plasma cells live no longer than a day, and produce only one type of antibody,
which targets the specific antigen that originally bound to the B-lymphocyte.
Antibodies:

bind to antigens, labelling them as targets for other defence cells such as
cytotoxic T-lymphocytes and macrophages

bind to bacterial toxins, neutralising them

activate complement

Memory B-cells

These cells remain in the body long after the initial event has been dealt with,
and rapidly respond to another encounter with the same antigen by stimulating
the production of antibody-secreting plasma cells.

Acquired immunity

Immunity may be acquired naturally or artificially and both forms may be

active or passive (Fig. 15.8).

Active immunity means that the individual has responded to an antigen and
produced his own antibodies, lymphocytes are activated and the memory cells
formed provide longlasting resistance.

In passive immunity the individual is given antibodies produced by someone

else. The antibodies are then destroyed and unless lymphocytes are stimulated,
passive immunity is short lasting.

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 CHAPTER ELVEN
THE URINARY SYSTEM

INTRODUCTION
The urinary system is one of the excretory systems of the body. It consists of the
following structures:

1. 2 kidneys, which secrete urine

2. 2 ureters, which convey the urine from the kidneys to the urinary bladder
3. 1 urinary bladder where urine collects and is temporarily stored
4. 1 urethra through which the urine is discharged from the urinary bladder.

The urinary system plays a vital part in maintaining homeostasis of water and
electrolyte concentrations within the body. Main functions of the kidneys are:

 Formation and secretion of urine

 Production and secretion of erythropoietin, the hormone responsible for
controlling the rate of formation of red blood cells.
 Production and secretion of renin, an important enzyme in the control of
blood pressure.
 Urine is stored in the bladder and excreted by the process of micturition

KIDNEYS

The kidneys (Fig. 13.2) lie on the posterior abdominal wall, one on each side of the
vertebral column, behind the peritoneum and below the diaphragm. They extend
from the level of the 12th thoracic vertebra to the 3rd lumbar vertebra.

Kidneys are bean-shaped organs, about 11 cm long, 6 cm wide, 3 cm thick and

weigh 150 g

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GROSS STRUCTURE OF THE KIDNEY

There are three areas of tissue which can be distinguished when a longitudinal
section of the kidney is viewed with the naked eye:

o A fibrous capsule, surrounding the kidney

o The cortex, a reddish-brown layer of tissue immediately below the
capsule.
o The medulla, the innermost layer, consisting of pale conical-shaped
striations, the renal pyramids.

The hilum is the concave medial border of the kidney where the renal blood and
lymph vessels, the ureter and nerves enter.

The renal pelvis is the funnel-shaped structure which acts as a receptacle for the
urine formed by the kidney. It has a number of distal branches called calyces,

MICROSCOPIC STRUCTURE OF THE KIDNEY

The kidney is composed of about 1 million functional units, the nephrons, and a
smaller number of collecting tubules. The collecting tubules transport urine
through the pyramids to the renal pelvis.

THE NEPHRON

The nephron consists of a tubule closed at one end, the other end opening into a
collecting tubule. There are three parts:

o The proximal convoluted tubule

o The medullary loop (loop of henle)

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 o The distal convoluted tubule, leading into a collecting duct.

FUNCTIONS OF THE KIDNEY

1. Formation of urine
2. There are three processes involved in the formation of urine:
3. Simple filtration
4. Selective reabsorption
5. Secretion.

Composition of urine

 Water 96%
 Urea 2%
 Uric acid
 Creatinine
 Ammonia
 Sodium
 Potassium / 2%
 Chlorides
 Phosphates
 Sulphates
 Oxalates

URETERS

The ureters are the tubes that convey urine from the kidneys to the urinary bladder.
They are about 25 to 30 cm long with a diameter of about 3 mm.

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STRUCTURE

The ureters consist of three layers of tissue:

 An outer covering of fibrous tissue,

 A middle muscular layer
 An inner layer, the mucosa,

FUNCTION

- The ureters propel the urine from the kidneys into the bladder by peristaltic
contraction of the smooth muscle

URINARY BLADDER

The urinary bladder is a reservoir for urine. It lies in the pelvic cavity and its size
and position vary, depending on the amount of urine it contains. The structure of
the bladder wall is composed of three layers that same as the ureter.

URETHRA

The urethra is a canal extending from the neck of the bladder to the exterior, at the
external urethral orifice. Its length differs in the male and in the female. The male
urethra is associated with the urinary and the reproductive systems

MICTURITION

The urinary bladder acts as a reservoir for urine. When 300 to 400 ml of urine have
accumulated, afferent autonomic nerve fibres in the bladder wall sensitive to
stretch are stimulated. In the infant this initiates a spinal reflex action and
micturition occurs. Micturition occurs when autonomic efferent fibres convey
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impulses to the bladder causing contraction of the detrusor muscle and relaxation
of the internal urethral sphincter.

In adult, When the nervous system is fully developed the micturition reflex is
stimulated but sensory impulses pass upwards to the brain and there is an
awareness of the desire to pass urine. By conscious effort.

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Reference
Anatomy and physiology in health and illness. Authors

“Ross and Wilson” 9edition.

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The copy right of the lecture note of anatomy and physiology ©
[email protected] without permission not copy and cannot
allow taking for soft copy. Please respect the right of this book.

For more information you can receive the following E-mail:

[email protected]

[email protected]

www.soojeede.com

By: Mohamed Ibrahim Abdi “Soojeede”

 Bsc – Veterinary medicine & Animal husbandry
 Bsc – Public health

Mogadishu – Somalia

Year – 2015

Thanks for Allah

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