Module 14.

0 - Nervous Tissue
The nervous system, in conjunction with the endocrine system, is responsible for
maintaining homeostasis throughout the body. The nervous system is able to perform
its diverse tasks as a result of the conductive properties of nervous tissue, which
permit the propagation of electrical signals to and from the brain through a complex
network of wiring. In order to understand the nature of this electrical network, we
must first explore the conductive properties of neurons, which are some of its most
basic functional units.

Module 14.1 - Organization of the Nervous

System
The Nervous System
 The body’s primary communication and control system.
 Can be divided according to:

o Structural categories

o Functional categories
Structural subdivisions of the nervous system

The central nervous system (CNS) consists of the brain and spinal cord and
functions as the body's nervous integration and command center.

The peripheral nervous system (PNS) is composed of peripheral nerves that

connect all body regions to the CNS and consists of two groups of nerves
extending to and from the brain and spinal cord.

 The cranial nerves are 12 pairs of nerves that originate from within the skull.
 The spinal nerves are 31 pairs of nerves that are attached to the spinal cord
and supply most of the body inferior to the head.

Module 14.2 - Sensory and Motor Divisions of

the Nervous System
In addition to the division of the nervous system into the CNS and PNS, the
nervous system can be functionally divided three components somatic nervous
system, autonomic nervous system and enteric nervous system.
The somatic sensory division of the nervous system detects general somatic
senses such as touch, pain, vibration, pressure, temperature, and
proprioception, which sense joint position and movement. Special somatic
 senses are detected by receptors located in the head for hearing, balance,
vision, and smell.
The somatic motor component is the voluntary nervous system. It is the branch
of the nervous system that initiates contraction of skeletal muscles under our
own voluntary control.
The autonomic nervous system and is also called the involuntary nervous
system, as it controls the contraction of smooth and cardiac muscle, secretion
from the body's glands, and the function of visceral organs without voluntary
input.
The enteric nervous system consists of neurons that occur throughout the gut.

Module 14.3 - Cytology of Nervous Tissue

Nervous tissue consists of two basic types of cell: neurons and glial cells.

Neurons
 excitable cells
 initiate and transmit nerve impulses

Glial cells
• nonexcitable cells
• support and protect the neurons

Neurons are specialized cells that conduct electrical impulses called action potentials
along the plasma membrane. The neuron is the basic functional unit of the nervous
system, and the human body contains billions of neurons.

Neuron Structure
The cell body, sometimes called the soma or perikaryon, is an enlarged portion of the
neuron which contains a nucleus surrounded by cytoplasm and cellular organelles. It
also contains the following special structures:

• chromatophilic (Nissl) bodies which are clusters of rough ER and free ribosomes
that continually produce proteins for the active cell.

• neurofibrils which are bundles of intermediate filaments that create a network

between chromatophilic bodies to prevent physical stretching of the cell.

Two types of processes extend from the cell body: Dendrites (tree-like) and axons.

Dendrites
  Dendrites are the numerous extensively branching processes which arise from
the cell body and function as receptive sites for incoming signals from other
neurons.
 They transmit electrical signals (graded potentials) towards the cell body.

Axons

 Each neuron has only one axon, which transmits impulses away from the
cell body.
 An axon forms a cone-shaped axon hillock where it exits the cell body.
 Some axons contain branches called axon collaterals, but branches at
the end of an axon are known as axon terminals (telodendria).
 Axons and their branches end in knobs called synaptic bulbs or knobs,
which release chemicals called neurotransmitters.

Module 14.4 - Neuron Classification

Neurons can be classified according to their structure.

• Unipolar (pseudounipolar) neurons start as bipolar neurons during development and

their processes fuse to form a short, single process that emerges from the cell body.

 Bipolar neurons are composed of a cell body with only two processes, an axon
and a dendrite. These are rare neurons and are only found in some special
sensory organs such as the olfactory mucosa of the nose and the retina of the
eye.
 Multipolar neurons have more than two processes emerging from the cell body.
They have numerous dendrites and one axon, and examples include motor
neurons, and the interneurons of the CNS.

Neurons can also be classified according to their function and direction of

travel of the nerve impulse.

Sensory (afferent) neurons transmit impulses toward the CNS. Virtually all
afferent neurons are unipolar neurons. The cell bodies are found in ganglia
outside the CNS and their single short processes can be divided into a central
process which runs centrally into the CNS and a peripheral process which
extends peripherally to the receptors.

Motor (efferent) neurons carry impulses from the CNS to effector organs. They
are mostly multipolar: their cell bodies are found within the CNS, and their
axons form junctions with effector cells.

Interneurons (association neurons) are usually multipolar and lie among the
motor and sensory neurons of the CNS.
Module 14.5 - Glial Cells
Glial cells are supporting cells and are sometimes referred to as neuroglia.

 Glial cells have branching processes and a central cell body.

 They outnumber neurons ten to one and compose half the mass of the brain.
 Unlike neurons, they can reproduce throughout life.

Glial Cells in the CNS

There are four types of glial cells in the CNS.

Astrocytes are the most abundant type of glial cell.

 They have numerous radiating processes with bulbous ends, which give them a
star- like shape.
 Functions include controlling the local environment around neurons, producing
molecules necessary for neuronal growth, replacing damaged neurons and
forming the blood-brain barrier (BBB).

Ependymal cells are cuboidal in shape and line the central cavity of the spinal
cord and the ventricles of the brain. They possess cilia which help circulate the
cerebrospinal fluid through these compartments.

Microglia are the smallest and least abundant glial cell and consist of elongated cell
bodies with numerous processes.

 These cells are phagocytic and behave like the macrophages of the CNS,
engulfing invading microorganisms and dead cells.
 They are derived from blood cells called monocytes.

Oligodendrocytes are large cells whose few branches wrap around axons in the CNS
and produce myelin sheaths.

Glial Cells in the PNS

The two types of PNS supporting cells are very similar and differ primarily in location.
Satellite cells surround neuron cell bodies within peripheral ganglia.
Neurolemmocytes (Schwann cells) surround axons in the PNS and form their myelin
sheaths.

Module 14.6 - Myelination of Axons

Axons of some neurons are covered in segmented structures composed of the
lipoprotein myelin, which forms an insulating layer around the axons.

Myelination increases the speed of impulse conduction along an axon.

Myelin Sheaths in the PNS

 Myelin is formed by Schwann cells, which wrap in concentric layers around the
axon.
 The neurilemma is a Schwann cell-based membrane external to the myelin
layers.
 Neurofibril nodes (nodes of Ranvier) are gaps along the axon between
Schwann cells.

Myelin Sheaths in the CNS

Oligodendrocytes form the myelin sheaths around axons in the CNS.

Unlike Schwann cells, they have multiple processes, so each process can coil around
multiple axons.

Unmyelinated Axons
Not all axons in the PNS and CNS are myelinated.

In the PNS, unmyelinated axons remain associated with a Schwann cell. However,
oligodendrocytes are not associated with unmyelinated axons in the CNS.

Module 14.7 - Synaptic Communication

A synapse is composed of these structures:

 The presynaptic neuron conducts an electrical signal toward a synapse and

releases the neurotransmitter (chemical message) stored in synaptic vesicles
from its synaptic knob.
 The synaptic cleft is the space between neurons in which neurotransmitters
must travel across.
 The postsynaptic neuron receives the neurotransmitter and transmits
electrical activity away from a synapse.

Module 14.8 - White and Gray Matter

Dissected sections of brain and spinal cord show variations described as white and
gray matter .
The white matter is aggregations of myelinated and unmyelinated axons of many
neurons. The concentration of myelin (which is white) lends this area its’ color. The
gray matter areas contain neuronal cell bodies, dendrites, unmyelinated axons, axon
terminals and neuroglia. The concentration of Nissl bodies impart a gray color to this
area.

The cerebral nuclei, often wrongly called the basal ganglia, have an important role in
motor control. These are Islands of gray matter containing neuron cell bodies found in
cerebrum, diencephalon and midbrain.

The cerebral nuclei consist of the following:

 The caudate nucleus, putamen and globus pallidus are associated with motor
control.
 The amygdala, although located in the cerebrum, is actually considered part of
the limbic system.
 The claustrum functions in the processing of visual information.

Module 15.0: The Spinal Cord and Spinal Nerves

The central nervous system comprises: the spinal cord and brain. The brain is far
more complex than the spinal cord and is often likened to a supercomputer, but that
analogy doesn't even begin to really do it justice. Although both are capable of
receiving tremendous amounts of input, processing it and sending the appropriate
output, the brain is infinitely more dynamic. Not only is it responsible for learning
and adapting, but it is also the source of all of our dreams, memories and behaviors.

Module 15.1 Spinal cord and nerves

The spinal cord is located within the vertebral canal of the vertebral column. The
vertebral foramina of all the vertebra stacked one on top of the other form the
vertebral canal.

Spinal Cord Meninges

The vertebral column is lined by dura mater known as the spinal dural sheath, which
is

composed of only a single meningeal layer.

Anesthetics are administered in the epidural space, located between the dural
sheath and the vertebral canal.

Internal to the dura mater, the arachnoid and pia mater are continuous with their
counterparts in the brain.
Denticulate ligaments are derived from pia mater, and they anchor the spinal cord to
the vertebrae.

The filum terminale is a thin strand of pia mater that attachs the conus medullaris to
the coccyx.

Structure of a single Nerve.

 Nerves are long, string-like organs in the PNS, composed of numerous parallel
axons of neurons wrapped in connective tissue.
 They are composed of myelinated and unmyelinated sensory and motor nerve
fibers.
 Each axon is first surrounded by myelin, then wrapped in a delicate layer of
connective tissue called the endoneurium.
 Groups of axons are bound into bundles called nerve fascicles and are
surrounded by a connective tissue wrapping called the perineurium.
 The exterior of the whole nerve is covered by a tough fibrous sheath called the
epineurium.

Spinal nerves are nerves associated with the spinal cord and like all nerves of the
peripheral nervous system are parallel bundles of axons and their associated
neuroglial cells wrapped in layers of connective tissue. Spinal nerves connect the CNS
to sensory receptors, muscles and glands in all parts of the body.

Module 15.2 - Gross Anatomy of the Spinal Cord

Link between the brain and the body. Exhibits some functional independence from
the brain. • The spinal cord and spinal nerves serve two functions:

o pathway for sensory and motor impulses

o responsible for reflexes

The spinal cord lies within the vertebral canal from the foramen magnum to
approximately the L2 vertebra.

Two deep grooves run the length of the cord, creating left and right halves and are
known as the posterior median sulcus and anterior median fissure.
The spinal cord is divided into cervical, thoracic, lumbar, sacral and coccygeal
regions.

 Each region contains the motor neurons to the corresponding spinal nerves.
 There are eight cervical nerves (C1-C8), twelve thoracic nerves (T1-T12), five
lumbar
 nerves (L1-L5), five sacral nerves (S1-S5) and one coccygeal nerve (Co).

 However, the regions of the spinal cord do not overlap with the corresponding
vertebrae.

Cervical and lumbar enlargements contain the neurons that innervate the upper and
lower limbs, respectively.

The inferior end of the spinal cord becomes the conus medullaris, which breaks up
into a collection of nerve fibers called the cauda equina.

The spinal cord is protected by bone, meninges, and CSF.

Module 15.3 - Spinal Nerves

Each spinal nerve is comprised of an anterior (ventral) and posterior (dorsal) root.

 The anterior root contains motor axons.

 The posterior root contains sensory axons.
 Attached to the posterior root, the cell bodies of the sensory neurons form the
posterior root ganglion.

Anterior and posterior roots join to form a spinal nerve in the intervertebral
foramen.

Upon exiting the intervertebral foramen, the spinal nerve branches into rami.
Posterior rami serve the skin and deep muscles of the back.

Anterior rami branch and join with one another to form nerve plexuses that primarily
serve the limbs.

 A nerve plexus is a complex network of nerves.

 These rami branch in cervical, brachial, lumbar, and sacral regions, but not in
the region of T2 - T12.

The Cervical Plexus

 Formed by the anterior rami of first four cervical nerves (C1-C4), it is buried
deep in the neck under the sternocleidomastoid muscle.
 Most are cutaneous nerves that supply the skin, but some innervate muscles of
the anterior neck.
 The phrenic nerve, the most important nerve of the cervical plexus, innervates
the diaphragm.

The Brachial Plexus

The brachial plexus is formed by anterior rami of C5 - T1 and is distributed through
the neck and axilla.

Its five roots are deep to the sternocleidomastoid and form three trunks: the upper,
middle and lower trunks.

Each trunk can be divided into anterior and posterior divisions.

 The anterior division innervates the flexors of the upper limb.

 The posterior division innervates the extensors of the upper limb.

The three trunks give rise to three cords: the lateral, medial and posterior cords.

These three cords give rise to five important nerves of the upper limb: the radial,
axillary, median, musculocutaneous and ulnar nerves.

 The radial nerve is a continuation of the posterior cord and is the largest
branch of the brachial plexus. It innervates muscles of the posterior upper
limb.
 The axillary nerve innervates the deltoid and teres minor.
 The median nerve innervates anterior forearm and thenar muscles and the
lateral two lumbricals
 The musculocutaneous nerve innervates the anterior arm muscles.
 The ulnar nerve innervates anterior forearm muscles and muscles of the hand.

The Lumbar Plexus

It arises from spinal nerves L1-L4.
Smaller branches innervate the posterior abdominal wall and psoas muscle. The main
branches innervate the anterior thigh.

The femoral nerve is the largest terminal branch, and it innervates anterior thigh
muscles.

The obturator nerve passes through the pelvis and innervates adductor muscles.

The Sacral Plexus

It arises from spinal nerves L4 - S4 and is located immediately caudal to the lumbar
plexus. Sometimes it is considered in conjunction with the lumbar plexus and called
the lumbosacral plexus.

The sciatic nerve is the thickest and longest nerve in the body and is actually two
nerves in a single sheath:
  The tibial nerve innervates most of the posterior lower limb muscles. It
becomes medial and lateral plantar nerves in the foot. I t also contributes to
the sural nerve, which supplies skin on the posterior leg.
 The common fibular (peroneal) nerve innervates muscles of the anterolateral
leg and gives rise to the superficial and deep fibular nerves.

Superior and inferior gluteal nerves innervate the gluteal muscles.

The posterior femoral cutaneous nerve innervates the cutaneous region of the
posterior thigh.
Pudendal nerve innervates muscles of the perineum.

Module 15.4 - Reflexes

Reflex arcs are simple chains of neurons that explain involuntary behaviors and
account for reflexes.

Reflexes are rapid, automatic motor responses that occur in response to a stimulus
and can be either visceral or somatic.

Components of a Reflex Arc

 Receptors are the sites where the stimulus is received.

 Sensory neurons transmit afferent impulses to the CNS.
 Integration center consists of one or more synapses in the CNS.
 Motor neurons conduct efferent impulses from integration center to an
effector.
 Effectors can represent muscles that contract or gland cells and respond to
efferent impulses by either contracting or secreting a hormone.

Module 19.0 - The Respiratory System

Typically, humans can survive for days without water and weeks without food, but
can only live for minutes without oxygen. This continuous requirement for oxygen is
necessary to enable the trillions of cells throughout the body to generate the energy
(in the form of ATP) that they need to sustain life. In addition to requiring oxygen,
the body must also eliminate carbon dioxide which is a byproduct of aerobic
metabolism. Both of these gases are exchanged through the respiratory system which
operates conjunction with the circulatory system that transports them.

Module 19.1 - The Respiratory System Functions

The respiratory system has many functions.

 It supplies body with oxygen and eliminates carbon dioxide.

  It enables vocalization (speaking).
 It allows olfaction (sense of smell).
 Respiratory structures defend against airborne pathogens.

Functional Anatomy of the Respiratory System

The respiratory organs are these:

 nose, nasal cavity, and paranasal sinuses.

 pharynx, larynx, and trachea.
 bronchi and their smaller branches of the lungs.
 lungs and their alveoli.

Module 19.2 - Upper Respiratory Tract

The upper respiratory tract includes the nose, nasal cavity, pharynx, and their
associated structures.

Nose and Nasal Cavity

The nose provides an airway for respiration.

• It moistens and warms air upon entry, filters particles from inhaled air, provides a
resonating chamber for speech, and contains the olfactory (smell) receptors.

The nose is divided into two main parts

 External nose, which is composed of the following:

o The bridge which consists of the nasal bones.

o The dorsum nasi and supporting lateral and alar cartilages.

 Nasal cavity

The external nares are commonly called the nostrils.

The nasal septum, which divides the nasal cavity into left and right halves, has
two parts:

 The anterior portion is composed of septal cartilage (hyaline cartilage).

 The posterior portion is formed by the ethmoid bone and vomer.
 The cavity is continuous with the nasopharynx through posterior nasal
apertures known as internal nares (choanae).

The nasal cavity is separated from the oral cavity by the palate, which is made up of
two parts:

 The hard palate is anterior and is composed of maxillae and palatine bones.
 The soft palate with uvula is posterior, and is composed of muscle.
The anterior portion of the nasal cavity, which contains hair follicles, is called
the

vestibule.
Two types of pseudostratified ciliated columnar epithelium line the nasal
cavity:

 Olfactory epithelium which also contains the olfactory receptors.

 Respiratory epithelium which lines most of the nasal cavity.
The nasal conchae are three medially projecting mucus-covered bony
structures in the nasal cavity .

 They include the superior, middle and inferior conchae.

 They direct particulate matter onto mucus-coated surfaces.
 The groove inferior to each of the conchae is called a nasal meatus.

Paranasal Sinuses
The paranasal sinuses are air-filled cavities inside the bones surrounding the nasal
cavity. They are located in the frontal, sphenoid, ethmoid, and maxillary bones and
are named accordingly. They serve to reduce the weight of the head.

Pharynx

This funnel-shaped passageway connects the nasal cavity and mouth to both the
respiratory and digestive systems. It runs from the base of the skull to the sixth
cervical vertebra, and its type of mucosal lining varies along its length. The pharynx is
subdivided based on location and function into three parts:

Nasopharynx

 Lies superior to the point where food enters, and serves only as an airway. It is
closed off by the soft palate during swallowing.
  It contains the openings of the auditory tubes and is lined with ciliated
pseudostratified epithelium.
 The nasopharynx contains the pharyngeal tonsil (or adendoids), which is
located higher the posterior wall and which destroys pathogens that enter via
inspired air.

Oropharynx

This lies posterior to the oral cavity and extends from the soft palate to the
epiglottis. It contains arch-like structures called fauces and is lined with a
stratified squamous epithelium.

Two types of tonsils are associated with the oropharynx:

 Palatine tonsils are found in the lateral walls of the fauces.

 Lingual tonsils cover the posterior surface of the tongue.

Laryngopharynx

This part of the pharynx is directly posterior to the larynx and is a passageway
for both food and air.

It is lined with stratified squamous epithelium and it is continuous with the

esophagus and larynx.

Module 19.3 - Lower Respiratory Tract

The lower respiratory tract is composed of the conducting airways and gas exchange
regions of the respiratory system.

Larynx
The larynx, often called the voice box, is located between the fourth and sixth
cervical vertebrae. The larynx is attached to the hyoid bone and is continuous with
the trachea (windpipe).

Its epithelium consists of stratified squamous (superiorly) and ciliated

pseudostratified columnar (inferiorly) epithelium.

The cartilages that make up this structure are interconnected by membranes and
ligaments:

 Thyroid cartilage contains the laryngeal prominence (Adam’s apple).

 Cricoid cartilage forms a complete ring on the inferior base of the larynx.
 Arytenoid cartilages anchor the vocal chords.
  Corniculate cartilages attach to the arytenoid cartilages.
 Cuneiform cartilages are located within the aryepiglottic fold.
 Epiglottis seals the laryngeal inlet during swallowing.

Within the larynx, there are two groups of muscles:

 intrinsic muscles attach to the arytenoid and corniculate cartilages.

 extrinsic (infrahyoid) muscles attach the thyroid cartilage to the hyoid bone.

Paired vocal folds (true vocal cords), composed of vocal ligaments and attached
mucosa, are found in the larynx.

 The opening between these vocal folds is called the rima glottidis.
 The vocal folds and rima glottidis make up the glottis.
 Vestibular ligaments and surrounding mucosa comprise the vestibular folds
and form the false vocal cords.
 Voice is produced by the intermittent release of air over the vocal cords, which
causes them to vibrate.
 Pitch is determined by the tension of the vocal cords and loudness depends on
the force of air passing across them.

The three main functions of the larynx are to allow vocalization, provide an open
airway and direct air and food into the appropriate channels.

Trachea
The trachea descends into the mediastinum, where it divides into two main bronchi
(primary bronchi).
Its mucosa consists of pseudostratified ciliated columnar epithelium with mucous-
secreting goblet cells.

 This allows it to filter debris and microbes from incoming air.

 Cilia move sheets of contaminated mucus superiorly.

It is composed of a mucous membrane and a submucosa surrounded by cartilage.

 The outer adventitia contains C-shaped hyaline cartilage rings (tracheal

cartiages) that keep the airway open.
 The trachealis muscle can narrow the trachea and decrease its diameter.

Bronchial Tree
The bronchial tree is composed of extensively branching respiratory passages.
  The two primary bronchi are the largest bronchi, with the right main bronchus
being slightly wider and shorter than the left.
 The carina is formed by the tracheal cartilage dividing the primary bronchi.
 The main bronchi branch into secondary (lobar) bronchi, with three on the
right, and two on the left.
 Tertiary (segmental) bronchi further branch into each lung segment.
 Bronchioles are little bronchi and are less than 1 mm in diameter.
 Terminal bronchioles are less than 0.5 mm in diameter and are usually
microscopic in size.

Although the tissue in the bronchial walls is similar to that of the trachea, several
changes occur as the diameter decreases.

 The C-shaped rings found in the trachea are replaced by irregular cartilage
plates in bronchi and continue to decrease in size and number until they are
absent in bronchioles.
 The pseudostratified ciliated columnar epithelium of the bronchi gives way to
simple columnar or simple cuboidal epithelium in the bronchioles.
 Smooth muscle regulates the diameter of the airways all the way down to the
bronchioles.

Respiratory Bronchioles, Alveolar Ducts, and Alveoli

Respiratory bronchioles arise from the terminal bronchioles and lead to
alveolar ducts and

alveolar sacs, which together form the respiratory zone. Alveoli form the
functional unit of the lung.

 They are lined by alveolar type I cells (squamous epithelial cells) and basal
laminae.
 Alveoli are covered by a dense network of capillaries that together form the
respiratory membrane.

 The tight association between the alveoli and capillaries facilitates gas
exchange.
 Alveolar type II cells (cuboidal epithelial cells) are scattered amongst the
alveolar type I cells and secrete a detergent-like pulmonary surfactant that
prevents the alveolar walls from sticking together and collapsing during
exhalation.
 In addition, alveoli are surrounded by elastic protein fibers, and are
interconnected by alveolar pores that equalize pressure between separate
alveoli.
 The internal surfaces of alveoli contain alveolar macrophages, which engulf
and remove tiny particles.
Module 19.4 - The Lungs
Pleura and Pleural Cavities
The pleura is a double-layered sac surrounding each lung and is composed of serous

membranes. It consists of the following:

 parietal pleura covering the thoracic wall.

 visceral pleura covering the external lung surface.

The pleural cavity is the space between the visceral and parietal pleurae. It
contains a pleural fluid that lubricates the two interacting surfaces and allows
them to slide easily over one another.

The pleural membranes divide the thoracic cavity into a central mediastinum and two
lateral pleural compartments.

Gross Anatomy of the Lungs

The lungs and their pleural sacs are located laterally to the mediastinum.

 The anterior, lateral, and posterior surfaces of the lungs contact the ribs, and
the

concave base of the lung rests on the diaphragm.

 The apex of each lung is located immediately deep to the clavicle.

 The costal surface faces the thoracic wall and the mediastinal surface faces
the mediastinum.
 The hilum is a depression on the medial surface through which the bronchi,
vessels, and nerves access the lungs. These structures are collectively referred
to as the root of the lung.

The left lung is smaller than the right and contains a cardiac impression and
cardiac notch.

The aorta also forms an impression on the left lung.

It has 2 lobes (superior and inferior), which are separated by the oblique
fissure.

The right lung is divided into 3 lobes (superior, middle, and inferior), which
are separated by the oblique and horizontal fissures.
 Each lobe is further subdivided into numerous bronchopulmonary segments
which are further divided up into hexagonal units known as lobules. This
segmentation often limits the spread of disease.

Module 19.5 - The Thoracic Cavity and

Respiration
There are two phases of pulmonary ventilation:

 inspiration (inhalation)
 expiration (exhalation)

During inspiration, the volume of the thoracic cavity increases and this causes a
decrease in internal gas pressure, allowing an influx of air.

Inspiration occurs as follows:

 The diaphragm flattens, thus increasing the length of the thoracic cavity
(superoinferior expansion).
 The external intercostal muscles contract raising the ribs, and increase the
volume of the thoracic cavity.

Deep inspiration also requires additional involvement of muscles:

 Scalenes, sternocleidomastoid, serratus anterior and pectoralis minor

further increase the volume of the thoracic cavity
 Serratus posterior superior elevates the ribs.

Quiet expiration is primarily a passive process. Inspiratory muscles relax, the

diaphragm moves superiorly, and the volume of the thoracic cavity decreases. Hiccups
are a non- respiratory movement caused by irritation of the diaphragm.

Forced expiration is an active process produced by contraction of the internal

intercostal muscles, abdominal (oblique, transversus abdominis and rectus
abdominus) muscles and transversus thoracis.

Innervation of the Respiratory System

The respiratory center found in the reticular formation of the medulla oblongata is
responsible for generating a baseline respiration rate. It consists of two distinct
nuclei:

 Dorsal respiratory group (DRG) contains neurons that stimulate the muscles of
inspiration.
  Ventral respiratory group (VRG) contains neurons that control muscles of
forced expiration.

The pontine respiratory group inhibits both the DRG and the apneustic center,
thus allowing the VRG to dominate.

Module 20.0 - The Digestive System

A significant portion of the body is dedicated to the processing of food, because the
energy and nutrients derived from our food are essential for life. Unfortunately the
cells in our bodies are incapable of directly using the food we eat, so it must first be
mechanically and chemically broken down. The portion of the body dedicated to this
task is known as the digestive system. In this module we explore the structures and
processes that make digestion possible.

Module 20.1 - General Structure and Function of

the Digestive System
Digestive system organs are divided into two groups.

 The gastrointestinal (GI) tract or alimentary canal is approximately 10 meters

long and is composed of the following:

o mouth, pharynx, and esophagus

o stomach, small intestine, and large intestine (colon)

 Accessory digestive organs of the GI tract are:

o teeth and tongue

o salivary glands, liver, gallbladder, and pancreas Ingestion is the intake of

food.

Digestionis the breakdown of food into smaller pieces and molecules.

 Mechanical digestion involves mixing actions such as chewing, churning, and

segmentation.
 Chemical digestion involves enzymatic breakdown of carbohydrates, proteins,
and fats.
Peristalsis is the muscular activity that moves material through the GI tract.
Module 20.2 - General Histology of GI Organs
The same four tissue layers or tunics are found in the GI tract from the esophagus to
the anus.

 The mucosa is the innermost layer and is composed of the following:

o Epithelium lines the luminal cavity and is involved in absorption. o Lamina
propria is loose connective tissue containing capillaries. o Muscularis mucosa
is a thin layer of smooth muscle.
 The submucosa lies external to the mucosa. It contains blood vessels,
lymphatic vessels, and nerve fibers.

 The muscularis externa lies external to the submucosa and is made up of two
layers responsible for peristalsis and segmentation:

o inner circular layer

o outer longitudinal layer

 The outermost tunic may be serosa or adventitia and contains connective

tissue, collagen and elastic fibers. Unlike adventitia, serosa is covered with
visceral peritoneum. Intraperitoneal organs have serosa and retroperintoneal
organs have adventitia.

Nerve plexuses within the GI tract consist of both autonomic and sensory
neurons.

 The myenteric nerve plexus is located in the muscularis.

 The submucosal nerve plexus lies within the submucosa.

Module 20.3 - Peritoneum, Peritoneal Cavity and

Mesentery
The peritoneum is a serous membrane having two components:

 Parietal peritoneum lines the inside surface of the body wall.

 Visceral peritoneum surrounds the digestive organs.
 The peritoneal cavity is a slit-like space between the parietal and visceral
peritoneum and contains a lubricating fluid.

Organs that are surrounded by visceral peritoneum are referred to as

intraperitoneal and includes most organs of the digestive system. Organs that
lie against the posterior abdominal wall and are only partially surrounded by
parietal peritoneum are referred to as retroperitoneal and include the
pancreas, duodenum, ascending and descending colon and rectum.

The mesentery is a double layer of peritoneum extending from the organs to

the body wall to surround and hold the intraperitoneal organs in place. It also
contains sites of fat storage and provides an access route for vessels and
nerves. Most mesenteries are dorsal, extending from the organs to the
posterior abdominal wall.

 The falciform ligament connects the liver to the anterior abdominal

wall.
 The lesser omentum connects the stomach and duodenum to the liver.
 The greater omentum connects the stomach and most GI organs.
 Mesentery proper connects most of the small intestine to the posterior
abdominal wall.
 The transverse and sigmoid mesocolons connect the transverse and
sigmoid colons, respectively, to the posterior abdominal wall.

Module 20.4 - The Oral Cavity

The oral cavity is commonly called the mouth and has two distinct regions:

 The vestibule is the space between the teeth and the cheeks and lips.
 The oral cavity proper is the region of the mouth that lies internal to the
teeth.

The initial mechanical and chemical digestion occurs in the oral cavity.

The oral cavity is composed of and protected by nonkeratinized stratified

squamous epithelium.

Cheeks, Lips and Palate

The lips and cheeks are formed respectively by the orbicularis oris and
buccinator muscles. The labial frenulum attaches the lips to the gingiva
(gums).
The hard palate is a bony structure that forms the roof of the mouth.
The soft palate is posterior to the hard palate and contains a hanging structure
called the uvula which is elevated during swallowing to prevent food from
 entering the nasal cavity. The opening where the oral cavity joins the
oropharynx is called the fauces.

Tongue
The tongue is constructed from interlacing fascicles of skeletal muscle and is
attached to

the floor of the mouth by the lingual frenulum.

The superior surface of the tongue contains four types of tongue papillae.

 Filiform papillae roughen the tongue for manipulation purposes.

 Fungiform papillae contain a few taste buds.
 Vallate papillae form a V-shaped row that points towards the back of the
tongue and contain most of the taste buds.
 Foliate papilla contain a few taste buds only during the infant and early
childhood stages of life.

Salivary Glands
Salivary glands produce saliva, which is a complex mixture of water, ions,
mucus and enzymes. The majority of saliva is produced before and during
meals; however, a small amount of saliva is continuously produced to keep the
mouth moist at all times.

Three pairs of extrinsic glands are located external to the mouth and secrete
saliva into the

mouth via ducts: the parotid, submandibular and sublingual salivary glands. The
parotid salivary glands are innervated by the glossopharyngeal nerve (CN IX) and the
submandibular and sublingual salivary glands are innervated by the facial nerve (CN
VII).

Teeth
Teeth reside in sockets located in the margins of the mandible and maxillae and are
surrounded by gum tissue.
All teeth have three main regions.

 The crown is the exposed portion of the tooth.

 The neck is where the crown narrows to join the root.
 The root is the portion of the tooth that lies beneath the gums.

In cross-section the tooth is composed of the following:

 enamel - the hard outer layer .

 dentin - bone-like material deep to the enamel covering.
  pulp cavity - the innermost part, composed of connective tissue (pulp)
containing vessels and nerves.
 cementum - the connective tissue covering the external root surface, which
allows the tooth to be held in place by the periodontal ligament.
 periodontal ligaments - join the roots and alveolar processes and are
continuous with the gingiva.
 root canal - joins the apical foramen and pulp cavity and houses the blood
vessels the nerves.

There are two sets of teeth which are present during a lifetime.

 Deciduous teeth are the 20 teeth that first appear at about six months of age
and last until about age twelve.
 Permanent teeth are the 32 teeth that mostly erupt by the end of
adolescence. The exception is the third molars (wisdom teeth) which erupt
later.

There are four types of permanent teeth, each with a different shape and
function: incisors, canines, premolars and molars.

Module 20.5 - Pharynx

The pharynx is composed of three sections. The nasopharynx is the passage for air.
The oropharynx and laryngopharynx are the passages for air and food and are lined
with stratified squamous epithelium.

The external muscle layer consists of superior, middle, and inferior pharyngeal
constrictors, which allow swallowing.

Module 20.6 - Esophagus

The esophagus is a muscular tube that begins as a continuation of the pharynx which
passes through the diaphragm esophageal hiatus and joins the stomach inferior to the
diaphragm. Its lumen is collapsed when empty, and expands to accommodate food.

The mucosa, composed of nonkeratinized stratified squamous epithelium, and

submucosa exist in longitudinal folds in the esophagus. The muscularis is composed of
skeletal muscle in the first third of the esophagus and smooth muscle in the inferior
two thirds.

The most external layer is an adventitia.

The superior esophageal (pharyngoesophageal) sphincter separates the pharynx and

esophagus and the inferior esophageal (esophagealgastric or cardiac) sphincter
separates the esophagus from the stomach.
Module 20.7 - Stomach
The stomach is a J-shaped organ where food is stored (approximately 4 hours) and
churned into chyme. The stomach is composed of the following:

 cardia - the ring-shaped zone encircling the cardiac orifice, where the
esophagus joins the stomach.
 fundus - the upper dome.
 body - the largest region, inferior to the fundus.
 pylorus - the lower funnel shaped region.

Release of chyme into the duodenum is controlled by the pyloric sphincter.

The greater and lesser curvatures refer to the inferior convex and superior
concave borders of the stomach.

The stomach lining contains numerous longitudinal gastric folds (rugae) which
allow for the distension of the stomach following a large meal.

The stomach secretes hydrochloric acid (HCl) into the lumen, where it kills harmful
bacteria. It also secretes pepsin, an enzyme that digests proteins under acidic
conditions.

It can directly absorb some substances, including water, electrolytes, aspirin, and
alcohol.

The muscularis is composed of three smooth muscle layers: an inner oblique, a middle
circular and an outer longitudinal layer.

Mucosa is covered in gastric pits containing five specialized cells types:

 Surface mucous cells produce mucin that protects the epithelium.

 Mucous neck cells produce another type of mucin that helps to maintain an
acidic

environment.

 Parietal (oxyntic) cells produce HCl and intrinsic factor.

 Chief (zymogenic) cells produce an inactive pepsin precursor (called
pepsinogen).
 Enteroendocrine cells release gastrin into the blood which regulates
secretion by the chief and parietal cells.

Also located in the gastric epithelium are undifferentiated stem cells which
grow into other types of cells to replenish the stomach lining.
Module 20.8 - Accessory Digestive Organs
Pancreas
The pancreas is located posterior to the stomach, between the duodenum of the
small intestine and the spleen. It is divided into three regions: the head, body and
tail. It is a mixed gland with both endocrine and exocrine functions.

The endocrine function of the pancreas is to produce insulin and glucagon and secrete
them into the blood to regulate blood sugar levels.

 These hormones are secreted by islet cells.

 The exocrine function of the pancreas is to secrete an alkaline fluid filled with
digestive enzymes and called pancreatic juice.
 Acinar cells make, store, and secrete pancreatic enzymes which are activated
when they reach the lumen of the duodenum.
 Ducts carrying pancreatic juice and bicarbonate, secreted by the epithelial
cells lining the pancreatic ducts, merge to form the main pancreatic duct.
 The main pancreatic duct drains into the hepatopancreatic ampulla which
connects to the major duodenal papilla of the duodenum.

Secretion produces and releases products into the GI tract.

Absorption is the transport of digested materials into blood and lymph.

Gallbladder
The gallbladder is a sac that resides in a shallow depression in the visceral surface of
the

liver. It stores and concentrates bile for future breakdown of fatty foods.

The left and right hepatic ducts form a common hepatic duct which carries bile
from the liver and to the cystic duct and then to the gallbladder. Upon contraction of
the gallbladder, bile is carried back through the cystic duct and then by the common
bile duct to the hepatopancreatic ampulla before entering the duodenum through
the major duodenal papilla.

Liver
The liver is the largest organ in the body, weighing approximately 1.4 kg. It lies
almost entirely within the ribcage for protection. The liver is a diverse and vital organ
that performs over 500 functions for the body; a major digestive function of the liver
is the production of bile.
The liver has two surfaces: the diaphragmatic surface which faces anteriorly and
superiorly and the visceral surface which faces posteroinferiorly.

The liver is composed of four lobes: the left, right, quadrate and caudate lobes. The
porta hepatis is the point of entry and exit of the following major structures:

 common hepatic duct formed from the right and left hepatic ducts
 hepatic portal vein
 hepatic artery proper

The ligaments of the liver include: the falciform ligament, round ligament of
the liver (ligamentum teres) and ligament venosus.

The liver is composed of approximately 1 million hexagonal hepatic lobules.

 Each lobule is an arrangement of hepatocytes (liver cells) surrounding a

central vein.
 Hepatocytes function to produce bile and blood plasma proteins and are
involved in detoxitifcation processes.
 Each lobule contains portal triads composed of a portal arteriole connected to
the hepatic artery, a portal venule connected to the hepatic portal vein and a
branch of the hepatic duct.
 Among the hepatocytes, bile canaliculi collect and drain bile into the hepatic
ducts.
 Hepatic sinusoids are blood-filled spaces in the lobules containing
reticuloendothelial (Kupffer) cells which function to destroy bacteria.

Blood supply to and from the liver involves the following:

 the hepatic portal vein brings oxygen-poor, nutrient-rich blood from the GI
tract, spleen and pancreas.
 the hepatic artery proper brings well-oxygenated blood from the celiac trunk.
 blood from both the hepatic portal vein and hepatic artery proper mix while
passing through the hepatic lobules.
 blood is drained into the central vein at the center of each lobule.
 central veins connect and form hepatic veins.
 hepatic veins drain into the inferior vena cava.

Module 20.9 - Blood Vessels, Lymphatic

Structures and Nerve Supply
 Blood is supplied to the GI tract by the celiac trunk and superior and inferior
mesenteric arteries. GI tract veins join and drain blood into the hepatic
portal system.

Lymphatic capillaries are found throughout the GI tract and is drained into the
thoracic duct via the cisterna chyli.

Lymphatic tissue primarily resides in the lamina propria of the mucosa.

 MALT is found in the small intestine and appendix.

 Peyer’s patches are also found in the small intestine.

Autonomic motor and sensory axons are associated with the GI tract.

• Autonomic plexuses include the celiac plexus, superior mesenteric plexus and
inferior mesenteric plexus.

Generally, digestive activity is promoted by parasympathetic innervation and

inhibited by sympathetic innervation.

Module 20.10 - Small Intestine

This is the longest portion of the GI tract and is the primary site for enzymatic
digestion and nutrient absorption. It has three segments: the duodenum, jejunum,
and ileum.

 The duodenum is a C-shaped segment and is the smallest portion of the small
intestine (approximately 25 cm). It receives chyme from the stomach, digestive
enzymes from the pancreas, and bile from the liver and gallbladder.

o The point where the bile and pancreatic ducts enter is called the major
duodenal papilla.

o The duodenum contains submucosal (Brunner) glands, which are unique to

this section of the small intestine and produce protective mucus.

 The jejunum extends from the duodenum to the ileum, and is approximately
2.5 m long. It has a larger lumen than duodenum, and its histological structure
is similar to that of the ileum but with more internal folds.
 The ileum is the final segment of the small intestine and it is approximately 3.6
m long. It empties its contents into the large intestine. In this section, lymph
nodules (Peyer’s patches) are abundant.

Three structural modifications for absorption exist in the small intestine.

  Circular folds (plicae circulares) increase surface area and control chyme flow.
They are produced by transverse ridges of the mucosa and submucosa.
 Villi are finger-like projections of the mucosa that increase surface area. Each
villus is covered with simple columnar epithelium and has a connective-tissue
core containing capillaries and lacteals to permit absorption.

• Microvilli (referred to a brush border) project from each villous cell and further
increase surface area for absorption.

Each intestinal villus is composed of the following:

 arteriole and venule which form a capillary network.

 lacteal which absorbs lipids.
 simple columnar epithelium with microvilli which absorb digested nutrients.
 goblet cells which produce mucin to lubricate and protect the intestinal walls.

Intestinal glands can be found between intestinal villi and are composed of the
following:

 enteroendocrine cells which secrete hormones into the bloodstream.

 simple columnar epithelial cells with goblet cells.

Module 20.11 - Large Intestine

The large intestine is the last major organ of the GI tract.

 Digested residue that reaches this point contains few nutrients.

 A small amount of digestion by colonic bacteria occurs.
 The main functions of the large intestine are to absorb water and electrolytes
and to produce solid feces.
 Mass peristaltic movements force feces toward the rectum. The large intestine
is subdivided into the following regions:

 The cecum is a blind pouch at the start of the large intestine. It receives
chyme from the small intestine through the ileocecal valve.
 The vermiform appendix contains lymphoid tissue that neutralizes pathogens.
 The colon is divided into distinct segments: ascending, transverse, descending,
and sigmoid colon. The right colic flexure is the bend between the ascending
and transverse colon. The left colic flexure is the bend between the transverse
and descending colon.
 The rectum descends along the inferior half of the sacrum.
 The anal canal is the last subdivision of the large intestine, and it contains
internal
 and external anal sphincters. Relaxation of these sphincters allows
defecation. The large intestine is lined with simple columnar epithelium and
goblet cells.

 Villi are absent in the large intestine.

 The mucosa contains intestinal glands with numerous mucus-secreting goblet
cells.

The cecum and colon have two smooth muscle layers: an inner circular and outer
longitudinal layers. The outer longitudinal layer has unique properties:

 it forms teniae coli, which are longitudinal strips of muscle that contract to
help move materials through the lumen.
 contractions of the teniae coli form haustra.
 on the external surface of the haustra are epiploic appendages which are fat
lobules.

The movement of digested material through the large intestine occurs in three ways.

 Peristaltic movements - similar to those of the small intestine

 Haustral churning - movement of digested material in a relaxed haustrum

Mass movements - result from contraction of the teniae coli.

Module 18.0 - The Senses

Unlike the general senses, which are essentially individual nerve endings scattered
throughout the body to measure touch, pain and temperature, the special senses,
which measure taste, smell, hearing and equilibrium, are all located in the head and
are far more complex in nature. Interestingly, studies have shown that when the
brain suffers sensory deprivation by the absence of the normal barrage of sensory
input, people will often begin to hallucinate. The brain's reliance on this constant
input really serves to underscore the interdependence of the special senses and the
CNS.

Module 18.1 - Olfaction

The sense of smell is called olfaction. There are over 1000 different smell receptors
that can bind odor molecules. The combination of receptors that are able to bind a
specific odor molecule creates an odor profile, which the brain interprets as a distinct
smell.

Like the taste buds of the tongue, the olfactory epithelium is composed of three cell
types:
  Cell bodies of olfactory receptor cells are the sensory cells that detect odor .
 Supporting cells are columnar cells that maintain the receptor cells.
 Basal cells give rise to new olfactory receptor cells.
Together all three of these cells form a pseudostratified columnar epithelium.

Axons from the sensory cells of the olfactory epithelium group together to form
bundles which are known as filaments of the olfactory cranial nerve (CN I).

 Filaments of the olfactory nerve (CN I) pass through the foramina in the
cribriform plate of the ethmoid bone, synapse with mitral cells of the
olfactory bulb, and are relayed to the cortex through the olfactory tract.
 The olfactory nerve (CN I) is the only sensory nerve that can relay information
directly to the cortex without first passing through the thalamus

Module 18.2 - Gustation

The sense of taste is known as gustation. Taste receptors are located in specialized
structures called taste buds, which are located within mushroom- like structures
called papillae.

The vast majority of taste buds reside on the surface of the tongue. Each taste bud is
a collection of about 50-100 epithelial cells composed of three main cell types:

 Gustatory cells are the chemical receptor cells that detect taste.
 Supporting cells are insulating cells that surround gustatory cells.
 Basal cells are regenerative cells that replace dead cells.

Gustatory cells have long microvilli that extend from their apical end through a
hole in the taste bud known as a taste pore. Sensory nerve fibers enter the
taste bud basally and associate with the gustatory cells.

Gustatory Discrimination
Traditionally four basic taste sensations were recognized: sweet, sour, salty, and
bitter. A fifth taste has been discovered called umami, which is activated by the
amino acid glutamate and detects chemicals like MSG. Despite the differences in
function, there is no structural difference among taste buds.

Although it was originally thought that each of these tastes was localized to a distinct
region of the tongue, researchers now realize that they can be detected in all areas
of the tongue.

Gustatory Pathways

Taste information reaches the cerebral cortex primarily through two cranial nerves.
  The facial nerve (CN VII) relays gustatory signals from the anterior two thirds
of the tongue.
 The glossopharyngeal nerve (CN IX) relays gustatory information from the
posterior one third of the tongue.
 All of the sensory neurons for taste synapse in the nucleus solitarius in the
medulla oblongata. The information is relayed through the brain stem, to the
thalamus for processing and then to the cerebral cortex.

Module 18.3 - Vision

The photoreceptors of the eyes make up 70% of all sensory receptors in the body and
40% of the cerebral cortex is dedicated to processing this visual information.

The visual organ is the eye and it resides in a socket known as the orbit. The posterior
portion of the orbit contains these structures:

 optic nerve (CN II)

 arteries and veins supplying the eye
 extrinsic eye muscles

Accessory Structures
The conjunctiva is a transparent mucous membrane that covers and protects

the eyelids and eye.

 Palpebral conjunctiva covers the inner surface of the eyelids.

 Ocular conjunctiva covers the anterior portion of the eye.

Together, the palpebral and ocular conjunctivae form a conjunctival sac.

The eyebrows consist of coarse hairs on the superciliary arches that serve to
shade and prevent sweat from running into the eye. Eyelashes also have a
protective role in preventing objects from contacting the eye.

The eyelids (palpebrae) form the movable anterior protective covering of the
eye.

 The opening between the upper and lower lids is called the palpebral fissure.
 The reddish bump in the medial corner of the eye where the ciliary glands are
located is called the lacrimal caruncle.
 The tarsal plates within the lids are composed of connective tissue and provide
sites for muscle attachment.
 Tarsal (Meibomian) glands are modified sebaceous glands that secrete oil over
the eye's surface to minimize dehydration.
The lacrimal apparatus of each eye produces lacrimal fluid (tears) to keep the
surface of the eye moist and is composed of two main structures:

 Lacrimal glands lie superolateral to the eye and produce the lacrimal fluid.
 Lacrimal sacs lie medial to the eye and drain excess lacrimal fluid into the
nasal cavity.

Lacrimal fluid contains lubricating mucus, protective antibodies, and lysozyme,

which destroys bacteria.

Eye Structure
The eye is designed to gather, focus, and process light into precise images. The eye
has anterior and posterior cavities which contain the aqueous humor

and vitreous humor, respectively.

 Similar to CSF, aqueous humor functions to regulate the aqueous

environment of the eye.

 Aqueous humor is produced by the ciliary body, secreted into the posterior
chamber where it flows through the pupil and into the anterior chamber. It is
reabsorbed into the scleral venous sinus (canal of Schlemm).
 Vitreous humor functions to maintain the shape of the eye and transmit light to
the retina.

Three tunics form the external wall of the eye: the fibrous, vascular and neural
tunics.

The fibrous tunic is the most external layer of the eyeball and is composed of

two regions of connective tissue:

 The sclera represents the posterior five-sixths of the tunic. It is a white,

opaque region and provides shape and anchorage for eye muscles.
 The cornea comprises the clear anterior one-sixth of the fibrous
tunic. It is composed of a thick layer of highly organized collagen fibers
sandwiched between sheets of superficial and deep corneal epithelia.

The vascular tunic is the middle coat of the eyeball and is composed of three
main parts:

 The choroid is a vascular, darkly pigmented membrane that forms the

posterior five-sixths of the vascular tunic and nourishes the other tunics. Its
 brown color is due to the presence of melanocytes and prevents the scattering
of light rays within the eye.
 The ciliary body is a thickened ring primarily made of smooth muscle; it
encircles the lens and is known as the ciliary muscle. The suspensory
ligaments are tiny fibrils that surround and attach the lens to the ciliary
processes of the ciliary body. The ciliary muscle relaxes to tighten the
suspensory ligaments and focus the lens for distant vision. When the ciliary
muscle contracts, it loosens the suspensory ligaments to change the shape of
the lens and accommodate for near vision.
 The iris is the visible, colored part of the eye. It is attached to the ciliary body
and is composed of smooth muscle. The round, central opening in the iris is
known as the pupil, and the size of its diameter is controlled by the sphincter
pupillae and dilator pupillae muscles.

The neural tunic (retina) is the deepest of the three tunics and is composed of
two layers:

 The pigmented layer consists of a single layer of melanocytes.

 The neural layer is composed of three main types of cells: photoreceptor,
bipolar, and ganglion cells.

Organization of the Neural Retina

Photoreceptors are found in the outer layer of the neural retina and there are two
main types.

 Rods are very sensitive to light and designed to facilitate vision in dim light.
 Cones are fewer in number than rods and require brighter light for stimulation.
In bright light they enable high-acuity, color vision. Three subtypes of cones
exist that are differentially sensitive to either red, green, or blue light.

The macula lutea is a retinal region located at the posterior pole and contains
mostly cones. The fovea centralis, a tiny spot in the macula lutea, is the
region of highest visual acuity. It contains only cones, and the density of these
decreases outwardly from the macula lutea.

Rods and cones synapse on bipolar cells which are located internal to the layer
of photoreceptors.

Bipolar cells then synapse on ganglion cells which are located internal to the

layer of bipolar cells. Ganglionic cells axons join to form the optic nerve (CN II) as
they exit the eye through the optic disc.

The optic disc is a blind spot created at the location where the optic nerve is
connected to the retina. No rods or cones exist here.
Lens
The lens is a thick, transparent, biconvex disc held in place by the suspensory
ligaments.
The lens is composed of two layers:

• The first is the lens epithelium, which covers the anterior surface of the lens.

o The second layer is composed of lens fibers that are continually added form the bulk
of the lens.

o Like the cornea, the lens is free of blood vessels (avascular), as vessels running
through these structures would interfere with transparency. Accommodation is
achieved because the curvature of the lens is adjustable, which allows for focusing on
nearby objects.

Module 18.4 - Equilibrium and Hearing

The ear is the receptor organ for both hearing and equilibrium (balance and
orientation). It is composed of three main regions: the external and middle ears,
which function in hearing, and the inner ear, which functions in both hearing and
equilibrium.

External Ear
This region is composed of three main parts.

 The auricle (pinna) collects and directs sounds deeper into the ear.
 The external auditory canal is a skin-lined conducting tube that carries sounds
to the eardrum and middle ear. This tube contains hairs and sebaceous glands.
It also contains ceruminous glands, which secrete a waxy substance to inhibit
microbe growth.
 The tympanic membrane (eardrum) is a membrane that forms the boundary
between the external and middle ear.

Middle Ear
The middle ear is a small, air-filled space, called the tympanic cavity, located within
the petrous portion of the temporal bone and lined with a thin mucous membrane.

The medial wall of the middle ear is penetrated by the oval window and the round
window.
The auditory tube, sometimes referred to as the pharyngotympanic or Eustachian
tube, connects the middle ear and pharynx to keep air pressure in the middle ear
consistent with the external air pressure.

The middle ear contains the auditory ossicles, which are the smallest bones in the
body. There are three ossicles.

 The malleus is attached to the eardrum and receives sound vibrations from it.
 The incus lies between the malleus and stapes and transmits sound vibrations
from the malleus to the stapes.
 The stapes receives sound vibrations from the incus and vibrates against the
oval window.

The stapedius and tensor tympani are skeletal muscles in the middle ear which
limit the movement of the ossicles.

Inner Ear
The inner ear, sometimes referred to as the labyrinth, is located within the petrous
portion of the temporal bone.

 The bony labyrinth is a cavity consisting of three parts: the semicircular

canals, vestibule, and cochlea. It is filled with perilymph, which is similar to
the CSF.
 The membranous labyrinth is a series of membrane-walled sacs and ducts.
They fit within the bony labyrinth and consist of three main parts: the
semicircular ducts, the utricle and saccule, and the cochlear duct. The
membranous labyrinth is filled with a clear fluid known as endolymph, which is
confined to the membranous labyrinth.

The vestibule is the part of the bony labyrinth that lies medial to the middle
ear and contains two structures known as the utricle and saccule.

 They function to measure static equilibrium and linear acceleration of the

head.
 These are two egg-shaped parts of the membranous labyrinth suspended in
perilymph.
 The utricle is continuous with the semicircular ducts, while the saccule
is continuous with the cochlear duct.
 Each of these contains a specialized region known as the macula, which is a
tiny spot of sensory epithelium that contains the receptor cells that monitor
the position of the head at rest.
 The macula is composed of two cell types: columnar supporting cells and
receptor cells called hair cells, which synapse with the vestibular nerve. The
hair cells are embedded in a jelly-like membrane called the otolithic
 (statoconic) membrane which contains calcium carbonate crystals known as
otoliths (statoconia).
 Hair cells are the receptors and each have numerous stereocilia and one
kinocilium.

The three semicircular canals lie posterior and lateral to the vestibule and include the
anterior, posterior, and lateral canals.

 The anterior and posterior canals are located in the vertical plane at right
angles to each other, while the lateral canal lies almost in the horizontal
plane. A membranous semicircular duct snakes through each semicircular
canal.
 An expansion known as the membranous ampulla is located within the bony
ampulla of each canal.
 Each ampulla contains a structure called a crista ampullaris, which houses
supporting cells and receptor hair cells for detection of rotational
acceleration.
 The kinocilium and stereocilia of the hair cells are embedded in the
gelantinous cupula.

Structures for Hearing

The cochlea is a spiraling chamber in the bony labyrinth and coils around a pillar
of bone known as the modiolus.

Within the cochlea, the scala media (cochlear duct) contains receptors for

hearing and lies between two chambers: the scala vestibuli and scala tympani.

• The vestibular membrane is the roof of the cochlear duct, while the basilar
membrane is the floor of the cochlear duct.

The spiral organ (organ of Corti) is the receptor epithelium for hearing, and it
consists of supporting cells and receptor cells, which are the inner and outer
hair cells.

 High-pitched or high-frequency sound vibrations transmitted to the fluid

in the cochlear duct by the stapes deflect the basilar membrane close
to the oval window.
 Lower-pitched sound vibrations transmitted to the fluid in the cochlear
duct by the stapes deflect the basilar membrane at a greater distance
from the oval window.
  The ascending auditory pathway transmits information from cochlear
receptors to the cerebral cortex through the vestibulocochlear (auditory)
nerve (CN VIII).

Module 16.0 - The Central Nervous System

The central nervous system is composed of two main components: the spinal
cord and the brain. The brain is far more complex than the spinal cord and is
often likened to a supercomputer, but that analogy doesn't even begin to do it
justice. Although both are capable of receiving tremendous amounts of input,
processing it, and sending the appropriate output, the brain is infinitely more
dynamic. Not only is it responsible for learning and adapting, but it is also the
source of all of our dreams, memories and behaviour .

Module 16.1 - Organization of the Brain

The brain is protected from injury by an array of structures.

 The skull provides a hard protective outer shell.

 The meninges are three connective tissue membranes that cover the brain.
 Cerebrospinal fluid surrounds the brain and acts like a watery cushion.

The blood-brain barrier prevents most harmful substances from entering the
brain. The brain is divided into four basic regions:

 cerebrum
 diencephalon (thalamus and hypothalamus)
 brain stem (midbrain, pons, and medulla oblongata)
 cerebellum

The cerebrum is divided into two halves, called the left and right cerebral
hemispheres. Each hemisphere is subdivided into five functional areas called
lobes. Outer surface of an adult brain exhibits folds called gyri (gyrus) and shallow
depressions between those folds called sulci (sulcus). The brain is associated with
12 pairs of cranial nerves.

Brain tissue is organized in the following manner:

The outer layer of gray matter forms the cortex of the brain and is made up of
a high density of motor neurons, interneurons, and unmyelinated axons.

The cortex surrounds an inner layer of white matter, which is largely

composed of myelinated axons.
 Deep within the white matter are internal clusters of gray matter called
nuclei.

Module 16.2 - Cranial Meninges

The cranial meninges are three connective tissue membranes that cover the CNS,
enclose the vessels that supply blood to the CNS, and contain the cerebrospinal fluid.

From superficial to deep, the cranial meninges are the dura mater, the arachnoid,
and the pia mater.

Dura Mater

 This outermost layer of the meninges is also the strongest.

 Its outer periosteal layer and inner meningeal layer enclose the dural sinuses.
 It extends inward to subdivide the cranial cavity, producing the falx cerebri,
falx cerebelli, and tentorium cerebelli.

Arachnoid

 It lies immediately beneath the dura mater.

 The subdural space exists between the dura mater and arachnoid.
 The subarachnoid space lies deep to the arachnoid and contains the CSF and a
web- like arrangement of vessels and fibers.

Pia Mater

• It consists of a delicate layer of connective tissue that clings tightly to the surface
of the brain and is richly vascularized with tiny vessels.

Module 16.3 - Brain Ventricles

The ventricles of the brain are interconnected with each other and are continuous
with the central canal of the spinal cord.

Four ventricles in the brain.

 There are two lateral ventricles are in the cerebrum, separated by a thin
medial partition called the septum pellucidum.
 Within the diencephalon is a smaller ventricle called the third ventricle.
 Each lateral ventricle communicates with the third ventricle through an
opening called the interventricular foramen
 The fourth ventricle is located within the pons and cerebellum.
 The ventricles are filled with cerebrospinal fluid and lined with ependymal
cells.
  The lateral ventricles are horseshoe-shaped ventricles located in cerebral
hemispheres.
 The third ventricle lies in the diencephalon and is connected with the lateral
ventricles by the interventricular foramen.
 The fourth ventricle lies in the hindbrain and is connected to the central canal
of the spinal cord.
 The mesencephalic aqueduct connects the third and fourth ventricles.

Module 16.4 - Cerebrospinal Fluid (CSF)

The brain is surrounded by and floats in cerebrospinal fluid (CSF), which reduces its
apparent weight and minimizes damage due to movement.

CSF is similar in composition to blood plasma, but contains more sodium and chloride
ions, and less protein.

CSF is formed by the choroid plexuses in the ventricles at a rate of about 500 ml per
day. The average volume of CSF in the CNS is ~ 150 ml and excess CSF is continually
being drained into the blood.

Module 16.5 - Blood-Brain Barrier

The blood-brain barrier (BBB) results from tight junctions between endothelial cells
lining the capillaries of the brain and the perivascular feet of astrocytes.

The BBB prevents most blood-borne toxins from entering the brain but does not
actually provide an absolute barrier.

Gases such as oxygen can easily pass through the capillary walls, as can alcohol,
nicotine, and anesthetics.

Module 16.6 - Brain Stem

The brain stem includes the mesencephalon (midbrain), pons, and medulla
oblongata. It is oriented vertically between the diencephalon and the spinal cord and
has numerous functions.

 It maintains automatic functions necessary for survival.

 It provides a corridor for all fiber tracts running between the cerebrum and the
spinal cord.
 It gives origin to ten of the twelve pairs of cranial nerves, and these ten pairs
play a major role in the innervation of the face and head.

Midbrain/Mesencephalon
 Located between the diencephalon and the pons, the mesencephalon contains
a central cavity called the mesencephalic aqueduct.

Cerebral peduncles located on the anterolateral surfaces contain pyramidal

(corticospinal) tracts, which extend into the spinal cord.

Superior cerebellar peduncles connect the mesencephalon to the cerebellum.

Periaqueductal gray matter surrounds the cerebral aqueduct and is involved in two
opposing functions:

 fight-or-flight reaction which elevates heart rate and blood pressure.

 mediation of response to visceral pain which decreases heart rate and blood
pressure. Contains nuclei (oculomotor and trochlear) that control eye
movement.

The tectum contains the corpora quadrigemina consists of two pairs of nuclei:
the superior and inferior colliculi which form bumps dorsally.

 The superior colliculi act in visual reflexes, such as tracking objects.

 The inferior colliculi act in auditory reflexes, such as tracking sounds.

The substantia nigra, located in the white matter, contains neuronal cell
bodies filled with melanin pigment.

• It is functionally linked to the cerebral (basal) nuclei, and disorders of this region
are involved in Parkinson's disease.

The tegmentum contains the red nucleus and the reticular formation and lies deep
to the substantia nigra.

• The red nucleus assists in coordination of movement, and its color is due to its rich
blood supply and iron in its cells.

Pons
The pons is the second region of the brainstem and lies between the midbrain and the
medulla oblongata.
It contains the nuclei of cranial nerves V, VI, and VII.
Other pontine nuclei are interspersed in the fibers of the pyramidal tracts.

Medulla Oblongata
The medulla oblongata is the most caudal portion of the brain stem and is continuous
with the spinal cord at the foramen magnum of the skull. It also forms the fourth
ventricle.

Several important autonomic nuclei are found here including the cardiac centre
(regulates heart activity), vasomotor centre (regulates blood pressure), and the
respiratory centre (regulates respiratory rate).

• There are also centers for vomiting, salivation, swallowing, sneezing, coughing and
gagging.

 Ridges called pyramids of the medulla run along its ventral midline.
 The decussation of the pyramids is the crossing-over point for the motor
tracts.
 Five cranial nerves (VIII-XII) have nuclei within the medulla.

Module 16.7 - Cerebellum

Located dorsal to the pons and medulla, the cerebellum coordinates body movements
and helps maintain equilibrium.

It is composed of two cerebellar hemispheres separated by the vermis.

The surface is folded into ridges called folia, which are separated by fissures.
Its hemispheres are subdivided into 3 lobes: the anterior, posterior, and
flocculonodular lobe.

The three regions of the cerebellum include the following:

 an outer cortex which is composed of gray matter.

 arbor vitae which is the internal white matter.
 the deep cerebellar nuclei which lie in the deeply situated gray matter.

Cerebellar peduncles are three thick tracts connecting the cerebellum to the brain
stem and include the superior, middle and inferior cerebellar peduncles.

Module 16.8- Diencephalon

Composed primarily of gray matter, the diencephalon forms the core of the forebrain
and is surrounded by the cerebral hemispheres. It is comprised of three paired
structures: epithalamus, thalamus, and hypothalamus.

Epithalamus
The epithalamus forms part of the roof of the third ventricle and consists of the
pineal gland and habenular nuclei.
 • The pineal gland secretes the hormone melatonin which is involved in
regulation of circadian rhythm.

Thalamus
The thalamus makes up 80% of the diencephalon and contains about a dozen major
nuclei that send axons throughout the cerebral cortex.

 Afferent impulses from all conscious senses except olfaction converge on the
thalamus and synapse in at least one of its nuclei.
 The thalamic nuclei function like relay stations to organize and modulate the
incoming sensory information that passes through them.

Hypothalamus
Located between the optic chiasm and the mammillary bodies, the
hypothalamus contains about a dozen nuclei and the pituitary gland projects
inferiorly from its base.

The hypothalamus is the primary visceral control centre for the body, and its
functions include:

 control of the autonomic nervous system

 control of emotional responses
 regulation of body temperature
 regulation of hunger and thirst sensations
 control of emotional behaviour
 regulation of sleep-wake cycles
 control of the endocrine system

Module 16.8 - Cerebrum

The cerebrum is composed of two cerebral hemispheres and accounts for 83% of the
total brain mass.

Fissures (deep grooves) in the cerebrum separate major regions of the brain.

 The transverse fissure separates the cerebrum and cerebellum.

 The longitudinal fissure separates the cerebral hemispheres.

Sulci are shallow grooves on the surface of the cerebral hemispheres.

Gyri are twisted ridges between sulci.

Major gyri and sulci are similar in all people.
The deepest sulci divide the cerebrum into lobes, which are named after the skull
bones that overlie them.

The five major lobes are the frontal lobe, parietal lobe, occipital lobe, temporal
lobe, and the insula.

The central sulcus separates the frontal and parietal lobes and is bordered by two
gyri: the precentral gyrus and the postcentral gyrus.

The parieto-occipital sulcus separates the occipital lobe from the parietal lobe.

The lateral sulcus separates temporal lobe from parietal and frontal lobes.
The insula lies deep within the lateral sulcus.

Module 16.9 - Cerebral White Matter

The cerebral nuclei, often wrongly called the basal ganglia, have an important role in
motor control. These are Islands of gray matter containing neuron cell bodies found in
cerebrum, diencephalon and midbrain.

The cerebral nuclei consist of the following:

 The caudate nucleus, putamen and globus pallidus are associated with motor
control.
 The amygdala, although located in the cerebrum, is actually considered part of
the limbic system.
 The claustrum functions in the processing of visual information.

Module 16.10 - The Cerebral Cortex

The cerebral cortex is responsible for conscious thought and permits humans to

 be aware of themselves and their sensations.

 initiate and control voluntary movements.
 communicate, remember, and understand.

The cerebral cortex is composed of gray matter and folds in the cortex
increase its mass to approximately 40% of the total brain mass. There
are three types of functional areas of the cortex.

 Motor areas control voluntary motor function.

  Sensory areas provide for conscious awareness of sensation.
 Association areas permit the integration of various inputs.

Module 16.11 Limbic

• The limbic system is a set of evolutionarily primitive brain structures located
on top of the brainstem and buried under the cortex . Limbic system structures
are involved in many of our emotions and motivations, particularly those that
are related to survival. Such emotions include fear, anger, and emotions
related to sexual behavior. The limbic system is also involved in feelings of
pleasure that are related to our survival, such as those experienced from eating
and sex.

Module 16.12 - Higher-Order Processing Centres

Different areas of the cerebral cortex communicate with each other and with the
brainstem and spinal cord. The fibers in the white matter are primarily myelinated
and are bundled into tracts.

Three types of tracts can be identified:

 The commissural tracts are composed of commissural fibers and permit

communication between cerebral hemispheres. The corpus callosum runs
horizontally within the white matter and is the largest commissure.
 Association tracts interconnect different parts of the cortex within the same
hemisphere.
 Projection tracts run vertically within the white matter descending from the
cerebral cortex and ascending to the cerebral cortex from lower regions.

Motor Areas
• Primary motor cortex (somatic motor area) is located in the precentral gyrus
of the

frontal lobe and controls motor functions.

o The large neurons of primary motor cortex are pyramidal cells.

o Corticospinal (pyramidal) tracts descend through the brainstem and spinal

cord.
 o The tracts contain axons that signal motor neurons to control skilled
movements.

o Pyramidal axons are contralateral: they cross over to muscles opposite to the
side of the brain controlling them.

o Specific pyramidal cells control specific areas of the body.

o Face and hand muscles are controlled by a large region of pyramidal cells.

o Motor homunculus is a representative body map diagram of the motor cortex.

 Motor speech area (Broca's area) is located in the left cerebral

hemisphere and controls movements necessary for speech production. A
corresponding region in the right cerebral hemisphere controls emotional
overtones of the spoken words.
 The frontal eye field is located anterior to the premotor cortex on the
frontal lobe, it controls voluntary eye movements, such as visually
tracking an object.

Sensory Areas
Sensory areas of the cortex are involved in conscious awareness of sensation and are
located in the parietal, temporal, and occipital lobes. There is a distinct sensory area
for each of the major senses.

• The primary somatosensory cortex is located along the postcentral gyrus and is
involved with conscious awareness of general somatic senses of the skin and
proprioception.

o Spatial discrimination allows the brain to locate a stimulus precisely.

o Projection is contralateral, which means the cerebral hemispheres receive
sensory input from the opposite side of the body.

o Sensory homunculus is a representative body map diagram of the sensory

cortex.

 The primary visual cortex is located deep within the calcarine sulcus on
the posterior and medial part of the occipital lobe. It is the first of a
series of areas that process visual input from the retina.
 The primary auditory cortex is located on the superior edge of the
temporal lobe and is responsible for conscious awareness of sound.
 The gustatory (taste) cortex is located in the insula and is responsible
for the conscious awareness of taste.
  The olfactory cortex is located in the temporal lobe. Olfactory nerves
transmit impulses to the olfactory cortex and provide conscious
awareness of smells.

Association Areas
The association areas are higher-order processing areas that make associations
between different types of sensory information. These relate new sensory input with
memories of past experiences to make a meaningful interpretation.

The premotor cortex is located anterior to the precentral gyrus and controls more
complex movements than the motor cortex. It receives highly processed visual,
auditory, and general somatic sensory information. It controls voluntary actions
dependent on sensory feedback and is involved in the planning of movements.

The somatosensory association area is located posterior to the primary

somatosensory cortex and is used to integrate sensory inputs such as touch and
pressure into a detailed understanding of the stimulus. It utilizes stored memories of
past sensory experiences in processing.

The auditory association area is located posterior to the primary auditory cortex,
and it allows the evaluation and memory of different sounds. It is located in the
center of Wernicke's area.

Wernicke’s area, commonly only found in the left hemishpere, is responsible for
recognizing and understanding speech.

The visual association area surrounds the primary visual area on the occipital lobe,
communicates with the visual cortex, and further processes visual information such as
colour, form and movement. Complex visual processing extends into the temporal and
parietal lobes.

The gnostic (common integrative) area is composed of parts of the visual, auditory,
and somatosensory association areas, and its function is poorly understood. It
integrates various sensory information to process a meaningful understanding of the
current environment and spatial relationships.
Module 16.13 - Cranial Nerves

The cranial nerves are attached to the brain and pass through the various foramina of the skull.

 There are twelve pairs of cranial nerves which are numbered from I - XII and named.
 Cranial nerves I and II are attached to the forebrain, and all others are attached to the brain
stem.
 They function primarily to supply structures of the head and neck, although the exception is
the vagus nerve (CN X), which extends into the abdomen.

Functional Classification of Cranial Nerves

Sensory nerves (I, II and VIII) are for smell, vision, hearing, and equilibrium.
Motor nerves (III, IV, VI, XI and XII) supply the skeletal muscles of the eye, neck and tongue.
Mixed motor and sensory nerves (V, VII, IX and X) supply sensory nerves to face, mouth, taste
buds, and viscera and motor nerves for chewing and facial expressions.
Cranial nerves III, VII, IX and X also serve the parasympathic nervous system.

Cranial Nerves

I. Olfactory nerve
• It originates in the receptor cells of the olfactory epithelium.
• Its nerve fibers enter the olfactory bulb.
• It extends posteriorly as the olfactory tract and ends in the olfactory cortex.
II. Optic nerve
• Fibers from the retina make up the optic nerve.
• The two optic nerves form a chiasm (crossover) and proceed to synapse in the thalamus.
• The thalamic fibers run to the occipital cortex.
III. Oculomotor nerve
• It innervates four of the extrinsic eye muscles: the inferior oblique, superior rectus,
medial rectus, and inferior rectus muscles.
• Its fibers originate in the midbrain and extend through the superior orbital fissure.
• Parasympathetic innervation is supplied to the iris muscle and the ciliary muscle
through this nerve.
IV. Trochlear nerve
• Its fibers begin in the dorsal midbrain and enter through the superior orbital fissure to
supply the superior oblique muscle (extrinsic muscle of the eye).
V. Trigeminal nerve
• This is the largest of the cranial nerves, and it extends from the face to the pons. • It
provides sensory information from the face and supplies motor innervation to chewing
muscles.
• It forms 3 main divisions:

i. In the ophthalmic division, cutaneous branches traverse the supraorbital foramen and
foramen rotundum.
ii. In the maxillary division, cutaneous branches pass through the infraorbital foramen.
iii. In the mandibular division, fibers enter the mental foramen, pass through the mandibular
foramen, and finally enter the skull via the foramen ovale before reaching the pons.

VI. Abducens nerve

It abducts the eyeball. Its fibers leave the pons, proceed through the superior orbital
fissure, and supply the lateral rectus muscle of the eye.

VII. Facial nerve

 It innervates muscles of facial expression, and relays taste information from the anterior
two thirds of the tongue
 Its fibers exit the pons and traverse the internal acoustic meatus to supply
parasympathetic motor fibers to the lacrimal (tear) glands and two of the salivary glands
(submandibular and sublingual).
 One branch emerges from the stylomastoid foramen to supply muscles of facial
expression.
 Its five main branches are cervical, mandibular, buccal, zygomatic and temporal.

VIII. Vestibulocochlear nerve

 It is the sensory nerve of hearing and balance.

 Its fibers arise from the hearing apparatus and traverse the internal acoustic meatus.
 Its vestibular branch nerve joins the brainstem at the pons-medulla border.

IX. Glossopharyngeal nerve

 It innervates structures of the tongue and pharynx and relays taste information from the
posterior one third of the tongue.
 Its fibers emerge from the medulla and leave the skull via the jugular foramen.
 It enters the throat, where it gives rise to three ganglia.

X. Vagus nerve

• Vagus nerve emerges from the medulla and passes through the jugular foramen. It extends into
the neck, thorax, and abdomen to supply many organs of the body.
XI. Accessory nerve :It is accessory part of the vagus nerve.
It is formed by the union of a cranial root derived from the medulla and a spinal root. These roots
merge before passing through the jugular foramen to become the accessory nerve. It supplies the
sternocleidomastoid and trapezius muscles.

XII. Hypoglossal nerve

 It arises in the medulla and exits the skull via the hypoglossal canal.
 It runs inferior to the tongue, where it supplies both intrinsic and extrinsic muscles.

Module 17.1 - Receptors

Receptors are structures that detect stimuli and then initiate signals in axons to relay
information to the CNS.

Classification of Receptors
There are three basic classes of receptors.

 Exteroceptors are sensitive to stimuli arising from outside the body. These
receptors are located at or near the body surfaces, such as the skin and include
receptors for touch, pressure, pain, and temperature.
 Interoceptors (visceroceptors) receive stimuli from internal organs. They are
located in the digestive tube, urinary bladder, and lungs. These receptors
monitor a variety of stimuli including stretching, temperature changes, and
chemical changes.
 Proprioceptors are located in tendons, joints, and ligaments and monitor the
degree of stretch for each of these structures.

Receptor Distribution
Exteroreceptors and proprioceptors are the receptors for general senses and
are sometimes referred to as somatic sensory receptors. Interoceptors are
often referred to as visceral sensory receptors.

Modality of Stimulus
There are six types of receptors which are classified according to the nature of
their stimulating agent.

• Chemoreceptors respond to specific chemicals in solution.

 Thermoreceptors respond to changes in temperature.

 Photoreceptors respond to light and are located in the eye.
  Mechanoreceptors respond to mechanical forces such as touch or vibration.
 Baroreceptors respond to changes in pressure.
 Nociceptors respond to harmful stimuli that result in damage and pain.

Module 17.2 - General Senses

General sensory receptors and corresponding neurons monitor touch, pressure,
vibration, stretch, pain, temperature, and proprioception.

Mechanoreceptors, called tactile receptors, are the most numerous general

sensory receptor .

Tactile receptors are divided into two fundamental structural groups based on
the presence or absence of connective tissue on their nerve endings:
unencapsulated or encapsulated tactile receptors.

Unencapsulated Tactile Receptors

The three unencapsulated tactile receptors are simple receptors which have no
connective tissue wrapping.

 Free nerve endings are the ends of dendrites abundant in epithelia and
underlying connective tissue. These receptors respond to pain and
temperature, which are affective senses; they yield an emotional response.
 Root hair plexuses are free nerve endings that wrap around hair follicles and
rapidly adapt to stimuli.
 Tactile (Merkel) discs are slowly adapting receptors for light touch located in
the epidermis in association with special tactile (Merkel) cells.

Encapsulated Tactile Receptors

These four encapsulated receptors are enclosed within a connective tissue
wrapping.

 Krause bulbs detect light pressure stimuli in mucous membranes.

 Tactile (Meissner's) corpuscles consist of intertwined nerve endings
surrounded by Schwann cells. These rapidly adapting receptors reside in the
dermal papillae and are

restricted to sensitive, hairless areas of the skin. They respond to light touch and
yield fluttering-types of sensations.

 Lamellated (Pacinian) corpuscles consist of a nerve ending surrounded by

layers of flattened Schwann cells. These rapidly adapting receptors are located
in the dermis and hypodermis and detect deep pressure.
  Ruffini corpuscles are located in the dermis and joint capsules and detect
pressure and distortion. These receptors are tonic and do not adapt.

Module 17.3 - General Characteristics of

Nervous System Pathways
The CNS uses pathways to conduct sensory and motor information to and from
the rest of the body.

 Each pathway is composed of a tract and at least one nucleus within the CNS.
 Ascending pathways carry signals from the sensory neurons to the brain.
 Descending pathways carry motor signals from the brain that will trigger
muscle contraction.

o About 90 percent of the axons of the upper motor neurons cross over to the
opposite (contralateral) side in the medulla oblongata in a process called
decussation. The term ipsilateral refers pathways do not crossover at the
medulla oblongata.

Module 17.4 - Sensory Pathways

Sensory pathways are ascending pathways that conduct general somatic and
visceral sensory impulses through chains of neurons.

These pathways exhibit somatotopy, which means that the tracts terminate on
the sensory homunculus of the primary somatosensory cortex in the postcentral
gyrus according to the body region they supply.

They are typically composed of primary (first-order), secondary (second-

order), and tertiary (third-order) neurons.

• First order neurons are the neurons that receive the sensory information in
peripheral structures and relay it to a secondary neuron in the CNS.

 Secondary neurons receive stimulus from primary neurons and carry this
information to the thalamus or cerebellum.
 Tertiary neurons receive stimulus in the thalamus from the axon of a secondary
neuron and carry the signal to the cortex.

Functional Anatomy of Sensory Pathways

There are three main somatosensory ascending pathways.
 • The posterior column-medial lemniscal pathway is the ascending pathway
that relays information such as limb position, touch, pressure, and vibration
and carries it to the cortex.

o It is composed of the posterior funiculus and medial lemniscal tracts.

o There is a synapse between the primary and secondary neurons in the medulla of
the brain stem, and decussation occurs here as well.

• The anterolateral pathway is composed of the anterior spinothalamic tract and the
lateral spinothalamic tract.

o Information such as crude touch, pressure, pain, and temperature is carried along
these tracts to the cortex.

o Decussation occurs in the spinal cord.

• The spinocerebellar pathway carries proprioceptive information to the cerebellum
to

help coordinate body movements.

o It is composed of the anterior and posterior spinocerebellar tracts. o There are no
tertiary neurons in this path.

Module 17.5 - Motor Pathways

Motor pathways deliver motor instructions from the brain to the spinal cord to control
skeletal muscle activity.

Motor pathways consist of a chain of two or three neurons, and most of these
pathways decussate at some point along their course.

 Upper motor neurons originate in the cortex or brain stem and synapse with
lower motor neurons.
 Lower motor neurons originate in either the anterior horn of the spinal cord or
within a cranial nerve nucleus and innervate skeletal muscle fibers.

All motor pathways are paired: there is one of each on each side of the body.

Functional Anatomy of Motor Pathways

 The pyramidal (direct) pathway transmits skilled voluntary movements from
the cortex to motor neurons that control skeletal muscles. Three tracts are
involved in this pathway:
 corticobulbar tracts innervate muscles of the face, neck and back via the
cranial nerves (CN III, IV, V, VI, VII, IX, X, XI and XII)
  lateral corticospinal tracts are responsible for skilled movement in the limbs

• anterior corticospinal tracts are responsible for controlling axial skeletal muscle
movements

Extrapyramidal (indirect) pathways transmit stimuli to muscles for subconscious and

postural movements through the following tracts:

 tectospinal tracts regulate positional changes of the eyes, head, neck and
arms
 vestibulospinal tracts are responsible for maintaining balance
 rubrospinal tracts innervate the flexor muscles of the limbs
 reticulospinal tracts are responsible for the automatic movements of posture
and balance

Indirect Components of Motor Pathways

 Cerebral nuclei relay information to the primary motor cortex from other
regions of the cerebral cortex. Additionally, they are responsible for generating
patterned movements, such as walking.
 The cerebellum continuously monitors the output of motor pathways and
compares it to the input from sensory pathways in order to correct for
discrepancies between the intended and actual movement. The cerebellum
also plays a key role in the coordination and timing of movements. It relays
information to the premotor and primary motor cortex.

Module 21.1 - Overview of the Urinary System

Although there are several components to the urinary system, the kidneys perform
the bulk of the work.

Kidneys maintain the volume and chemical consistency of the blood (homeostasis).

 They filter many liters of fluid from blood and remove toxins, metabolic
wastes, and

excess water from the body through the formation of urine.

 The main waste products filtered by the kidneys include:

o urea formed from the chemical breakdown of amino acids.

o uric acid formed from the breakdown of nucleic acids.

o creatinine formed from the breakdown of creatine phosphate in skeletal muscles.

• Additionally, the kidneys secrete the hormone erythropoietin in response to low
blood oxygen levels to stimulate production of red blood cells.

All the other structures of the urinary system simply provide a transport or storage
function and are referred to as the urinary tract.

This includes the following:

 ureters - carry urine from the kidneys to the bladder.

 urinary bladder - stores urine till it can be excreted.
 urethra - transports urine from the bladder to exterior of the body.

Module 21.2 - Anatomy of the Kidneys

The two kidneys are located retroperitoneally, lateral to the T12 – L3 vertebrae.
• The average kidney is 12 cm long, 6 cm wide, 3 cm thick, and bean-shaped.

The hilum is the vertical cleft on the concave surface of the kidney and is the site
where vessels, nerves and the ureter enter and exit each kidney.

External to and surrounding the kidney, there are four tissue layers.

 A connective tissue capsule, called the fibrous (renal) capsule, surrounds the
kidney and is itself surrounded by perinephric fat (adipose capsule), composed
of adipose tissue.
 The dense connective renal fascia is external to the adipose capsule, and
thepararenal fat surrounds the renal fascia.
 A coronal section through the kidney will reveal several distinct structures:
 renal cortex (light in color) - the outer layer that surrounds the renal
medulla.
 renal medulla (darker in color) - the inner layer.
 renal columns - extensions of the renal cortex which divide the
renalmedulla into 5- 11 renal pyramids per kidney.
 renal papilla - the apex of each pyramid which projects into a minor calyx.
 major calyces - formed from the joining of minor calyces and function to
empty urine

into the renal pelvis.

 renal pelvis - drains urine into the ureter.

 lobes - composed of renal pyramid and surrounding renal cortex.

Module 21.3 - Nephrons

 The main functional unit of the kidney is the nephron, which is composed of
the following:

 renal corpuscle
 proximal convoluted tubule
 nephron loop (loop of Henle)
 distal convoluted tubule

The distal convoluted tubule of each nephron joins and empties into a collecting
duct, which plays an important role in concentrating urine.

There are two types of nephrons in the kidney.

 Cortical nephrons have shorter loops of Henle which reside primarily in the
cortex. These comprise ~ 85% of all nephrons in the kidney.
 Juxtamedullary nephrons have longer loops of Henle which extend into the
medulla and allow for the production of very concentrated urine. These
comprise ~ 15% of all nephrons in the kidney.

Urine Formation
There are three processes involved in the formation of urine.

 In filtration, water and some dissolved solutes (called filtrate) passively moves
from the blood in the renal capillaries into the renal structures.
 In reabsorption, filtrate moves back into the blood. The majority of the
filtrate will return to the blood and the remaining filtrate that is not
reabsorbed is called tubular fluid.
 Secretion is the active process of transporting undesirable molecules from the
blood into the tubular fluid.

Renal Corpuscle
The renal corpuscle is composed of a glomerulus and a glomerular
(Bowman’s) capsule.

The glomerulus is a tuft of fenestrated capillaries that easily allow blood

plasma to leave the blood.

The glomerular capsule surrounds the glomerulus and has two layers.

 The parietal layer is simple squamous epithelium.

 Surrounding the glomerulus, the visceral layer consists of podocytes which
have processes called pedicels separated by thin spaces called filtration slits
to allow for filtrate to move into the capsular space.
Proximal Convoluted Tubule
Filtrate from the glomerulus enters the proximal convoluted tubules. This tubule,
confined to the cortex, is composed of cuboidal cells and is most active in
reabsoption.

Nephron Loop (Loop of Henle)

The nephron loop is a U-shaped loop consists of the following:

 A descending limb which is continuous with the proximal convoluted tubule and
functions to reabsorb water.
 An ascending limb which is continuous with the distal convoluted tubule and
functions to reabsorb salt.

Distal Convoluted Tubule

Confined to the renal cortex, the distal convoluted tubule is composed of
simple cuboidal epithelium and functions to secrete potassium and hydrogen
ions into the tubular fluid. Reabsorption of sodium ions and water also occurs
here in response to the action of the hormones, aldosterone and antidiuretic
hormone.

Collecting tubules receive urine from distal convoluted tubules of several

nephrons and empty it into collecting ducts and then into a papillary duct.

Module 21.4 - Renal Vasculature

At any given time approximately one quarter of the systemic cardiac output is
directed to the kidneys through the renal arteries.

 Each renal artery divides into five segmental arteries as it enters the hilum.
 Segmental arteries divide into interlobar arteries.
 At the base of the pyramids, the interlobar arteries further divide into arcuate
arteries.
 Branching from the arcuate arteries into the renal cortex are interlobular
arteries and afferent arterioles.
 Afferent arterioles enter the glomerulus, which is the capillary network of the
renal corpuscle in the nephron of the kidney, and efferent arterioles exit from
the glomerulus.

All arteries have similarly named veins associated with them.

 From the glomerulus, blood flows through efferent arterioles into either
peritubular capillaries (renal cortex) or vasa recta (renal medulla).
  Blood is collected from the peritubular capillaries and vasa recta and drained
sequentially into interlobular veins, arcuate veins, interlobar veins and renal
veins.
 The renal veins empty into the inferior vena cava.

Module 21.5 - Juxtaglomerular Apparatus

The juxtaglomerular apparatus is a special region of contact between the
afferent arteriole and distal convoluted tubule. It functions in the regulation of
blood pressure.

• Juxtaglomerular cells are modified smooth muscle cells that secrete renin
into the blood.

The macula densa is a portion of distal convoluted tubule that contains tall,
closely packed epithelial cells that act as chemoreceptors and measure solute
concentration.

Module 21.6 - Ureters

The ureters carry urine from each kidney to the urinary bladder, a distance of ~ 25
cm. Their oblique entry into the bladder prevents backflow of urine. They consist of
the following three tunics.

 The mucosa is composed of transitional epithelium.

 The muscularis is composed of two layers of muscle: an inner longitudinal layer
and the outer circular layer.
 The adventitia is the connective tissue surrounding the ureter.

Module 21.7 - Urinary Bladder

The bladder is an expandable muscular sac, composed mainly of smooth
muscle, which functions to store and expel urine.

 A full bladder is spherical and expands superiorly into the abdominal

cavity.
 An empty bladder lies entirely within the pelvis.

The trigone is the immovable triangular portion of the urinary bladder between the
two openings for the ureters and the opening for the urethra.

The bladder has four tunics.

  The mucosa is composed of transitional epithelium and lines the lumen of the
bladder. Rugae which are folds within the mucosa allow for increased
stretching of the bladder lumen.
 The submucosa is composed of irregular connective tissue.
 The smooth muscle layers of the muscularis are referred to as the detrusor
muscle. An internal urethral sphincter is formed from smooth muscle at the
junction opening to the urethra.
 The connective tissue of the adventitia forms the most external layer of the
bladder.
 Blood flow to and from the bladder occurs by branches of the internal iliac
artery and veins, respectively .

Module 21.8 - Urethra

The urethra forms the final passageway for urine prior to exiting the body. The
process of uridination is called micturition and is controlled by two urethral
sphincters.

 The internal urethral sphincter is composed of involuntary smooth muscle.

 The external urethral sphincter is composed of voluntary skeletal muscle and
inhibits micturition.

The length of the urethra in females is approximately 3 - 5 cm and the lumen is lined
with stratified squamous epithelium.

The length of the urethra in males is approximately 20 cm and there are three named
sections.

The prostatic urethra lies directly inferior to the bladder, passes through the
prostate gland and is lined by transitional epithelium.

The membranous urethra passes through the urogenital diaphragm and is lined by
stratified or pseudostratified columnar epithelium.

The spongy urethra passes through the length of the penis. The epithelium lining this
region is pseudostratified columnar at the proximal end and stratified squamous
epithium at the distal end.

Module 22.1 - Overview of the Reproductive

System
The structures of both the male and female reproductive systems share common
features including function and derivation from the same developmental structures.
The primary sex organs of the female are the ovaries and of the male are the testes.
These organs are responsible for the production of sex cells (gametes) and sex
hormones.

Module 22.2 - Anatomy of the Male Reproductive

System
Scrotum
The scrotum is the skin and superficial fascia surrounding the testes. A septum
provides a separate compartment for each testis, and an externally visible midline
seam called the raphe passes over the scrotum.

Its location outside the body provides an environment which is three degrees Celsius
cooler than body temperature. The temperature of the testes is regulated by their
distance from the body, and this is adjusted by muscles:

 The dartos muscle is a layer of smooth muscle that causes scrotal skin to
wrinkle when contracted. When this muscle relaxes, the testes descend away
from the body to a cooler temperature.
 The cremaster muscle consists of bands of skeletal muscle surrounding the
testes, and its contraction elevates the testes, bringing them to a warmer
environment.

T estes
The testes develop inside the abdomen and descend into the scrotum during fetal

development.

Deep to the superficial fascia is the spermatic cord, which is composed partly of
external and internal spermatic fascia and the cremaster muscle and fascia.

 It descends through a tunnel in the anterior abdominal wall called the inguinal
canal.
 It houses the blood vessels, including the testicular artery and pampiniform
plexus,

as well as the automoic nerves which supply the testis.

Deep to the internal spermatic cord is a serous sac called the tunica vaginalis,
which encloses the testis. Deep to the tunica vaginalis is the tunica albuginea,
the fibrous capsule of the testis.
 Septal extentions (sepata) of the tunica albuginea divide each testis into 250-
300 wedge- shaped lobules. Each of these lobules contains one to four coiled
seminiferous tubules.

 The seminiferous tubule is the site of sperm production and connects to a

branching network of tubes known as the rete testis.
 Sperm are further conducted to the epididymis via a series of efferent
ductules.

Seminiferous tubule epithelium consists of spermatogenic cells, which are the sperm-
forming cells, and sustentacular (Sertoli) cells, which are columnar support cells.

• Sustentacular cells extend from the basal lamina to the lumen and surround
spermatogenic cells. Tight junctions exist between these cells, creating a blood-testis
barrier that limits the transport of material from the blood to the lumen of the
seminiferous tubules

Myoid cells are smooth muscle-like cells that surround seminiferous tubules and
rhythmically contract to help move the sperm through the tubule

Interstitial (Leydig) cells reside in clusters within the connective tissue between
seminiferous tubules. They secrete testosterone, which is a sex hormone that
maintains secondary sex characteristics.

Anatomy of a Spermatozoon
A mature spermatozoan is composed of a head, a midpiece, and a tail.

 The head contains the nucleus and has a helmet-like acrosome cap containing
digestive enzymes that permit penetration of the oocyte.
 The midpiece contains the mitochondria that generate the energy for
propulsion of the cell.
 The tail is an elaborate flagellum that whips around to propel the sperm to the
egg.

Epididymis
The duct of the epididymis is approximately 4-5 m meters long and is twisted to form
an arch over the posterior side of the testis. It consists of a pseudostratified columnar
epithelium containing tufts of stereocilia, which are long motile microvilli.

It takes approximately 20 days for sperm to migrate the entire length, and during this
time in the epididymis they gain the ability to swim and to fertilize an egg.

Ductus Deferens
The ductus deferens or vas deferens run superiorly from the epididymis to the
ejaculatory duct to store the sperm and transport it during ejaculation. The terminal
region of the ductus deferens is an enlargement called the ampulla.

Each ductus deferens is composed of an outer adventitia, an extremely thick

muscularis that peristaltically propels sperm during ejaculation, and an inner mucosa
lined by ciliated columnar epithelium.

Ejaculatory Duct
The ejaculatory duct, composed of pseudostratified ciliated columnar epithelium,
moves

sperm from the ductus deferens to the urethra.

Urethra
The urethra carries sperm from the ejaculatory ducts to the exterior of the body, and
can

be divided into three main parts.

 The prostatic urethra passes through the prostate gland.

 The membraneous urethra passes through the urogenital diaphragm.
 The spongy urethra passes through the penis and contains numerous urethral
glands that lubricate the urethra prior to ejaculation.

Accessory Glands
The accessory glands all contribute their secretions to seminal fluid, which
mixes with the sperm to form semen.

Seminal vesicles are located on the posterior surface of the urinary bladder.

 They are lined with secretory pseudostratified columnar epithelium surrounded

by a

thick layer of smooth muscle.

 Muscle contraction during ejaculation empties the gland.

 Each seminal vesicle joins with the ductus deferens to form an ejaculatory duct
inside the prostate.
 The seminal vesicles secrete about 60% of the semen volume, and the fluid
contains fructose to nourish sperm and various substances to enhance
fertilization.

The prostate gland encircles the prostatic urethra.

  It is composed of 20-30 compound tubuloalveolar glands embedded in a mass of
dense

connective tissue and smooth muscle known as the fibromuscular stroma.

 The prostate secretes about 25-30% of seminal fluid volume and contains
substances that enhance sperm health.

The bulbourethral (Cowper’s) glands are pea-sized glands inferior to the

prostate gland.

• They produce a mucus that enters the spongy urethra prior to ejaculation.

• This fluid cleanses the urethra and makes pH suitable for fertilizations.

Penis
The penis is the organ that delivers semen out of the body and into the female
reproductive tract.

There are three main regions.

 The root contains the attached bulb of the penis.

 The glans is the tip of the penis which contains the external urethral orifice
and is covered by loose skin known as the prepuce (foreskin).
 The body (shaft) contains the three erectile bodies, which are thick tubes
composed of a sponge-like network of venous spaces wrapped in a sheath of
connective tissue (tunica albuginea).
 The midventral erectile body surrounds the spongy urethra and is known as the
corpus spongiosum, which is enlarged distally to form the glans. Proximally,
the midventral erectile body forms the bulb of the penis, which is anchored to
the urogenital diaphragm.
 The paired dorso-lateral erectile bodies are known as the corpora cavernosa
and form the crura of the penis proximally.

Most nerves and blood vessels of the penis are located along the dorsal midline.
A deep central artery supplies each of the corpora cavernosa, and two dorsally
located veins drain all the blood from the penis.

 Erection is facilitated by the parasympathetic dilation of arteries, and the

penis fills with blood. As the erectile bodies swell, they restrict venous
drainage and maintain engorgement.
 Ejaculation is under sympathetic control. Smooth muscle throughout the ducts
and glands begins to contract to force semen through the urethra.
 Module 22.3 - Anatomy of the Female
Reproductive System
Ovaries
These are two small almond-shaped organs, which lie on the wall of the true pelvis.
Each is held in place by ligaments and a mesentery.

 The broad ligament is a part of the peritoneum that hangs on top of the uterus
and includes the mesovarium, which surrounds and anchors the ovaries to this
structure.
 The ovarian ligament anchors each of the ovaries to the uterus.
 The suspensory ligament is a lateral continuation of the broad ligament, and it

anchors the ovaries to the lateral pelvic wall.

Each ovary is surrounded by a fibrous capsule known as the tunica albuginea,
which is

covered by a simple cuboidal epithelium called the germinal eipithelium. The

ovary can be divided into two main regions.

• The cortex contains the developing gametes known as oocytes. These are contained
within sac-like structures called ovarian follicles, which are separated by connective
tissue.

• The medulla is composed of connective tissue that contains the main ovarian
arteries, veins, nerves, and lymph vessels. These structures all enter the ovary
through the hilum.

The ovarian follicles are named according to their stage of development.

 Primordial follicles in the ovary at the time of birth and each contain a
primary oocyte surrounded by flat supportive follicular cells.
 When an oocyte begins to grow, follicular cells become cuboidal and the
resulting structure is the primary follicle.
 The primary follicle develops an exterior coating of connective tissue called
theca folliculi, and the primary follicle becomes a secondary follicle as a fluid-
filled antrum develops.
 Vesicular (Graafian) follicles are mature follicles ready to be selected for
ovulation.
 Following ovulation, the remaining follicle becomes the corpus luteum which
secretes the sex hormones estrogen and progesterone.

Uterine Tubes
The uterine tubes are also called Fallopian tubes or oviducts and are located
between the ovaries and the superior end of the uterus. Uterine tubes receive the
ovulated oocyte and provide an environment for fertilization.

 A funnel-like structure called an infundibulum exists on the ovarian end, and this
opening is surrounded by finger-like projections called fimbriae.
 The infundibulum feeds into an expanded region called the ampulla, which is
typically the site of fertilization.
 There is a narrow region of each uterine tube between the ampulla and the uterus
called the isthmus.
 The projection of the isthmus into the wall of the uterus is called the interstitial
segment.

Uterine tube walls contain a serosa, muscularis, and mucosa composed of ciliated
columnar epithelial cells that work to transport the oocyte to the uterus.

Uterus

This hollow muscular organ receives and nourishes the fertilized egg throughout
pregnancy and is located in the pelvic cavity anterior to the rectum.

The uterus is composed of several regions:

 The body is the middle region of the uterus.

 The fundus is the most superior portion of the uterus and is located above the
attachments of the uterine tubes.
 The isthmus is the narrow region inferior to the body of the uterus.
 The cervix is the distal segment of the uterus which projects into the vagina.
 The cervical canal is the tunnel that connects the interior of the vagina to the
uterine cavity. The superior and inferior of the cervical canal are the internal os
and external o, respectively. It contains cervical glands, which secrete mucus able
to block pathogens.

The broad ligament attaches the uterus anteriorly and posteriorly to the rest of the
peritoneum, and the paired round ligaments attach the uterus to the side wall of the
pelvis. However, most of the physical support for the uterus comes from the muscles
of the pelvic floor (pelvic and urogenital diaphragms).

The wall of the uterus is the site of implantation for the fertilized egg and is
composed of three basic layers.

 The perimetrium is the outer serous membrane, which is continuous with the
broad ligament (and the peritoneum).
 The myometruim is a bulky layer of smooth muscle that grows in thickness during
pregnancy .
 The endometrium is the mucosal lining of the uterine cavity and is lined by simple
columnar epithelium with ciliated and secretory cells.
 The endometrium is composed of two layers:

o Stratum functionale is the superficial functional layer that undergoes cyclical

changes and is shed monthly.

o Stratum basalis, the basal layer, is never shed and is responsible for regenerating
the functional layer.

Vagina
The vagina is a thick-walled tube lying distal to the uterus.

The vaginal wall consists of three layers.

 Adventitia is the outer layer, composed of fibrous connective tissue.

 Muscularis is the middle smooth muscle layer.
 Mucosa is the innermost layer, marked by transverse folds (rugae), and composed
of a vascular lamina propria and astratified squamous epithelium.

The vaginal orifice is the external opening to the vagina.

The hymen is an incomplete membranous diaphragm formed by fused mucosal folds.
The fornix is a recess formed at the superior end of the vagina.

External Genitalia
The external female genitalia are collectively referred to as the vulva, which
comprises these structures:

 The mons pubis is a mound of subcutaneous connective tissue covering the

pubic symphysis.
 The labia majora are the hair-covered fatty outer skin folds that cover the
labia minora.
 The labia minora are paired folds of skin that enclose the vaginal orifice and
form the vestibule.
 The clitoris contains erectile tissue (corpora cavernosa), is analogous to that of
the penis. Unlike the penis, the clitoris does not contain the urethra.
 The vestibular bulbs consist of erectile tissue that is located on either side of
the vaginal orifice and increases in sensitivity during sexual intercourse.
 The greater vestibular glands (glands of Bartholin) are located on the inner
folds of the vestibule and secrete mucin during sexual arousal.

Mammary Glands
Mammary glands or breasts are modified sweat glands that function only in females.
Fat deposition during puberty is part of their development.
Milk-carrying lactiferous ducts lie within and deep to the nipple, and the lactiferous
ducts contain the lactiferous sinuses, which is where the milk collects before
release. The nipple is surrounded by a darker region of skin known as the areola.

Internally the breast is composed of 15-25 compound alveolar glands, or lobes which
are further divided into lobules. These lobules are composed of grape-like clusters of
alveoli separated by large amounts of adipose (fat) tissue. Alveolar walls are lined
with simple cuboidal, milk-secreting epithelium.

The glandular structure of the breasts remains inactive in non-pregnant women, and
milk production begins shortly after childbirth.

Suspensory ligaments help support the breast by attaching the skin to the pectoralis
major muscle.

Module 22.4 - Perineum

The perineum is a diamond-shaped structure that lies inferior to the muscles of the
pelvic floor and is circumscribed anteriorly by the pubic symphysis, laterally by the
ischial tuberosities, and posteriorly by the coccyx.

 2 distinct triangle bases

 formed by an imaginary horizontal line extending between the ischial
tuberosities of the ossa coxae.
 The urogenital triangle is the anterior triangle of the perineum, where the
vaginal orifice in females and the base of the penis in males are found.
 The anal triangle is composed of muscles that form the posterior half of the
perineum, where the anus is located in both sexes.