ANATOMY AND PHYSIOLOGY

THE CELL

I. ESSENTIAL CONCEPTS:

A. Cellular Composition:

1. Nucleus
2. Cytoplasm
3. Cell Membrane

B. Homeostasis – State of Equilibrium

II. CELLULAR DYSFUNCTION:

A. Fluids – Intracellular vs. Extracellular

B. Electrolytes – K, PO4, Na, Cl
C. Acid-Base Balance
D. Regulatory Mechanisms:
1. Osmosis
2. Diffusion
3. Filtration
4. Active Transport
E. Sources of Normal Fluid Loss
1. Kidneys
2. 4. GI Tract
3. Skin
4. Lungs
F. Homeostatic Mechanisms
1. Renal System
2. Cardiovascular System
3. Pulmonary System Normal ABG Values
4. Buffer System
5. Endocrine System - pH: 7.35 to 7.45
- Pituitary Gland (ADH) - PO2: 80-100 mmHg
- Adrenal Cortex (Aldosterone)
- Parathyroid (Parathormone) - PCO2: 35-45 mmHg
- HCO3: 22-26 mEq/L

THE NERVOUS SYSTEM

1. BRAIN
a. Cerebrum
b. Cerebellum
c. Basal Ganglia
d. Brainstem
e. Diencephalon

PROTECTIVE STRUCTURES:

a. Meninges: Dura Mater

Arachnoid Mater
Pia Mater

b. CSF - 500 – 700 ml/day

- produced by Choroid Plexus
- circulates at subarachnoid space

2. SPINAL CORD
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 Cervical
Thoracic
Lumbar
Sacral
Coccygeal

a. Descending Tracts
b. Ascending Tracts
3. PNS
a. CN – 12 pairs
b. SN – 31 pairs
MUSCULOSKELETAL SYSTEM

I. BONES: (206)
a. Types of Osseous Tissue
- Compact Bone
- Spongy Bone

b. Classification Accdg. to Shape

- Long - Flat - Sesamoid
- Short - Irregular

c. Parts of Long Bone

d. Bone Marrow
- Yellow Marrow – storage of adipose tissue
- Red Marrow – produces RBC & WBC

e. Skeleton
- Axial Skeleton – skull, vert. column, thorax
- Appendicular Skeleton – bones of the limbs

II. JOINTS:
Synarthrosis
Ampiarthrosis
Diarthrosis

III. SKELETAL MUSCLES: (Striated Voluntary Muscle)

a. Sarcolemma c. Perimysium
b. Endomysium d. Epimysium

IV. LIGAMENTS:

V. TENDONS:

VI. CARTILAGE
a. Hyaline Cartilage
b. Fibrocartilage
c. Yellow Cartilage

FUNCTIONS:

I. BONES:
 Protects Vital Organs
 Support Body Tissues
 Muscle Attachment
 Hematopoeisis
 Storage of Mineral Salts
II. JOINTS:
a. Ball & Socket
b. Hinge
c. Saddle
d. Pivot
e. Gliding
f. Condyloid

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III. SKELETAL MUSCLES
 Provide Movement
 Posture
 Heat Production

IV. LIGAMENTS
 Jt. Stability & Restriction of Motion

V. TENDONS
 Bind Muscle to Bone

VI. CARTILAGE
 Shock Absorption
 Protects Bones & Joints

RESPIRATORY SYSTEM

A. Structures

1. Upper Respiratory Tract – nose, sinuses, pharynx, larynx.

2. Lower Respiratory Tract – trachea, mainstem, bronchi, segmental bronchi, terminal bronchioles,
alveoli.

3. Lungs

(R) Lung vs (L) Lung

3 Lobes 2 Lobes

thicker, broader thinner, narrower,

shorter longer

4. Chest Cavity

5. Pleura
a. Parietal Pleura
b. Visceral Pleura

6. Respiratory Muscles
a. Diaphragm
b. Ext. Intercostals
c. Accessory Muscles

7. Pulmonary Blood Supply

8. Neurologic Control

B. Functions:

1. Upper Respiratory Tract

a. air conduction
b. protection from foreign matter
c. warming/humidifying air

2. Lower Respiratory Tract

a. Trachea – connects larynx & lungs

b. Bronchi – conduct air to alveoli
c. Alveoli – gas exchange

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 3. Lungs

a. Ventilation
b. Diffusion of Gases
c. Acid-Base Regulation

4. Chest Cavity
5. Pleura
6. Respiratory Muscles
7. Pulmonary Blood Supply
8. Neurologic Control

CARDIOVASCULAR SYSTEM

I. THE HEART

1. Pericardium – membranous sac that covers the heart

a. Visceral Pericardium
b. Parietal Pericardium

2. Heart Wall
a. Epicardium or Visceral Pericardium
b. Myocardium
c. Endocardium

3. Chambers
b. Right Atrium
c. Right Ventricle
d. Left Atrium
e. Left Ventricle

4. Heart Valves
a. Antriovertricular Valves
- Tricuspid
- Bicuspid or Mitral

b. Semilunar Valves
- Pulmonic Valve
- Aortic Valve

* Papillary Muscles
* Chordae Tendinae
5. Cardiac Conduction System
a. Electrical pathways
- Sinoatrial (SA) node) - Pacemaker
- AV Node - @ Sinus Rhythm 60-100 Dpm
- Bundle of His
- Purkinje Fibers

b. Electrical Impulse Activity – Measured by ECG

- Phases of ECG – P, Q, R, S, T
* P Wave – atrial depolarization
* QRS Complex – ventricular depolarization
* T Wave – Ventricular repolarization

6. Coronary Arteries
a. Right Coronary Artery
b. Left Main Coronary Artery

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Arterial Blood Gases
Type
Respiratory acidosis
pH < 7.35 partial pressure of
arterial carbon dioxide (Paco2) >
45 mm Hg (too much carbon
dioxide (CO2) = too much acid =
acidosis
Respiratory alkalosis
pH > 7.45; Paco2, <35 mm Hg
(too little CO2= too little acid –
alkalosis)
Metabolic acidosis
pH < 7.35; bicarbonate (HCO 3) <
22 mEq/L (too little HCO3 = too
little base acidosis
Metabolic alkalosis
pH < 7.35; HCO3 > 26 mEq/L (too
much HCO3 = too much base -
alkalosis
Causes
Respiratory failure, respiratory arrest,
pulmonary edema, chronic
obstructive pulmonary disease,
pneumonia, pneumothorax,
atelectasis, overdose, aspiration
Hyperventilation, pain, anxiety,
hypoxemia, ventilators
Diabetic ketoacidosis; starvation
(ketoacidosis), lactic acidosis; renal
failure, diarrhea; acetylsalicylic acid
poisoning
Vomiting, nasogastric tube; diuretics
antacids, too much HCO3; too much
IV, HCO3 ordered by health care
provider
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Clinical Manifestations Treatment
If sudden onset: increased heart rate, -
decreased level of consciousness (LOC), Improve ventilation (chest
feeling of fullness after vasodilation from physiotherapy: turn, cough,
CO2 in head, dysrhythmias, deep breathe; suction; oxygen
If chronic: weakness, dull headache (O2)
-
Assess vital signs, breath sounds,
and neurologic assessment
signs.
-
Monitor arterial blood gases
(ABG) and pulse oximetry
readings.
Lightheadedness, unable to concentrate, -
numbness, tingling, tinnitus. Treat the cause.
-
Encourage slow breaths.
Changes in LOC (confusion, drowsiness), -
headache, nausea and vomiting, Administer sodium bicarbonate,
Kussmaul’s respirations (increased rate monitor intake and output,
and Increased depth), dysrhythmias) ABGs, vital signs, and
dyshythmias; use seizure
precautions
Tingling, dizziness and bradypnea -
(conserve O2), hypertonic muscles, Restore fluid volume and
dysrhythmias electrolytes.
-
Monitor vital signs, intake and
output, ABGs, and
dysrhythmias.
-
Perform a neurology assessment.
II. FUNCTIONS OF THE HEART

1. Cardiac Output – SV X HR
a. Stroke Volume – amt. of blood ejected per beat
- Preload
- Afterload
b. Heart Rate - normal 60 – 100 bpm

2. Cardiac Cycle
a. Systole – contraction phase
b. Diastole – relaxation (filling) phase

3. Heart Sounds
a. S1 – tricuspid & mitral valves closure
b. S2 – aortic & pulmonic valves closure
c. S3 – ventricular gallop
d. S4 – atrial gallop

4. Neurologic Factors Regulating Heart Function

a. Sympathetic Stimulation
b. Parasympathetic Stimulation
c. Chemoreceptor Response
d. Baroreceptor Response

THE VASCULAR SYSTEM

A. STRUCTURE

1. Arteries
2. Arterioles
3. Capillaries
4. Venules
5. Veins
- Superficial Veins
- Deep Veins
6. Lymphatic System
- Lymphatic Vessels
- Lymph Nodes
- Lymph Ducts Right Lymphatic Duct
Thoracic Duct

HEMATOLOGIC SYSTEM

A. STRUCTURE
1. Bone Marrow
a. Red Marrow
b. Yellow Marrow
c. Stem Cells

2. Blood Cells
- normal Hematocrit – 45%
a. Erythrocytes (RBC)
- 5 million cells/mm3 of blood
- Biconcave disks containing hemoglobin
- normal Life Span is 120 days
b. Leukocytes (WBC)
- 5,000 – 10,000 cells/mm3 of blood
* 2 Major Types
1. Granular Leukocyte

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 Artery VS Vein
(Conducting Vessels) (Capacitance Vessels)
3 layers –Tunica Adventitia 3 Layers –Tunica Adventitia
Tunica Media Tunica Media
Tunica Intima Tunica Intima

Thicker & More Elastic Thicker & Less Elastic

Deeper ion Location More Superficially located
(-) Valves (+) Valves

Carries Oxygenated Blood Carries Unoxygenated Blood

Higher Pressure Lower Pressure

- 70% of all WBCs

- Subdivided into Neutrophils
Eosinophils
Basophils

2. Mononuclear Leukocyte (Agranular)

- Subdivided into Lymphocytes
Monocytes
c. Thrombocytes (Platelets)
- 150,000 – 450,000 cells/mm3
- produced in bone marrow, lungs & spleen from Megakaryocytes
- normal Life Span is 7 to 14 days

3. Plasma
- 55% of Blood Volume
- Contains Plasma Proteins – Albumin
Globulin
Fibrinogen

B. FUNCTIONS

1. Gen Functions of Blood:

- O2 Transportation
- Waste Transportation
- Hormonal Transportation
- Defense Against Infection
- Chemical, Acid-Base & Thermal Regulation
- Homeostasis

2. Bone Marrow
3. Blood Cells
a. Erythrocytes
b. Leukocytes
- Neutrophils
- Eosinophils
- Basophils
- Monocytes
- Lymphocytes – B – Lymphocytes
T – Lymphoytes
c. Thrombocytes
* Coagulation Factors (Table)

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 Blood Coagulation proteins
Factor Synonyms
I Fibrinogen
II Prothrombin
III Tissue thromboplastin, tissue factor
IV Calcium ion
V Proaccelerin factor, labile factor
VII Serum prothrombin, conversion accelerator, stable factor
VIII Antithemophilic factor
IX Christmas factor
X Stead-Power factor
XI Plasma thromboplastin antecedent
XII Hageman factor
XIII Fibrin stabilizing factor
Prekallikrein Fletcher factor
High-molecular- Fitzgerald factor, Flaujeac factor, Williams factor, contact
weight kininogen activation cofactor

4. Plasma
a. Plasma Proteins
b. Constituent Substances in Plasma
- Blood Coagulation (Clotting and Hemostasis)
1) Vascular Phase
2) Platelet Phase
3) Coagulation Phase
- Maintenance of Acid-Base Balance

- Clot Lysis
- Transportation of Nutrients and Hormones

IMMUNE SYSTEM

A. Functions
1. Defense Against Infection
2. Maintenance of Homeostasis
B. Organs & Tissues
1. Bone Marrow
2. Thymus
3. Lymph Nodes
4. Spleen
5. Tonsils/Adenoids
6. Hematopoietic System
C. Nonspecific Immunologic Defense (Natural Immunity)
1. Physical Barriers
2. Chemical Barriers
3. Biologic Response Modifiers
4. Actions of White Blood Cells
a. Neutrophils
b. Eosinophils & Basophils
c. Granulocytes
d. Monocytes & Macrophages
5. Inflammatory Response
6. Natural Killer Cells
7. Complement

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D. Specific Immunologic Defense
1. Types of Immunity
a. Inborn Immunity
b. Acquired Immunity
2. Mechanism of Specific Immunity
2 Types:
a. Humoral Immunity (B-Lymphocyte)
- involves formation of antibodies
5 Types of Antibodies:
- IgG – activates complement, crosses placenta
- IgA – present in body fluids (blood, saliva, breast milk, vaginal secretions)
- IgM – first antibody produced in immune response
- IgD – important for B cell activation
- IgE – allergic & hypersensitivity rxns
– defense against parasites
b. Cell-Mediated Immunity (T-Lymphocytes)
- delayed hypersensitivity reactions
- transplant rejection
- viral, fungal, chronic infections
* T-lymphocytes (devised from thymus)
Types of T-Cells:
- Helper T Cells (T4)
- Suppressor T Cells (T8)
- Memory T Cells
- Cytotoxic T Cells

3. Stages of Specific Immune Responses

a. Recognition
b. Proliferation
c. Response
d. Effector

ENDOCRINE AND METABOLIC SYSTEMS

A. Hormones - chemical substances secreted by endocrine glands directly into blood

stream.
1. Types of Hormones:
e. Protein or Peptide Hormone – insulin, vasopression, GH, ACTH.
f. Amine Hormones or Amino Acids – EPI, NE
g. Steroids – cortisol, Estrogen, Testosterone
2. Hormone Regulation

B. PITUITARY GLAND

1. Anterior Lobe
a. GH
b. Prolactin
c. Thyroid-Stimulating Hormone (TSH)
d. ACTH
e. Follicle Stimulating Hormone
f. Leutinizing Hormone
2. Posterior Lobe
a. Oxytocin
b. ADH/Vasopressin

C. THYROID GLAND

1. Thyroxine (T4) and Triiodothyronine (T3)

2. Thyrocalcitonin

D. PARATHYROID GLAND

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 1. Parathormone

E. ADRENAL GLANDS

1. Adrenal Medulla
a. Epinephrine (Adrenalin)
b. Nonepinephrine
2. Adrenal Cortex
a. Mineralocorticoids (i.e. Aldosterore)
b. Glucocorticoids (i.e. Cortisol)
c. Adrenal Sex Hormones (i.e. Androgen and Estrogen)

F. PANCREAS – both an endocrine and exocrine gland.

1. Exocrine Function – secrete pancreatic digestive enzymes

2. Endocrine Function – controlled by alpha, beta and delta cells of the islets of Langerhans.
a. ALPHA cells – secrete GLUCAGON
b. BETA cells – secrete INSULIN
c. DELTA cells – secret SOMATOSTATIN and GASTRIN

G. GONADS

1. Ovaries - Estrogen and Progesterone

2. Testes - Testosterone

GI SYSTEM

B. Structures
1. Oral Structures
2. Esophagus
* Esophageal Opening
a. Upper Esophageal Sphincter
b. Lower Esophageal Sphincter (Cardiac Sphincter)
3. Stomach
* 3 Parts
a. Fundus
b. Body
c. Antrum (Pylorus)
4. Sphincters
5. Small Intestine
a. Duodenum
b. Jejunum
c. Ileum
6. Large Intestine
a. Cecum
b. Colon
c. Rectum
7. Iliocecal Valve
8. Appendix
9. GI Tract Layers (5) – 1. Inner Mucosal Layer
2. Submucosal layer
3. Circular Smooth Muscle Layer
4. Longitudinal Smooth Muscle Layer
5. Outer Peritoneal Layer
- Parietal Peritoneum
- Visceral Peritoneum
C. Function

1. Digestion – occurs in upper GIT, stomach and small intestines.

2. Elimination – defecation occurs in the large intestine and rectum.

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 HEPATIC SYSTEM

A. Structure
1. Liver – largest glandular organ
– located in right upper abdominal quadrant
– 4 lobes – left, right, caudate and quadrate
– Contains HEPATOCYCTES (Liver Cells) and
KUPFER’S CELLS (Phagocytic Cells)
– BILE is composed of H2O, electrolytes,
lecithin, fatty acid, cholesterol, bilirubin and
bile salts.
– blood supply is from PORTAL VEIN (75%)
and HEPATIC ARTERY (25%)

2. Biliary System
Canaliculi
a. Hepatic Duct
b. Oddi’s Sphincter
c. Gall Bladder

3. Pancreas - fish-shaped organ

- extends horizontally from duodenum to spleen
- the pancreatic exocrine units (ACINI) produce
bet. 1,200 – 3,000 ml of pancreatic juice.

B. FUNCTION

2. Liver

a. regulates blood glucose levels

b. synthesis of glucose from amino acids of lactate
c. converting ammonia to urea
d. synthesis of plasma proteins and clotting factors
e. breaking down fatty acids into ketone bodies
f. storing vitamin and trace metals
g. drug metabolism and detoxification
h. bile secretion

3. Biliary System

a. Draining bile
b. Storing bile in gall bladder

4. Pancreas – has endocrine and exocrine function

a. Secretes pancreatic juice for digestion

3 Types of Digestive Enzymes
- AMYLASE hydrolyzes CHO to disaccharides
- LIPASE hydrolyzes FAT to fatty acids and glycerol
- TRYPSIN splits protein
b. Secretes H2O and bicarbonate to neutralize gastric juice.

URINARY AND RENAL SYSTEM

A. Structure
1. Urinary System
a. Ureters
b. Bladder
c. Urethra
d. Urinary Meatus

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 2. Kidneys – lie between T12 – L3
– retroperitoneal in location

a. External Structures
- Hilum
- Renal Capsule

b. Internal Structures
- Medulla
- Renal Pyramids
- Papillae
- Renal Pelvis
- Nephron – Glomerulus
– Proximal Tubule
– Loop of Henle
– Distal Tubule
– Collecting Duct

c. Renal Circulation – Renal Arteries

d. Neurologic Control – Symphathetic/Parasymphathetic

B. FUNCTION

1. Urinary System:
a. Ureters – transport urine to bladder
b. Bladder – reservoir for urine
c. Urethra – carries urine from bladder to the outside of the body.
d. Urine Formation
3 Processes:
1. Filtration – happens in Glomerulus
2. Reabsorption – done by prox & distal convoluted tubules.
3. Secretion – reabsorption in reverse
e. Micturition (voiding)
- under voluntary and involuntary control
- 150 – 300 ml – urge to void
- 400 – 600 ml – normal bladder capacity
- 1.5 L/day – normal urine output
- bladder normally contains no residual urine after voiding.

2. Kidneys – overall function

a. blood pressure regulation by renin secretion

b. RBC production by erythropoietin secretion
c. Metabolism of vitamin D.
INTEGUMENTARY SYSTEM

A. STRUCTURE
3 Layers of Skin:

1. Hypodermis (Subcutaneous Layer)

- Innermost Layer
- Loose areolar connective tissue or adipose (fat) tissue

2. Dermis (Corium)
- Middle Layer
- composed of collagen fibers
- Provide mechanical strength
- Contains blood vessels, nerves, lymphatics, hair follicles, sebaceous & sweat
glands

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Major Functions of nephron components

Nephron Component Major function

Glomerulus - Fitration
Proximal tubule - 65% sodium (Na) and water
(H2O) reabsorbed (antidiuretic
hormone (ADH) not required)
- Glucose, potassium (K), amino
acids reabsorbed
- Bicarbonate (HCO3-) reabsorbed
- Hydrogen (H+) secreted
- Urea reabsorbed
- Filtrate leaves isotonic
Henle’s loop - Countercurrent multiplying
exchange mechanism established
between long, thin loops of Henle of
juxtamedullary nephrons and
adjacent vasa recta.
- Filtrate leaves hypotonic
Distal tubule - Na+ reabsorbed and K+ secretad
in presence of aldosterone; opposite
occurs in absence of aldosterone.
- H2O reabsorbed with Na+; ADH
also influences water reabsorption
- Filtrate leaves hypotonic or
isotonic.
Collecting duct - Na+ reabsorbed and K+
regulated by aldosterone
- Acid-base regulation; H+
secretion, HCO3 – reabsorption,
ammonia secretion, ammonium
excretion.
- ADH Determine final urine
volume.

2 Layers:

a. Papillary Layer / Upper Layer

b. Reticular Layer / Lower Layer

3. Epidermis
- 5 Layers – Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale

- Contains 2 Main Types of Cells:

a. Melanocytes – produce melanin
b. Keratinocytes

- Appendages:
a. Hair

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 b. Nails
c. Sebaceous Glands
d. Sweat Glands
1. Apocrine Glands
- respond to autonomic rather than thermal stimulation
- located in axilla, areola, groin, perineum, circumanal and periumbilical

2. Eccrine Glands
- respond to elevated environmental & body temperature
- distributed in skin all over the body
- secretes sweat which is clear, aqueous solution containing 99% H 2O & 1% solid

B. FUNCTIONS:

1. Protective Function

2. Water Balance

3. Sensory Function

Receptors:
- Naked Nerve Endings – mediate all four sensory modalities cold, warmth, pain,
touch
- Free Nerve Endings – mediate pain
- Merkel’s Disks / Meissner’s – touch
- Ruffini’s Endings – warmth
- Pacinian Corpuscles – pressure
- Krause’s End Bulb – cold
4. Vitamin D Production

5. Thermoregulatory Function
- Heat Production
- Heat Loss
a. Radiation
b. Conduction
c. Convection

6. Immunologic Functions
b. Wheal & Flare Reaction
c. Release of Histamine & Bradykinin
d. Immune Complexes

7. Circulatory Function

8. Aesthetic Function

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