This document provides a summary of key topics in anatomy and physiology that are relevant for the Philippine Nursing Licensure Examination, including the cell, integumentary system, musculoskeletal system, nervous system, endocrine system, cardiovascular and hematologic systems, gastrointestinal system, urinary system, and reproductive system. The cell, its structures and functions, and the process of cellular division are described. An overview is given of the skin and its layers, functions of temperature regulation and protection.

1. Nursing Review of Anatomy and Physiology Review for Philippine Nursing Licensure Examination

3. Outline of Selected Topics in Anatomy and Physiology The Cell Integumentary Musculoskeletal Nervous Endocrine Cardiovascular and Hematologic Gastrointestinal Urinary/Fluids and Electrolytes Reproductive

4. The Cell Basic Structural and Functional Unit of the body

5. Functions of the Cell Basic unit of life Protection and support Movement Communication Cell metabolism and energy release Inheritance

6. The Cell Composed of the Cytoplasm, Cell Membrane, the organelles, the nucleus and the inclusions

8. The Cell The cytoplasm is the viscous, translucent, watery material where the organelles are located

9. The Cell The Cell membrane is a semi-permeable membrane that serves as the boundary separating the cellular structures from the external environment

11. The cell membrane Selectively permeable Bi-lipid layers Functions to regulate passage of substances

12. The cell membrane Phagocytosis- cell eating Pinocytosis- cell drinking Endocytosis- cell engulfment Exocytosis- cell excretion

15. Cell connections Tight junction= binds adjacent cell together and form permeability barrier, which regulates what material crosses Desmosome= mechanical link that functions to bind cell to one another Hemidesmosomes= anchor the cell to the basement membrane Gap junction= small channel that allows molecules and ions to pass from one another

17. The cellular organelles These are the cellular metabolic units with specific functions to maintain the life of the cell These include the mitochondrion, endoplasmic reticulum, ribosome, golgi apparatus, lysosomes, peroxisomes, cytoskeleton and centrosomes

18. The mitochondrion The POWERHOUSE of the cell Contains enzymes and the complexes responsible for the production of the ATP Also contains mitochondrial DNA Metabolic processes occurring in this organelle include – Kreb’s cycle, beta-oxidation of fats, urea cycle, heme synthesis This organelle is maternally inherited

20. The endoplasmic reticulum An extensive network of membrane-enclosed tubules There are two types- Rough and Smooth endoplasmic reticulum Rough endoplasmic reticulum is covered with ribosomes  site of protein synthesis Smooth endoplasmic reticulum has no ribosome  site of lipid synthesis

22. Ribosome Together with the endoplasmic reticulum  is the site of protein synthesis Maybe found in the cytoplasm and in the mitochondria They may be free or attached to the endoplasmic reticulum

23. Golgi Apparatus This organelle modifies, concentrates and packages proteins This also packages enzymes into lysozomes Proteins and enzymes usually are transported from the rough endoplasmic reticulum to the golgi apparatus

25. The lysosomes These are membrane-limited digestive bodies that contain enzymes that break down foreign or damaged materials The enzymes digest all materials brought in by phagocytosis

27. The peroxisomes Similar to lysosomes, these are membrane-bound sacs containing oxidases (not found in the lysosomes) Oxidases are enzymes capable of reducing oxygen to hydrogen peroxide

28. The cytoskeleton A series of tubules and rods that runs through the cytoplasm supporting the cellular structures This is also responsible for cellular movements

30. The centrosomes This contains the centrioles  short cylinders adjacent to the nucleus responsible for cellular division

31. The cellular inclusions These are non-functional units made up of chemical substances These may or may not be present in all cells Examples are pigments, granules, and fat globules

32. Cilia and Flagella Cilia are short, hair-like extensions that occur in large numbers on the outer surface of the cell Flagella are long projections formed by centrioles that propel the cell

34. The Nucleus The central control of the cell Controls cell growth, metabolisms and reproduction Contains DNA Contains chromosomes  DNA + proteins appearing as granules in the non-dividing cell Genes  segments of chromosomes

36. Cell Division Formation of two daughter cell from a single parent cell. Mitosis – formation of new cell necessary for growth and tissue repair. Meosis – formation of sex cell necessary for the reproduction.

37. Cellular division Two types- Mitosis and Meiosis Mitosis- equal division of materials which yields two exact duplicates of the original cell The diploid number (46) of chromosomes is maintained All of the body cells undergo mitosis except the gametes or sex cells

38. Mitosis All body cell undergo mitosis except sex cell. There are two step in mitosis: Genetic material within the cell is replicated. Cell divided to form two daughter with same amount and type of DNA.

39. The cellular division Five steps of cellular division I-P-M-A-T Interphase - inactive or resting state Prophase -Chromatin coils to form chromosomes, centrioles begin to assemble Metaphase -chromosomes line the equator, and they split lengthwise Anaphase -Chromatids separate and move to the opposite poles Telophase -chromosomes uncoil and nucleoli reappear

40. INTERPHASE – time between cell division during which DNA replicate. DNA strand separate where old strand joined with new strand of DNA to form two new DNA molecule.

41. Four stage of Mitosis Prophase – chromatin condensed into chromosome. Chromosome consist of two chromatin join by centromere. Centriole move to opposite pole. Nucleus and nuclear envelope disappear. 2. Metaphase – chromosome aligned at the center, w/ spindle fiber. 3. Anaphase – chromatin separate to form two sets of identified chromosome. Chromosome assisted by spindle fiber.

42. 4. Telophase – chromosome disperse. Nuclear membrane and nucleolus formed. Cytoplasm divided into two cell.

43. Differentiation – process by which cell develop with specialized function. Egg and sperm cell formed single cell during fertilization divided by mitosis to form two cell then become four cell and so forth which differentiate, give rise to different cell. E.g. bone cell, muscle cell

45. The cellular division Meiosis is a reduction division occurring in the sex cells Sex cells have only one pair of chromosomes (23)  haploid number

46. Cell Physiology

48. DIFFUSION The movement of SOLUTES or particles in a solution from a higher concentration to a lower concentration This is a passive process, no energy is required

50. OSMOSIS The movement of solvent or water from a diluted solution into a more concentrated solution through a semi-permeable membrane The pressure that draws water inside the vessel which is more concentrated is called Osmotic pressure

52. Filtration If a sugar is placed in plain water, the glucose molecules will dissolve and distribute in the solution Factors that affect diffusion-concentration gradient, particle size, solubility and temperature

53. Special osmosis A special type of osmotic pressure is exerted by the proteins in the plasma. It is called ONCOTIC PRESSURE

54. FILTRATION The movement of both solute and solvent by hydrostatic pressure, i.e., from an area of a higher pressure to an area of a lower pressure An example of this process is urine formation

55. Hydrostatic pressure Hydrostatic pressure is the pressure exerted by the fluid against the container Increased hydrostatic pressure is one mechanism producing edema

56. Active transport This is the movement of solutes across a membrane from a lower concentration to a higher concentration with utilization of energy Example is the Sodium-Potassium pump, Endocytosis and Exocytosis

59. Tissue Group of cells with similar structure and function There are four (4) Basic types Epithelial Connective Muscle Nervous

60. BODY TISSUES Epithelium Lining, covering and glandular tissues of the body The functions are to protect, absorb, filtrate and secrete substances

61. Epithelial tissues Simple epithelium Lined by ONE Layer of cell Stratified epithelium Lined by many layers of cells

62. Epithelial tissues Simple epithelia 1. Simple squamos- alveoli, BV 2. Simple cuboidal- glands 3. Simple columnar- GI tract 4. Pseudo stratified epithelium- bronchial lining

63. Epithelial tissues Stratified epithelium 1. Stratified Squamos- skin 2. Stratified cuboidal- reproductive duct 3. Transitional epithelium- bladder and ureter

67. Connective tissues Bone Cartilage Muscle Blood Blood vessels Adipose tissue

71. The SKIN

72. The Integumentary System The largest body system Includes the skin and accessory structures like the hair, nails, and glands Function: Protection of body structures and regulation of body temperature

74. The Skin as first line protection The skin seals off the body from the immediate environment There are three layers of the skin: Epidermis, dermis, and hypodermis.

75. Skin cells There are many other cells aside from the keratinized squamos cells of the skin. Melanocytes produce pigment melanin. Langerhan’s cells participates in the immune system. Histiocytes are specialized macrophages

77. Skin as temperature regulator Abundant nerves, blood vessels and glands are within the skin’s deeper layer They aid in temperature regulation Blood vessels constrict or dilate depending on the temperature

78. Skin functions Sweat glands produce sweat to control temperature by evaporation The piloerector ( arrector pili ) muscles will contract to raise the hairs to trap the heat

79. Other skin functions Vitamin D synthesis 7-dehydrocholesterol  Cholecalciferol (D3) Route of excretion Insensible fluid loss of about 500 ml/day Sweat contains water, electrolytes, urea and lactic acid

80. Other skin functions Skin and mucus membrane are the first line defense of the body in immunity Skin has receptors for pain, cold, pressure and heat.

81. The Skin layers: EPIDERMIS The outermost layer with stratified squamos epithelium Varies in thickness depending on the body part Thinnest in the eyelids and thickest in the soles and palms

82. EPIDERMIS The layers are- C-L-G-S-B The outermost layer is the stratum corneum  with keratin The stratum basale is the layer which regenerates/replaces new skin cells Melanocytes in the skin produce melanin

83. The Skin layers: DERMIS The second layer- cutis vera Is flexible and elastic Two layers- papillary and reticular Contains blood vessels, lymphatic vessels, nerves and appendages

84. The Skin layers: DERMIS The connective tissues in the dermis contain collagen (gives its strength) elastin (gives its flexibility) and reticular fibers (connect collagen and elastin)

85. The Skin layers: Hypodermis This is the subcutaneous tissue Not strictly a part of the skin Functions to insulate the body to conserve heat

86. Hypodermis Serves as the energy storage and mechanical shock absorber With little vascular supply and scant nerve supply

87. The Skin appendages Hairs- long shafts composed of keratin. Expanded lower end is called hair bulb or root. There are extensive nerve and blood supply in the hair bulbs Nails-flattened structure of specialized type of keratinized surface. The visible part is the nail body .

88. Fig. 5.5

89. Appendages Sebaceous glands-glands which produces an oily material called sebum, found in all body parts except the palms and soles. Sweat glands or sudoriferous glands- glands which secrete sweat, found in all body parts except in the nipples. Two types exist- Eccrine and Apocrine

90. Fig. 5.6

91. The Musculoskeletal System This system consists of the muscles, tendons, ligaments, bones, cartilage, joints, and bursae

92. The Musculoskeletal System Functions: Locomotion and protection blood production in the bone marrow heat generation, maintenance of posture and storage of minerals

93. The Muscles Three types of muscles exist in our body Voluntary skeletal muscle Involuntary cardiac muscle Involuntary visceral smooth muscle

94. The Muscles Muscles are composed of muscle fibers having numerous nuclei and striations

98. Properties of Muscles Electrical excitability Ability to contract to certain stimuli Contractility Ability to contract forcefully when stimulated Extensibility Ability to stretch without being damaged Elasticity Ability to return to its original length and shape

99. Muscle Physiology Muscle fibers are enclosed sheaths- perimysium, epimysium and endomysium Each muscle cell has actin and myosin filaments arranged in a sarcomere This sarcomere is the basic structural unit of the muscle

100. Muscle Physiology Muscle contraction occurs as actin and myosin slide past one another causing the sarcomeres to shorten Calcium ion is released by the muscle endoplasmic reticulum to initiate contraction ATP is used both for muscle contraction and muscle relaxation

103. Fig. 7.5a

104. Fig. 7.6

105. Fig. 7.7a

106. Fig. 7.7b

107. Muscle Physiology Muscle contraction can be of two types 1. ISOMETRIC- iso = same, metric=distance: The length of the muscle does not change, but the tension increases 2. ISOTONIC- iso =same, tonus=tone: The amount of muscle tension is constant but the length of the muscle varies

108. Muscle Physiology Muscle tone= refers to the constant tension produced by muscles of the body for long periods of time FAST-twitch muscles= contract quickly and fatigue quickly SLOW-twitch muscles=contract slowly and are more resistant to fatigue

109. Muscle Physiology Smooth Muscle= is not striated, contracts more slowly, is autorhythmic and under involuntary control Cardiac muscle- is striated, is autorhythmic , and under involuntary control

110. MUSCLE and JOINT MOVEMENTS Flexion- decreasing the angle between two joints Extension- increasing the angle between two joints Abduction- movement of the limb away from the midline Adduction- movement of the limb towards the midline

111. MUSCLE and JOINT MOVEMENTS Internal rotation- moving the body part inward towards the midline External rotation- moving the body part outward away from the midline Supination- turning a body part upward Pronation- turning a body part downward

112. MUSCLE and JOINT MOVEMENTS Inversion- turning the foot inward Eversion- turning the foot outward Retraction- moving a body part backward Protraction- moving a body aprt forward

113. Muscles of the face 1. Frontalis 2. Orbicularis oculi 3. orbicularis oris 4. Buccinator 5. Zygomaticus Facial Nerve innervation

114. Muscles of Mastication 1 . Masseter 2. Temporalis 3. Pterygoid muscles Innervated by TRIGEMINAL NERVE

115. Muscles of the neck 1. Platysma 2. Sternocleidomastoid

116. Muscle of the upper limb 1. Biceps 2. triceps 3. deltoid

117. Muscles of the lower limb 1. Hamstring muscles 2. Quadriceps 3. Gluteal muscles 4. calf muscles

118. TENDONS These are bands of fibrous connective tissue that attach muscles to bones

119. LIGAMENTS These are dense, strong, flexible bands of fibrous connective tissue that bind bones to other bones

120. BONES Bone is a living growing tissue made of porous mineralized structure. The human skeleton contains 206 bones Axial bones are bones on the midline like the vertebrae, skull, facial bones, ribs and sternum Appendicular bones include the scapulae, bones of the arms and legs

122. Classification of Bones Long bones- - These bones have a shaft and ends. Ex: tibia, humerus, femur Short bones- Small and cubical shaped- Ex: carpals and tarsals Irregular bones- vertebrae, mandible Sesamoid bones- bones embedded in the tendons. Ex:patella Flat bones- with spongy bones inside. Ex: scapulae, ribs, clavicle

123. Structure of the bone Long bones have a diaphysis ( shaft) and epiphysis (ends) Bones consist of layers of calcified matrix occupied by bone cells. The outer layer of bone is composed of dense compact bone (cortical bone) The inner layer is composed of spongy cancellous bones

125. Bone Structure Blood supply of bones reaches by way of arterioles in the haversian canal, through the vessels in the Volkmann's canal Bone formation can be from the cartilage and from the membrane

126. Bone Structure OSTEOBLAST- bone cell responsible for bone formation and calcification OSTEOCLAST- bone cell responsible for bone resorption and destruction

127. Bone Ossification Ossification is the formation of bone by the osteoblasts. This involves the mineralization of bones from a cartilage (endochondral) and from a membrane (membranous ).

128. Fig. 6.5a

129. Fig. 6.6

130. Bone Remodeling Bone remodeling involves the removal of old bones by cells called osteoclasts and deposition of new bones by the osteoblasts. Bone is the major storage of calcium If calcium levels in the blood falls, it is removed from the bone

131. Bone repair When a bone is broken, blood vessels are also damaged  clot 2-3 days after injury, blood vessels and cells invade the blood clot  callus formation Osteoblasts enter the callus and begin to form a spongy bone Immobilization of the bone is required because the delicate new matrix of bone is easily damaged by excessive movement

132. Fig. 6.8

133. The Skull Skeleton of the head Made of 21 bones Cranial bones Frontal Parietal Temporal occipital

134. The Skull Facial bones Maxilla Mandible Zygoma Nasal Vomer Palatine

135. The paranasal sinuses These are air-filled cavities in the facial bones surrounding the nose and open into the nasal cavity They decrease the weight of the skull and act as resonator of sounds Frontal, maxillary, ethmoid and sphenoid

137. The Vertebrae Composed of 32-33 bones 7 cervical 12 thoracic 5 lumbar 5 sacral 3-4 coccygeal

138. Functions of the vertebrae 1. Supports the weight of the head and trunk 2. Protects the spinal cord 3. Allows spinal nerves to exit the spinal cord 4. Provides a site for muscle attachment 5. Permits the movement of the head and trunk

139. The Cervical Vertebrae 7 in number C1- atlas C2- axis C7- cervical prominence Atlas and occipital bone= “yes” motion Atlas and Axis= “no” motion

140. The Thorax Made up of the sternum and ribs The sternum has 3 parts Manubrium Body Xiphoid process The slight elevation in the sternum is called the Sternal Angle of Louis . It identifies the location of the second rib

141. The Ribs The ribs are 12 pairs True ribs= 1-7 False ribs= 8-10 Floating ribs=11-12

143. The shoulder The clavicle and scapulae constitute the shoulder The clavicle Articulates with the sternum Most commonly fracture bone The Scapulae Attached to the ribs and vertebrae by muscles only Has an acromion process, where the clavicle attaches

145. The Upper extremity Composed of the following bones Humerus Ulna Radius Carpals (wrist bones) Metacarpals Phalanges

147. The pelvic girdle Composed of the 3 fused bones- pubis, ilium and ischium Constitute the hip bone

148. The pelvic girdle Female pelvis has the following structure: The pelvic inlet is large/oval, symphysis is shallow. obturator foramen is oval or triangular, sacrum is broader The male pelvis has the following: The pelvic inlet is small/round to heart-shape, symphysis is deep. Obturator foramen is round

149. Fig. 6.32

152. The Lower extremity bones Composed of the Thigh bones- femur The leg bones- Tibia and Fibula The ankle- tarsal bones The foot- metatarsal bones

154. CARTILAGE A dense connective tissue that consists of fibers embedded in a strong, gel-like substance. Cartilage supports and shapes various structures such as the ear pinna, intervertebral disks, ear canal, larynx, etc. It serves as cushion and shock absorber

156. Types of Cartilage Fibrous cartilage Found in the intervertebral disks Hyaline cartilage Found in the symphisis, the thyroid cartilage Elastic cartilage Found in the ears, the epiglottis

157. Joints

158. Fig. 6.39a

159. Fig. 6.39b

160. Fig. 6.40a

161. Fig. 6.40b

162. Fig. 6.40c

163. Joints These are point of attachment or contact between two bones Variously classified according to its movement and flexibility Fibrous joints- with fibrous tissue with little or no movement Cartilaginous joints- with cartilage Synovial joints- with capsule; freely movable joints

165. Synovial joints Freely movable joints With joint cavity/capsule Articular surface Synovial membrane Synovial fluid

166. Synovial joints Plane joint- intercarpal joint of wrist Hinge joint- elbow and ankle Pivot- atlas and axis Condyloid- “egg-shape” metacarpophalengeal joint

167. Synovial joints Saddle joint- joint of the thumb Ball and socket- hip joint

168. Bursae Small synovial fluid sacs located at friction points around joints, between tendons, ligaments and bones Act as cushions, decrease stress on adjacent structure

170. The Nervous System

171. The Nervous System The nervous system coordinates all body functions, enabling a person to adapt to changes in internal and external environment The nervous system is composed mainly of the nerve cells (neurons) and supporting cells (neuroglia)

172. The neuron This is the basic conducting cell of the nervous system Highly specialized but cannot reproduce itself Main parts are the cell body (soma), the fibers: axon and dendrites.

173. The neuron The axon is a long process with myelin sheath. This conducts impulses away from the cell body The dendrites are short, thick, diffuse branching processes that receive impulses and conduct them towards the cell body

175. The neuroglia The supporting cells They supply nutrients to the neurons and help maintain the electrical potential They also form part of the blood-brain barrier

176. The neuroglia Oligodendrocytes produce myelin sheath in the CN Schwann cells produce myelin sheath in the peripheral NS

180. The Organization of the Nervous System The nervous system is divided functionally and structurally into 2 parts 1. Central Nervous System- the Brain and the spinal cord 2. Peripheral Nervous System- the cranial nerves and spinal nerves

183. The Organization of the nervous System The Peripheral Nervous System is further classified into THREE Functional Divisions 1. The Somatic Nervous System- controls the skeletal muscles 2. The Autonomic Nervous System- controls the visceral organs 3. The Enteric Nervous System- controls the functions of the GIT

184. The Central Nervous System Composed of the brain The brain consists of the gross structures: cerebrum, cerebellum, brainstem and the diencephalon. Diencephalon- Thalamus. Hypothalamus and pineal body Brainstem- Pons, medulla and Midbrain

186. Fig. 8.23

187. The Cerebrum This is the largest part of the brain Consists of right and left hemisphere connected by the corpus callosum Each cerebral hemisphere is composed of different lobes- frontal, temporal, parietal and occipital Embedded in the cerebrum is the BASAL ganglia

189. The Frontal Lobe of the cerebrum Influences the personality of the person Also responsible for judgment, abstract reasoning, social behavior, language expression and motor movement.

190. The Temporal lobe of the Cerebrum This part of the cerebrum controls the hearing, language comprehension, storage and recall of memories The LIMBIC system is deeply located in the temporal lobe. This controls the basic drives such as hunger, anger, emotion and sexual drive.

191. The Parietal lobe of the cerebrum This is the principal center for the reception and interpretation of Sensation This part interprets and integrates the sensory inputs like touch, temperature and pain It interprets size, shape, distance and texture

192. The occipital lobe of the cerebrum This functions mainly to interpret visual stimuli

193. Speech areas in the cerebrum 1. Wernicke’s area- responsible for the sensory reception of speech. 2.Broca’s Area- responsible for the motor speech

195. Fig. 8.28

196. The Cerebellum The second largest brain region Has also two hemispheres Functions to maintain muscle tone, coordinate muscle movement, posture and control balance/equilibrium If this is damaged, muscle tone decreases and fine motor movements become very clumsy

198. The Brainstem Lies inferior to the cerebrum Continuous with the cerebrum and the spinal cord It is composed of the midbrain, the pons and the medulla oblongata Functions: houses the center for respiration and cardiovascular system

199. The Midbrain This connects with the cerebrum Contains numerous ascending and descending tracts and fibers

200. The Pons Connects the cerebellum with the cerebrum Houses the respiratory center and cardiovascular center Exit points for cranial nerves 5, 6 and 7

201. The Medulla oblongata The most inferior portion of the brainstem Serves as the center for autonomic reflexes to maintain homeostasis, regulating respiratory vasomotor and cardiac functions Serves as exit of cranial nerves 9,10,11 and 12

202. The Diencephalon The thalamus and the hypothalamus The thalamus is the relay station of all sensory stimuli towards the brain The hypothalamus controls body temperature, appetite, water balance, pituitary secretions and sleep-wake cycle

203. The Basal ganglia

204. Brain circulation: The circle of Willis

205. The spinal cord A long cylindrical structure extending from the foramen magnum to the L1 in adult, L3/L4 in pedia

206. The spinal cord In the cross section of the spinal cord, we find the GRAY matter- contains neurons; and WHITE matter-consists of nerve fibers There are 31 pairs of spinal nerves that exit the spinal cord

209. The spinal cord Each spinal nerve is formed by the dorsal root (sensory) and the ventral root (motor) Cervical segments= 8 pairs Thoracic segments=12 pairs Lumbar= 5 pairs Sacral=5 pairs Coccygeal=1 pair

210. The Meninges These are 3 connective tissue layers surrounding the brain and spinal cord. 1. DURA MATER- the superficial, thickest layer. The area above the dura mater is called epidural space 2. ARACHNOID- second layer, thin and wispy. 3. PIA MATER- the deepest layer, adhered to the brain and spinal cord substance

212. The Meninges The space in between the arachnoid and pia mater is called the arachnoid space This arachnoid space contains the cerebro-spinal fluid (CSF) In this space, blood vessels are also found

213. The Ventricles These are CSF filled cavities in the brain The lateral ventricle- found in the cerebrum The third ventricle- in the center of the thalamus and hypothalamus The fourth ventricle- located at the base of the cerebellum

214. The CSF This is the fluid found inside the ventricles that bathe the brain and spinal cord Function: provides protective cushion around the CNS Produced by the choroid plexus in the ventricles Absorbed by the arachnoid granulations

215. Tracing the CSF pathway Lateral ventricle Interventricular foramen of Monro Third ventricle Cerebral aqueduct of Sylvius Fourth ventricle Exits trough the median foramen of Magendie or the lateral foramen of Luscka Subarachnoid spaces in the cisterna magna, spinal cord subarachnoid space of the brain superior sagittal sinus

217. The cranial nerves Are 12 pairs of nerves that exit the brain Can be classified as Sensory Motor Mixed (sensory and motor)

221. The Autonomic Nervous System The part of the peripheral nervous system that innervates cardiac muscles, smooth muscles and glands Functionally divided into Sympathetic Nervous System Parasympathetic Nervous System

222. The SYMPATHETIC system Originates from the T1-L2/L3 segments of the spinal cord (thoracolumbar) Utilized by the body for FLIGHT and FIGHT response Neurotransmitter agents are Epinephrine and Norepinephrine (coming from the adrenal gland) ADRENERGIC system

223. Sympathetic responses Increased: HR RR BP Visual Acuity (Pupillary Dilation) Smooth Muscle tone  sphincters are contracted Vasoconstriction Metabolism  ↑ glucose, ↑ fatty acids

224. Sympathetic responses Decreased Peristalsis Salivary secretions Ejaculation

225. Parasympathetic system CHOLINERGIC system The vegetative system Feed and Breed responses Cranio-sacral location Cranial nerves- 3, 7, 9, 10 and S2-S4 Neurotransmitter is Acetylcholine

226. Parasympathetic responses Increased Gastric secretions Salivary secretions peristalsis Pupillary constriction Decreased Smooth muscle tone  sphincters are relaxed erection

228. Nerve Physiology The nerve cells are excitable cells Any stimulus will change the membrane potential and cause an action potential to generate  impulse transmission The myelin sheath of the nerve cell is responsible for the SALTATORY conduction  increases the nerve transmission

230. Fig. 8.11

231. Fig. 8.12

232. The SYNAPSE This is the region where communication occurs between 2 neurons or between a neuron and a target cell A neurotransmitter is released from the nerve cell towards the other cell with receptor

233. Fig. 8.13

235. Special Senses

236. The eye and the visual pathway Vision is made possible by the stimulation of the photoreceptor cells in the retina Receptor cells are the RODS and CONES The eye is made up of three layers Fibrous layer- sclerae and cornea Uvea- choroid and iris and ciliary bodies Nervous coat- retina

239. Fig. 9.13

240. The optic nerve This is the collection of fibers from the cells in the retina It passes through the brainstem as the optic chiasm it will reach the occipital lobe for visual interpretation

242. The Vestibular apparatus This is the part of the ear that helps in equilibrium Located in the inner ear The saccule and utricle control LINEAR motion The semicircular ducts control the Angular movement/ acceleration

244. The Hearing Apparatus

245. The Olfactory apparatus Consists of the nose and the olfactory nerve Stimulation form the olfactory nerves will reach the limbic system of the brain

246. The Gustatory apparatus The receptor for taste are cells in the tongue group together called the taste buds They are numerous in the vallate and fungiform papillae

247. The Gustatory apparatus Basic taste modalities Sweet- tip of the tongue Salty- over the dorsum of the tongue Sour- sides of the tongue Bitter- back of the tongue

249. Endocrine System

250. The Endocrine System This system is made up of widely distributed organs whose secretions (called HORMONES) are poured into the blood to reach the target cells

252. Hormones These are chemical substances released by the glands into the blood Each hormone will go to the target organ and binds its receptor Two types exists: 1. Peptides or protein hormones 2. Lipid or steroid hormones

255. The hormonal regulation There exists an inter-related regulation between the HYPOTHALAMUS, Pituitary and the endocrine gland.

258. The hormonal regulation We call it the Hypothalamic-pituitary-endocrine axis The exception are the pancreas and the parathyroid gland

259. The endocrine glands The pituitary- anterior and posterior The pineal gland The thyroid gland The parathyroid gland The adrenal gland The pancreas The gonads- testes and ovary

261. The pituitary gland : anterior lobe Also called Adenohypophysis Hormones produced Growth hormone The stimulating hormones- ACTH, TSH, FSH and LH Prolactin

262. The pituitary gland: posterior lobe Also called the neurohypophysis This lobe does not secrete hormones but only stores hormones Antidiuretic hormone (vasopressin) Oxytocin

263. The pineal gland Also called epiphysis cerebri Secretes melatonin

264. The thyroid gland Located in the lower part of the anterior neck With two lobes connected by the isthmus

265. The thyroid gland Secretes thyroxine (T4) and tri-iodothyronine (T3) The T3 is the most active hormone Function of T3/T4: Increase metabolic rate, essential for normal growth and maturation

268. The thyroid gland It also secretes CALCITONIN This is released in response to an INCREASED calcium level in the blood Function: decreases bone resorption and increases calcium excretion in the kidney to decrease the calcium levels

270. The parathyroid glands 2 pairs (4) of yellowish glands closely related to the posterior surface of the thyroid gland Secretes parathyroid hormone (PTH)

271. The parathyroid glands Functions of the hormone: Increases bone breakdown by osteoclasts Increases Vitamin D synthesis Increases Calcium level in the blood Causes retention of calcium in the kidney

273. The Adrenal glands a pair of gland resting on top of each kidney with 2 layers ADRENAL CORTEX Secretes mineralocorticoids Secretes glucocorticoids Secretes androgens- sex hormones ADRENAL MEDULLA Secretes the cathecolamines- Epinephrine, and norepinephrine

275. Fig. 10.17

276. Fig. 10.18

277. The Adrenal Cortex Mineralocorticoid- Aldosterone Increases sodium retention, water retention secondarily Causes excretion of potassium

278. The Adrenal Cortex Glucocorticoids- cortisol Increases fat and protein breakdown Increases glucose synthesis Inhibit inflammation and immune response

279. The Adrenal Cortex Adrenal androgens Estrogens, androgens and progestins Insignificant in males Increase female sexual drives, pubic hair and axillary hair growth

280. The pancreas The endocrine portion of the pancreas is the ISLETS of LANGERHANS This islet is composed of three types of cells- alpha, beta and delta

281. Fig. 10.19

282. The pancreas The Alpha cells secrete GLUCAGON The Beta cells secrete INSULIN The delta cells secrete SOMATOSTATIN

284. Pancreatic insulin Causes Hypoglycemia by two mechanisms: Glucose breakdown- glycolysis Glycogen production- glycogenesis

285. Pancreatic insulin Needed by most body cells to allow Glucose to enter the cell membrane The brain cells, intestinal cells, the red blood cells and the islet cells do not need insulin for glucose entry

286. Pancreatic glucagon Causes increased level of Glucose by: Glycogen breakdown- glycogenolysis Glucose production- glucogenesis

287. The Gonads : Male- Testes The testes houses the Interstitial cells of Leydig which secrete ANDROGENS Testosterone Dehydrotestosterone Androsterone

288. The Androgens Aid in spermatogenesis Maintain functional reproductive organs Responsible for secondary sex characteristics Responsible for male sexual drives

289. The Gonads: Female- Ovary The Follicular cells of the ovarian follicle secrete ESTROGEN and the corpus luteum secretes PROGESTERONE

290. The estrogen Aids in uterine and mammary gland development Maintains the structure of the external genitalia Produces the secondary sexual characteristics in female Maintains normal menstrual cycle

291. The progesterone Together with estrogen, maintains normal menstruation Increases body temperature Decreases muscle tone and peristalsis Maintains pregnancy

292. The CARDIOVASCULAR SYSTEM

294. The CARDIOVASCULAR SYSTEM This system is composed of the heart and the blood vessels The main functions of this system are: to transport oxygen, hormones and nutrients to the tissues and to transport waste products to the lungs and kidneys for excretion

295. The Gross Anatomy of the Heart The heart is located within the thorax behind the sternum in the compartment called MEDIASTINUM The heart is commonly described as the size of a clenched fist

296. The Gross Anatomy of the Heart The shape is conical, with a base and an apex The base is directed upward The apex is directed downward to the left at the level of the 5 th ICS LMCL

297. Heart Surface ANTERIOR SURFACE Right ventricle POSTERIOR SURFACE Left ventricle

299. The Heart : Anatomy The heart has three layers The epicardium The myocardium The endocardium The heart is covered by the pericardium with a parietal and visceral layers The pericardial sac is a potential space in between the two pericardial layers with a minimal (15 cc) fluid

300. Fig. 12.4

301. The Heart: Anatomy The heart has four chambers The right atrium The right ventricle The left atrium The left ventricle

302. The Heart: Anatomy The heart also has four valves that guard the openings in the chambers The tricuspid valve – between the right atrium and right ventricle The mitral or bicuspid valve- between the left atrium and left ventricle The pulmonic valve- between the right ventricle and the pulmonary trunk The aortic valve- between the left ventricle and the aorta

304. The Heart: Anatomy The blood supply of the heart: The coronary arteries are the blood supply There are two main coronary arteries- the right coronary artery and the left coronary artery The venous drainage of the heart is the coronary sinus; the anterior cardiac vein and the smallest cardiac vein

305. Blood Supply

307. Venous Drainage Coronary sinus will collect all the venous blood from the heart into the RIGHT atrium The anterior cardiac vein drains NOT into the coronary sinus but DIRECTLY into the right atrium

308. Circulation

309. Fig. 12.11

310. The Heart : Physiology This consists of The conducting system The cardiac cycle The cardiac output and Blood pressure The preload and afterload The Starling’s law of the heart

311. The Heart: Physiology The conducting system of the heart is a group of specialized heart cells that functions to conduct electrical impulses independent of any nerve supply

312. The Heart: Physiology The parts of the conducting system of the heart are: The SA (sino-atrial) node The AV (atrio-ventricualr) node The Bundle of His with its right and left bundle The Purkinje fibers

314. The Heart: Physiology The intrinsic conduction system causes the heart muscle to depolarize in one direction The rate of depolarization is around 75 beats per minute The SA node sets the pace of the conduction This electrical activity is recorded by the Electrocardiogram (ECG)

318. The Heart: Physiology The cardiac cycle consists of the contraction phase and the relaxation phase in each heartbeat The SYSTOLE is the contraction phase The DIASTOLE is the relaxation phase

321. The Heart: Physiology Heart sounds can be auscultated S1, S2, S3, and S4 S1 is due to the closure of the AV valves S2 is due to the closure of the semilunar valves S3 is due to the rushing of blood through the AV opening S4 is due to contraction of the atrium

322. The Heart: Physiology The amount of blood the heart pumps out in each beat is called the STROKE VOLUME When this volume is multiplied by the number of heart beat in a minute (heart rate), it becomes the CARDIAC OUTPUT When the Cardiac Output is multiplied by the Total Peripheral Resistance, it becomes the BLOOD PRESSURE

323. The Heart: Physiology The PRELOAD is the degree of stretching of the heart muscle when it is filled-up with blood The AFTERLOAD is the resistance to which the heart must pump to eject the blood

324. The Heart: Physiology Starling’s Law of the Heart states that the force of contraction is proportional to the degree of stretching of the cardiac muscle fibers As the length of the muscle fiber is stretched, the contractile force increases But when the maximum length has been reach, any further stretching will impair the contraction

326. The Blood vessel: Anatomy This consists of the artery, vein and capillary together with the lymphatic vessels The ARTERY has thicker wall, deeply located, pulsating, reddish, with abundant smooth muscles and elastic tissues that carries oxygenated blood away from the heart towards the body tissues

328. The Blood vessel: Anatomy The VEIN is thin-walled, superficially located, non-pulsating, bluish vessel that carries unoxygenated/deoxygenated blood towards the heart Arterioles are small arteries Venules are small veins CAPILLARIES are diffuse network of thin- walled tubules that connect arterioles and venules together

329. The Blood vessel: Physiology The diameter of the arterioles is the main contributor of the peripheral resistance In the presence of epinephrine, cold temperature and irritation, the smooth muscles of the blood vessels will contract making the lumen smaller  ↑ resistance In the presence of histamine , warm temperature, the vessels will dilate  ↓ resistance

330. Anatomy & Physiology Refers to a change in heart rate A positive chronotropic effect refers to an increase in heart rate A negative chronotropic effect refers to a decrease in heart rate Refers to a change in the speed of conduction through the AV junction A positive dromotropic effect results in an increase in AV conduction velocity A negative dromotropic effect results in a decrease in AV conduction velocity Refers to a change in myocardial contractility A postive inotropic effect results in an increase in myocardial contractility A negative inotropic effect results in a decrease in myocardial contractility Chronotropic effect Dromotropic effect Inotropic effect Terminology

331. Basic Electrophysiology Primary Property Contractility Automaticity Conductivity Where Found Myocardium Electrical conduction system Primary Function Contraction and Relaxation Generation and conduction of electrical impulses Kinds of Cardiac Cells Myocardial cells Specialized cells of the electrical conduction system Myocardial Cell Types

332. Systemic circulation The aorta- leaves the left ventricle to form the ascending aorta, aortic arch, descending aorta, thoracic aorta and abdominal aorta The Vena cava ( superior and inferior) drains the whole body and returns the blood to the right atrium

333. Vascular System

334. Physiology of circulation Blood pressure is the measure of force exerted by blood against the blood vessel wall Measured by sphygmomanometer Normally BP is measured as systolic pressure and diastolic pressure PULSE PRESSURE = SP-DP

335. Physiology of circulation Capillary exchange Most exchange of gas and substances occur across the wall of the capillary Usually, the exchange is due to the filtration difference and diffusion

337. BP regulation Central Pons and medulla Sympathetic nervous system– Increases heart rate Parasympathetic nervous system (vagus)– decreases heart rate

338. BP regulation Baroreceptors Receptors sensitive to stretch located in the carotid sinuses and aortic arch ↓ stretch  reflex increase in heart rate  ↑BP ↑ stretch  reflex decrease in heart rate  ↓BP

339. BP regulation Hormonal Epinephrine  vasoconstriction  increased resistance  increased BP Angiotensinogen A1 Angiotensin 2 ADH  water reabsorption  ↑Blood volume  increased BP ANF  increase sodium excretion  increased urine  decreased blood volume  decreased BP blood lung

341. Fig. 13.22

342. Fetal circulation

344. Cardiac assessment Inspection Palpation of the apical pulse and PMI at the 5 th ICS LMCL Auscultation for the heart sounds S1 and S2 Auscultation for the heart valves TV MV PV AV

346. Fig. 13.23

347. Blood Blood is a special connective tissue Total blood volume is about 5 liters Blood is composed of two portions: 1. Formed elements- RBC, WBC, Platelets 2. Plasma- the liquid portion Hematocrit is the percentage of RBC per unit volume of blood

350. Fig. 11.2

352. The RED Blood Cell Non-nucleated cellular element in the blood Biconcave Transports Oxygen loosely bound to Hemoglobin Red pigment is due to hemoglobin Lifespan is 120 days Reticulocytes are immature RBC

353. Fig. 11.4

355. The Leukocytes or WBC Nucleated, larger than the RBC Divided into Granulocytes and Agranulocytes

356. The Leukocytes or WBC GRANULOCYTES Neutrophils- most abundant WBC, 60-70%. This is the first cell to arrive in injury/inflammation. Increased in bacterial infection In females, there is the presence of the Barr bodies, the condensed X chromosome

357. The WBC 2. Eosinophils- cell type that is capable of limited phagocytosis, with granules containing peroxidase. This is increased during parasitic and allergic reactions

358. The WBC 3. Basophils- a WBC that is capable of releasing Histamine, heparin and serotonin during anaphylaxis . The rarest type of WBC.

359. The WBC Agranulocytes: 1. Lymphocyte- second most abundant (next to neutrophils) Found increased in Viral infection and chronic infection. This can be: T-lymphocyte B-lymphocyte

360. The WBC Agranulocytes: T-lymphocyte - mediator of Cellular Immunity B-lymphocyte - mediator of Humoral immunity because this cell secretes ANTIBODIES when transformed into plasma cells.

361. The WBC 2. Monocyte- has kidney-shaped nucleus, a very large WBC that stays only for 2-3 days in the circulation. This becomes the MACROPHAGE in the tissues.

362. The Platelets Also called thrombocytes Smallest formed element, lifespan is 8-10 days Involves in clot formation Forms the platelet plug in an injured vessel Releases chemicals that can cause activation of the clotting mechanism

363. Table. 11.2

364. The Blood groups Blood types are grouped into A, B, AB and O based on the presence of the antigen on the surface of the RBC If antigen A is present, then the blood is type A If antigen B is present, then the blood is type B If antigen A and antigen B is present, then the type is AB If no antigen is present, then blood type is O

366. Fig. 11.11

367. The Blood groups Blood group A has Antibody B, that can react to blood type B and AB Blood group B has antibody A, that can react to blood type A and AB Blood group AB has no antibody Blood group O has no antigen, but has Both antibody A and B

369. Rh group Along with the ABO group, there is an Rh system in the blood The “D” antigen is the most prevalent A person with “D” antigen is Rh (+) A person with no “D” antigen is Rh (-) Most Filipinos are Rh (+)