ORGAN SYSTEM
A. INTEGUMENTARY SYSTEM
(a) Skin - protection, excretion (H2O, salt, organic waste), detection, maintenance of normal body temp., synthesis
(steriods, Vit D), storage (nutrients).
• epidermis (top layer) - provides mechanical protection
> stratum corneum
> stratum granulosum
> stratum spinusom > stratum basale
• dermis (second layer) > papillary layer - upper dermal region.
> reticular layer - deepest skin layer.
• subcutaneous layer(bottom layer) - adipose tissue.
(b) Hair - produced by a hair follicle, is a flexible epithelial structure.
~ Head - protects scalp from UV rays, cushions blows to the head, insulate the skull.
~ Nostrils/Ear Canals/Eyes - keep foreign particles and insects from entering.
• Vellus hairs - fine "peach fuzz" hairs located around the entire body.
• Terminal hairs - heavy, more deeply pigmented and sometimes curly hairs.
(c) Nails - protect the fingers and toes, help to pick up small object, composed of hard keratin. Nail body is the
visible nail, free edge of this is what we trim. Under the nail body is the nail bed. The whitish crescent on the nail is
the lunula(little moon). Portion of the skin grows onto the nail body is cuticle.
(d) Cutaneous Glands (exocrine glands) - release their secretions to the skin surface via ducts.
• sebaceous (oil) gland - produce an oily lipid that coats hair shaft and epidermis.
• sweat gland(sudoriferous) : eccrine gland - produce sweat
: apocrine gland - play a minimal role in thermoregulation
BURNS
A burn is tissue damage and cell death caused by intense heat, electricity, ultraviolet radiation (sunburn), or
certain chemicals.
first-degree burns, only the epidermis is damaged. The area becomes red and swollen, heal in two to three days
without scarring.
Second-degree burns involve injury to the epi dermis and the upper region of the dermis. The skin is red and
painful, and blisters appear.
Third-degree burns destroy the entire thickness of the skin, so these burns are also called full-thickness burns.
Infections and Allergies
Athlete s foot. An itchy, red, peeling condition of the skin between the toes, resulting from fungus infection. Also
called tinea pedis.
Boils and carbuncles. Inflammation of hair follicles and sebaceous glands, common on the dorsal neck.
Cold sores (fever blisters). Small fluid-filled blisters that itch and sting, caused by a herpes simplex infection.
Contact dermatitis. Itching, redness, and swelling of the skin, progressing to blistering.
Impetigo. Pink, water-filled, raised lesions (commonly around the mouth and nose) that develop a yellow crust and
eventually rupture
Psoriasis. A chronic condition, characterized by overproduction of skin cells that results in reddened epidermal
lesions cov ered with dry, silvery scales that itch, burn, crack, and sometimes bleed.
~ Hyperproliferation. characterized by increase in DNA synthesis and a markedly decreased turnover rate
for epidermis.
~ Abnormal Keratinocyte Differentiation. increased expressions of certain keratin and a delay in expression
of other keratin that are expressed in normally differentiating skin.
COMMON DRUGS FOR SKIN
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Clotrimazole (antifungal), ketoconazole (Nizoral), terbinafine (Lamisine AT) - ringworm & athlete's foot
Benzoyl Peroxide - acne
(Retinoids) Tazorac, Differin, Retin A - acne
Salicylic Acid - acne and warts
Anthalin, Clindamycin, mupirocin(antibacterial) - psoriasis
MECHANISM of SCAR FORMATION. The scarring is created by fibroblast proliferation, a process that begins with a
reaction to the clot. To mend the damage, fibroblasts slowly form the collagen scar.When the skin is wounded, the
tissues break, which causes a protein called collagen to be released. Collagen builds up where the tissue is
damaged, helping to heal and strengthen the wound.
NERVOUS SYSTEM. The nervous system maintains body homeostasis with electrical signals; provides forsensation,
higher mental functioning, and emotional response; and activates muscles and gland. Stimuli, and the gathered
information is called sensory input. It processes and interprets the sensory input and decides what should be done
at each moment a process called integration. It then effects, or causes, a response by activating muscles or glands
(effectors) via motor output.
a. Central Nervous System (CNS) consists of the brain and spinal cord.
b. Peripheral Nervous System (PNS) made up of cranial and spinal nerve.
> Sensory / afferent- nerve fibers
> Motor / efferent
: Somatic (voluntarily) skeletal muscles
: Autonomic(involuntarily) cardiac & smooth muscle glands.
>Parasympathetic and Sympathetic autonomic parts
ION CHANNELS IN NERVOUS SYSTEM
Proteins allowing charged particles to cross the membranes found in neurons and glia, where they are
involved in maintaining the electrochemical gradients that allow neurons to produce action potentials and neurons
and glia to release and recycle.
Resting membrane potential. the electrical potential difference across the plasma membrane when the cell is in a
non-excited state. Traditionally, the electrical potential difference across a cell membrane is expressed by its value
inside the cell relative to the extracellular environment.
Action Potential Initiation and Generation Many different types of stimuli excite neurons to become active and
generate an impulse. For example, light excites the eye receptors, sound excites some of the ear receptors, and
pressure excites some cutaneous receptors of the skin.
Propagation of the action potential. Depolarization of the first membrane patch causes permeability changes in
the adjacent membrane, and the events described in step are repeated. Thus, the action potential propagates
rapidly along the entire length of the membrane.
Cholinergic neurons produce ACH and store ACH in their synaptic terminals. The postganglionic neuron of the
parasympathetic division is also cholinergic. The postganglionic neuron for the sympathetic division is usually an
adrenergic neuron which means that it produces norepinephrine (NE) as its neurotransmitter.
Adrenergic receptors (adrenoceptors) are receptors that bind adrenergic agonists such as the sympathetic
neurotransmitter NE and the circulating hormone epinephrine (EPI). Cholinergic receptors, on the surface of cells
that get activated when they bind a type of neurotransmitter called acetylcholine. There are two types of
cholinergic receptors, called nicotinic and muscarinic receptors - named after the drugs that work on them.
INTEGRATION and CONTROL OF AUTONOMIC NERVOUS SYSTEM. It controls the function of many muscles, glands
and organs within the body. The brain stem with pituitary and pineal glands: The medulla is a subregion of the
brainstem and is a major control center for the autonomic nervous system. The hypothalamus acts to integrate
autonomic functions and receives autonomic regulatory feedback from the limbic system to do so.
The sympathetic nervous system is working at full speed not only when you are emotionally upset but also when
you are physically stressed. For example, if you have just had surgery or run a marathon, your adrenal glands
(activated by the sympathetic nervous system) will be pumping out epinephrine and norepinephrine.
Parasympathetic Nervous System. parasympathetic system conserves energy as it slows the heart rate, increases
intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract.
SEEING. The transparent inner neural layer of the retina contains millions of receptor cells, the rods and cones,
which are called photoreceptors because they respond to light. Electrical signals pass from the photoreceptors via
a two neuron chain bipolar cells and then ganglion cells before leaving the retina via the optic nerve as nerve
impulses that are transmitted to the optic cortex. The result is vision
SMELLING. The thousands of olfactory receptors, recep tors for the sense of smell, occupy a postage stamp size
area in the roof of each nasal cavity. Air entering the nasal cavities must make a hairpin turn to enter the
respiratory pas sageway below, so sniffing, which causes more air to flow superiorly across the olfactory receptors,
intensifies the sense of smell.
HEARING. EXTERNAL EAR- Sound entering the external acoustic meatus sets the eardrum into vibration. MIDDLE
EAR- Auditory ossicles transmit the vibratory motion from the eardrum to the oval window. The
pharyngotympanic tube allows pressure to be equalized on both sides of the eardrum. RECEPTORS of the
semicircular canals respond to the rotational body movements.
EQUILIBRIUM. STATIC- The maculae report on changes in the position of the head in space with respect to the pull
of gravity when the body is not moving. DYNAMIC- When your head moves in an arclike or angular direction, the
endolymph in the canal lags behind. Then, as the cupula drags against the stationary endolymph, the cupula bends
like a swinging door with the body s motion. This stimulates the hair cells, and impulses are transmitted up the
vestibular nerve to the cerebellum. Bending the cupula in the opposite direction reduces impulse genera tion.
When you are moving at a constant rate, the receptors gradually stop sending impulses, and you no longer have
the sensation of motion until your speed or direction of movement changes.
MECHANISM OF AQUEOUS HUMOR PRODUCTION AND OUTFLOW
Three mechanisms are involved in aqueous humor formation: diffusion, ultrafiltration and active secretion. Active
secretion is the major contributor to aqueous humor formation.The aqueous humor leaves the eye by passive flow
via two pathways - the trabecular meshwork and the uveoscleral pathway. Aqueous humor flows from the ciliary
body into the anterior chamber, out through a spongy tissue at the front of the eye called the trabecular
meshwork and into a drainage canal (dark blue region next to the trabecular meshwork).
DISEASES AND DISORDERS AFFECTING THE NERVOUS SYSTEM
Alzheimer's disease. Alzheimer's disease affects brain function, memory and behaviour.
Bell's palsy. Bell's palsy is a sudden weakness or paralysis of facial muscles on one side of the face.
Cerebral palsy. Affects the nervous sytem and muscle control, movement and coordination.
Epilepsy. Long term condition
Motor neurone disease (MND) . Causes weakness in the muscle, leading to paralysis
Multiple sclerosis (MS) . Chronic disease that affects central nervous system.
Neurofibromatosis. Manageable genetic condition characterized by benign tumor.
Parkinson's disease. Results from damage to nerve cell in the brain, which impacts the smooth control of muscle
and movement.
COMMON DRUGS FOR NERVOUS AND SPECIAL SENSES DISORDERS
Acamprosate tablets (Campral EC)
Adrenaline (epinephrine) for anaphylaxis (Emerade, EpiPen, Jext)
Agomelatine tablets (Valdoxan)
Almotriptan for migraine (Almogran)
Amantadine, Apomorphine for Parkinson's disease (APO-go, Dacepton)
Amisulpride (Solian)
Apomorphine for Parkinson's disease (APO-go, Dacepton)
CARDIOVASCULAR SYSTEM
ANATOMY: Cardiovascular System. This system has three main components: the heart, the blood vessel and the
blood itself. The heart is the system's pump and the blood vessels are like the delivery routes. Blood can be
thought of as a fluid which contains the oxygen and nutrients the body needs and carries the wastes which need to
be removed.
DIFFERENT STRUCTURES OF THE HEART
Valves
valves located in the heart: the atrioventricular valves (tricuspid and mitral) and the semilunar valves
(pulmonary and aortic).
Wall of the heart
The wall of the heart consists of three distinct layers—the epicardium (outer layer), the myocardium
(middle layer), and the endocardium (inner layer).
External surface of the heart
Interventricular sulci or shallow grooves : antrioventricular groove, along the line where the right atrium
and the right ventricle meet; it contains a branch of the right coronary artery). anterior interventricular
sulcus, runs along the line between the right and left ventricles and contains a branch of the left coronary
artery.
Chambers of Heart : atria (upper chamber) and ventricle ( lower chamber)
FUNCTION OF THE HEART
To serve as a muscular pump propelling blood into and through vessels to and from all parts of the body.
The heart functions as a double pump. The right heart is the pulmonary pump (right heart to lungs to left heart).
The left heart is the systemic pump (left heart to body tissues to right heart).
FLOW OF BLOOD THROUGH THE CHAMBERS OF THE HEART & SYSTEMIC PULMONARY CIRCULATION. Blood
enters the right atrium and passes through the right ventricle. The right ventricle pumps the blood to the lungs
where it becomes oxygenated. The oxygenated blood is brought back to the heart by the pulmonary veins which
enter the left atrium.
Pulmonary circulation moves blood between the heart and the lungs. It transports deoxygenated blood to the
lungs to absorb oxygen and release carbon dioxide. The oxygenated blood then flows back to the heart. Systemic
circulation moves blood between the heart and the rest of the body.
Systemic and pulmonary circulation transition to the opposite type of circulation when they return blood
to the opposite side of the heart.
ELEMENTS OF CARDIAC FUNCTION & MECHANISMS OF BLOOD PRESSURE CIRCULATION
Cardiac function elements: SA node, AV node, bundle of HIS, bundle branches, and Purkinje fibers.
In maintaining blood pressure in the body, the kidneys provide a hormonal mechanism for the regulation of blood
pressure by managing blood volume. The renin‐angiotensin‐aldosterone system of the kidneys regulates blood
volume. In response to rising blood pressure, the juxtaglomerular cells in the kidneys secrete renin into the blood.
PATHOPHYSIOLOGY OF HYPERTENSION & CONGESTIVE HEART FAILURE
Hypertension. Blood pressure is determined by the cardiac output balanced against systemic vascular resistance.
The process of maintaining blood pressure is complex, and involves numerous physiological mechanisms, including
arterial baroreceptors, the renin–angiotensin–aldosterone system, atrial natriuretic peptide, endothelins, and
mineralocorticoid and glucocorticoid steroids. Together, these complex systems manage the degree of
vasodilatation or vasoconstriction within the systemic circulation, and the retention or excretion of sodium and
water, to maintain an adequate circulating blood volume.
Dysfunction in any of these processes can lead to the development of hypertension. This may be through
increased cardiac output, increased systemic vascular resistance, or both.
Congestive Heart Failure. The pumping action of the healthy heart maintains a balance between cardiac output
and venous return. But when the pumping efficiency of the heart is depressed so that circulation is inadequate to
meet tissue needs, congestive heart failure (CHF) occurs.
COMMON DRUGS FOR REPRESENTATIVE CARDIOVASCULAR DISORDERS
Aldosterone inhibitors: Eplerenone (Inspra) and spironolactone (Aldactone)
Angiotensin II receptor blockers (ARBs): These are used to lower blood pressure for people with heart failure.
Beta-blockers: They block the effects of adrenaline (epinephrine)
Calcium channel blockers: These treat chest pain (your doctor may say “angina”) and high blood pressure.
Digoxin: It helps an injured or weakened heart to send blood through the body and work more efficiently.
Vasodilators: These relax your blood vessels so blood can flow more easily through your body.
Warfarin: This helps prevent clots from forming in your blood.
LYMPHATIC AND IMMUNE SYSTEM
Anatomy of Lymphatic System
The lymphatic system consists of lymph vessels, ducts, nodes, and other tissues. Around 2 liters of fluid leak
from the cardiovascular system into body tissues every day. The lymphatic system is a network of vessels that
collect these fluids, or lymph.
Function of the Body's First and Second line of Defense
First Line Defense: 1)Skin- its keratinized epidermis is a strong physical barrier to most microorganisms that swarm
on the skin. 2) Mucuos membrane- provide similar mechanical barriers within the body. 3)Secretions of skin and
mucous membranes.
Second Line Defense: 1)Phagocytic cells- (macrophages and neutrophils) engulf and destroy pathogens that
penetrate epithelial barriers. 2)Natural killer cells- lyse and kill cancer cells, virus-infected body cells, and some
other nonspecific targets well before the adaptive arm of the immune system is enlisted in the fight.
3)Antimicrobial proteins- broad-spectrum anti-infectives against a wide array of Gram-negative and Gram-positive
bacteria, mycobacteria, fungi, and enveloped viruses 4)The inflammatory responseProduction and Drainage of
lymph
[Production]Lymph is formed when the interstitial fluid is collected through tiny lymph capillaries, which are
located throughout the body. It is then transported through lymph vessels to lymph nodes, which clean and filter
it.[Drainage] Lymphatic vessels empty the lymph into the right lymphatic duct and left lymphatic duct (also called
the thoracic duct). These ducts connect to the subclavian vein, which returns lymph to your bloodstream. The
subclavian vein runs below your collarbone.
Process of antigen-antibody binding
With protein antigens, the antibody molecule contacts the antigen over a broad area of its surface that is
complementary to the surface recognized on the antigen. Electrostatic interactions, hydrogen bonds, van der
Waals forces, and hydrophobic interactions can all contribute to binding.
Process of Phagocytosis and inflammation
[Phagocytosis]1: Activation of Phagocytic cells and Chemotaxis. 2: Recognition of invading microbes. 3: Ingestion
and formation of phagosomes. 4: Formation of phagolysome.5: Microbial killing and formation of residual bodies.
6: Elimination or exocytosis.
Inflammatory response Protective leukocytes enter the area; fibrin walls off the area; and tissue repair occurs.
Mechanism of Immunity
Innate immunity is activated when cells use specialized sets of receptors (Pattern recognition receptor, PRR) to
recognize different types of microorganisms that have managed to penetrate the host. The mechanisms of innate
immunity provide the initial defense against infections.
Adaptive immunity is based on the special properties of lymphocytes which can respond selectively to thousands
of different non-self-materials, or 'antigens', leading to specific memory and a permanently altered pattern of
response - an adaptation to the animal's own surroundings.
Pathophysiology of Diseases and Disorders Affecting the Immune System
Rheumatoid arthritis (RA) systematically destroys joints. This effectively results in the body's immune system
attacking the tissues of the joints, causing pain and inflammation.Myasthenia gravis impairs communication
between nerves and skeletal muscles.
Multiple sclerosis (MS) destroys the white matter (myelin sheaths) of the brain and spinal cord.
Graves disease, in the the thyroid gland produces excessive amounts of thyroxine
Type 1 diabetes mellitus destroys pancreatic beta cells, resulting in deficient production of insulin.Systemic lupus
erythematosus (SLE), a systemic disease that occurs mainly in young women and particularly affects the
kidneys,heart, lungs, and skin
Glomerulonephritis, a severe impairment of kidney function
Common Drugs for Representative Immunologic Disorder
Leflunomide (Arava), methotrexate (Trexall), sulfasalazine (Azulfidine), minocycline (Minocin)- treatment for
Rheumatoid Arthritis.
Mycophenolate mofetil, azathioprine, rituximab, ciclosporin, tacrolimus- Immunosupressants; used for
Glumerulonephritis.
Prednisone, azathioprine, IV immunoglobulin (IVIg), plasmapheresis, and cyclosporine - for Myasthenia Gravis
(Anti-thyroid)propylthiouracil, methimazole (Tapazole)- for Graves Disease
[Rapid-acting insulin] insulin glulisine (Apidra), insulin lispro (Humalog) and insulin aspart (Novolog). [Long-acting]
insulin glargine (Lantus, Toujeo Solostar), insulin detemir (Levemir) and insulin degludec (Tresiba) - for Type 1
Diabetes
RESPIRATORY SYSTEM
Anatomy of the Respiratory System
Respiratory tract is divided into upper (organ outside thorax - nose, pharynx and larynx) and lower respiratory tract
(organ within thorax - trachea, bronchi, bronchioles, alveolar duct and alveoli).
Function of the Respiratory Passageway
Pharynx (throat): delivers air from your mouth and nose to the trachea (windpipe). Trachea: Passage connecting
your throat and lungs. Bronchial tubes: Tubes at the bottom of your windpipe that connect into each lung. Lungs:
remove oxygen from the air and pass it into your blood.
Process of Respiration
1) Pulmonary Ventilation- Movement of air in and out of the lungs passage (Thorax and Diaphragm).
2) External Respiration- Exchange of gases between air and blood at pulmonary capillaries (Alveoli).
3) Transport of gases through blood vessels- O2 and CO2 carried in blood associated with RBC's.
4) Internal Respiration- Exchange of gasses between blood and body cells at systemic capillaries. O2 out of the
blood, CO2 into the blood.
5) Cellular Respiration- Breakdown of molecules at mitochondria within cells to form ATP, this uses up oxygen and
produces CO2 as a by-product.
Process of Bronchodilation and Bronchoconstriction
[Bronchodilation] Sympathetic stimulation causes bronchodilation. During an asthma attack, the muscles that
encircle the airway tighten or constrict, limiting the flow of air to and from the lungs. The airway may also become
further inflamed and plugged with mucus.
[Bronchoconstriction] Parasympathetic stimulation causes bronchoconstriction. The bronchus, the pathwaymoves
air to and from your lungs. This muscle contraction causes the bronchus to narrow and restrict the amount of air
passing into and out of your lungs.
Pathophysiology of Respiratory Disorders
COPD (emphysema and chronic bronchitis) and lung cancer- significant cause is cigarette smoking.
Emphysema - characterized by permanent enlargement and destruction of alveoli. The lungs lose their elasticity,
and expiration becomes an active process.
Chronic bronchitis - characterized by excessive mucus production and its pooling in lower respiratory passageways,
which severely impairs ventilation and gas exchange. Patients may become cyanotic as a result of chronic hypoxia.
Lung cancer- extremely aggressive and metastasizes rapidly. The three most common lung cancers are squamous
cell carcinoma, adenocarcinoma, and small cell carcinoma.
Common Drugs for Representative Respiratory Disorders
Inhaled steroids, Combination inhalers, Oral steroids, Phosphodiesterase-4 inhibitors, Theophylline- for COPD,
chronic bronchitis
[Short-acting bronchodilators]albuterol (Proair HFA, Ventolin HFA), levalbuterol (Xopenex), ipratropium (Atrovent
HFA), albuterol/ipratropium (Combivent Respimat)- for emphysema
Carboplatin or cisplatin, Docetaxel (Taxotere)- for lung cancer
DIGESTIVE SYSTEM
Anatomy of the Digestive System
The digestive system consists of the alimentary canal (a hollow tube extending from mouth to anus) and
several accessory digestive organs. The wall of the alimentary canal has four main tissue layers mucosa,
submucosa, muscularis externa, serosa. The serosa (visceral peritoneum) is continuous with the parietal
peritoneum, which lines the abdominal cavity wall.
Process of Digestion, Absorption and Defecation
Ingestion. Food is taken into the mouth where it is physically broken down by the teeth into smaller pieces. The
presence of food in the mouth triggers a nervous reflex that causes the salivary glands to deliver a watery fluid
called saliva to the mouth.
Absorption. The simple molecules that result from chemical digestion pass through cell membranes of the lining in
the small intestine into the blood or lymph capillaries.
Defecation. Waves of muscular contraction (known as peristalsis) in the walls of the colon move fecal matter
through the digestive tract towards the rectum.
Process of Metabolism by the Liver
Liver cells remove nutrients from hepatic portal blood.
It performs glycogenesis, glycogenolysis, and gluconeogenesis to maintain homeostasis of blood glucose levels.
Its cells make blood proteins and other substances and release them to blood. Liver cells burn fats to provide some
of their energy (ATP).
Excesses are stored or released to blood in simpler forms.
Fats and cholesterol are transported in the blood by lipoproteins.
LDLs transport cholesterol to body cells;
HDLs carry cholesterol to the liver for degradation.
Pathophysiology of Digestive Disorders
GERD. The gastric refluxate is a noxious material that injures the esophagus and elicits symptoms. Esophageal
exposure to gastric refluxate is the primary determinant of disease severity. This exposure arises via compromise
of the anti-reflux barrier and reduced ability of the esophagus to clear and buffer the refluxate, leading to reflux
disease. However, complications and symptoms also occur in the context of normal reflux burden, when there is
either poor epithelial resistance or increased visceral sensitivity. Reflux therefore develops via alterations in the
balance of aggressive and defensive forces.
PEPTIC ULCER. a physiologic balance exists between gastric acid secretion and gastroduodenal mucosal defense.
Peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted.
HEMORRHOIDS are present in healthy individuals. Hemorrhoidal columns exist in utero. When these vascular
cushions produce symptoms, they are referred to as hemorrhoids. Hemorrhoids generally cause symptoms when
they become enlarged, inflamed, thrombosed, or prolapsed.
Common Drugs for Representative Digestive Disorders
Antacids, Histamine blockers, Histamine 2 (H2) blockers, Proton pump inhibitor- for GERD
Omeprazole (Prilosec), lansoprazole (Prevacid),pantoprazole (Protonix)- for Peptic Ulcer
Nifedipine ointment- treatment for hemorrhoids.
lidocaine cream (for hemorrhoids that are thrombosed)
ENDOCRINE SYSTEM
Functions of the Different Endocrine Glands
Hypothalamus Gland- produces multiple hormones that control the pituitary gland. It’s also involved in regulating
many functions, including sleep-wake cycles, body temperature, and appetite.
Pituitary gland- The hormones it produces affect growth and reproduction.
Pineal gland- important for sleep-wake cycles.
Thyroid gland - helps in metabolism.
Parathyroid gland - maintains control of calcium levels in your bones and blood.
Thymus gland- produces hormones important for the development of a type of white blood cell called a T cell.
Adrenal gland- produce hormones important for regulating functions such as blood pressure, heart rate, and stress
response.
Pancreas gland- controls blood sugar levels.
The Signaling System for Production of Hormones
Signals from distant cells are called endocrine signals, and they originate from endocrine cells. The ligands released
in endocrine signaling are called hormones, signaling molecules that are produced in one part of the body but
affect other body regions some distance away.
Hormones travel the large distances between endocrine cells and their target cells via the bloodstream, which is a
relatively slow way to move throughout the body. Because of their form of transport, hormones get diluted and
are present in low concentrations when they act on their target cells.
Pathophysiology of Endocrine Disorders
Type 1 diabetes is usually diagnosed in children and young adults. It develops when the body’s immune system
destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood
glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.
Polycystic Ovary Syndrome (PCOS). The endocrinologic abnormality of PCOS begins soon after menarche.
Chronically elevated luteinizing hormone (LH) and insulin resistance are 2 of the most common endocrine
aberrations seen in PCOS. The genetic cause of high LH is not known.
Osteoporosis. A metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not
compensated by osteoblastic bone formation. This causes bones to become weak and fragile, thus increasing the
risk of fractures.
Common Drugs for Representative Endocrine Disorders
Insulin - used to treat type 1 diabetes
metformin and clomiphene (Clomid), rosiglitazone (Avandia) - for Polycystic Ovary Syndrome(PCOS)
Alendronate (Fosamax), Risedronate (Actonel), Bisphosphonates- used for Osteoporosis
URINARY SYSTEM
Anatomy of Urinary System
Urinary system ( renal system or urinary tract) consists of the kidneys, ureters, bladder, and the urethra. The
purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure,
control levels of electrolytes and metabolites, and regulate blood pH.
Function of Renal System
Renal System filters blood and create urine as waste by-product, it produces, stores and eliminates urine, the
fluid waste excreted by the kidneys. The kidneys make urine by filtering wastes and extra water from blood. Urine
travels from the kidneys through two thin tubes called ureters and fills the bladder. Muscles in the ureter walls
tighten and relax to force urine down and away from the kidneys. The bladder's walls relax and expand to store
urine, and contract and flatten to empty urine through the urethra. The urethra duct that transmits urine from the
bladder to the exterior of the body during urination.
Process of Urine Formation
Filtration. During filtration, blood enters the afferent arteriole and flows into the glomerulus where filterable
blood components, such as water and nitrogenous waste, will move towards the inside of the glomerulus, and
nonfilterable components, such as cells and serum albumins, will exit via the efferent arteriole. These filterable
components accumulate in the glomerulus to form the glomerular filtrate.
Reabsorption. The next step is reabsorption, during which molecules and ions will be reabsorbed into the
circulatory system. The fluid passes through the components of the nephron (the proximal/distal convoluted
tubules, loop of Henle, the collecting duct) as water and ions are removed as the fluid osmolarity (ion
concentration) changes. In the collecting duct, secretion will occur before the fluid leaves the ureter in the form of
urine.
Secretion. During secretion some substances±such as hydrogen ions, creatinine, and drugs—will be removed from
the blood through the peritubular capillary network into the collecting duct. The end product of all these processes
is urine, which is essentially a collection of substances that has not been reabsorbed during glomerular filtration or
tubular reabsorbtion.
Mechanism for Acid-base Balance
The bicarbonate buffering system maintains optimal pH levels and regulates the carbon dioxide concentration that,
in turn, shifts any acid–base imbalance. Renal physiology controls pH levels through several powerful mechanisms
that excrete excess acid or base.
Role of Kidney in Drug Elimination
Kidney is responsible for drug biotransformation and excretion. kidneys degrade and remove medications
from the body. Drugs is excreted by the kidney by glomerular filtration (passive) or by tubular secretion (active).
They may also be reabsorbed from the filtrate across the renal tubular epithelial lining, usually by passive diffusion.
Some drugs are eliminated by excretion in the bile (a greenish yellow fluid secreted by the liver and stored in the
gallbladder).
Pathophysiology of Acute and Chronic Renal Failure
Chronic renal failure is caused by a progressive decline in all kidney functions, ending with terminal kidney
damage. During this time, there is modulation and adaptation in the still-functional glomeruli, which keeps the
kidneys functioning normally for as long as possible.
Acute kidney injury (AKI) is the leading cause of nephrology consultation and is associated with high mortality
rates. The primary causes of AKI include ischemia, hypoxia or nephrotoxicity. An underlying feature is a rapid
decline in GFR usually associated with decreases in renal blood flow.
Common Diuretics
Loop-acting diuretics, such as Bumex, Demadex, Edecrin or Lasix.
Potassium-sparing diuretics, such as Aldactone, Dyrenium or Midamor.
Thiazide diuretics, such as Aquatensen, Diucardin or Trichlorex.
REPRODUCTIVE SYSTEM
Anatomy of Reproductive System
The female reproductive tract is all located within the pelvis. It is made up of the vulva, the vagina, the cervix,
the uterus, the fallopian tubes and the ovaries. These organs are supported in the pelvis by ligaments. The vulva
refers to the external female genitalia.
The male reproductive system includes the penis, scrotum, testes, epididymis, vas deferens, prostate, and
seminal vesicles. The penis and the urethra are part of the urinary and reproductive systems.
Function of Male and Female Reproductive System
Male: .To produce, maintain, and transport sperm (the male reproductive cells) and protective fluid (semen) To
discharge sperm within the female reproductive tract during sex.
Penis — It contains the urethra, which carries both urine and semen. It is used for urinating and sexual intercourse.
Scrotum —It holds the testes in place.
Testes (or testicles) — They produce sperm and testosterone, which is the male sex hormone.
Epididymis —All sperm from the testes must pass through the epididymis, where they mature and start to ‘swim’.
Vas deferens — It carries sperm from the epididymis up to the prostate gland and urethra.
Prostate gland — It produces the fluid secretions that support and nourish the sperm.
Urethra — carries both urine and sperm.
Female: The function of the external female reproductive structures (the genitals) is to enable sperm to enter the
body and to protect the internal genital organs from infectious organisms.
Labia majora: The labia majora enclose and protect the other external reproductive organs.
Labia minora: They lie just inside the labia majora, and surround the openings to the vagina (the canal that joins
the lower part of the uterus to the outside of the body) and urethra.
Bartholin's glands: produce a fluid (mucus) secretion.
Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion.
Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body.
Uterus (womb): receives the fertilized egg and supports its development during pregnancy.
Ovaries: The ovaries produce eggs and hormones.
Fallopian tubes: serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus.
CONTRACEPTIVES with REPRODUCTIVE SYSTEM
Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is
placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting
pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate:
0.1-0.4%.
Copper T intrauterine device (IUD)—This IUD is a small device that is shaped in the form of a “T.” Your doctor
places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure
rate: 0.8%.
Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains
a progestin that is released into the body over 3 years. Typical use failure rate: 0.1%.
Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months from
their doctor. Typical use failure rate: 4%.
Combined oral contraceptives—Also called “the pill,” combined oral contraceptives contain the hormones
estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than
35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill.
Typical use failure rate: 7%.
Progestin only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one
hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same
time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%.
Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This
method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a
new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a
menstrual period. Typical use failure rate: 7%.
Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring
inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put
in a new ring. Typical use failure rate: 7%.
Pathophysiology of Reproductive Disorder
HIV is commonly transmitted via unprotected sexual activity, blood transfusions, hypodermic needles, and from
mother to child. Upon acquisition of the virus, the virus replicates inside and kills T helper cells, which are required
for almost all adaptive immune responses.
Sexually transmitted diseases (STDs) are transmitted via the mucous membranes of the vagina, penis, urethra or
rectum, during sexual contact with an infected individual. Transmission can also occur via membranes of the throat,
respiratory tract, mouth and eyes.
Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, veno-occlusive, psychogenic and/or
pharmacogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate (cGMP) or cyclic
aminophosphate (cAMP) pathway or other regulatory mechanisms including gap junction or ionic channel.
Chlamydia is unique among bacteria, having an infectious cycle and two developmental forms. These include the
infectious form called the elementary body (EB) and the reticulate body (RB). The EB is metabolically inactive and is
taken up by host cells. Within the host cell, the EB will differentiate into the metabolically active RB. The RB will
then use host energy sources and amino acids to replicate and form new EB, which can then infect additional cells.
C. trachomatis targets the squamocolumnar epithelial cells of the endocervix and upper genital tract in women,
and the conjunctiva, urethra, and rectum in both men and women.
The bacterium is transmitted through direct contact with infected tissue, including vaginal, anal, or oral sex,
and can even be passed from an infected mother to the newborn during childbirth.
Common Drugs for Representative Reproductive Disorders
chlamydia : azithromycin , doxycycline
HIV: Tenofovir alafenamide + emtricitabine, or TAF/FTC (Descovy) Tenofovir disoproxil fumarate + emtricitabine, or
TDF/FTC (Truvada) Tenofovir disoproxil fumarate + lamivudine, or TDF/3TC (Cimduo) Zidovudine + Lamivudine or
ZDV/3TC (Combivir)
STD: azithromycin, Doxycycline, Erythromycin and ofloxacin (Floxin).
Erectile Dysfunction: Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), Avanafil (Stendra)
The development of the organ systems, life stages, aging process, and genetics
The reproductive organs are developed from the intermediate mesoderm. The permanent organs of the adult
are preceded by a set of structures which are purely embryonic, and which with the exception of the ducts
disappear almost entirely before the end of fetal life.
Female life stages include premenarche (before the first menstrual period) stage; the reproductive,
premenopausal stage; the early menopausal transition stage; the late menopausal transition stage; and finally,
menopause.
Aging process in female occurs through menopause. The ovaries stop making the hormones estrogen and
progesterone.The ovaries also stop releasing eggs (ova, oocytes). After menopause, you can no longer become
pregnant. Your menstrual periods stop. Vaginal walls become thinner, dryer, less elastic, and possibly irritated.
Sometimes sex becomes painful due to these vaginal changes. Your risk of vaginal yeast infections increases. The
external genital tissue decreases and thins, and can become irritated.
In male, when a male gamete meets a female gamete, they can form a new organism. Sperm form when
certain cells in the male reproductive system divide by meiosis. When they grow older, males produce millions of
sperm each day.
Aging process in male, aging changes in the male reproductive system occur primarily in the testes. Testicular
tissue mass decreases. The level of the male sex hormone, testosterone decreases gradually. There may be
problems getting an erection. This is a general slowing, instead of a complete lack of function.
Genetic variability and epigenetic factors affect reproduction and fertility from gametogenesis to birth. The
human genome is contained within 23 pairs of chromosomes, each containing hundreds or thousands of genes.
The estimated 20 000 genes each make an average of three proteins.