SYLLABUS AND LECTURE OUTLINE
ANATOMY AND PHYSIOLOGY 2
FALL 2004
NAME __________________________________
TABLE OF CONTENTS
Syllabus
page 3
Chapter 18
The Endocrine System, 5
Chapter 28
The Reproductive Systems, 10
Chapter 29
Development, 16
Chapter 19
The Blood, 18
Chapter 20
The Heart,
Chapter 21
Blood vessels and hemodynamics,
Chapter 22
The Lymphatic System, nonspecific resistance to disease, & immunity, 29
Chapter 23
The Respiratory System, 35
Chapter 24
The Digestive System, 41
Chapter 25
Metabolism, 46
Chapter 26
The Urinary System, 49
Chapter 27
Electrolytes and acid base balance, 53
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Interesting facts:
 Adrenal glands produce the greatest number of hormones.
 Smallest endocrine gland is parathyroid.
 Largest pure endocrine gland is thyroid.
 Endocrine gland proportionately largest at birth is thymus.
 More babies are born between 3:00-4:00 a.m. than any other time of day.
 Sperms travel ≈ 3.5 mm/minute for a distance of ≈ 10 cm to site of fertilization.
 All the seminiferous tubules, laid end to end measure about a mile.
 The wt of a non-pregnant adult uterus is 28g while that of a pregnant uterus is
1kg.
 There are about 99,758 km of blood vessels in the body, the equivalent of
approximately 2.5 times around the world.
 The human heart creates enough pressure in the left ventricle to squirt blood 9.1
meters.
 Capillaries are 1/30th the diameter of a human hair … but all capillaries in the
human body, laid end to end = 96,000 km.
 It takes one minute for a blood cell to travel through the entire body.
 Human heart rate = 100,800 beats/day.
 Fetal heart starts beating during fourth week of pregnancy.
 Only artery that carries oxygen-poor blood is pulmonary artery.
 Lowest blood pressure is in the right atrium.
 Humans breathe 20 times per minute, over 10 million times per year and about
700 million times in a lifetime.
 Lungs are the only organs that float in water.
 The largest lung lies on the right side and has three lobes; the smaller left lung
has only two lobes.
 If you yelled for 8 years, 7 months and 6 days, you would have produced
enough sound energy to heat one cup of coffee.
 A sneeze creates a force of air moving nearly 160 km/h .
 It is impossible to sneeze with your eyes open.
 One cigarette shortens your life by 14 minutes
 The digestive system is a 9-meter-long tube, open at both ends.
 Every person has a unique tongue print.
 Surface area of small intestine is 60 square meters .
 Longest section of gut is small intestine (5 meters).
 Narrowest part of gut is esophagus.
 Widest part of gut is stomach.
 Most acidic substance in body is hydrochloric acid in stomach.
 The stomach has to produce a new layer of mucus every two weeks, otherwise it
will digest itself.
 The stomach can stretch to 50 times its empty size and hold 4 liters.
 Cells with shortest life span are epithelium of duodenum = 3 days.
 Greenest substance in the body = bile in the gall bladder.
 Source of most diverse mixture of digestive enzymes = pancreas.
 Section of gut with richest blood supply = jejunum of small intestine.
 The left kidney is higher than the right.
 All the renal tubules laid end to end = 60 meters.
 Yellow color of urine caused by pigment derived from bile.
 A male’s urethra is five times longer than a female’s.
 The most worm-like organ in the body is the ureter.
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ST. LOUIS COMMUNITY COLLEGE AT FLORISSANT VALLEY
BIOLOGY DEPARTMENT, MSET DIVISION
ANATOMY AND PHYSIOLOGY 2 (BIO:208-508 & BIO:208-509), FALL 2004
Instructor
Dr. Chaya Gopalan, PhD
Lecture
SM-265 BIO:208-508 9:00-9:50AM; BIO:208-509 11:00-11:50AM MWF
Office
SM-227
Phone
595 2392
e-mail
cgopalan@stlcc.edu
Web Page
http://users.stlcc.edu/cgopalan
Office Hours
MWF 8:00-9:00AM, 1:00-3:00PM; T 12:00-12:30PM, 2:30-3:00PM
Text
Fundamentals of Anatomy and Physiology, 10th ed. by Tortora and Grabowski.
Lab Manual
Lab manuals by Allen and Harper and Gopalan packaged with the text
Credit
Three Lectures and one Lab = 4 credit hours
Prerequisite
BIO-207
Course Objective
This course covers systemic study of the human body where endocrine, reproductive,
cardiovascular, respiratory, lymphatic, digestive, and urinary systems will be discussed.
Purpose
Anatomy and Physiology course is a prerequisite for majority of the allied health professions.
Honors
This course can be taken as an Honors credit course. Last day to sign up for honors is Oct. 15.
Fieldtrip
A fieldtrip to the cadaver lab at the Forest Park campus will be on Oct. 21.
Grading Scale: Ninety-100% is an A, 80-89% is a B, 70-79% is a C, 60-69% is a D, 59% and below is an F. Last day to
withdraw from regular semester course with a grade of "W" is Nov. 12. If a student is not successful in obtaining a passing
grade, an F will be automatically given. If the student is making progress but not being able to pass the course, the
student may request for a PR (progress reenroll) grade. Final grade is based upon the completion of the following
assignments. Each assignment carries the specific weight shown.
Number
1
2
3
4
Weight
15
15
15
15
Name
Lecture Test 1
Lecture Test 2
Lecture Test 3
Lecture Test 4
5
15
Final Exam (Lecture Test 5)
6
7
25
15
Lab Grade
Quizzes and other assignments
There will be 5 unit tests. Fifth test is also considered as the final exam, which is not a comprehensive exam. The total
number of points earned towards quizzes, class participation, and other assignments will be added up at the end of the
semester. If the weight of the extra credit work is more than your lowest test grade, extra credit grade will replace the
lowest test grade or a missed test.
Accessories: The Science and Math Learning Center (SM 246) has study guides, models, microscopes, slides, and
textbooks available for use and experienced tutors provide additional help.
ADA Statement: Any student in this class with a documented disability, who needs special testing arrangements, note
taking, or other accommodations, should feel free to discuss this with the instructor. All discussions will remain
confidential. No information will be shared without your permission.
Attendance: Lectures will include materials not found in the text, as well as elucidation of text materials. Thus, attendance
is very critical. Accurate records of attendance will be maintained. Attendance for lecture tests is required during your
scheduled date and time. If you could not be present for a scheduled test due to sickness or unavoidable circumstance,
contact your instructor as soon as possible. In such case, the instructor will give you another test at a mutually agreeable
time. If the student has not contacted the teacher prior to the test and does not attend a scheduled test and wants to take
the test at a later time, a test will be given and graded at 80% scale (20% points are cut). In case class is cancelled, the
test will be given at the next scheduled class period. Short quizzes, announced or unannounced, will be given regularly to
Gopalan, Fall 2004
3
check student progress and encourage regular study habits. No make up for quizzes or other in-class activities that
would contribute towards extra credit. Students are responsible to obtain handouts or important announcements
shared when they were absent either by contacting the instructor directly or through Blackboard or their classmates.
Cell phones must be turned off during class time.
Students are required to successfully complete both lecture and laboratory portions of this course in the same
semester. You must earn a lab grade of at least 50% in order to qualify for a passing grade in this course. Cell
phones must be turned off during class period.
TENTATIVE SCHEDULE
WEEK
LECTURE ASSIGNMENT
1
8/23-8/27
Chapter 18: The Endocrine System
2
8/30-9/3
Chapter 18: The Endocrine System continued
Chapter 28: The Reproductive Systems
3
9/6
9/8-9/10
9/13-9/15
9/17
NO SCHOOL, Labor Day Holiday
Chapter 28: The Reproductive Systems continued
Chapter 28: The Reproductive Systems continued
Chapter 29: Development
5
9/20
9/22-9/24
LECTURE TEST 1
Chapter 19: The Blood
6
9/27-10/1
Chapter 19: The Blood
Chapter 20: The Heart
7
10/4-10/8
Chapter 20: The Heart continued
8
10/11
10/13-10/15
LECTURE TEST 2
Chapter 21: Blood vessels
9
10/18
10/20
10/22
Chapter 21: Blood vessels
NO SCHOOL
Chapter 22: The Lymphatic System and Immunity
10
10/25-10/29
Chapter 22: The Lymphatic System and Immunity
continued
11
11/1-11/5
Chapter 23: The Respiratory system
12
11/8
11/10
11/12
Chapter 23: The Respiratory system Continued
LECTURE TEST 3
Chapter 24: The Digestive System
13
11/15-11/19
Chapter 24: The Digestive System continued
14
11/22
11/24
11/26
Chapter 25: Metabolism
LECTURE TEST 4
NO SCHOOL, Thanksgiving
15
11/29-12/3
Chapter 26: The Urinary System
16
12/6-12/10
Chapter 26: The Urinary System continued
Chapter 27: Fluid, Electrolyte, and Acid-Base
Homeostasis
17
12/13 or 12/17
Final Exams: Exact date and time will be
announced
4
Gopalan, Fall 2004
DATE
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Chapter 18
THE ENDOCRINE SYSTEM
Endocrine glands (page 587): Hormone, Hormone receptors: page 588
Chemical classes of Hormones (Table 18.2, page 591)Lipid-soluble hormones:
1. Steroids- eg. cortisol, testosterone, estrogens, and
progesterone.
2. Thyroid hormones: T3 and T4
Water-soluble hormones:
Amine hormones- eg. epinephrine (E), norepinephrine (NE),
and melatonin.
Peptide and protein hormones- eg. insulin, antidiuretic
hormone (ADH or vasopressin), thyroid-stimulating hormone
(TSH), oxytocin, growth hormone (GH), and prolactin.
Prostaglandins- local hormones that are important in many
physiological processes.
Hormone transportation- page 590.
MECHANISMS OF HORMONE ACTION
Action of lipid-soluble hormonesSteroid and thyroid hormones- hormone + receptor (within the cytoplasm
[steroid hormones] or the nucleus [thyroid hormones])  hormonereceptor complex  activates appropriate genes and stimulate the
production of enzymes or hormones other proteins (hormone effect) (Fig.
18.3, page 592).
Action of water-soluble hormones (Fig. 18.4, page 593)Peptide hormones- require a second messenger (eg. cAMP).
1. Hormone (first messenger) + receptor  G protein activation
2. Activated G protein stimulates an enzyme called adenylate cyclase
which converts ATP to cAMP (second messenger).
3. cAMP  enzyme activation  hormone effect. eg. E, NE, calcitonin,
PTH, pituitary hormones, and glucagon.
CONTROL OF HORMONE SECRETION (page 594)- Hormone secretion
is self-regulated by feedback control mechanisms.
HYPOTHALAMUS-secretes several releasing and inhibiting
hormones. These hormones act on the anterior pituitary to regulate the
secretion of pituitary hormones. The hypothalamus also produces two
hormones, oxytocin and ADH, which are stored in the posterior pituitary.
PITUITARY GLAND (Fig. 18.5, page 595)- two parts:
Anterior pituitary or adenohypophysis and
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Posterior pituitary or neurohypophysis.
Hypothalamo-hypophyseal portal system- connects the hypothalamus
and the anterior pituitary (Fig. 18.5, page 595) and
Hypothalamo-hypophyseal tract- connects the hypothalamus with the
posterior pituitary (Fig. 18.8, page 601).
Posterior pituitary (Table 18.5, page 602)- stores and releases two
hormones:
1. Oxytocin- important in the contraction of the uterus during childbirth
and release of milk from mammary glands during lactation (page
600).
2. Antidiuretic hormone (ADH or vasopressin) (Fig. 18.9, page 602)regulates fluid balance in the body.
Diabetes insipidus- ADH deficiency.
Anterior pituitary (Table 18.3-18.4, page 596, 600)- secretes
1. Human Growth Hormone (hGH or somatotropin)- stimulates body
growth by increasing uptake of amino acids by the cells and by
stimulating protein synthesis (Fig. 18.7, page 598).
Regulation of hGH secretion: GHRH  hGH; GHIH  hGH.
DwarfismGigantismAcromegaly- oversecretion of hGH in adulthood.
2. Prolactin- mammary glands to produce milk during lactation (page
599).
Control of prolactin secretion: Prolactin-inhibiting hormone (PIH) 
PRL.
3. Thyroid-stimulating hormone (TSH)-  secretion of T3 and T4
Control of TSH secretion: TRH  TSH.
4. Adrenocorticotropin (ACTH)-  secretion of glucocorticoids
Control of ACTH secretion: CRH  ACTH.
Gonadotropins:
5. Follicle-stimulating hormone (FSH)
6. Luteinizing hormone (LH)
Will be discussed along with reproductive hormones in chapter 28.
THYROID GLANDAnatomy (Fig. 18.10, page 603)- isthmus, thyroid follicles, colloid,
thyroglobulin.
Thyroid follicles secrete two hormones: triiodothyronine (T3) and
thyroxine (T4).
Synthesis of thyroid hormones (Fig. 18.11, page 604)1. Iodide trapping
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2. Iodide >iodine
3. Addition of iodine to tyrosine to form T3 and T4.
Functions- Calorigenesis-  cellular respiration  fuel consumption 
oxygen consumption  body temperature.
Control of thyroid hormone secretion- TRH  TSH T3 and T4 (Fig.
18.12, page 605).
Cretinism- hypothyroidism during infancy.
Goiter- an enlarged thyroid gland.
Myxedema- adult hypothyroidism.
Graves’ disease- hyperthyroidism.
The C cells of the Thyroid gland: Calcitonin- produced by the thyroid
gland in response to increased Ca++ level in the blood (Table 18.6, page
606).
PARATHYROID GLANDS- secrete parathyroid hormone (PTH) or
parathormone that regulates calcium level in the blood (Fig. 18.13, page
607).
Regulation of secretion of calcitonin and PTH (Fig. 18.14, page 608) Ca++  calcitonin;  Ca++  PTH.
THE ADRENAL GLANDS- The gland is organized into two regions:
cortex and the medulla (Fig. 18.15, page 609).
The adrenal Cortex- secretes mineralocorticoids, glucocorticoids and sex
steroids. The cortex can be subdivided into three zones:
Zona glomerulosa: mineralocorticoids (aldosterone)
Zona fasciculata: glucocorticoids (cortisol)
Zona reticularis: sex steroids.
Aldosterone- main mineralocorticoid. Helps maintain sodium and
potassium balance and indirectly regulates body fluid volume and blood
pressure.
Regulation of aldosterone secretion- Renin-angiotensin pathway
(Fig. 18.16, page 611)-  Blood volume  blood pressure  renin. Renin
converts angiotensinogen  angiotensin I  angiotensin II 
aldosterone.
Cortisol- major glucocorticoid. Promotes
1. Glucose synthesis and glycogen formation in the liver
2. Lipolysis
3. Protein catabolism and
4. Antiinflammatory effect.
Regulation of Cortisol secretion (Fig. 18.17, page 591)CRH  ACTH  cortisol. Stress  CRH secretion.
Addison’s disease-  glucocorticoids.
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Cushing’s disease-  glucocorticoids.
Sex steroids- congenital adrenal hyperplasia.
The adrenal medulla- secretes epinephrine (E) and norepinephrine (NE)
which prepare the body to cope with stress (Fig. 18.15, page 610).
THE PANCREAS: THE ISLETS OF LANGERHANS Fig. 18.18, pages
615)- produce two major hormones:
1. Insulin-  blood glucose level, storage of glucose (in the form of
glycogen or fat), amino acids and fatty acids within the cells; 
protein synthesis.
2. Glucagon-  blood glucose level; mobilization of glucose
(glycogenolysis), fatty acids, and amino acids (gluconeogenesis).
HypoglycemiaHyperglycemia: Diabetes mellitus-  glucose level in the blood.
Two types:
Type I or insulin-dependent diabetes mellitus.
Type II or non-insulin-dependent diabetes mellitus.
Pineal gland- secretes a hormone called melatonin (page 618).
REVIEW QUESTIONS
1. What are glands? What are the two main types of glands? How are they different from
one another?
2. What are endocrine glands?
3. What is a hormone?
4. List all the endocrine glands in the body and their locations.
5. What are the two classes of hormones? How many subtypes in each group and give
examples.
6. What are prostaglandins? What are they made of? Give examples of prostaglandins and
some of their functions.
7. How are hormones transported from the place of secretion to the target structure?
Describe the mechanism of action of lipid-soluble hormones.
8. Describe the mechanism of action of peptide (or protein) hormones or catecholamines.
9. What are second messengers? Give an example of a second messenger.
10. How is hormone secretion controlled?
11. Which feed back regulation mechanism of hormone secretion is more common: positive
or negative?
12. List all the releasing and inhibiting hormones that the hypothalamus secretes. How are
they transported to the anterior pituitary gland?
13. Name the pituitary hormones that are controlled by various releasing and inhibiting
hormones of the hypothalamus.
14. Which two hormones are secreted by the hypothalamus (other than the releasing and
inhibiting hormones)?
15. How is the hypothalamus connected to the posterior pituitary gland?
16. Describe the role of vasopressin (antidiuretic hormone or ADH) in the body. Where does
it act and which mechanism mainly controls the secretion of vasopressin?
17. What is diabetes insipidus?
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Describe the role of oxytocin in the body.
List all the hormones secreted by the anterior pituitary and their target structures.
Describe the role of growth hormone in the body. How is its release controlled?
What condition results from hypersecretion of growth hormone during childhood?
What condition results from undersecretion of growth hormone during childhood?
What condition results from hypersecretion of growth hormone in an adult?
What is the importance of thyroid-stimulating hormone (TSH or thyrotropin) in the body?
How is the secretion of TSH controlled?
What are gonadotropins? Name the two gonadotropins secreted by the anterior pituitary
gland.
Name the target organs for follicle-stimulating hormone (FSH) and luteinizing hormone
(LH) in the male and in the female.
Describe the role of prolactin in the body.
How is prolactin secretion controlled?
Describe the structure of the thyroid gland.
List the hormones secreted by the thyroid gland.
Which cells produce calcitonin? Where are they found?
Which cells synthesize thyroxine (tetraiodothyronine or T4) and triiodothyronine (T3)?
How is T3 and T4 made? What purpose does iodine serve in the thyroid gland?
How is T3 and T4 released into blood? How are these hormones transported in the
blood?
Describe the calorigenic effect of T3 and T4.
How is T3 and T4 secretion controlled?
Define cretinism, myxedema, Graves’ disease, and goiter. How can these situations be
corrected?
What is the role of calcitonin in the body?
What controls the secretion of calcitonin?
Describe the structure and the location of parathyroid glands.
Name the hormone secreted by parathyroid glands and its importance in the body.
What controls the secretion of parathyroid hormone?
Describe the structure of the adrenal gland.
Where are adrenal glands located?
What are the three zones of the adrenal cortex? Which hormone is secreted by which
zone?
Name the major mineralocorticoid.
What is the importance of aldosterone in the body?
Describe renin-angiotensin-aldosterone pathway.
How is aldosterone secretion controlled?
Describe the actions of hydrocortisone or cortisol.
Describe the antiinflammatory effects of cortisol.
Define Addison’s disease, Cushing’s syndrome, and congenital adrenal hyperplasia.
List the hormones secreted by the adrenal medulla and their effects on the body.
Name the endocrine structure of the pancreas.
What is the importance of alpha or A cells?
What is the importance of beta or B cells?
Name the pancreatic hormones that regulate blood glucose level.
Describe the regulation of secretion of glucagon and insulin.
How does insulin control blood glucose level?
How does glucagon control blood glucose level?
What is diabetes mellitus? What are the two main types of diabetes mellitus?
Define polyuria, polydipsia, and polyphagia.
Define hypoglycemia.
Name the hormone secreted by the pineal gland and its role in the body.
Gopalan, Fall 2004
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Chapter 28
THE REPRODUCTIVE SYSTEMS
MALE REPRODUCTIVE SYSTEM- consists of testes, epididymis,
ductus deferens (vas deferens), ejaculatory duct, and the urethra (Fig.
28.3, page 1016). The scrotum encloses the testes and penis is an
erectile organ.
Accessory reproductive glands are seminal vesicles, prostate gland,
and bulbourethral (Cowper’s) glands.
THE SCROTUM- is the outpocketing of the abdomen (Fig. 28.4, page
1018).
Dartos and Cremaster musclesThe spermatic cord (page 1024)Descent of the testes- testes move from the abdominal cavity through
the inguinal canal to the scrotum under the influence of testosterone.
Cryptorchidism (page 1017)Inguinal HerniaTesticular torsionTESTES (page 1014)- are primary male sex organs.
Structure- lobules, seminiferous tubules: Sertoli cells & spermatogenic
cells: spermatogonia, primary spermatocytes, secondary spermatocytes,
spermatids, and sperms.
Sertoli or sustentacular cells- are large cells found within the
seminiferous tubules. Tight junctions at the base forms blood-testis
barrier. Germ cells (spermatocytes) pass between adjacent Sertoli cells
to lumen. Sertoli cells secrete inhibin that inhibits FSH secretion and
androgen-binding protein (ABP) that helps testosterone bind to within the
seminiferous tubule. They also secrete mullerian-inhibiting factor (MIF) in
the developing testes.
Cells of Leydig or interstitial cells- are found outside the seminiferous
tubules and secrete androgens.
SPERMATOGENESIS- is the formation of sperm (Fig. 28.6, page 1020).
Spermatogonia (2n, stem cells in the wall of the seminiferous tubules)
 differentiation
primary spermatocyte (2n)
 meiosis I
2 secondary spermatocytes (n)
 meiosis II
4 spermatids (n)
 spermiogenesis (differentiation)
4 spermatozoa (sperms) (n)
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Structure of the sperm- 3 parts: head, midpiece and a tail. Acrosome,
present at the tip of the head, is important in the process of fertilization
(Fig. 28.8, page 1021).
Hormonal regulation- GnRH (hypothalamus)  LH and FSH (anterior
pituitary). FSH  spermatogenesis. LH acts on Leydig cells and 
androgen secretion (Fig. 28.9, page 1022).
EFFECTS OF ANDROGENS- differentiation of the male genitals and
reproductive duct system, descent of the testes, puberty, maintenance of
spermatogenesis, accessory sex organs, secondary sexual
characteristics, and initiating and maintaining normal male sexual
behavior.
DUCTS OF THE TESTES
Sperm from the seminiferous tubules  epididymis.
EPIDIDYMIS (page 1023)- consists of a head, body, and a tail. Stores
sperms and facilitate their functional maturation. Recycles damaged
sperms and also monitor and adjust the composition of the tubular fluid.
VAS DEFERENS OR DUCTUS DEFERENS (page 1024)- transfers
sperms from the epididymis to the ejaculatory duct and also store
sperms.
Ampulla- enlarged end of ductus deferens.
VasectomyEJACULATORY DUCTS- vas deferens from each side + the duct from
the seminal vesicles  ejaculatory duct.
URETHRA (page 1024)- is divided into three portions: the prostatic,
membranous, and penile or spongy urethra. It is the passageway used
by both the urinary and reproductive systems.
ACCESSORY REPRODUCTIVE GLANDS
SEMINAL VESICLES- secrete fluid medium for the transport of sperms
(page 1024).
PROSTATE GLAND- secretes an acidic milky fluid (page 1025).
Prostate cancerBULBOURETHRAL GLANDS OR COWPER'S GLANDS- neutralize the
acidity of the urethra in preparation for ejaculation (page 1026).
SEMEN- consists of sperms and secretions from the male reproductive
glands (page 1026).
Semen analysisPENIS (Fig. 28.12, page 1027)- is divided into three regions: the root,
body, and glans penis.
The penis also consists of three columns of erectile tissue.
Corpora cavernosaCorpus spongiosum- expands to form a cap called the glans penis.
Dilation of the erectile tissue with blood produces erection.
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A loose fold of skin called the prepuce or foreskin covers the glans
penis.
Circumcision (page 1027)-
FEMALE REPRODUCTIVE SYSTEM consists of the ovaries, uterine
tubes (fallopian tubes), uterus, vagina, and external genitalia (Fig. 28.13,
page 1028).
OVARIES- are primary female sex organs.
Ligaments- mesovarium, broad, suspensory, and ovarian ligament.
Ovarian Histology (Fig. 28.15, page 1031)- tunica albuginea, stroma:
cortex and medulla. Ovarian follicles: primary, secondary, and tertiary
(Graafian) or mature follicles.
Structure of the primary, secondary, and tertiary follicles- granulosa
cells, zona pellucida, theca externa, theca interna, follicular fluid, antrum,
and corona radiata:
OOGENESIS (Fig. 28.17, page 1032)- is the production of a secondary
oocyte (growing ovum).
OOGONIA- are diploid cells that complete their mitotic division before
birth and produce primary oocytes. Primary oocytes begin their meiosis
but stop at prophase of meiosis I. The small, round structure that
contains primary oocyte is referred to as a primary follicle.
PUBERTY- primary follicles secondary follicles  Graafian follicle.
Primary oocyte  secondary oocyte and first polar body. The secondary
oocyte is suspended in metaphase II.
OVULATION- is the release of secondary oocyte.
Oogonia (diploid cells formed during prenatal life)

primary oocyte (during 3rd month of prenatal development; diploid)
 puberty (meiosis I)
secondary oocyte (haploid) + 1st polar body
ovulation
secondary oocyte released into the fallopian tube.
 fertilization > meiosis II
ovum (haploid) + 2nd polar body.
Corpus Luteum- is the ruptured follicle that becomes a new endocrine
gland. It secretes progesterone and estrogens, which control changes in
the accessory sex organs in the second half of menstrual cycle, and
prepares the endometrium for the reception of a fertilized ovum.
Corpus Albicans- degenerated, nonfunctional corpus luteum.
UTERINE OR FALLOPIAN TUBES (Fig. 28.18, page 1034)- fimbriae,
ampulla:
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Peristaltic contractions and the ciliated epithelium help move the
secondary oocyte through the uterine tubes. Fertilization occurs within
the fallopian tube. If there is no fertilization, secondary oocyte
degenerates in this tube.
UTERUS- is divided into the fundus, body, and cervix. Isthmus marks the
junction of the cervix and the body.
Histology of the uterus (Fig. 28.20, page 1036):
The wall of the body and fundus of the uterus consists of three layers:
Endometrium- basal layer (stratum basalis) and functional layer
(stratum functionalis).
Myometrium- a very thick layer that is made up of layers of smooth
muscle.
Perimetrium or serosa- thin layer of connective tissue.
Endometriosis- growth of endometrial tissue outside the uterus.
Uterine prolapsePap smearHysterectomyVAGINAVULVA OR PUDENDUM (external genitalia)- consists of vestibule, labia
minora (labium minus), clitoris, prepuce, labia majora and mons pubis
(Fig. 28.22, page 1038).
Perineum (Fig. 28.23, page 1039): episiotomyMAMMARY GLANDS (Fig. 28.24, page 1040)- are the organs of milk
production (lactation). Nipple (papilla), areola, lobes, lactiferous duct,
lactiferous sinus, lobule, and alveoli.
Breast cancerMenarcheFEMALE REPRODUCTIVE CYCLE (Fig. 28.28, page 1046)- is divided
into three phases:
1. Menstrual phase- degeneration of the functional layer of the
endometrium.
2. The proliferative phase or preovulatory phase or follicular
phase- formation of the Graafian follicle in the ovary and
reorganization of the functional layer of the endometrium.
3. The secretory phase or postovulatory phase or luteal phaseformation of the corpus luteum within the ovary and thickening of
the functional layer of the endometrium.
Gopalan, Fall 2004
13
Hormones and the preovulatory period (page 1044)1. GnRH FSH + LH growth of the follicle  estrogens.
2. About the 12th or the 13th day, due to prolonged high level of
estrogens  GnRH (positive feedback effect).
3. A sudden surge of LH + FSH  ovulation (Fig. 28.27, page 1044).
Hormones and the Postovulatory period in a nonpregnant cycle
(page 1045)- The remaining Graafian follicle  corpus luteum.
Enlargement of the corpus luteum  more progesterone + estrogens 
continued thickening of the endometrium. High concentration of
estrogens and progesterone  GnRH  LH + FSH.
On day 22 or 23 of the cycle, corpus luteum involutes.  estrogens and
progesterone  arteries in the uterine wall constrict + endometrium
becomes ischemic. Damaged arteries rupture and bleed and cells die 
the functional layer of the uterus is detached and discarded
(menstruation).
 estrogens and progesterone GnRH and the cycle starts again.
Amenorrhea- no menstruation until age 16 (page 1045).
Menopause-  responsiveness to LH and FSH by the ovaries estrogen
and progesterone  irregular ovarian cycle  regression of reproductive
structures.
REVIEW QUESTIONS
1. Name the organs of the male reproductive system.
2. What is the importance of dortos and cremaster muscles? Where do you find these muscles?
3. What is cryptorchidism? Can it be corrected?
4. What are seminiferous tubules? Why are they present?
5. Define and describe each step in spermatogenesis.
6. What are sustentacular or Sertoli cells? Where are they present and how are they important?
7. Where are Leydig cells (interstitial cells) present? What is their function?
8. What is spermiogenesis?
9. Describe the structure of a sperm.
10. What is the importance of acrosome?
11. Summarize the hormonal regulation of spermatogenesis.
12. List the effects of testosterone in the male.
13. Describe the accessory structures of male reproductive system.
Gopalan, Fall 2004
14
14. What is the importance of the epididymis?
15. What is the importance of ductus (vas) deferens?
16. What is inguinal hernia?
17. Ejaculatory duct is formed by the fusion of which two structures?
18. What are the three parts of the urethra?
19. Name the accessory reproductive glands in the male.
20. What is the function of seminal vesicles?
21. What is the function of prostate gland?
22. What is the function of bulbourethral or Cowper’s glands?
23. Describe the composition of semen.
24. Describe the structure of the penis.
25. What is circumcision?
26. Name the primary organs of female reproductive system.
27. To which structures do the mesovarium, ovarian ligament, and suspensory ligament anchor
the ovary?
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Describe the structure of ovary.
What structures in the ovary contain endocrine tissue and what hormones do they secrete?
What happens to most ovarian follicles?
Follow the growth cycle of an ovarian follicle from the time it is formed to the time it is
disintegrated as corpus albicans (ovarian cycle) in a nonpregnant woman.
Describe the structure of a mature (Graafian) follicle.
Define ovulation.
When is meiosis completed in the oocyte?
Describe the structure and function of the uterine (fallopian) tube.
What are the three parts of the uterus?
What are the three layers in the wall of the uterus?
What are the two layers of the endometrium? Which one is shed during menstruation?
Define episiotomy, hysterectomy, endometriosis, and uterine prolapse.
Describe the structure of a mammary gland.
What hormones regulate milk synthesis and release?
Name the functions of the female reproductive hormones.
Summarize the uterine cycle.
Summarize the relation between GnRH, LH, FSH, estrogens, and progesterone in the
ovarian and uterine cycles.
Which hormones stimulate proliferation of the endometrium? Ovulation? Growth of the corpus
luteum? The surge of LH at midcycle?
Which hormones stimulate rebuilding of the stratum functionalis (functional layer of the
endometrium)?
Define preovulatory phase (proliferative) & postovulatory (luteal) phase.
Define menstruation.
When does ovulation occur in a typical menstrual cycle?
Define menarche, amenorrhea, and menopause.
Gopalan, Fall 2004
15
Chapter 29
DEVELOPMENT
Fertilization- is the fusion of the sperm and the ovum producing a
zygote (Fig. 29.1, page 1064).
Capacitation- changes that occur in the sperm as it passes through the
female reproductive tract before it reaches the secondary oocyte (page
1063).
Multiple births (page 1064)1. Identical twins (monozygotic)
2. Conjoined or Siamese twins
3. Fraternal (dizygotic) twins.
Cleavage (Fig. 29.2, page 1065)- zygote  morula (day 4)  blastocyst
(day 6).
The cells of the blastocyst are arranged into a peripheral layer called the
trophoblast and an inner group known as the inner cell mass. The fluid
filled space is called blastocele. Zona pellucida disintegrates and the
blastocyst enlarges.
Implantation (Fig. 29.3, page 1066)- trophoblast cells of the embryo on
the side of implantation differentiate and form two distinct cell
populations: the inner cytotrophoblast and the outer
syncytiotrophoblast: villi.
Eighth day after fertilization: cytotrophoblast proliferates and form
amnion adjacent to the inner cell mass. Inner cell mass at this stage is
called embryonic disc. It has two layers: ectoderm and endoderm.
Twelfth day after fertilization: cells of the endoderm form yolk sac.
Embryonic developmentGastrulation (14day)- results in the formation of three distinct layers:
ectoderm, endoderm, and mesoderm. The layer of the inner cell mass
that lines the blastocele develops into the embryonic disc > embryo.
Extraembryonic membranes- four membranes: yolk sac, amnion,
chorion, and allontois.
Placentation (third week)- endometrium > decidua: decidua basalis,
capsularis, perietalis. Chorionic villi extend outward into the maternal
tissues, forming a network through which maternal blood flows.
GestationMaternal changesHormones of pregnancy- hCG, relaxin, estrogens, progesterone,
prolactin and oxytocin.
Labor (Parturition)- childbirth.
Dilation stageExpulsion stage- childbirth.
Placental stage- ‘afterbirth’.
Gopalan, Fall 2004
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REVIEW QUESTIONS
1. Define fertilization.
2. Define capacitation.
3. Define the terms: dizygotic (fraternal), monozygotic (identical), and conjoined twins.
4. What is a zygote? How and when is it formed?
5. What is a morula? When is it formed?
6. What is a blastocyst? When is it formed? How is it different from the morula?
7. Define implantation. How does it occur? In which phase of the uterine cycle does the
implantation occur?
8. What is gastrulation? When does it occur?
9. How is the embryo formed? Which cells of the blastocyst give rise to the embryonic disc?
10. What are the four extraembryonic membranes? What is their importance?
11. Describe placentation. Which part of the decidua helps form the maternal part of the
placenta?
12. What is the function of the placenta?
13. List the hormones that are involved in pregnancy and their role in pregnancy.
14. Which hormone serves as the basis of early pregnancy tests? Why?
15. Define labor. What are the three stages of labor?
Gopalan, Fall 2004
17
Chapter 19
THE BLOOD
FUNCTIONS- transportation, regulation of pH and electrolyte
composition, (page 634).
Physical characteristics of blood (page 634)Volume- 5 L.
Venipuncture and arterial puncture:
pH- 7.35 and 7.45.
ViscosityCOMPONENTS OF THE BLOOD (Fig. 19.1, page 635)
BLOOD PLASMA- is the fluid matrix of blood. Contains about 91%
water, about 7% protein and varying amounts of inorganic and organic
substances (Table 19.1, page 636).
Plasma proteins- three types: albumins- 54%, globulins- 38% and
fibrinogen- 7%.
Serum- plasma without its clotting factors.
FORMED ELEMENTS are blood cells and fragments suspended in the
plasma.
Hematocrit- Percentage of whole blood occupied by formed elements.
Hemopoiesis or Hematopoiesis- formation of blood cells (Fig. 19.3,
page 638).
Red blood cells (RBC) or erythrocytes (Fig. 19.4, page 640)Structure- biconcave discs; lack nuclei and mitochondria; life span: 120
days; contain hemoglobin.
Hemoglobin- the oxygen-carrying pigment that gives the RBC and the
blood red color.
Structure of a hemoglobinErythropoiesis: production of RBCs.
Anemia- Sickle cell anemiaPernicious anemiaIron-deficiency anemiaAplastic anemiaThalassemiaLIFE CYCLE OF RBCs (Fig. 19.5, page 641)1. Globin2. Iron- transferrin: ferritin and hemosiderin.
3. Heme units- heme  biliverdin  bilirubin  conjugated bilirubin 
urobilinogens and stercobilinogens  urobilin and stercobilin.
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White blood cells (WBC) or leukocytes- defend the body against
disease-causing agents. Exhibit chemotaxis and diapedesis (Fig. 19.8,
page 644).
WBCs are classified into two groups (Fig. 19.7, page 643):
1. Granular leukocytes- include neutrophils, eosinophils, and
basophils.
2. Agranular leukocytes- include monocytes and lymphocytes.
LeukocytopeniaLeukocytosisPlatelets or thrombocytes- are not complete cells. They are tiny
fragments of membrane-enclosed cytoplasm that are pinched off from
megakaryocytes, giant cells in the bone marrow. Half-life: 4 days;
important in blood clotting.
ThrombocytopeniaHemostasis (page 647)- arrest of bleeding. Three phases:
1. Vascular spasm- vasoconstriction.
2. Platelet plug formation- damage to endothelium of blood vessels
exposes collagen, platelets stick to collagen, release ADP + serotonin +
thromboxane A2 vasoconstriction (Fig. 19.9, page 647).
ADP and thromboxane A2 cause additional platelets to aggregate at the
site of injury producing a platelet plug.
3. Clotting (Fig. 19.11, page 649)Clotting factors- Ca++ + 11 different proteins. Except for a few which are
made by the activated platelets, all others are made by the liver and are
in circulation.
Vitamin K- stimulates the synthesis of four of the coagulating factors.
Extrinsic pathway- damaged tissues release a chemical called
thromboplastin that initiates a shortcut to the production of a clot. Since
this chemical is not part of blood, it is called the extrinsic pathway.
Thromboplastin and calcium ions together activate factor X which in the
presence of factor V forms prothrombinase.
Intrinsic pathway- This pathway produces clot without any external
chemicals other than the blood components (no thromboplastin).
Activation of one type of clotting factor activates another and another and
eventually form prothrombinase.
Common Pathway- prothrombin  thrombin. Thrombin converts
fibrinogen to fibrin  CLOT FORMATION.
Clot retraction- tightening of the fibrin clot.
Control of Clot formation- anticoagulants prevent coagulation.
Fibrinolysis- Plasminogen  plasmin (fibinolysin)  dissolves blood clot.
Anticoagulants- Antithrombin III, heparin, thrombomodulin, warfarin
(coumadin) and prostacyclin.
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Hemophilia- inadequate coagulation.
Thrombus and EmbolusBLOOD GROUP SYSTEM (Fig. 19.12, page 651 and Table 19.6, page
653)- Based on the type of antigen present on the RBC, the blood group
is divided into four types: A, B, AB, and O. Antibodies against these
antigens produced are as follows:
Blood type
Antibodies (agglutinins) in the plasma
(antigen or agglutinogen the RBC)
A
B
O
AB
B
A
A and B ‘universal donor’
None ‘universal recipient’
Rh FACTOR- another group of antigens present on the RBC. An
individual with the Rh factor is Rh positive; and the person without Rh
factor is Rh negative (page 652).
Erythroblastosis fetalis (Fig. 19.13, page 652)- fetus with abnormally
low level of RBCs.
RhoGam-
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
REVIEW QUESTIONS
Describe major functions of the blood.
Describe important components of the blood.
How much of the volume of whole blood is plasma?
Name the three major groups of plasma proteins and give a function for each group.
What is hemoglobin? Describe its structure.
What is the average red cell count for a healthy man and woman? Range? Average blood
volume?
Define venipuncture and arterial puncture.
What is the pH of blood? Is blood more viscous or less viscous compared to water?
Define serum.
Define hematocrit.
Describe the life cycle of an erythrocyte.
How do deficiencies in vitamin B12 and iron affect red blood cell production?
Give a cause for each of these anemias: pernicious, iron deficiency, sickle cell, and
thalassemia.
Name and give the functions of all five types of leukocytes. Give the % of each of these in
total WBCs.
Define leukocytosis and leukopenia.
What is the normal platelet count and what is thrombocytopenia?
Define hemostasis.
List the major steps leading to the formation of a blood clot. How is extrinsic different from
intrinsic pathway?
What are the functions of vitamin K, thrombin, fibrin, and calcium in clotting?
What are anticoagulants? Give examples and the mechanism by which they work.
Define hemophilia, thrombus, and embolus.
Define ABO blood types.
Where are agglutinogens (antigens) and agglutinins (antibodies) located?
Explain the basis of Rh blood types.
What is erythroblastosis fetalis? How can it be corrected?
Gopalan, Fall 2004
20
Chapter 20
THE HEART
Location (Fig. 20.1, page 661)Pericardium (Fig. 20.2, page 662): parietal and visceral (epicardium)
Pericarditis and Cardiac tamponade (page 660)WALL OF THE HEART- endocardium, myocardium, and epicardium (Fig.
20.2, page 662).
Cardiac muscle- sarcoplasmic reticulum, Transverse or T tubules, and
intercalated discs (Fig. 20.9, page 673).
Chambers of the heart: (Fig. 20.3 and 20.4, pages 662-664)
Valves of the heart: Atrioventricular (AV) and Semilunar (aortic and
pulmonary) valves (Fig. 20.4, page 665)Chordae Tendineae and Papillary musclesRight Atrium- receives superior and inferior vena cavae and coronary
sinus.
Foramen ovale  fossa ovalis.
Right AV valve: tricuspid valve.
Right Ventricle pulmonary semilunar valve (tricuspid valve) 
pulmonary trunk  pulmonary arteries.
Left Atrium- receives two pairs of pulmonary veins.
Left AV valve- mitral or bicuspid valve.
Left ventricle- aortic semilunar (tricuspid) valve ascending aorta.
Valvular Heart Disease- Rheumatic heart disease:
Blood supply (Coronary Circulation) (Fig. 20.8, page 671)Coronary arteries- right and left.
Coronary veins- cardiac veins  coronary sinus  right atrium.
Ischemic heart diseaseCoronary ischemiaAngina PectorisMyocardial infarction (MI) or Heart attackPHYSIOLOGY OF CARDIAC MUSCLE CONTRACTION
Action potential in a cardiac muscle fiber (Fig. 20.11, page 676):
1. Resting membrane potential (-90 mV).
2. Slow Depolarization- Leakage of Na+ shifts the polarity to -75 mV.
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3. Voltage-regulated Na+ channels (fast channels) open: Rapid
depolarization (-75 mV to + 30 mV; 3-5 msec).
4. Plateau phase (175 msec) slow Ca++ channels open as the fast Na+
channels close (0 mV).
5. Slow K+ channels open: Repolarization (250 - 300 msec).
6. Refractory period: Absolute refractory period- 200 msec.
Relative refractory period- 50 msec.
The Conduction system and Pacemaker (Fig. 20.10, page 675)Sinoatrial node (SA node)- pacemaker of the heart  Atrioventricular
node (AV node) AV bundle or bundle of His  right and left bundle
branches Purkinje fibers (conduction myofibers).
Ectopic pacemakers- the origin of abnormal signals.
The Electrocardiogram (ECG or EKG)- measurement of electrical activity
of the heart (Fig. 20.12, page 677; Fig. 20.13, page 679).
P wave- depolarization of the atrial myocardium.
QRS complex- ventricular depolarization.
T wave- repolarization of the ventricle.
P-R interval- start of atrial depolarization to start of ventricular
depolarization.
P-Q interval- time required for action potential to travel within the atria,
AV node and the bundles.
S-T segmentQ-T interval- ventricular depolarization and ventricular repolarization.
Cardiac arrhythmias- abnormal patterns of cardiac electrical activity:
Bradycardia and tachycardiaThe Cardiac Cycle- is the time taken from the onset of one contraction to
the beginning of next contraction (700 - 800 msec) (Fig. 20.14, page
681).
Two phases:
1. Systole- contraction: pumps blood into adjacent chamber.
2. Diastole- dilation: chamber fills with blood.
PHASES OF THE CARDIAC CYCLE- at the end of the previous cycle,
all four chambers are relaxed and ventricles are partially filled with blood.
All four valves are closed.
1. Atrial filling and atrial systole (0.1 sec)- The atria are being filled with
blood. As the volume of blood increases in the atria, the pressure
also increases which allows the opening of the AV valves and blood
passively moves into the ventricles. Atrial systole (contraction within
the atria) pushes the remaining blood from the atria into the
Gopalan, Fall 2004
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ventricles. Increased blood volume in the ventricles increase
pressure which makes the AV valves close.
End-diastolic volume (EDV)- At the end of atrial systole, each ventricle
contains maximum amount of blood (130 ml).
Isovolumetric contraction- All four valves are closed, the volume of
blood in the ventricles is constant but due to isometric contraction, the
pressure begins to rise.
2. Ventricular Systole (0.3 sec)- When the pressure in the ventricles
exceed the pressure in the arteries pulmonary trunk and aorta,
semilunar valves open and blood is ejected into the pulmonary and
aortic trunks.
Stroke Volume (SV)- the amount of blood ejected from the ventricles
(70-80 ml; 60% of EDV).
End-systolic volume (ESV)- When the pressure in the pulmonary trunk
and the aorta exceeds the pressure in their respective ventricles, the
semilunar valves close and the remaining amount of blood in the
ventricles is referred to as ESV (50 ml, 40 % of EDV).
3. Ventricular diastole (0.4 sec)Isovolumetric relaxation- All four valves are closed, ventricular
myocardium is now relaxing.  pressure. Passive filling of the ventricles
begins.
Cycle repeats.
AUSCULTATION- listening to the heart (Fig. 20.15, page 682).
HEART SOUNDS- During each cardiac cycle, two heart sounds can be
heard through a stethoscope applied to the chest wall.
First heart sound- the "lubb" results from vibrations caused by AV valve
closure during ventricular systole.
Second Heart sound- the "dupp" results from vibrations caused by
semilunar valve closure during ventricular diastole.
Murmurs- abnormal heart sounds.
Causes:
1. Incompetent valves- valves fail to close properly. It could be
because of damage to the papillary muscles.
2. Stenosed valves- valves with abnormally narrow opening.
CARDIAC OUTPUT (page 683-684)
Heart rate (HR)- number of beats per minute; the basal heart rate is
about 72 bpm.
Cardiac Output (CO)= stroke volume X heart rate
70 ml X 75 = 5,250 ml/min or 5.25 L/min
Gopalan, Fall 2004
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Cardiac Reserve- Difference between resting and maximum cardiac
output.
REGULATION OF STROKE VOLUMEStroke volume = EDV-ESV.
Stroke volume depends on the three factors discussed below:
1. Preload- is the degree of stretching experienced during ventricular
diastole (length-tension relationship). The amount of stretching
depends on EDV.  EDV  larger preload.
Two factors that affect preload are
a. duration of diastole (heart rate EDV)
b. venous pressure (venous pressure EDV)
Frank-Starling's law of the heart- the greater the blood volume that is
returned to the heart, the greater the force of contraction and the greater
the blood volume that is pumped by the heart.
2. Contractility- is the amount of force produced during a contraction.
Positive and negative inotropic agents:
3. Afterload- is the amount of tension the contracting ventricle must
produce to force open the semilunar valves to eject blood. The
greater the afterload, the longer the period of isovolumetric
contraction  shorter duration of ventricular ejection  larger ESV.
REGULATION OF HEART RATE (Fig. 20.16, page 685)Neural control- Autonomic nervous system.
Parasympathetic regulation-  heart rate.
Sympathetic regulation-  heart rate + force of contraction.
Chemical regulation of Heart RateConcentrations of ions in the extracellular environment affect cardiac
function.
 K+  heart rate + stroke volume  heart block.
 Ca++  force of contraction.
Hormones epinephrine and norepinephrine from the adrenal medulla
stimulate heart rate.
Congestive Heart Failure (page 684)-
1.
2.
3.
4.
5.
6.
7.
REVIEW QUESTIONS
Describe the location of the heart.
Define pericardium and name the two partitions of the pericardium.
Define pericarditis and cardiac tamponade.
What are the three layers that form the wall of the heart?
Describe the structure of the cardiac muscle. What is the significance of T tubules and intercalated discs?
Name the four chambers and the four valves in the heart.
What vessels enter or exit the atria and the ventricles?
Gopalan, Fall 2004
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8. What are the functions of the valves?
9. Which chamber of the heart has the thickest wall and why?
10. What is the path of blood flow from the heart to the lungs, back to the heart, from the heart to systemic
circulation, and back to the heart again?
11. Which blood vessel delivers oxygenated blood to the heart and which vessel drains
deoxygenated blood from the heart? Follow the route of blood flow in coronary
circulation.
12. Define coronary ischemia, angina pectoris, and myocardial infarction.
13. Describe an action potential in a cardiac muscle fiber.
14. Describe the conduction system of the heart. Which component of the conduction system
provides the only electrical connection between the atria and ventricles?
15. Name the pacemaker of the heart. What are ectopic pacemakers?
16. Name important factors which can change the rate at which the SA node causes the heart to beat.
17. Define electrocardiogram (ECG). What are the different components of a normal ECG? What
do they indicate? What is the significance of the P-Q (PR) interval and S-T segment?
18. Use a rate of 75 beats/min to explain each phase of the cardiac cycle.
19. Discuss different parts of a normal ECG pattern in relation with the cardiac cycle.
20. Explain the normal heart sounds.
21. Contrast tachycardia and bradycardia.
22. How much blood is in each ventricle at the end of ventricular diastole? What is this volume called?
23. Define end-diastolic volume, end-systolic volume, stroke volume, isovolumetric contraction,
and isovolumetric relaxation.
24. Which heart sound is related to blood turbulence associated with closure of the AV valves?
25. Define auscultation.
26. Define systole and diastole.
27. What are murmurs? What are some of the causes of murmurs?
28. What is cardiac output? How is it calculated?
29. What factors affect stroke volume?
30. Define Frank-Starling's law of the heart.
31. What factors regulate heart rate?
32. Explain how the sympathetic and parasympathetic divisions of the autonomic nervous system
adjust heart rate?
33. What is congestive heart failure?
Gopalan, Fall 2004
25
Chapter 21
BLOOD VESSELS AND HEMODYNAMICS
Blood vessels form a tubular network:
Heart  arteries  arterioles  capillaries  venules  veins  heart.
Structure of the Blood Vessel Wall (Fig. 21.1, page 698)- the wall of the
arteries and veins are made up of three coats or tunics:
Tunica externa (tunica adventitia)Tunica mediaTunica intima (tunica intima)Vasa vasorum- vessels of vessels.
ARTERIES
Large arteries- elastic.
Medium arteries- muscular.
Small arteries or arterioles- have narrow lumen- provide
Greatest resistance.
Aneurism- bulge in a weakened wall of an artery.
Lipoproteins (Fig. 25.13, page 920)- Low-density lipoproteins (LDLs)
High-density lipoproteins (HDLs)
Very low-density lipoproteins (VLDLs)
Atherosclerosis- plaque formation in the blood vessels (page 689).
CAPILLARIES have the greatest cross-sectional area (Fig. 21.3, page
700).
Precapillary sphincterTypes of capillaries (Fig. 21.4, page 701)1. Continuous2. FenestratedSinusoids- specialized fenestrated capillaries.
VEINS
Venules or small veinsMedium sized veinsLarge VeinsValves (Fig. 21.5, page 702)Varicose veinsDifferences between Arteries and veinsAnastamoses- permit blood flow between the joined vessels (page 702).
BLOOD DISTRIBUTION- Veins are called capacitance vessels and
most of the blood is within the veins.
Gopalan, Fall 2004
26
DYNAMICS OF CAPILLARY EXCHANGE (Fig. 21.7, page 704)materials move across the capillary wall by diffusion, filtration, and
reabsorption.
1. Net hydrostatic pressure = 35 mm at the arterial end and 18 mm at the
venular end.
2. Net colloid osmotic pressure = 25 mm Hg.
3. Net filtration pressureDifference between net hydrostatic pressure- net colloid osmotic
pressure.
a. Arterial end: (35 - 25) = 10 mm Hg.
Movement occurs from the capillary to the interstitial fluid.
b. Venous end: (16 - 25) = -7 mm Hg.
Movement occurs from the interstitial fluid to the capillary.
Edema- abnormal accumulation of interstitial fluid (page 705).
Comparison of average blood pressure in different vesselsArterial: 100 - 35 mm Hg
Capillary: 35 -18 mm Hg
Venous: 2 - 18 mm Hg.
HEMODYNAMICS: PHYSIOLOGY OF CIRCULATION
Blood pressure (BP)- is the force exerted by the blood against the inner
walls of the blood vessels (page 706).
BP = blood flow X resistance (120/80).
Systolic BP 110-120 mm/Hg.
Diastolic BP 75-80 mm/Hg.
Measurement of BP (page 714)Auscultation- Sphygmomanometer.
The first sound of Korotkoff (due to turbulent flow of blood through a
constriction in the artery) occurs when the cuff pressure is equal to the
systolic pressure. The last sound of Korotkoff is heard when the cuff
pressure is equal to the diastolic BP.
Hypertension- sustained high BP.
Hypotension- low BP.
Pulse (page 713)- is produced by a shock wave from ventricular ejection
of blood into the aorta; this shock wave is transmitted through the walls
of the large arteries and is assessed by palpating an artery.
Resistance (page 706)Factors that contribute to peripheral resistance are
a. Vascular resistance:
i. Length of the vessel. Longer the vessel, greater the
resistance.
ii. Size of the blood vessel lumen.
b. Blood Viscosity:  viscosity  flow.
Gopalan, Fall 2004
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Venous Return- The skeletal muscle pump and respiratory pump play a
key role in venous return (page 707).
Velocity of blood flow- the speed with which blood flows is inversely
proportional to the cross-sectional area (Fig. 21.11, page 709).
Regulation of blood pressure and blood flow:
Role of Cardiovascular center- Cardiovascular center regulates the
diameter of the blood vessels via the sympathetic nervous system (Fig.
21.12, page 710).
Ex. Cardiovascular center activation  sympathetic output 
vasoconstriction  peripheral resistance  BP.
Baroreceptor reflexes- Baroreceptors are sensitive to changes in BP
(Fig. 21.13-21.14, pages 711-712). For example,
a.  BP  baroreceptor activity  cardiovascular center of medulla.
 parasympathetic output  heart rate  cardiac output  BP.
b.  BP baroreceptor activity  cardiovascular center of medulla.
 sympathetic output  vasodilation peripheral resistance  BP.
Chemoreceptor reflexes- Chemoreceptors are sensitive to changes in
blood O2 and CO2 concentration and the pH.
a.  BP  blood supply  O2 +  CO2 +  H+ levels  chemoreceptor
activity
 cardiovascular center in the medulla  sympathetic output 
vasoconstriction  peripheral resistance  BP.
b.  CO2 or  pH  cardiac center  heart rate  cardiac output.
Hormonal regulation (page 712)ADH-  BP or  osmotic concentration of plasma  ADH secretion.
a.  vasoconstriction
b. reabsorption of water from the kidneys.
Renin-angiotensin-aldosterone mechanism BP  secretion of renin which converts angiotensinogen to angiotensin
I  Angiotensin II  vasoconstriction and  aldosterone which
stimulates the reabsorption of Na+ and H2O  BP +  CO +  secretion of
ADH and Aldosterone  thirst.
Epinephrine and norepinephrineANPAutoregulationShock- hypovolemic, cardiogenic, vascular and obstructive shock.
BLOOD VESSELS- Two circuits (Fig. 21.17, page 718):
Pulmonary circulation- right ventricle  pulmonary trunk  pulmonary
arteries  lungs  pulmonary veins  left atrium.
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Systemic circulation- begins in the left ventricle and ends in the right
atrium.
Ascending aorta  coronary arteries (Fig. 21.19, page 722).
Aortic arch  brachiocephalic ( right common carotid and right
subclavian), the left common carotid and the left subclavian artery (Fig.
21.19 &21.20, pages 722 & 726).
Descending aorta  thoracic and abdominal aorta (Exhibit 21.1b, page
721).
Arteries to the head and the neck (exhibit 21.3, page 725, Fig. 21.20,
page 726)Common carotid arteries  head and the neck.
Subclavian arteries  upper limb, chest wall, shoulders, back and the
CNS.
common carotid arteries  external and internal carotid arteries.
External carotid arteries  face, nose and mouth.
Internal carotid arteries  brain.
Subclavian arteries  vertebral arteries (cerebellum)  basilar artery
(pons and the cerebellum).
Internal carotids and vertebral artery are interconnected to form cerebral
arterial circle or circle of Willis.
Arteries of the upper limb- subclavian  axillary  brachial  radial and
ulnar  palmar  digital arteries (Exhibit 21.3, page 725).
Abdominal aorta and its branches- abdominal aorta is divided into
visceral and parietal (Fig. 21.21 and 21.22, pages 728, 732-733), Exhibit
21.5, pages 729-733).
Unpaired- celiac, superior mesenteric, and inferior mesenteric arteries.
Paired arteries- suprarenal, renal, lumbar, and gonadal arteries.
Arteries of the pelvis (Fig. 21.4, page 728 and Fig. 21.6, page 736;
Exhibit 21.6, pages 734-736)- Abdominal aorta  two common iliac
arteries  external (lower limbs) and internal iliac arteries (urinary
bladder, rectum, uterus, and vagina).
Arteries of the lower limb (Exhibit 21.6, page 736)- external iliac 
femoral  popliteal  anterior and posterior tibial.
Veins- three major veins returning blood to the heart are coronary sinus,
superior and inferior vena cava (Exhibit 21.7, page 737).
Veins of the head and neck (Exhibit 21.8, page 740)- External jugular
vein (posterior head and neck)  subclavian vein  brachiocephalic
vein  superior vena cava.
Internal jugular vein (brain, the anterior head, face and the neck) 
subclavian vein  brachiocephalic vein  superior vena cava.
Veins of the upper limb- Radial and ulnar  brachial  axillary vein 
subclavian vein (Exhibit 21.9, page 742, Fig. 21.26, page 743).
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Veins of the abdomen and pelvis (Fig. 21.27, page 745; Exhibit 21.11
page 746)Hepatic portal system- abdominal viscera  hepatic portal vein  liver
sinusoids  hepatic vein  inferior vena cava (Fig. 21.29, page 751).
Veins of the lower limbAnterior and posterior tibialis  popliteal  femoral  external iliac
veins common iliac  inferior vena cava (Exhibit 21.12, page 748;
Exhibit 21.11 page 746).
Fetal Circulation- ductus venosus, foramen ovale, and ductus
arteriosus (Fig. 21.31, page 754).
REVIEW QUESTIONS
1. Name the three kinds of blood vessels and give a function for each.
2. Describe the wall of each type of blood vessel. Describe the importance of smooth
muscle in the tunica media of the arteries.
3. Define vasa vasorum.
4. Define aneurism.
5. What are lipoproteins? What are the different types of lipoproteins? What are their
functions?
6. Describe atherosclerosis.
7. Which type of blood vessels give greatest resistance to blood flow? Why?
8. Which vessels have greatest cross-sectional area? Why?
9. What are the two types of capillaries? Where do you find each type?
10. What are sinusoids? Where do you find these?
11. What is the function of the precapillary sphincter?
12. What are varicose veins?
13. Compare arteries and veins.
14. What are anastamoses? What is the significance of these structures? Give examples.
15. Which types of blood vessels are called capacitance vessels? Why?
16. What are blood reservoirs? Why are they important?
17. Describe the exchange of substances between the capillary and the interstitial fluid. List
the different types of forces involved in the movement of fluids and how they affect the
flow of fluid back into the capillary.
18. What is the difference between hydrostatic pressure and osmotic pressure? Which
pressure force water out of the arterial end of a capillary? Which pressure sucks water
back into the capillary at the venous end?
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19. What is edema? What are some of the causes of edema?
Describe blood pressure. What are the two measures of blood pressure? What are the
normal ranges of values for the two measures?
20. How is blood pressure measured?
21. Define hypertension and causes of hypertension.
22. Define hypotension.
23. What is a pulse? How is it measured?
24. What is pulse pressure?
25. What is the velocity of blood flow? Why does blood flow faster in arteries and veins than
in capillaries?
26. What factors affect resistance?
27. Compare blood pressure in arteries, veins, and capillaries.
28. List the factors that affect blood pressure.
29. How is blood pressure regulated? What is the role of the cardiovascular center,
baroreceptors, chemoreceptors, and hormones in regulating blood pressure?
30. Name the hormones that regulate the cardiovascular system. How does each hormone
affect the system?
31. What is autoregulation? Explain how it occurs through physical and chemical changes in
blood.
32. What is shock? What are the four types of shock?
33. What are the branches of the ascending aorta?
34. Which arteries supply the brain?
35. What is circle of Willis? What is the significance of this?
36. Describe the blood supply of limbs.
37. Follow the branching of the abdominal aorta.
38. What are the three unpaired abdominal aortic branches? Which structures do they
supply?
39. Name some of the paired branches of the abdominal aorta.
40. Where are the two common iliac arteries? How do they branch further and which parts do
they supply?
41. List the major veins that drain blood from the brain back to the heart.
42. Describe the hepatic portal system. What is the significance of this system?
43. Describe fetal circulation? What changes occur in a newborn?
44. Where are ductus venosus, foramen ovale, and ductus arteriosus? Which parts do they
connect?
45. Name two veins that carry oxygenated blood.
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Chapter 22
THE LYMPHATIC SYSTEM, NONSPECIFIC RESISTANCE TO DISEASE, AND IMMUNITY
Functions of the lymphatic system (page 765)Organization of the lymphatic system (Fig. 22.1, page 766)1. LYMPH2. LYMPHATIC VESSELSa. Lymphatic capillaries (Fig. 22.2, page 767)Lactealsb. Lymph venules and veinsFlow of lymph (Fig. 22.3, page 768)Lymph  lymphatic capillaries  lymphatic veins lymph node
(filtration)  lymphatic veins thoracic duct (from all of the lymph veins
except the upper right side of the body) + right lymphatic duct (upper
right side of the body)  subclavian veins.
Edema3. LYMPHATIC TISSUESLymph nodules- are small masses of lymph tissue (page 774).
Tonsils- large lymph nodules.
a. Lingual tonsils
b. Palatine tonsils and
c. Pharyngeal tonsil (adenoid)
4. LYMPHATIC ORGANSLYMPH NODES (Fig. 22.6, page 772)- are masses of lymph tissue
surrounded by a connective tissue capsule.
Lymph  afferent lymphatic vessels  sinuses cortex  medulla 
efferent lymphatic vessels.
Functions- 1. filters lymph; 2. antigen presentation.
THE THYMUS (Fig. 22.5, page 770)Structure- lobes, lobules: the cortex and the medulla.
Function- helps develop T lymphocytes.
THE SPLEEN- is the largest lymphatic structure.
Structure- red pulp and white pulp: (Fig. 22.7, page 773)
Functions- recycles RBCs and is important in the immune system.
Splenectomy-
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NON-SPECIFIC RESISTANCE TO DISEASE
Physical barriers- Skin, mucous membrane in the nasal passages,
lacrimal apparatus, saliva, vaginal secretion, flow of urine, sebum,
hyaluronic acid, gastric acid secretion, and digestive enzymes.
Phagocytosis- neutrophils and macrophages (fixed or free): (Fig. 22.9,
page 777)
Natural killer (NK) cells. Recognition Adhesion  release of perforin
 lysis of abnormal cell (page 776).
Interferons (page 776)- are proteins secreted by leukocytes, fibroblasts
and lymphoid tissue which inhibit viral multiplication and cell division.
Virus infects a cell  the cell secretes interferons  antiviral proteins
( viral multiplication).
Complement system- includes a group of proteins in blood (plasma
enzymes) and tissue fluids, which augments the effects of the direct
actions of antibodies. The actions include destruction of target cell
membrane, inflammation, chemotaxis and promote phagocytosis by
opsonization (Fig. 22.18, page 791).
Inflammation- when pathogens invade tissues, they trigger an
inflammatory response (Fig. 22.10, page 778).
Tissue damage  mast cells release chemicals (histamine, heparin, and
prostaglandins)  attract phagocytes (removal of debris), dilation of
blood vessels, increased blood flow, and increased vessel permeability
 area becomes red, swollen, warm, and painful  tissue repair.
Fever (page 779)- bacteria  endotoxin pyrogen (produced by
leukocytes)  body temperature  bacteria susceptible to defense
mechanism.
IMMUNITY
is a defense mechanism that recognizes, remembers and produces
antibodies against millions of antigens (foreign agents) that invade the
body. Cells involved in immune system are LYMPHOCYTES.
Lymphocyte Production and maturation (Fig. 22.11, page 781)Types of Immune responses:
1. Antibody-mediated immunity: B-lymphocytes or B cells are
responsible for antibody-mediated immunity.
Two types of B cells are:
Plasma cells- are the cells that produce antibodies and release them
into the circulation.
Memory B cells- responsible for accelerated response to a second
exposure to the antigen.
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2. Cell-mediated immunity: T-lymphocytes or T cells are
responsible for cellular immunity.
Three types of T cells are:
The cytotoxic T cells or Killer T cells- destroy transplanted and other
foreign cells by cell rupture.
Helper T cells- process the antigen for interaction with B cells. Stimulate
the activity of B and T lymphocytes.
Memory T cells- are responsible for an accelerated response to
subsequent exposure to the antigen.
Cluster Designation markers (CD markers)- are receptors on T cells.
Two important CD markers are
CD 8: present on cytotoxic T cells. Cytotoxic cells respond to antigens
present on cells with Class I MHC proteins.
CD 4: present on helper T cells. They respond to Class II MHC proteins.
Major Histocompatibility Complex (MHC) antigens (page 782)- the
genes that are on chromosome 6 and control the synthesis of MHC
proteins are called major histocompatibility complex (MHC). In
humans the MHC proteins are also called as the HLAs (human
leukocyte antigens).
There are two classes of MHC proteins: Class I and Class II.
Class I proteins are found on the cell membrane of all nucleated cells.
Class II proteins are present on antigen-presenting cells and
activated T-lymphocytes.
Antigens (page 780)- have immunogenicity (to provoke an immune
response) and reactivity (ability to react with the antibodies or T cells).
Hapten (page 782)CELL-MEDIATED IMMUNITY:
T cell activation- T cells are activated when they are exposed to antigens
presented by the antigen-presenting cells.
Antigen-presenting cells- are specialized cells that are responsible for
activating T cell defenses. Eg. macrophages, B cells, and Kupffer cells.
These cells have class II MHC proteins (see below for the classification
of MHC proteins).
Antigen presentation- antigen-presenting cells partially digest the antigen
and present antigen on the cell surface. These cells then migrate to
lymphatic tissue to present antigen to T cell (Fig. 22.13, page 783).
Antigen recognition- T cells recognize antigens when they are bound to
glycoproteins present on the cell membrane. The structure of
glycoproteins (MHC proteins) is genetically determined.
Activation, Proliferation, and Differentiation of T cells (Fig. 22.14,
page 786)-
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Antigen presentation by the antigen-presenting cells (with class II MHC
proteins)  helper T cells that contain CD4 markers. Activated helper T
cells 
1. T cell division and the production of a clone of T cells that
differentiate into different types of T cells. Killer T cells
identify cells with antigens and destroy them (Fig. 22.15,
page 787).
2.  B cell division: antibody-mediated immune response.
ANTIBODY- MEDIATED IMMUNITYImmunoglobulins (antibodies)- are specific proteins produced in
response to antigens.
ANTIBODY STRUCTURE (Fig. 22.17, page 789)There are 5 different types of antibodies:
IgM, IgG, IgA, IgD, and IgE.
Activation, proliferation and differentiation of B cells (page 22.16,
page 788)- Pathogen invades the body  antigen appears on the
surface of a B cell (bound to class II MHC proteins) 
1. B cell
2. helper T cell  cytokines  activation of B cell  cell
division and a clone of B cell  plasma cells (antibody
production) and memory B cells.
Effect of antibodies on antigensNeutralization- binding to sites where antigen binds.
ImmobilizationAgglutination and precipitation- forming insoluble immune complex.
Enhancing phagocytosis (Opsonization)- coat antigens that would
attract phagocytes.
Activation of Complement systemIMMUNOLOGICAL MEMORY (page 792)
Active immunity- is stimulation of immune system by exposure to
antigens. First exposure of antigen results in primary response (slow).
Subsequent exposure is called secondary response (fast).
a. naturally acquired active immunity and
b. Artificially acquired active immunity: vaccination or
immunization.
Vaccination- produces primary response making the immune system
ready for secondary response from subsequent infection.
Passive immunity- is obtained by receiving antibodies produced by
another person or by an animal.
Natural and induced passive immunity:
Selfrecognition and self-tolerance (Fig. 22.20, page 793)-
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Positive selection:
Negative selection:
Immune DisordersAutoimmune diseases (page 799)- results from the failure of selfrecognition system resulting in autoantibodies. Eg. Rheumatoid
arthritis, insulin-dependent (Type I) diabetes mellitus, Graves’
disease, multiple sclerosis, and systemic lupus erythematosus.
Immunodeficiency diseases- eg. Severe combined imunodeficiency
disease (SCID): inherited.
AIDS (acquired immune deficiency syndrome) (page 797)destruction of helper T cells by the HIV leads to the loss of immune
response and increased susceptibility to infection.
Allergy (Hypersensitivity)- abnormal immune response to antigen
(page 798-799).
Allergen- an antigen that triggers allergic responses.
Type I (Anaphylaxis)- a circulating allergen affects mast cells
throughout the body. Very common. Eg. bee sting, penicillin injection
(anaphylactic shock).
Type II (Cytotoxic reactions)- Incompatible blood transfusion.
Type III (Immune Complex) reactions- Antigen-antibody complex
stimulates inflammation. Eg. Glomerulonephritis, SLE, and Rheumatoid
arthritis.
Type IV (Cell-mediated or Delayed hypersensitivity) reactions- is due
to abnormal T lymphocyte response, which produces symptoms within
48 h. APCs process allergen. Eg. Poison ivy and tuberculosis testing.
Mononucleosis:
REVIEW QUESTIONS
1. What are the functions of the lymphatic system?
2. What are the components of the lymphatic system?
3. How is lymph different from plasma or interstitial fluid?
4. What are the smallest lymphatic vessels called? How are they different from blood
capillaries?
5. What are lacteals? Where do you find these?
6. Describe the formation of lymph.
7. Describe the flow of lymph.
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8. Define cysterna chili.
9. What are the two major ducts that collect lymph and return to vascular system?
10. Define edema.
11. What are lymph nodules?
12. What are tonsils? Name the tonsils and their locations.
13. What are lymph nodes? What are their functions?
14. What happens to foreign substances in lymph that enters a lymph node?
15. Describe the structure and function of the thymus.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
Which is the largest lymphatic structure? Describe its structure and function.
What is splenectomy?
List some of the protective structures in the body that defend against disease.
Define phagocytosis.
What are interferons? How do they defend the body?
What are natural killer cells? How do they defend the body?
Describe complement system.
How is inflammation a defense system?
What causes symptoms of inflammation such as redness, pain, heat, and swelling?
How does fever defend the body?
Define immunity.
What are lymphocytes? What are the two types of lymphocytes? How and where are they
formed?
What are the two types of B cells? What are their functions?
What are the three types of T cells? What are their functions?
Describe cell-mediated immunity in detail.
Define antigen and hapten.
Which cells are antigen-presenting cells and where in the body are they found?
What are MHC proteins? What are the two classes of MHC proteins? How are they different?
What are CD markers? What is the role of CD8 and CD4 in the immune system?
Describe antibody-mediated immunity.
What are antibodies?
Describe the structure of an antibody.
What is the function of the variable region of the antibody?
Describe the different types of antibodies.
Which type of T cell participates in both cell-mediated and antibody-mediated immune
responses?
What are cytokines? Give examples of cytokines.
Define innate immunity, active immunity, and passive immunity.
What is vaccination?
Define self-recognition, self-tolerance, positive selection and negative selection.
Define autoimmune disease. Discuss some of the autoimmune diseases that you have
learned.
Define immunodeficiency diseases. Give examples.
What causes AIDS?
Define Systemic lupus erythematosus (SLE).
Define severe combined immunodeficiency.
Define allergy.
What is an allergen?
What are some of the different types of allergy? How are they different?
Gopalan, Fall 2004
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Chapter 23
THE RESPIRATORY SYSTEM
Functions of the Respiratory System- gas exchange, prevent
dehydration, sound, olfaction, and pH regulation.
Structures of the Respiratory System (Fig. 23.1, page 807)Nose- External nares or nostrils  vestibule  nasal cavity  internal
nares (Fig. 23.2, page 808).
Paranasal sinusesThe nasal conchae (turbinates)The nasal mucosaCystic fibrosisPharynx or Throat (Fig. 23.4, page 810)- a common pathway for both
respiratory and digestive systems connecting nasal cavity to the larynx
and oral cavity to the esophagus. It is divided into three parts:
nasopharynx, oropharynx, and laryngopharynx.
Larynx or voice box (Fig. 23.5, page 811)- connects the pharynx to the
trachea. It consists of vocal cords, the vibration of which produces
sounds.
Laryngeal cartilages- epiglottis, thyroid cartilage (Adam's apple), cricoid
cartilage, arytenoid, cuneiform, and corniculate cartilages.
Voice production (Fig. 23.6, page 813)LaryngitisTrachea or Windpipe (Fig. 23.7, page 814)- connects the larynx to the
primary bronchi.
Tracheal cartilagesTracheostomyIntubationBronchi- Trachea  right and left primary bronchi (Fig.23.8, page 815).
LUNGS- are air-filled, sponge-like structures that contain alveoli (Fig.
23.10-page 819).
Lobes and lobules of the Lungs (Fig. 23.10, page 817)Bronchial Tree- primary bronchi (extrapulmonary)  secondary bronchi
and tertiary bronchi (intrapulmonary).
Bronchoscopy--
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Bronchioles- tertiary bronchi  bronchioles  terminal bronchioles 
respiratory bronchioles  gas exchange.
Alveoli- the air sacs that form the structural and functional units of lungs
(Fig. 23.12, page 820).
Type I and Type II cells:
Respiratory membrane- surfactant reduces surface tension.
Pneumonia- inflammation of lobules of the lung.
Blood supply to the lungsPulmonary embolismThe lung coverings- the lungs are covered by a thin serous membrane
called the pleura: inner visceral pleura and outer parietal pleura. The
space between the two layers is called the pleural cavity.
PleurisyRESPIRATORY PHYSIOLOGY
Pulmonary Ventilation or Breathing- is the movement of air into and
out of the lungs. It includes inhalation and exhalation (Fig. 23.15-23.16,
page 823-824).
Compliance- is a measure of force needed to distend the lungs.
Boyle's Law (Fig. 23.13, page 821)Muscles of Respiration- the diaphragm, external, and internal
intercostal muscles (Fig. 23.14, page 822).
Atmospheric pressureIntrapulmonic or alveolar pressure (page 823)Inhalation or inspiration- is the movement of air into the lungs.
Diaphragm & external intercostal muscles contract  volume of thoracic
cavity  lungs expand  lung volume  intraalveolar pressure (760-758
mm Hg)  air into the lungs.
Expiration- is the movement of air out of the lungs.
Inspiratory muscles relax  thoracic volume  lungs recoil  lung volume
 intraalveolar pressure (763 mm Hg)  air out of the lungs.
Pneumothorax- air in the thoracic cavity.
Modes of Breathing (page 825)Quiet breathing (eupnea): the diaphragm and external intercostal
muscles, passive exhalation.
Deep breathing or diaphragmatic breathing: diaphragm contraction
(inhalation), diaphragm relaxation (exhalation).
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Shallow breathing or costal breathing: contraction of external
intercostal muscles (inhalation), relaxation of external intercostal muscles
(exhalation).
Forced breathing (Hyperpnea): Exhalation is by the contraction of
internal intercostal muscles.
ApneaDyspneaAtelectasisLUNG VOLUME AND CAPACITIES (Fig. 23.17, page 827)
Respiratory cycle- a single cycle of inhalation and exhalation.
Spirometer- is the instrument that is used to measure the rate of
ventilation.
Tidal volume- is the volume of air inspired or expired during a normal
breath (500 ml).
Minute volume- is the total amount of air that flows into the respiratory
tract in one minute. Tidal volume X respiratory rate (12 breaths/minute X
500 ml = 6 L).
Inspiratory reserve volume- is the amount of air that can be inspired
above and beyond the normal tidal volume (3,000 ml).
Expiratory reserve volume- is the amount of air that can be expired
beyond a normal tidal expiration (1,200 ml).
Residual volume- the amount of air that remains in the lungs even if the
expiratory reserve volume is expelled (1,200 ml).
Vital capacity- is the maximum amount of air that can be moved out of
the lungs after a maximum inspiration and expiration (4,700 ml i.e., 500 +
3,000 + 1,200 ml).
Anatomical Dead space - is air remaining in the airways does not
undergo gas exchange (150 ml).
Gas exchange between the alveoli and the blood in the pulmonary
capillaries (Fig. 23.18, page 829)Dalton's law of partial pressure- a total pressure of a gas mixture is
equal to the sum of partial pressures of its constituent gases (pages 827828).
Henry's Law (page 828)- the amount of gas that will dissolve in a liquid
is proportional to its partial pressure and its solubility coefficient (its
physical and chemical attraction for that liquid).
Gas exchange occurs by simple diffusion.
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a. The concentration difference of O2 between the alveoli and the blood
allows the diffusion of O2 from the alveoli to the pulmonary
capillaries.
PO2 inspired air- 159.6 mm; alveolar air- 105 mm; capillary- 40 mm Hg.
b. The concentration difference of CO2 between the blood and the
alveoli allows the diffusion of CO2 from the blood in the pulmonary
capillaries into the alveoli.
Alveolar air- 40 mm Hg and capillary 45 mm Hg.
Decompression sickness- ‘Bends’
Gas exchange between the blood of the systemic capillaries and the
cells- Concentration difference between the systemic capillaries and the
cells allows the diffusion of O2 or CO2. O2 diffuses from the blood into the
tissue cells and CO2 diffuses from the cells into the blood (Fig. 23.18,
page 829).
Blood PO2 105mm; cell PO2- 40mm; blood PCO2 40mm; cell PCO245mm Hg.
TRANSPORT OF OXYGEN AND CARBON DIOXIDE
OXYGEN TRANSPORT (Fig. 23.19, page 832)
Hemoglobin and Oxygen TransportOxygen-Hemoglobin saturation curve (Fig. 23.20, page 833)Loading- binding of oxygen to hemoglobin to form oxyhemoglobin;
occurs in the lungs.
Unloading- dissociation of oxyhemoglobin releasing oxygen; occurs in
systemic capillaries.
Factors affecting Loading/unloading (Figs.23.21-23.23, pages 833-834)1. PO2- 100 mm Hg in arteries, and 40 mm Hg in veins.
2. PCO2-  CO2  ability of hemoglobin to hold oxygen ( unloading).
3. pH- Bohr effect- affinity of hemoglobin to oxygen decreases with
decrease in pH (more unloading) and increases with increase in pH (less
unloading).
 pH  CO2.
4. Temperature- affinity of hemoglobin to oxygen decreases with
increased temperature (more unloading).
Hemoglobin and 2,3-biphosphoglycerate (BPG)-  BPG  unloading.
Fetal HemoglobinAcclimatization to high altitude- involves changes that help deliver
oxygen more effectively despite reduced arterial PO2.
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Carbon monoxide poisoningCARBON DIOXIDE TRANSPORT (Fig. 23.19, page 832, Fig. 23.24,
page 836).
Carbon dioxide in blood is in three forms: dissolved, bound to
hemoglobin, or as bicarbonate.
Chloride shift- H2CO3  H+ + HCO3H+ is buffered by their combination with deoxyhemoglobin (trapping)
whereas HCO3- diffuses out resulting in more positive charge inside the
red blood cell. This attracts Cl- and allows the entry of Cl- into the cell and
is called chloride shift. A reverse chloride shift is in the pulmonary
capillaries. H2CO3  CO2 and H2O.
Haldane EffectCONTROL OF RESPIRATION
1. Neural control of respiration (Figs. 23.25-23.26, page 837)Respiratory center in the brain stem (Pons and medulla) regulates the
rate and depth of respiration.
Respiratory center  contraction of the respiratory muscles  inspiration.
No contraction  the respiratory muscles relax  expiration.
Apneustic center-  inspiration center.
Pneumotaxic center-  inspiration center and apneustic center.
2. Chemical control of respiration- the chemical composition of
arterial blood and CSF influences the respiratory center ( CO2, H+)
(Fig. 23.27, page 838).
Hypercapnia and hypocapnia3. Inflation reflex or Hering-Breuer reflex- Baroreceptors (stretch
receptors).
COPDEmphysema (Full of air)AsthmaTuberculosisREVIEW QUESTIONS
1. List the functions of the respiratory system.
2. What is the path taken by air molecules into and through the nose? Include the significance
of paranasal sinuses, nasal conchae, and the nasal mucosa.
3. Define cystic fibrosis.
4. What are the three parts of the pharynx and where are they located?
5. Describe the structure and function of the larynx.
6. How does the epiglottis prevent aspiration of foods and liquids?
7. Define Adam's apple.
Gopalan, Fall 2004
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8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
What is the main function of the vocal folds?
Define laryngitis.
Describe the structure and function of the trachea.
What is the role of cartilage in the trachea?
Define tracheostomy and intubation.
Which structures are parts of the conducting portion of the respiratory system?
Follow the branching of the trachea through the respiratory bronchioles. Mention the
structures that are extrapulmonary.
Describe the structure of the lungs.
How many lobes and secondary bronchi present in each lung?
Why are right and left lungs slightly different in shape and size?
Define alveolus.
What is the thickness of the alveolar-capillary membrane?
What is the role of surfactant in the lungs?
Define bronchoscopy, pneumonia, and pulmonary embolism.
Define pleura. What are the two layers of the pleura?
Define pleurisy.
What is compliance?
Define Boyle's law.
If the volume is decreased, how does the pressure change?
What are the main muscles of respiration?
Define atmospheric pressure, intrapulmonic or alveolar pressure, and intrapleural pressure.
Describe the process of inspiration.
Describe the process of expiration.
Define pneumothorax.
Define eupnea, hyperpnea, apnea, and dyspnea. Also define deep breathing or
diaphragmatic breathing, and shallow breathing.
Define atelectasis.
Define spirometer.
Define tidal volume, minute volume, inspiratory reserve volume, expiratory reserve volume,
residual volume, vital capacity, and anatomical dead space.
Define Dalton's law of partial pressure.
What is the partial pressure of oxygen and carbon dioxide at the sea level?
Define Henry's law.
Describe the process of gas exchange between the alveoli and the blood in the pulmonary
capillaries.
Define decompression sickness.
Describe the process of gas exchange between the blood of the systemic capillaries and the
cells.
Describe the process of transportation of oxygen in the blood.
Define loading and unloading.
Describe the oxygen-hemoglobin saturation curve.
List the factors that affect loading and unloading.
Define Bohr effect.
Define BPG and its role in loading and unloading.
How is fetal hemoglobin different from hemoglobin after birth?
How does the body adjust to high altitude and why?
What are the three ways carbon dioxide is transported in the blood?
What is the significance of bicarbonate in the blood?
Describe chloride shift.
Describe the neural control of respiration.
Describe the chemical regulation of respiration.
Define Hering-Breuer reflex or Inflation reflex or baroreceptor reflex.
Define hypercapnia and hypocapnia.
Define COPD, emphysema, asthma, and tuberculosis.
Gopalan, Fall 2004
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Chapter 24
THE DIGESTIVE SYSTEM
Functions of the digestive system (page 852)- ingestion, secretion,
digestion, absorption, and rejection.
Histological organization of the digestive tract (Fig. 24.2, page 854)The mucosa- epithelium, lamina propria, and muscularis mucosa
The submucosa- plexus of Meissner or submucosal plexus:
Muscularis- plexus of Auerbach or myenteric plexus; circular and
longitudinal muscles.
SerosaPeritoneum- Visceral and parietal (Fig. 24.3, page 856).
RetroperitonealAscites- accumulation of serous fluid.
Peritoneal Folds- mesenteries, greater omentum, and mesocolon.
Peritonitis (page 857)MOUTH: prepares food for swallowing and partly digest food.
Tongue, lingual frenulum, gingivae (gums), labia (lips), cheeks, hard and
soft palates, and uvula (Fig. 24.4, page 858):
Salivary glands- three pairs: parotid, sublingual, and submandibular (Fig.
24.5, page 859).
Saliva- salivary amylase: starch  disaccharides.
The teeth- mastication- large food particles  pulp (bolus).
Structure- root, root canal, crown, pulp, dentin, enamel, and cementum
(Fig. 24.6, page 861).
Types of teeth- incisors, canines (cuspids), premolars (bicuspids), and
Molars (Fig. 24.7, page 862).
Dental succession- primary teeth or deciduous teeth and permanent
dentition or secondary dentition.
Physiology of digestion in the mouthMechanical digestion:
Chemical digestion:
PHARYNXPhysiology of deglutition (swallowing)- buccal, pharyngeal, and
esophageal phases (Fig. 24.8, page 864).
ESOPHAGUS- transport food from the mouth to the stomach. The
esophagus exhibits peristalsis that squeezes bolus towards lower
esophageal sphincter (Figs. 24.9 and 10, page 865).
Esophageal hiatusAchalasia, heart burn, and vomitingHiatal hernia-
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STOMACH- consists of a cardia, fundus, body, and pylorus. The
longitudinal folds of the mucosa of the stomach are called rugae (Fig.
24.11, page 867).
Gastric glands (Fig. 24.12, pages 868-869)Parietal cells- secrete HCl and intrinsic factor
Chief cells- secrete pepsinogen
Mucous cells- secrete mucus
G cells- secrete gastrin.
Stomach mixes food with gastric juice (chyme), delivers it in small
quantities to the small intestine.
Chemical digestionGastritis and peptic ulcersRegulation of gastric secretion and motility (Fig. 24.14, page 871)Cephalic phaseGastric phaseIntestinal phaseNeural response: Enterogastric response that inhibits gastrin secretion
and gastric contraction (Fig. 24.16, page 873).
Hormonal response: Secretin  chief cell and parietal cell activity and
 secretion of buffers. Cholecystokinin (CCK) and GIP-  gastric
secretion and contraction (Fig. 24.16, page 873).
PANCREAS- the exocrine part of the pancreas consists of acinar cells,
which produce pancreatic juice that contains bicarbonates and digestive
enzymes. The pancreatic duct joins the common bile duct to form the
hepatopancreatic ampulla (ampulla of Vater) (Fig. 24.17, page 875).
Pancreatic enzymes1. Pancreatic-amylase: starch  maltose.
2. Trypsinogen is activated by enteropeptidase (enterokinase) of the
small intestine to trypsin: polypeptide chains  small peptides.
3. Trypsin activates chymotrypsinogen to chymotrypsin: polypeptides
 peptides.
4. Pancreatic lipase: fat  fatty acids + monoglycerides.
5. Nucleases: nucleic acids  simple nucleotides.
LIVERLobes- right, left, caudate and quadrate lobes.
Liver lobules- hepatocytes secrete bile  bile canaliculi  right and left
hepatic ducts  common hepatic duct. Along with cystic duct from the
gallbladder  common bile duct (Fig. 24.19, page 878).
Blood supply- portal triad (Fig. 24.18-24.19, pages 878-879).
Functions of the liver (page 880)- Secretion of bile. Processing of
absorbed nutrients, absorbs fats and fat-soluble vitamins (vitamin A, D,
E, and K), removes biologically active molecules such as hormones and
drugs from the blood, helps regulate blood glucose concentration,
produces plasma proteins, and coagulating factors.
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Functions of bile- emulsification.
Regulation of bile secretion (Fig. 24.21, page 879)CirrhosisHepatitis- Hepatitis A (infectious), Hepatitis B (through blood contact),
and Hepatitis C (blood, tears, saliva or sexual contact).
JaundiceGALLBLADDER (Figs. 24.19 and 24.21, pages 878-879)- Bile is stored
and concentrated in the gallbladder and discharged into the duodenum
during a meal. CCK  contraction of the gallbladder.
Gallstones (page 880)CholecystitisSMALL INTESTINE: is divided into the duodenum, jejunum, and ileum
(Fig. 24.22, page 882).
Ileocecal sphincter (valve)Duodenum receives chyme from the stomach, pancreatic juice from the
pancreas and bile from the gallbladder.
HISTOLOGY- plicae circulares, villi, intestinal glands or crypts of
Lieberkuhn (Fig. 24.23, page 883).
Intestinal juice and brush border enzymes- maltase, sucrase, lactase,
and peptidases.
Physiology of digestion and absorption in the small intestine (Fig.
24.25, page 888)Mechanical digestion- segmentation and peristalsis.
Chemical digestionCarbohydrate digestion and absorptionProtein digestion and absorptionLipid digestion and absorption- micelles (fatty acids, monoglycerides,
lysolecithin)  intestinal epithelial cells.
Resynthesis of triglycerides and Phospholipids- Fatty acids +
glycerol  triglycerides.
Protein + droplets of triglycerides, phospholipids and cholesterol 
Chylomicrons  lacteals  thoracic duct  blood. In blood, lipoprotein
lipase converts triglycerides  free fatty acids and glycerol. Excess fatty
acids  adipose tissue.
LARGE INTESTINE- is made up of cecum, colon, and rectum. Colon is
divided into the ascending colon, transverse colon, descending
colon and sigmoid colon (Fig. 24.27, page 892).
Taenia coli; haustra; epiploic appendages.
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Ileo-cecal valve  cecum  ascending colon  transverse colon 
descending colon  sigmoid colon  rectum  anorectal canal  anal
sphincters  anal orifice.
Function of the large intestine- the large intestine functions in finishing
absorption, forming and storing feces, and eliminating feces from the
body.
DiverticulosisPhysiology of Defecation- passage of fecus to the rectum distends wall 
parasympathetic activity  powerful peristaltic contractions of
descending colon, pelvic colon and rectum + relaxation of the internal
anal sphincter  relaxation of the external anal sphincter voluntarily 
feces expelled (page 895).
REVIEW QUESTIONS
1. List the functions of the digestive system.
2. Describe the structure of the lining of the digestive tract.
3. What is the function of the nerve plexuses in the wall of the gastrointestinal tract?
4. Define peritoneum. What are the two layers of the peritoneum?
5. Define the term retroperitoneal.
6. Define ascites.
7. Define mesentery, greater omentum, and mesocolon. Which peritoneal extension binds the
small intestine to the posterior abdominal wall?
8. Define peritonitis.
9. Which structure of the mouth contains intrinsic and extrinsic muscles and what are their
functions?
10. What are the three pairs of salivary glands? Where are they located?
11. What is saliva made of?
12. What are the functions of saliva?
13. Describe the structure of the tooth.
14. What are the different types of teeth?
15. What is the human dental formula?
16. What type of tissue is the main component of teeth?
17. How is food processed in the mouth?
18. What is the function of salivary amylase?
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19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Define bolus.
Define deglutition.
Describe the process of deglutition.
Describe peristalsis.
Define achalasia and heart burn.
Define hiatal hernia.
Describe the structure of the stomach.
What types of cells are found in gastric glands and what do they secrete?
What is gastric juice made of?
Describe the digestion and absorption of food in the stomach.
Define chyme.
Which cells secrete HCl? How is it secreted?
How is gastric activity regulated? How does cephalic phase, gastric phase, and intestinal
phase specifically regulate gastric function?
32. What are the effects on the stomach of increased stimulation of the vagus nerves?
33. Describe gastritis.
34. Describe the structure of the pancreas.
35. What is pancreatic juice made of?
36. Why is secretion of pancreatic juice rich in bicarbonate ions helpful in digestion?
37. List the enzymes that are found in the pancreatic juice and their role in digestion.
38. How is pancreatic juice brought to the small intestine?
39. Describe the structure of the liver.
40. What are the cells of the liver called? What is their function?
41. Describe the duct system between the liver, gallbladder, pancreas, and the small intestine.
42. What is bile made of? What is the main function of bile?
43. Define jaundice.
44. Define cirrhosis.
45. Define hepatitis.
46. What controls the secretion of bile?
47. List the functions of the liver.
48. Describe the structure of the gallbladder.
49. What is the function of gallbladder? What controls the release of bile from the gallbladder?
50. What are the different parts of the small intestine? Which portion of the small intestine is the
longest?
51. Describe the structure of the small intestine.
52. Define plicae circulares.
53. What are villi? What is the functional significance of the capillary network and lacteal in the
center of each villus?
54. Define brush border.
55. What are brush border enzymes? How are they important in digestion?
56. Summarize the digestion and absorption of carbohydrates.
57. Summarize the digestion and absorption of proteins.
58. Describe the digestion and absorption of lipids.
59. A monoglyceride may be larger than an amino acid. Why can monoglycerides be absorbed
by simple diffusion whereas amino acids cannot?
60. What are micelles?
61. Define chylomicrons.
62. What are the different parts of the large intestine?
63. What are the different parts of the colon?
64. Define taenia coli, haustra, and epiploic appendages.
65. Define diverticulitis.
66. What are the functions of the large intestine?
67. Describe the process of defecation.
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Chapter 25
METABOLISM
Metabolism is a collective term for all of the chemical processes that
take place within the body.
Two categories (Fig. 25.1, page 908):
1. Anabolism - is a protein synthetic process requiring energy.
2. Catabolism - is the breakdown of proteins and other large molecules
to smaller molecules releasing energy.
ENERGY PRODUCTION
CARBOHYDRATE METABOLISM (Fig. 25.2, page 910)
Energy from glucose catabolism is generated in three phases:
1. GLYCOLYSIS- Process of conversion of glucose to pyruvic acid with
the release of energy (Fig. 25.3, page 911).
During glycolysis, glucose which is a 6 carbon compound, is converted
into two molecules of pyruvic acid (3-carbon compound). At the end of
glycolytic pathway there is a net gain of 2 ATP per glucose molecule.
Glucose + 2 NAD + 2 ATP  2 pyruvic acid + 4 ATP + 2 NADH
Mitochondrial ATP production (Fate of pyruvic acid)Glycolysis  pyruvic acid  acetic acid  acetyl CoA  Krebs cycle
(Fig. 25.5, page 913).
2. Krebs cycle (citric acid cycle or TCA [tricarboxylic acid] cycle)- is a
series of respiratory chemical reactions that produces energy (Fig.
25.6, page 914).
This includes 1 ATP + 3 NADH + 1 FADH2.
3. Electron Transport system (ETC)- ETC is a series of chemical
reactions during which electrons (H+) are passed from one acceptor
molecule to another, with the release of energy. Production of ATP
associated with oxidation by the flavoprotein-cytochrome system is
called oxidative phosphorylation.
CoQ  cytochrome B  Cytochrome C1 + C  cytochrome a 
cytochrome a3.
Oxidative phosphorylation is the generation of ATP through a reaction
sequence that requires coenzymes and consumes oxygen (Figs. 25.825.9, pages 916-917).
Function of Oxygen- oxygen is the final electron acceptor of electron
transport chain. 2e- + 2H + 1/2 O2  H2O.
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Energy yield of glycolysis and cellular respiration- two ATPs from
glycolysis, 2 from the TCA cycle, 32-34 from the electron transport
system (Table 25.1, page 918).
Anaerobic respiration- if the oxygen supply to the tissues is inadequate,
pyruvic acid is reduced to lactic acid by the addition of two hydrogen
atoms. When adequate oxygen becomes available, lactic acid is oxidized
back to pyruvic acid.
Glycogenesis- The formation of glycogen from glucose (Fig. 25.11,
page 919).
Gluconeogenesis- formation of glucose by the liver from
noncarbohydrate precursors (eg. pyruvic acid) (Fig. 25.12, page 919).
Lactic acid  pyruvic acid  glucose (liver).
LIPID METABOLISM (Fig. 25.14, page 922)
Lipolysis- is the breakdown of fat. In lipolysis, triglycerides yield glycerol
and fatty acids. Glycerol can be converted to phosphoglyceraldehyde
that can enter glycolysis. Beta-oxidation of fatty acid results in the
formation of a number of acetyl CoA that then enters Krebs cycle.
Lipogenesis - formation of fat, mainly occurs in the adipose tissue and
in the liver when the concentration of blood glucose is elevated. Acetyl
CoA  lipids.
Ketone bodies:
KetosisKetoacidosisPROTEIN METABOLISM (Fig. 25.15, page 924)
Amino acids can serve as sources of energy through
a. Transamination- a particular amino acid and a particular keto acid
can serve as substrates to form a new amino acid and a new keto
acid.
b. Deamination- amino acids are converted into keto acids as their
amino group is incorporated into urea.
VITAMINS- two main types: fat-soluble and water-soluble (Table 25.6,
pages 940-941).
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REVIEW QUESTIONS
1. Define metabolism.
2. Distinguish between anabolism and catabolism.
3. Define glycolysis. Describe its principal events and outcome. What is the fate of pyruvic
acid?
4. Describe how acetyl coenzyme A is formed.
5. Outline the principal events and outcomes of the Krebs cycle.
6. Explain what happens in the electron transport chain.
7. Summarize the outcomes of the complete oxidation of a molecule of glucose.
8. Define glycogenesis and glycogenolysis. Under what circumstances do they occur?
9. Define gluconeogenesis. Why is it important?
10. What is the fate of a triglyceride as an energy source in the body?
11. Explain the principal events of the catabolism of glycerol and fatty acids.
12. What are ketone bodies?
13. Define ketosis.
14. Define lipogenesis and explain its importance.
15. Relate deamination to amino acid catabolism.
16. Summarize major steps involved in protein synthesis.
17. Distinguish between essential and nonessential amino acids.
18. Define a vitamin. Distinguish between a fat-soluble and a water-soluble vitamin.
19. For each of the following vitamins, indicate its principal function and effect of deficiency:
A, D, E, K, B1, B2, niacin, B6, B12, pantothenic acid, folic acid, biotin, and C.
20. Describe abnormalities associated with increased concentrations of vitamins.
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Chapter 26
THE URINARY SYSTEM
Functions (pages 949-950)Organization of the urinary system- Kidneys (urine produced within the
nephrons  calyces  renal pelvis)  ureters  urinary bladder 
urethra (Fig. 26.1, page 949).
KIDNEYS
Coverings- renal or inner capsule, adipose capsule, and renal fascia
(Fig. 26.2, page 951).
Anatomy- Renal hilus, renal sinus, renal cortex, medulla (renal pyramids,
renal papilla, renal columns), Minor calyx, Major calyx, and renal pelvis
(Fig. 26.3, page 952).
Renal blood vessels- renal arteries  interlobar arteries  arcuate
arteries  interlobular arteries  afferent arterioles  GLOMERULUS
 efferent arterioles  peritubular capillaries  interlobular veins 
arcuate veins  interlobar veins  renal veins (Fig. 26.4, page 954).
Microscopic structure of the kidney- The functional unit of the kidney is
the nephron.
Based on the location of nephrons, they are grouped into cortical and
juxtamedullary nephrons (Fig. 26.5, pages 955-956).
The nephron is made up of renal corpuscle [glomerular (Bowman's)
capsule and glomerulus], and renal tubule (proximal convoluted tubule,
descending and ascending limbs of loop of Henle, distal convoluted
tubule and the collecting duct) (Fig. 26.6, page 957).
Glomerular capsule- is two layered: outer parietal and inner visceral.
Podocytes- are modified squamous epithelial cells. They have fingerlike extensions called pedicels that act like filtration slits (Fig. 26.8,
page 961).
Vasa recta (Fig. 26.5b, page 956)Juxtaglomerular apparatus- macula densa.
RENAL PHYSIOLOGY
Mechanism of urine formation- Three processes (Fig. 26.7, page 959):
1. Glomerular filtration
2. Tubular reabsorption and
3. Tubular Secretion- some substances that are not filtered can still be
excreted through membrane transport mechanisms.
1. Glomerular Filtration- The porous glomerular endothelium and
the high hydrostatic pressure in the capillaries are the two factors which
facilitate filtration. This movement is opposed by the capsular hydrostatic
pressure and by the colloid osmotic pressure of the blood (Fig. 26.9,
page 962).
A. Blood pressure in the glomerulus:
B. Hydrostatic pressure and osmotic pressure in the glomerular capsule:
C. Net filtration pressure = a – b
Gopalan, Fall 2004
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The amount of filtrate per minute is called glomerular filtration rate
(GFR). It varies from 115-125 ml/min; 7.5 L/h or 180 L/day!
Regulation of Glomerular filtration rate (Fig. 26.10, page 963, Table 26.2,
page 964)Renal autoregulation-  glomerular pressure  dilation of afferent
arteriole + dilation of glomerular capillaries + constriction of efferent
arteriole.
Hormonal regulation-  filtration pressure or  osmolarity of the filtrate
juxtaglomerular apparatus  renin   angiotensin I  angiotensin II 
aldosterone + ADH + constriction of efferent arterioles  GFR +  renal
pressure.
Neural regulation- sympathetic activation  vasoconstriction of the
afferent arterioles  GFR.
2.
Tubular Reabsorption- is a selective process that reclaims
materials from tubular fluid and returns them to the blood. Facilitated
diffusion, active transport, cotransport, and countertransport are involved
in modifying the filtrate (Fig. 26.11, page 966).
a. Proximal tubules- Approximately 65% filtrate is absorbed
across the proximal convoluted tubules. Na+ by active transport,
Cl- follows Na+ (passive movement), water follows Na+ and Cl(Fig. 26.12-26.14, pages 967-969).
b. Reabsorption at the Loops of Henle- the reabsorption of most
of the remaining water occurs as a result of the action of the
countercurrent multiplier system (Fig. 26.15, page 969).
Urine concentration (Fig. 26.19, page 974)Countercurrent mechanism-the extrusion of Na+ and Cl- from the
ascending limb causes the tissue fluid to become more
concentrated. This exerts an osmotic imbalance allowing water to
diffuse out of the descending limb. The hypertonicity of the tissue
fluid is multiplied by a positive feedback mechanism involving the
descending limb, which is permeable to water.
Role of Vasa recta and urea- help maintain hypertonicity within the
medulla.
Distal convoluted tubule and collecting ductADH-  permeability of the distal tubule and the collecting duct 
absorption of water.
As the collecting ducts pass through the hypertonic renal medulla, water
leaves by osmosis.
AldosteroneANP-  GFR,  Na+ reabsorption;  ADH + aldosterone.
Diuretics are used clinically to increase the urine volume and thus to
lower blood volume and blood pressure.
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Evaluation of kidney functionBlood urea nitrogen (BUN) and Creatinine test to evaluate the kidney
function.
Urinalysis (page 977)Kidney diseases- Glomerulonephritis, Kidney stones, Polycystic kidney
disease, Pyelonephritis, and renal failure.
The Ureters (Fig. 26.21, page 979)- muscular tubes; peristalsis.
The Urinary Bladder (Fig. 26.21, 979)- detrusor muscle.
The Urethra (Fig. 26.21, page 979)- Prostatic, membranous, and penile
urethra in the male.
Micturition Reflex- is due to the action of muscular sphincters in the
urethra (page 980).
Filling of the urinary bladder  stretch receptors  parasympathetic
neurons  relaxation of internal urethral sphincter  urgency felt 
relaxation of external urethral sphincter  emptying.
REVIEW QUESTIONS
1. List the functions of the kidneys.
2. Which organs compose the urinary system?
3. Discuss the location, size, and position of the kidneys.
4. Why are kidneys said to be retroperitoneal?
5. What are the three coverings of the kidneys?
6. Define renal hilus, renal sinus, renal cortex, medulla, pyramids, papilla, renal columns,
papillary ducts, minor and major calyces, and renal pelvis.
7. Trace the path of blood flow through the kidneys.
8. How much blood enters the renal arteries per minute?
9. What is a nephron? What are the different parts of the nephron?
10. What are the two types of nephrons based on their location?
11. What are the two parts of the renal corpuscle?
12. Define the structure of the Bowman's capsule.
13. Define podocytes, pedicels, filtration slits and their functions.
14. Define macula densa and juxtaglomerular apparatus.
15. Describe the mechanism of glomerular filtration.
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16. List mechanisms that favor glomerular filtration.
17. Define Glomerular Filtration Rate (GFR).
18. How is GFR regulated? Describe hormonal, neural, and autoregulation in detail.
19. Describe the mechanism of reabsorption in the proximal convoluted tubule. How much of
filtrate is reabsorbed here?
20. Describe the mechanism of reabsorption in the loops of Henle.
21. What is countercurrent mechanism?
22. Which solutes contribute to the high osmotic pressure of interstitial fluid in the renal medulla?
23. Describe the mechanism of reabsorption in the distal convoluted tubule.
24. List the hormones that contribute to the regulation of water reabsorption.
25. Define tubular secretion.
26. In tubular secretion, are substances entering or leaving the bloodstream?
27. What are diuretics? How do they function?
28. How do you evaluate kidney function?
29. Describe the physical characteristics and the chemical composition of urine.
30. Discuss the anatomy, histology, and physiology of the ureters, urinary bladder, and urethra.
31. Describe micturition. What is a lack of voluntary control over micturition called?
32. List and describe the physical characteristics, normal constituents, and abnormal constituents
of urine.
33. Discuss the causes of glomerulonephritis, renal failure, polycystic kidney disease,
pyelonephritis, and kidney stones.
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55
Chapter 27
ELECTROLYTES AND ACID-BASE BALANCE
ELECTROLYTES IN BODY FLUIDS (Fig. 27.6, page 997)
Sodium balance (Table 27.2, page 1000)- Na+ plays a crucial role in
water and electrolyte balance and the excitability of neurons and muscle
cells. The kidneys regulate Na+ levels of the body.
Aldosterone helps to regulate Na+ reabsorption by the kidneys.
Aldosterone secretion is controlled by renin-angiotensin-aldosterone
pathway.
Hypernatremia-  plasma Na+
Hyponatremia-  plasma Na+
Chloride balance (Table 27.2, 1000)- Cl- helps to regulate osmotic
pressure differences between fluid compartments and is essential in pH
balance. Cl- levels are indirectly regulated by aldosterone because Clgenerally follows Na+.
Potassium balance (Table 27.2, 1000)- K+ is extremely important to the
functioning of excitable cells, in intracellular fluid regulation and in pH
regulation. K+ balance in the body is also influenced by aldosterone.
Hyperkalemia-  plasma K+
Hypokalemia-plasma K+
Calcium and phosphate balance (Table 27.2, page 1000)- Calcium
and phosphate are important to the integrity of the skeletal system and
the teeth. Calcium is also important in synaptic transmission, blood
clotting and muscle contraction. Phosphate is required in the synthesis of
nucleic acids and high-energy compounds. It also is an important buffer
in red blood cells and in the renal tubules. Parathyroid hormone,
calcitonin, and calcitriol (vitamin D) regulate the level of calcium and
phosphate in the body.
Hypercalcemia-  plasma Ca++
Hypocalcemia-  plasma Ca++
ACID-BASE BALANCE (page 1001)
pH- is a measurement of the hydrogen ion concentration of a solution.
Lower pH indicate a higher hydrogen concentration or a higher acidity.
Higher pH indicates a lower hydrogen concentration or a higher
alkalinity.
Carbonic acid-bicarbonate buffer system (page 1002):
Respiratory system- refer to chapter 23: respiratory system.
Renal regulation- the kidneys eliminate excess acids and bases and
return pH to normal.
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Carbonic acid-bicarbonate buffer system:
In the lumen (filtrate), H+ + HCO3-  H2CO3  CO2 + H2O.
Diffusion of CO2 into tubular cells.
Inside the tubular cells, CO2 + H2O  H2CO3  H+ + HCO3-  active
transport of H+ into the lumen (exchange Na+ for H+)
H2CO3- + Na+  NaHCO3 into extracellular fluid  capillary.
In the lumen, H+ is buffered by either NH3+ or HPO4-2 and excreted.
Thus, excess H+ is removed and HCO3- is recycled.
Protein buffer system- amino acids accept or release H+ (page 1001).
 pH: COOH  COO- + H+
 pH: NH2 + H+. NH3+
Phosphate buffer system (page 1002) pH: H2PO4- H+ + HPO42Acid-base imbalances (page 1005)Acidosis-  H+ concentration of the arterial blood  pH.
Respiratory acidosis- hypoventilation  hypercapnia 
respiratory acidosis.
Metabolic acidosis- lactic acidosis, ketoacidosis,
glomerulonephritis, diuretics, diarrhea (loss of HCO3-).
Alkalosis-  H+ concentration  pH.
Respiratory alkalosis- hyperventilation  hypocapnia 
respiratory alkalosis.
Metabolic alkalosis-  HCO3-.
REVIEW QUESTIONS
1. Explain the role of sodium, chloride, potassium, calcium, and phosphate ions in the body.
2. Define hyponatremia, hypernatremia, hypokalemia, Hypercalcemia, hypocalcemia, and
hypercalcemia.
3. How does the kidney help maintain blood pH?
4. Describe bicarbonate-carbonic acid buffer system.
5. Describe the phosphate buffer system.
6. Describe the protein buffer system.
7. Define acidosis, alkalosis, respiratory acidosis, respiratory alkalosis, metabolic acidosis, and
metabolic alkalosis.
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