Human Anatomy and Physiology One

Week One
What is HAP and what is it studied in the module?
• Anatomy is the study of the structure of the human body while Physiology is the
study of the function of the body. Structure tends to mirror function as seen by the
liver whose structure is determined by function (to produce bile and filter blood);
• Histology is the study of tissues while Cytology is the study of cells by the use of
microscopy;

Histology
Epithelium (Epithelial Tissue)
Characterists
• Densely packed cells;
• Avascular, which means there are no blood vessels;
• Sits on basement membrane (the basement membrane is a thin, fibrous,
extracellular matrix of tissue that separates the lining of an internal or external
body surface from underlying connective tissue in metazoans);
• Forms either a covering, a lining or a gland;
• Polar;
• Cytokeratins (they are an important component of intermediate filaments, which
help cells resist mechanical stress).
Classification
• If simple (only one layer), the epithelial can be simple squamous (flat) which are
found where easy diffusion is required (blood vessels, lymph vessels, pleural,
cardiac and abdominal cavities). It mainly acts as a barrier, ideal for gas and fluid
exchange.
• Only layered cells might also be simple cuboidal cells which are good for easy
diffusion but also some processing/storage/synthesis of material. They form the
 ‘germinal’ epithelium lining of the ovary and appear in various ducts of the body,
such as ducts from salivary glands. Designed for secretions of mucus and storage
of substances.

• If there’s more than only one layer, the epithelial can be simple ciliated (hair)
columnar which are located in the fallopian tubes and central canal of spinal cord
and are capable of absorption, secretion and movement of particles due to the cilia

they contain.
• If not simple ciliated columnar, poly-layered epithelial tissues can be stratified
epithelia. They appear to be more than one layer but that’s not the truth, they are

only stratified when needed.

• There is also the glandular epithelia which is one or more cells that produce
and secrete a specific product. The product is always a water-based fluid
 (aqueous) and usually contains proteins (the product is referred to as a

secretion).
Specialisation of the Epithelia
INTERCELLULAR INTERACTIONS
• Occluding junctions;
• Anchoring junctions;
• Communications junctions;
• Basement membranes.
PROTECTIVE BARRIER
• Occluding junctions;
• Desmosomal junctions;
• Keratinisation;
• Surface sphingolipids.
CELL SURFACE SPECIALISATIONS
• Microvilli (absorptive);
• Basal folds (absorptive);
• Membrane plaques;
• Cilia;
• Cell surface proteins;
• They can also have secretory adaptions such as protein secreting cells, mucin
secreting cells, steroid secreting cells and ion pumping cells.

Connective Tissue
It’s a variety of cells, non living cell products and blood. The tissue is mainly made
up of extracellular matrix and cells. They fill the spaces between organs and tissues
and provides them with structural and metabolic support. They can either be called
Specialised Connective Tissue Proper or Connective Tissue Proper.

Composition of ECM
• Fibres which are long, thin structures of protein that provide strength and
adhesion between tissues.
• Amorphous matrix (ground substance) which is a complex mixture of large
molecules (mainly glycosaminoglycans - GAGs -, proteglycans - PGs - all
composed of carbohydrates), which provides them with viscous properties and
binding sites, and fluid (water, salts and small, soluble molecules) that assist in
the passage of material through the ECM.
The Extracellular Matrix
• Also know as Amorphous Matrix, the ground substance of the extracellular
matrix is an amorphous (formless) gelatinous matrix. This gelatinous matrix is
transparent, colourless and fills the spaces between the fibres and cells. It consists
of large molecules (GAGs) which bound together to form even larger molecules
(PGs). 90% of the extracellular matrix is made up of water making it resistant to
compressive forces.

Connective Tissue Proper

LOOSE
• Also known as Loose C.T due to the many small spaces seen within the tissue.
It’s the most encountered of the connective tissues. Mainly composed of the

collagenous fibres, elastic fibres, mast cells, fibroblasts and lymphocytes.

DENSE
• Contains fewer cells and it’s similar to those found in loose connective tissue. It’s
predominated by type 1 collagen fillers. It can take two forms : dense regular
(ligaments and tendons) and dense irregular (dermis of the skin, deep fascia of

the muscles).
Specialised Connective Tissue
PROPER
CARTILAGE
 • The Hyaline Cartilage is a non-vascular fibrous connective tissue found at
vertebral ends of the ribs, nose, larynx and trachea. It’s normally characterised by

arrangement of twin chondrocytes (cartilage cells).

• The White Fibrous Cartilage is very though with more flexibility than the hyline
one. It contains large pleomorphic cells in a matrix, one or more cells per lacuna
and elastic fibres orientated in all directions. It’s located in the pubic symphysis,

meniscus of the knee and the inter-vertebral discs.

• The Adipose Tissue are vacuous cells containing white or brown adipose (fat). It’s
responsible for the storage and metabolism of fat. The nucleus is a flattened
structure allowing maximum storage. Fat globules appear as empty spaces as it is

dissolved out by tissue preparation techniques.

Muscle Tissue
All muscle tissue are specialised for contraction, able to shorten to create a contractile
force, extensible - which means they can be stretched and maintain their contractile
ability -, excitable and able to respond to stimuli.
Skeletal Muscle
• Contractions move part of the skeleton (they’re voluntary contractions). They are
distinguishable by their stripy appearance (repeating structure of the muscle) and
have fibres named Myofibrils which are made up of repeating units called muscle

sarcomeres.
Cardiac Muscle
• This type of muscle is found in the heart, they constitute the muscular wall of the
heart (myocardium). Their movement is involuntary, we can’t control it. They
have a similar organisation to the skeletal muscle - stripy appearance because of

the repeating units (muscle sarcomeres).

Smooth Muscle
• They are found in the blood vessel walls and tubular organs such as the the
intestine. Their contractions are also involuntary. Unlike the cardiac and skeletal
 muscle, they have no sarcomeres and their contractile proteins (myosin and actin)

are more randomly arranged than in a skeletal or cardiac muscle.

Nerves
The nervous tissue includes all cells that provide communication between other tissue
types. They are the key to the communication network of the body.
• Neuronal which are nerve cells in the brain, spinal cord and ganglia. They are
specialised cells that conduct electrical impulses.
• Synapse which is the junction between neurons and tissues. They transmit
messages (the nervous impulse by ions).

How to identify tissue?

• The methods that exist to get samples of the tissue are needle biopsy, endoscopic
biopsy, excision biopsy, curettage biopsy and resection specimens. While when
processing and microtome consists of fixation, dissections, processing,
embedding, microtomy and staining.
Week Two and Three

The Plasma Membrane

Membrane Transport Processes
There are two main types of membrane processes : the passive transport which
doesn’t go against the concentration gradient and requires no energy input and the
active transport which requires energy input - mainly from ATP - and goes against
the concentration gradient.

There are two main means of transport in passive transport :

• Diffusion : passive spread of particles through random motions from high to low
concentration. It’s affected mainly by the amount of substance, the temperature,
surface area and diffusion distance.
• Osmosis : passive spread of water through selective permeable membranes from
high to low concentration. It can pass through the lipid bilayer by smile diffusion
or through aquaporins (integral membrane proteins).

MOVEMENT OF WATER AND SOLUTES

• Semipermeable membranes separate fluid compartments. Osmosis can occur.
• Permeating solutes - hydrophobic/lipophilic can move across membrane and
water equilibrates
• Non permeating solutes - hydrophilic/lipophobic. Cannot move across
membrane and therefore establish water gradient.

OSMOLARITY VS TONICITY
• Osmolarity - absolute measure of solutes.
• Tonicity - relative concentration of salt solutions in extracellular fluid/blood
versus inside of the cell.

WATER CONCENTRATION
• Isotonic : the water inside the cell is the same as the water outside the cell.
 • Hypotonic : water inside the cell is less than the water outside the cell. Water will
tend to enter the less.
• Hypertonic : more water inside the cell than water outside. Water will tend to
leave the cell.

Like passive transport, active transport has also two main means of transport:
• Simple diffusion (lipid soluble) such as steroid hormones.
• Facilitated diffusion (lipid insoluble) : channel meditated for ions and carrier
meditated for glucose.

ION CHANNELS
Ions channels specific for a certain ion. They move across the membrane against an
electrochemical gradient.
• Leak Channels : randomly alternate between open/closed.
• Voltage gated: ions through only above a certain voltage (electrical potential)
• Ligand gated : open/close only when ligand (neurotransmitter binds)
• Mechanically gated : open/close in response to mechanical stimulation
(vibration).

Resting Membrane Potential

The RMP is normally negative about (-70 mV) this means that more K+ leaks out
than Na comes in. Largely negative proteins always remain in cytosol.

Secondary Active Transport

These are driven by energy in Na gradient.
• Antiporters - carry two substances across membrane in opposite directions.
• Symporters - carry two substances across membrane in same direction.

Week Four

Nerve Cell - Neuron

Neurons receive information through dendrites and transmit information through
axons. The information is one-way traffic and is passed from cell to cell by release of
chemical signals from terminals
Electrical Charge
• Neutrons establish differences in ion concentration and electrical charge across
membranes, this is also called resting membrane potential (RMP). When an neutron
is polarised this means the interior of cell more is more negatively charged than the
outside (-70 mV)
• If more K+ enter the cell this means that depolarisation is happening.
• Repolarisation happens when K+ leaves the cell.
• Hyper polarisation means K+ is leaking out of the cell before equilibrium is
restored.

Changes from the RMP

The cells are already polarised which means they are primed and ready to produce an
action potential. Graded potentials must be produced to depolarise cell to threshold
(this is received in the dendrites).

Week Five
The Brain and Central Nervous System and Special Senses
The Brain is part of the nervous centre and has, essentially, three major regions :
hindbrain, midbrain and forebrain.
Midbrain
• The midbrain is associated with vision, hearing, motor control, sleep/wake, arousal
(alertness), temperature regulation. Whenever certain pigmented cells, also known
as substancia negra, appear that means loss of neurons, eventually leading to
Parkinson.
In the midbrain it’s possible to find the diencephalon (between brain) which is

constituted by thalamus, hypothalamus, pituitary gland and major endocrine grand

(interface between nervous and endocrine systems, controlled by the hypothalamus).
• The thalamus is responsible for distributing almost all sensory and motor
information going to the cerebral cortex and regulates levels of awareness and
emotional aspects of sensation.
• As for the hypothalamus, it regulates autonomic nervous system, secretion of
hormones by the pituitary gland and has extensive afferent/efferent connections
with thalamus, midbrain and some other cortex areas that receive information
from the autonomic nervous system.
Cerebellum (little brain) - divided into several lobes, receives sensory input from
spinal cord, receives motor information from cerebral cortex, receives input about
balance from vestibular organs of inner ear. Coordinates planning, timing, pattering
of skeletal muscle activity during movement, controls maintenance of posture,
coordinates movement of head and eyes. If damaged, loss of precise motor control
and ataxia might happen. Alcohol affects it.
A stroke, or cardiovascular accident, is caused by the lack of blood in a part of the
brain.

Forebrain
• It’s the largest region of the brain and consists of the cerebral cortex, underlying
white matter (myelinated axons and glial cells) and three functionally related deep-
lying clues of euros (nuclei) - basal ganglia, hippocampus and amygdala.
• Theres two hemispheres which are divided by a fissure (front-to-back) which are
both concerned with perceptual, cognitive and high motor functions, emotions and
memory.
Basal Ganglia - masses of grey matter found deep within cortical white matter. The
main components are the corpus striatum (caudate nucles, lentiform
nucleus/putamen) and the globes pallidus. It directs subsconcious activities (habits) of
which of several possible behaviours to carry out at a given time.
Hippocampus and amygdala - they’re part of the limbic system which influences
endocrine autonomic nervous system . The hippocampus are required for formation
of long-term memories and are implicated in maintenance of cognitive maps for
navigation while the amygdala signals cortex of stimuli such as a reward and fear and
social functions (ex.: mating). They’re highly interconnected with nucleus accumbens
which is the brain’s pleasure centre - role in sexual arousal and “high” derived from
drugs. They’re also connected to parts of the thalamus and hypothalamus.

Cerebral Cortex
It’s the largest part of the brain holding 83% of its mass and controls all higher
mental functions including all conscious thoughts and experience along with
intellectual functions.
It has four lobes being these the temporal lobe (memory, hearing), frontal lobe
(executive function, language), parietal lobe (sense of self) ad occipital label (vision).
Theres three types of functional areas being these the motor, sensory and association
areas.

Anatomy of the Cerebrum (also known as brain)

Folded surfaces increase the surface area. The elevated ridges are the gyro while the
shallow depressions the sulk. The deep grooves are the fissures while the grey matter
is constituted of cell bodies and found in the basal nuclei. The white matter on the
other hand is mainly based off fibre tracts (axons), deep in cerebral cortex and it
surrounds the basal nuclei.
White matter of the cerebrum - association fibres (bundles of fibres unite different
parts of the same cerebral hemisphere). Arcurate: local, longitudinal: whiten one
hemisphere, commissural between hemispheres, projection links cerebral cortex with
the rest of the central nervous system.
Hemispheres of the Cerebrum
Each hemisphere concerned with sensory and motor processes on the opposite side of
the body. Decussations are the crossing over of pathways from side of initial signal to
the opposite side for processing. Even through similar in humans they are not
completely symmetric in striation of equivalent in function.

The brain has other features such as central cavities expanded filled with
cerebrospinal fluid, lined with ependymal cells and continuous with each other and
central canal of spinal cord.

Brain Protection
Meninges - constituted by the dura matter which in turn is made of 2 layers of
fibrous connective tissue, fused except for dural sinuses (venous channels), archnoid
matter and Pia matter (soft).
Cerebrospinal fluid (CSF) - made in choroid plexuses (filtration of plasma from
capillaries through ependymal cells). Cushions and nourishes brain. Assayed in
diagnosing meningitis, bleed, MS. Excess of it will lead hydrocephalus (big heads).
Blood-Brain Barrier - tight junctions between endothelial cells of brain capillaries,
instead of usual permeability. Brain endothelial capillaries in capillaries in contact
with foot processes of astrocytes therefore separated from neurons. Allow movement
of nutrients, O2 and CO2. Protects brain against flections in ion concentrationd. Not
against uncharged and lipid solute molecules such as alcohol, nicotine and some
drugs.

The Special Senses

Theres two main types of senses : the general (somatic) senses which go throughout
the body such as heat and pain and the special senses which are specialised organs in
head (smell, taste, vision).

Sensory receptor cells - they’re confined to the head region, housed in complex
sensory organs (eye, ear) or distinctive epithelia structures (taste bud). Distinct and
specific reception cells, not free ending of sensory neutrons. Neuronlike ephitelial
cells or small peripheral neutrons that transfer sensory information to other neutrons
in afferent pathways. Transduce a physical or chemical stimulus into a change in
membrane potential. Can detect taste, light, sound, pressure, pain from the
environment.

The olfactory epithelium - Receptors lie in patch of olfactory epithelium on the roof
of the nasal cavity. They’re bathed by swirling air inhaled from the air. Odorant
molecules enter the nasal cavity and dissolve in layer of mucous.
• Contains millions of bipolar neurons;
• Surrounded by columnar epithelial cells for support;
 • At base of the epithelium are olfactory stem cells (basal cells) to form new
replacement neurons;
• Each receptor cells has a apical dendrite projecting to the epithelial surface
ending in a long olfactory cilia radiates.

The sense of smell works by odour molecules binding to receptors in the cilia.
Action potential from those cells re conducted to the olfactory bulb. The olfactory
information is then integrated in the olfactory bulb and relayed to the cerebral cortex
in the brain. Basal cells periodically replace olfactory receptor cells and mucus layer
is produced by support cells and olfactory glands to dissolve odour molecles.

The olfactory sensory neutron. Axons of olfactory neurons in the epithelium project
to the olfactory bulb then project through the olfactory tract to the cortex. The
olfactory cortex is responsible for the conscious perception of smell. The medial
olfactory area is involved in visceral and emotional reaction to odours (limbic). The
intermediate olfactory area receives input from the medial area and cortex. Axons
from the intermediate area project along the olfactory tract to the bulb – action
potentials carried along axons modulate activity of neurons in the olfactory bulb.

Taste - There are 5 major tastings (salt, sour, sweet, bitter, savoury). Dissolved
tastants stimulate taste cells which release neurotransmitters. Action potentials may
be stimulated in the axons of sensory neurons.

The taste receptors are present in taste buds which exist in the mucosa of the mouth
and the larynx. About 10,000 taste buds are found on the surface of the tongue called
papillae. A small number of taste buds can also be found in the roof of the mouth
(palate), the inner cheeks and the epiglottis.
Taste buds are globular collections of 50-100 epithelial cells. Each bud contains
gustatory and basal epithelial cells. Long microvilli (taste hair) project from the cell
and are bathed in saliva containing dissolved molecules to which generate impulses
with stimulate taste. Cells in the taste bud are replenished every 7-10 days by diving
basal epithelial cells, replacing the gustatory cells scraped or burned off by eating.

Axons of the sensory taste neutrons pass through cranial nerves facial,
glossopharyngeal and vagus and through the ganglion of each never. The axons enter
the brainstem and synapse in the nucleus of the tracts solitatus. Axons from the
nucleus of the tracts solitarius synapse in the thalamus. Axons from the thalamus
terminate in the taste area of the cerebral cortex.

Eyes
• Electromagnetic spectrum - The eyes are responsible for the detection of visible
light which is a small part of the electromagnetic spectre with about 400 to 700
nm wavelengths. Objects can absorb or reflect certain wavelengths of light -
colour.
 • Accessory structures of the eye - There’s six accessory structures of the eye : the
eyelash and eyebrow which protect the eyeballs from foreign objects, sweat direct
rays or the sun, the lacrimal caruncle which contains sebaceous gland and sweat
glands, the material commissure which are the angles of the palpebral fissure near
temporal bone, the palpebral fissure which is the space between upper and lower
eyelids that expose the eye, the eyelid which shades during slip, protects from
excessive light and foreign objects and spreads lubrication over the eyeball and, at
last, the medial commissure, the angles of the palpebral fissure near nasal bone.
It’s the extrinsic eye muscles which move the eye in almost all directions. Small
motor neurone allow for smooth, precise and rapid eye movement. The eyeball can
move laterally, medially, superiorly and inferiorly.
ANATOMY OF THE EYE
Fibrous tunic (superficial layer of the eye)
• Cornea - transparent coat which covers the coloured iris, curved to help the retina,
outer coat (non keratinised stratified squamous epithelium), middle coat (collagen
fibres and fibroblasts) and inner surface (simple squamous epithelium).
• Sclera - white of the eye, layer dense connective tissue (collagen and fibroblasts),
gives shape to the eyeball, makes it rigid, allows attachment of extrinsic eye
muscles
Vascular tunic (middle layer of the eye)
• Choroid and ciliary body - highly vascularised to provide retina with nutrients,
lines the sclera, contains melanocytes to produce pigment melanin (layer appears
dark brown).
• Iris - coloured portion of the eyeball, shaped like a flat doughnut, consists of
melanocytes which dictate eye colour (the higher the melanin the darker the
colour), also consists of smooth muscle fibres.
It provides oxygen, nutrition etc to the internal eye structure. Posteriror (choroid)
pigment reduces light scattering, anterior (iris) controls the amount of light entering
the pupil, ciliary muscles (smooth muscles, autonomic regulation), ciliary processes
produce aqueous humour).
Nervous tunic (inner layer of the eyeball)
• Retina : lines 3/4 of the eyeball, multiple layers (about 10), 3 neuronal layers
(photoreceptors (detect light), bipolar cells, ganglionic cells.
• Macula - exact centre o the posterior portion of the retina
• Fovea - small depression in the centre of macula containing only cones.
Macula/Fovea are the area of greatest visual acuity. Optic disc (blind spot) nerves
exit, blood vessels enter/exit the eye.
The retina contains retinal pigmented epithelium which is an outer simple cuboidal
epithelium where pigment reduces light scattering.

Refraction & accommodation - refraction is the bending of light rays passing from
one medium to another. The cornea and lens refract light rays. The lens is flattened
by ciliary muscle relaxation, rounded by ciliary muscle contraction, counter intuitive,
the increase in lens curvature for near vision is accommodation.
Rods (bipolar photoreceptors that contain rhodopsin) - sensitive to low intensity
light, used mostly at night, do not discriminate colours (monochromatic).
Photoreceptors - neurotransmission - when the photoreceptor is in the dark the
membrane potential is slightly depolarised and glutamate is release continuously.
When the light stimulates the photoreceptor cell the membrane hyper polarises and
glumate release is stopped.
Cones - require more eight for stimulation than rhods, less numerous than rods,
humans have 3 different kinds of cones, they absorve different wavelengths and
detect colour.

Sound - audition is the ability to detect and interpret sound waves, auricles collect
and direct sound waves to the auditory canal. The tympanic membrane covers the end
of the auditory canal and vibrates in response to pressure waves. Auditory systems
use mechanoreceptors to convert pressure waves to receptor potentials.
Middle ear - vibrations of the tympanic membrane are transmitted via the ossicles
(malleus, incus and stapes) to smaller movements with greater force at the (smaller)
oval window. Oval window movement are forced into pressure changes in the fluid-
filled inner ear.
Inner ear - the cochlea (coiled & tapered chamber with 3 parallel canals separated by
2 membranes - Reissner’s (Vestibular) membrane and the basilar membrane). The
organ of court sits on the basilar membrane and forces pressure waves into action
potentials. Upper and lower canals are joined at the distal end, the round window is a
flexible membrane at the end of the canal. Pressure waves can travel “all the way
around” to reach the round window, or take a “shortcut” across the basilar membrane.
This short cut flexes the basilar membrane and stimulates hair cells.
Frequency-dependent detection - the basilar membrane is lined with protein fibres,
fibres are short near the oval and round windows at the base of the cochlea (high
frequency waves vibrate them), fibres are longer near the distal end of the cochlea
(low frequency waves vibrate them). Hence, different vibrational frequencies flex the
basilar membrane at different locations. Action potentials stimulated by
mechanoreceptors at different positions along the organ of Corti are transmitted to the
brain via different parts of the auditory nerve.
Lower-frequency detection - sound waves of frequency <20Hz travel around the
“helicotrema” and are not detected. Sounds of higher frequency result in pressure
waves in the perilymph that set up vibrations in the basilar membrane. As fluids are
incompressible the pressure wave causes a bulge in the cochlea. These bulges
resonate with fibres of the basilar membrane which are tuned to those particular
frequencies.
Hair cells - specialised epithelial cells in organs of hearing and balance. They’re
mechanoreceptors which means they convert vibrations into a receptor potential.
Deformable microvilli (sterocilia) which bend to open or close ion channels.
Depolarised plasma membrane (neurotransmitters are released).
Auditory pathway :
1. Auricle directs sound waves into external auditory canal;
2. Sound waves strike the tympanic membrane to cause vibration;
 3. Malleus vibrates in sync with tympanic membrane to then vibrate the incus
and stapes;
4. Footplate of stapes vibrates in oval window at 20x more vigorous pace due to
ossicles;
5. Stapes movement at oval window sets up fluid pressure waves in the
perylimph of the cochlea, pushing perilymph to the Scala vestibuli;
6. Pressure waves travel through perilymph of scala vestibuli and move to
endolymph in cochlear duct;
7. Pressure waves cause basilar membrane to vibrate, moving the hair cells fot
he spiral organ to generate nerve impulses in cochlear nerve fibres;
8. Sound waves of various frequencies cause basilar membrane regions to
vibrate more intensely.
9. Nerves impulses pass along the neutrons of the cochlear branch of
vistubulocochlear nerve;
10. The axon terminals synapse with the cochlear nuclei in the medulla oblongata;
11. Then impulses the auditory areas of the cerebral cortex of both hemispheres,
where information is integrated and interpreted.
Balance : the vestibular system is involved in the sense of balance. The otoliths are
granules containing protein and calcium carbonate found in a gel in the inner ear. The
otoliths stimulate hair cells to depolarise or hype polarise in response to movement.
Nerve impulses pass along vestibular ganglia which form the vestibulocochlear
nerve. These nerves synapse in vestibular nuclei along with input from eyes and neck
and trochlear and abducens nerves.
Reflexes
They’re an automatic, sudden and involuntary response to an impulse (stimulus).
There’s the spinal reflex where the integration occurs in the spinal cord and the reflex
arc where nerve impulses pathway that produces a reflex.
Stretch reflex - Contraction of a skeletal muscle in response to stitching of the mucle.
Monosynaptic reflex. Patellar or knee-jerk reflex: Stretching of a muscle →
activation of muscle spindles → sensory neuron → spinal cord → motor neuron →
muscle contraction.
Tendon reflex - Polysynaptic reflex. Control muscle tension by causing relaxation
when tension is great. Sensory receptors are the Golgi tendon organs. Applied tendon
tension → tendon organ stimulation → nerve impulse → spinal cord → motor neuron
causes muscle relaxation and relieves tension.
Withdrawal reflex - Polysynaptic reflex. Ipsilaterial. Stepping on a tack (stimulus) →
nerve impulse → interneuron activation → motor neuron activation → muscle
contraction → withdrawal of the leg.

The Heart
The cardiovascular system
The functions of the cardiovascular system are the transport of gases, nutrients and
hormones, regulation of the body temperature and the immune protection. It’s
constituted by three components - the heart, vessels and blood.
The Heart
• It’s the pump of the circulatory system, weighting about 350g and beating about
10,000 times a day. The heart has three distinct layers - the epicardium (thin,
transparent outer layer of the heart (visceral layer of serous pericardium), the
myocardium which is the thick middle layer of cardiac muscle and the
endocardium which is the simple squamous epithelium, continuous with veins
and arteries of vasculature.
• The heart is made out of cardiac muscle tissue which is striated with short fibres,
parallel muscle proteins that slide along each other causing the cell to shorter
(contract). Neighbouring cells connect via gap auction in intercalated discs.
• The heart has four chambers being the upper 2 the right and left atria and the
Lower 2 the right and left ventricles.
• Also has two separate circuits, the right side of the heart takes venous blood from
the body pumping it to the lungs so it might oxygenate (pulmonary) and the left
heart works with freshly oxygenated blood, pumping it to the body (systemic).
• It’s a closed system. Arteries have higher pressure than veins and supply blood to
tissue while veins are the reservoir that return blood to the heart.
The myocardium gets nutrients from blood flowing through coronary circulation. The
coronary veins collect coronary sinus on back of heart which empties right into the
right atrium with oxygen depleted blood from the rest of the body.
Functions of atria and ventricules
• Right and left atria complete the filling of ventricles before these contract;
• The ventricles are the main pump for pulmonary and systemic circuits being that
the pulmonary is at a lower pressure so a smaller muscle is needed.
• Blood flows from area of high pressure to area of low pressure.
• Flow of blood dictated by differences in pressure, not muscles, operates heart’s
valves.
Heart Valves
• Atrioventricular valves (tricuspid, mitral) allow blood to flow from atria into
ventricles. Closing AV values subject to strong forces as ventricles start
contracting. Valves tethered to walls of ventricles by chordae tendineae attached
to papillary muscles.
• Outflow (semilunar) valves (pulmonary, aortic) allow blood to flow from
ventricles into outflow vessels. Three firm corps that each look like a semi-full
moon. Open with ventricular ejection, close when blood in aorta and pulmonary
outflow tracks begins to leak back into ventricles.
Heart Sounds
All 4 heart valves (tricuspid, mitral, pulmonary and aortic) open and close during the
cardiac cycle, in pairs. The valves opening are usually silent with the sounds being
produced by the valves closing in the following order - tricuspid, mitral, pulmonary
and aortic.
Initiation of the heart beat
The heart muscle is autorhythimic which means it doesn’t need the nervous system in
order to sustain lifelong heartbeat. It’s myogenic, meaning it begins in the tissue not
in the nervous system. When transplanted hearts are re-warmed and following
cardiopulmonary bypass they begin to beat.
Coordinating contractions
Individual cells form bands of muscle around the heart and work as a unit - functional
syncytium. Atrial muscle syncytium contracts as a single unit to force blood down
into the ventricles. Syncytium of ventricular muscle starts contracting at the apex,
squeezing blood upward to exit outflow tracts.
Cardiac Conduction
Some groups of myocytes (muscle cells) don’t contract very well thus working as a
pacemaker and conduction system for electric signals.
Excitable cells
Membrane depolarises to generate electrical signal passed from cell to cell. All
myocytes spontaneous depolarise at given rate - some groups of cells faster than
others. A group of autorhytmic cells reaches threshold and triggers action potential
thus all cells in that area of the heart also depolarise.
Setting the pace
Sinoatrial (SA) node - normal pacemaker. Located in the right atrial wall just below
where superior vena cava enters chambers.
Action potential from SA node propagates throughout wall of atria and into the
ventricles via atrioventricular (AV) node in interatrial septum. At AV node, the signal
is delayed, allowing atria a chance to move blood into the ventricles.
From the AV node, the signal passes through AV bundle to left and right bundle
branches in interventricular septum, towards apex of heart. Finally, Purkinje fibres
rapidly conduct action potential through the ventricles (0.2 seconds after atrial
contraction).
Cardiac muscle Potential
The action potential initiated by SA node travels through the conduction system to
excite contractile muscle cells in atria and ventricles.
At RMP, the cells are found at -90 mV then the AP propagates throughout the heart
by opening and closing Na+ and K+
The calcium triggers the contraction of the heart, similar to the skeletal muscle. A
electrical activity leads to Ca2+ release from the sarcoplasmic reticulum which sends
actin and myosin into a contraction cycle.Tension is developed as filaments slide past
one another. The adrenaline released by the nervous system increases contraction
force by enchasing Ca2+ entry into cytosol.

There’s a plateau (refractory period) in which cardiac muscle lasts longer than the
contraction itself (unlike skeletal muscle). Another contraction will not begin until
relaxation is well away. A sustained contraction (tetanus) cannot occur in cardiac
muscle as it needs to leave sufficient time between contractions for chambers to fill
with blood. If tetanus happened in the heart muscle blood flow would cease.

Cardiac cycle
The ventricular function is the most important function. Throughout the cycle two
major principal events occur such as ventricular filling (during diastole) and ejection
during systole. Systolic blood pressure measured in arm - reflection of maximum
pressure developed by left ventricle during contraction (120 mmHg) Diastolic blood
pressure – pressure in arteries during the arterial relaxed but filling stage (diastole)
(80 mmHg).

The cycle follows this sequence : atrial diastole and systole, atrial diastole and
ventricular systole and, finally, ventricular diastole.

Atrial diastole and systole

The blood returning from the lungs/body flows passively down into ventricles
through open valves. The atrial systole is responsible for 20%
Isovolum(etr)ic contraction : Both ventricles contract, intravenricular pressure rises,
closing AV valves and then ventricles stay completely closed chambers for brief
period.
Ventricular ejection : the rising ventricular pressure forces the semilunar valves to
open and as such the blood is ejected from the heart,
Isovolum(etr)ic relaxation: the ventricles relax and the ventricular pressure drops.
Blood backflows, closing semilunar valves, closing the ventricles. Atria continue
filling with blood and when the pressure of the atria excess the ventricular pressure,
AV valves open causing the ventricle filling to begin (ventricular diastole).
Ventricular systole happens bro.

Cardiac output
Affected by changes in the Stroke volume, heart rate or both. On its own, stroke
volume is affected by the amount of ventricular filling before contraction, contractile
of ventricle and resistance in blood vessels or valves heart is pumping into.
The more the heart muscle is filled before contraction, the more forcefully the heart
will contract and the greater the volume of blood ejected during systolic contraction.
Preload - volume of blood in ventricles at the end of diastole. It’s increased during
hypervolemia, regurgitation of cardiac valves and heart failure.
Afterload - the resistance left ventricle must overcome to circulate blood. Increased in
hyper tension and vasoconstriction.
Autonomic Nervous System Innervation
Although the heart doesn’t rely on nerves for basic rhythms, abundant sympathetic
and parasympathetic innervation alters the rate and force of heart contractions. Thus,
the ANST will then regulate the changes in cardiac output to maintain blood pressure,
flow and volume throughout the body.

Sympathetic - increased heart rate (SA node), increased calcium entry in myocytes
and thus increased force of contraction. Noradrenaline, beta receptors – increased
chemical modulator (called cyclic AMP)
Parasympathic - decreased heart rate, reduced calcium entry and thus decreased force
of contraction. acetylcholine, muscarinic receptors – decreased (cyclic AMP)

Contractility
Stimulation of sympathetic nervous system during exercise increases venous return,
stretches heart muscle and increase cardiac output. Failing hearts cannot generate
sufficient force.

Cardiac reserve
Its the difference between CO at rest and the maximum CO heart can generate.

Vessels (2nd component of cardiovascular)

Major veins - superior and inferior venue cavae. There’s about 4 pulmonary veins
and coronary sinus.
Major arteries - aortic arch (ascending and descending portions), pulmonary trunk
(left and right pulmonary arteries), coronary arteries.
Pulmonary Circuit - Deoxygenated blood to the heart. Comes from the body
(venous return). Flows into right atrium from 3 sources (two vena cave and coronary
sinus). Blood then goes through right ventricle to lungs to be oxygenated.
Blood Flow - Systemic Circuit - Oxygenated blood returns from lungs to left atrium
to be pumped through outflow tract of systemic circulation (aorta).
Arteries - vessels that always conduct blood away from the heart, so usually
containing oxygenated blood. They’re thick walled, elastic and exposed to high
pressures and friction forces. As they bifurcate, they get smaller and less elastic
(more muscular).
Arterioles - greatest pressure drop, diameter adjusted to regulate blood flow.
Sphincters in arterioles direct flow in tissue bed.
Capillaries - thinnest vessels, lowest rate of blood flow and where nutrient exchange
occurs.
Veins - vessels that always bring blood back to the heart so usually venous blood.
They’re thin walled, compliant and exposed to low pressures. Not a lot of friction
forces and valves are there to prevent backflow. They’re all blood reservoir.
Venous valves - hinge like flaps formed from tunica intima. Most abundant in limbs
where upward flow of blood is opposed by gravity. One way valves prevent
backflow. When the skeletal muscles compress the veins, they force blood towards
the heart.

Haemodynamics
Blood pressure - measured in larger conducting arteries where maximum pulses of
the heart can be detected - usually brachial artery. They’re two types of blood
pressure : the systolic BP which has higher pressure and is measured when the left
ventricular systole when the aortic valve is open and the diastolic BP the lowest
pressure measured during left ventricular diastole when valve is closed.
Blood Pressure regulation
Constriction of blood vessels raises blood pressure. Vessel diameter actively
regulated by vasomotor fibres - sympathetic nerve fibres innervate smooth muscle
layer and release noradenaline - vasoconstrictor
Vasodilation reduces blood pressure - decreased sympathetic activity.

The Respiratory System

Oxygen is needed for cellular respiration done in the mitochondria.
Respiratory system : structure
Upper respiratory tract : Nasal passage, oral cavity, pharynx, larynx
Lower respiratory tract : Intercostal muscles, Bronchi, Bronchioles , Heart and
Diaphragm.

Division of function
Conduction zone - conducts air to lungs - bulk flow. Anatomic dead space.
Respiratory zone - main site of gas exchange by diffusion (respiratory bronchioles)
Nose - external part of cartilage and skin, lined with mucous membrane, openings to
exterior - external nares, nasal cavity divided by septum, nasal conchae allow air to
warmed, moistened and filter air. Olfactory receptors detect stimuli. Nose also plays
role in modifying speech using “resonating” chambers.
Pharynx and larynx:
Nasopharynx - Adenoids (lympoid structures in posterior walls) and Eustachian tubes
(equilibrate air)
Oropharynx - food and air pass through, directed by epiglottis and vestibular folds
Laryngopharynx - connects to oesophagus, larynx
Larynx - as air passes, changes in structure elicit sounds

The lower respiratory tract

Trachea - Primary bronchi - Secondary bronchi - Tetriary bronchi - Bronchioles -
Terminal bronchioles

Trachea (windpipe) - extends from larynx to primary bronchi. It’s composed of

shaped ships of cartilage and smooth muscle lined with pseudo stratified ciliated
columnar epithelium
There’s 4 layers : mucosa, submucosa, hyaline cartilage and adventitia

Cells lining the respiratory tract

Cilia, Globet cells, Ciliated cells and Lamina propria.

Lungs
Paired organs found in thoracic cavity, each lung is separated from each other by the
heart and other structures in mediastum. Each lung is enclosed by a double layered
pleural membrane : Parietal pleura - lines the walls of thoracic cavity and the visceral
pleura covers lungs themselves

Right lung - three lobes separated by two fissures

Left lung - two lobes separated by one fissure
Lobes of the lungs
Each lobe receives it’s own bronchus that branch into secondary and tertiary bronchi.
Terminal bronchioles branch into respiratory bronchioles that divide into alveolar
ducts. Lung lobule is the terminal structure unit.

Part Two
Pulmonary ventilation includes :
Breathing - inhaling of fresh air and exhalation of stale air
Inhalation - when alveolar pressure falls below atmospheric pressure
Contraction of diaphragm and external intercostals causes lungs to expand.
Lung expansion reduces pressure, allowing air to be inhaled

Relaxation of those muscles causes lungs to deflate - air is exhaled.

Alveoli
Rounded outpounching lined with simple squamous epithelium. Alveolar sac - 2 or
more alveoli sharing a common opening. Type I alveolar cells - main site of gas
exchange, Type II alveolar cells - secrete alveolar fluid which includes surfactant.
Alveolar macrophages - engulf foreign particles.

The pulmonary blood supply :

Pulmonary arteries carry deoxygenated blood returned from systemic circulation to
the lugs.
Pulmonary veins return newly oxygenated blood back to the heart.

Alveolar ventilation : primary function of the lungs. It’s the volume of gas that
reaches alveoli per unit time. Amount of air breathed per breath minus the air left in
the lungs.

Dead Space - anatomic dead space - volume of conduction zone

Physiologic dead space - alveoli not ventilated/blood supply impaired - disease state.
Breathing in general
1. Oxygen diffuses into the arterial ends of pulmonary capillaries and CO2
dissolves into the alveoli because of differences in partial pressures.
2. As a result of diffusion at the venous ends of pulmonary capillaries, the Po2 in
the blood is equal to the Po2 in the alveoli and the PCO2 in the blood is equal to
that on the alveoli.
3. The PO2 of blood in the pulmonary veins is than than in the pulmonary
capillaries because of mixing with deoxygenated blood from veins draining the
bronchi and bronchioles.
4. Oxygen diffuses out of the arterial ends of tissue capillaries and CO2 diffuses out
of the tissue because of differences in partial pressures.

Surface of lungs
They’re moist for easy diffusion of gases, they reduce the surface tension of liquids,
fluid covering alveoli has surface tension that makes lungs elastic.Lung surfanct
released by cells in alveoli when they are stretched thus less force is needed to inflate
lungs. Prevent them from collapsing (surfactant).

Week Nine
Blood
Blood volume increases pressure in vessel - more blood pressing against vessel wall.
Reduction in blood volume - blood donation, accident and trauma
Greater viscosity increases resistance.
Blood is constituted of Plasma, Buffy coat layer, Erythrocytes and haemotrocit

Plasma - Mostly water, electrolytes, hormones, proteins, dissolved gases, glucose and
other nutrients. Albumin is synthesised in live and contributes to blood viscosity and
pressure. Globulins and fibrinogen which is a clotting protein.

Haematopoietic - It produces blood. Bone marrow and development in spleen.

Mature in bone marrow or lymphoid tissue. Can be harvested for transplant.

Erythropoeisis - Productions of RBC’s, increases when reduced oxygen (hypoxia)

stimulates kidneys to release hormone Erythopoeisis.

Erythrocytes (red blood cells) - 98% of protein is haemoglobin, they’re bincocaved

discs and live for 100 to 120 days. It’s biconcave dic increases gas exchanges, the
size allows it to squeeze through the capillaries and have no mitocondria, ribosome or
nuclei which allows maximum space for haemoglobin to carry oxygen. They have a
flexible membrane and are anaerobic glycolysis which means they don’t actually use
any oxygen themselves yet have a limited life span.

Haemaglobin - it’s a tetramer protein of four monomers containing 2 alpha chains

and 2 beta chains. On a regular adult, there’s supposedly 3 types of haemoglobin. It’s
held together by hydrophobic and other non-covalent bonds. It contains an iron
porphyrin ring carries the O2 molecule. Each subunit can bind 1 molecule of oxygen
and binds reversibly to O2.

Myoglobin : O2 carrier in muscle tissue, same as haemoglobin but only has one
subunit. Implications for O2 binding.

Oxygen-Haemaglobin curve : When PO2 is high, more O2 binds to haemoglobin

and when PO2 is low, less O2 binds to haemoglobin.

Factors affecting Haemaglobin curve : The pH, Partial pressure of CO2,

Temperature and biphosphoglycerate.
If the pH increses, or Pco2 decreases, O2 will combine more tightly with
haemoglobin. If ph decreases, or Po2 increases then O2 dissociates more easily from
haemoglobin thus available for tissues.

Carbon dioxide is transported in red blood cells as bicarbonate ions. Bicarbonate is

converted back to carbon dioxide at the lungs.

Anemia : It’s when haemoglobin shows mutation thus getting stuck in capillaries
more easily and getting fragile and cannot deliver sufficient oxygen.

Life cycle of Red Blood Cells : life span of 120 days, new cell enters circulation 2
millions per second, they are balanced by rate of destruction and removed from
circulation when ruptured, destroyed by fixed phagocytic macrophages in spleen and
liver. Recycled products used in many processes including forming new RBC’s.
Leukocytes (white blood cells) : nuclei and other organelles yet no haemoglobin (thus
the missing of the colour red). They are divided in two groups :
Granulocytes - neutrophils, eosinophils and basophils;
Agranulocytes - lymphocytes and monocytes.

Neutrophils - most numbers about 60 to 7’%, polymorphonucleocyte, phagocytes

Eosinophils - large garnules, 2/4% of circulations white blood cells, number will
increase with parasitic infection and development of allergies.
Basophils - contain large histamine granules, lowest number of WBC’s and are
important in inflammatory response.
Monocytes - from same precursor cell as granulocytes, other major grooup of
phagocytic cells and about 3/8% in circulating WBC yet numerous in tissues.
Lymphocytes - space cytoplasm, large nucleus. They develop from different
precursor cells and respond to very specific foreign antigens being about 20 to 30%
of WBC’s. They increase in response to a viral infection and move between lymphoid
tissues, lymp and blood. They are part of the acquired immune response.
WBC Indices - Leukocytosis means they’re loads of them so there’s a disease
happening such as infection and cancer. Leukopenia means there’s not a lot and sore
there’s a severe disease happening.
Platelets - huge cells formed in bone marrow that splinter into fragments. They leave
the bone marrow and enter circulation and are irregular shaped discs lacking nucleus
with a bunch of vesicles. They have a short life span and their granules contain
chemicals to promote blood clotting.
Haemostasis - sequence of response to stop bleeding. Quick, localised and
controlled. Primarily there’s there mechanisms such as the vascular spasm (damaged
vessels constrict), the formation of a platelet plug and blood clotting (coagulation)
(the platelets adhere to endothelium to form a plug) . Secondary is the strengthening
of the plug (fribin) and finally the fibrinolysis which is the degradation of the plug.

Stages of clotting
Extrinsic - few steps, rapid, leak of tissue factor into blood
Intrinsic - more complex, slower, in response to damaged endothelial cells or
phospholipids released by activated platelets
Converge on common pathway.
Clot retraction - pulls edges of damaged vessel closer together.
Fribionolysis - blood clotting - a positive feedback cascade - needs to be limited. The
friarnolytic system dissolves small, inappropriate clots and clots once damage has
been repaired
Plasmiogen activated to plasmin to dissolve clots. May be triggered by atheroclerosis,
trauma or infection. Clot dislodged becomes an embolus - can block vessels in heart,
brain or lugs.
Blood groups
Like all other cells, red blood cells have proteins on their surface also known as
antigens or surface marks.
A/B antigens - ABO system
Rhesus antigen - 85% of population have it (positive)
People with a given antigen type (A or B) have antibodies to the opposite type.
This is important during blood donation as type AB are universal recipients as they
have no antibodies while O is the universal donor since they have no antigens. If
wronged, haemolysis occurs causing fever, renal failure and shock.